Ac 4388 WAN 75 Metropolitan Borough of Wandsworth. Annual Report on the Health, Sanitary Condition, &c. OF THE BOROUGH For the Year, 1938, 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, 1938, 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 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth. Sir, Ladies and Gentlemen, I beg to present my Annual Report on the administration of the Health Services of the Borough for the year 1938, together with the Report of the Public Analyst. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— F. G. Caley, M.A., M.B., B.C., M.R.C.S., L.R.C.P., D.P.H. Deputy M.O.H. and Tuberculosis Officer:— J. J. MacDonnell, M.B., B.S., M.R.C.S.. L.R.C.P. 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. Dr. Trott attended a course of instruction for Medical Officers at the Government Anti-Gas School at Easingwold, in April. B 2 Report of the Medical Officer of Health for 1938. 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. D. 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, 132, West Hill, Wandsworth, 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 Wandsworth, No. 1 Dr. C. F. Kirwan, 9, Melody Road, Wandsworth, S.W. 18. Wandsworth, No. 2 Dr. J. W. M Little, 248, Earlsfield Road, Wandsworth, S.W. 18. Swaffield Road Dr. J. W. M. Little, Institution 248, Earlsfield Road, Wandsworth, S.W. 18. Two fresh appointments of Public Vaccinator have been made during the year. Dr. J. W. M. Little has been appointed in that capacity for Wandsworth No. 2 District, and to Swaffield Road Institution, the vacancy being caused by the death of Dr. H. A. Topalia. Dr. C. F. Kirwan has been appointed to Wandsworth No. 1 District following the retirement of Dr. E. R. Badcock. 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. B 2 4 Report of the Medical Officer of Health for 1938. 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 — H. F. Leacock May, 1936 ” Yes Two A. F. Saunders Jan. 1938 ” Yes One †A. W. Lock Jan. 1938 ” Yes — J. W. Marshall Oct. 1938 ” No — Food and Drugs: W. H. Jones Sept. 1926 S.I. Exam. Bd. Yes Four Food 3 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: Now acting as temporary Sanitary Inspector. †S. R. Coomber April, 1935 Joint Eoard Ex. — — *Mr. Pearce is seconded for duty under the Air Raid Precautions Scheme. Staff 5 As stated in last year's Report, on 19th October, 1937, the Council authorised the appointment of two additional Sanitary Inspectors, owing to the increased duties required under recent legislation. Mr. A. F. Saunders and Mr. A. W. Lock were appointed, and they commenced their duties in January, 1938. In March the Council decided, with the approval of the Home Office, that Mr. W. G. Pearce, who had qualified as a Government Anti-gas instructor in October, 1936, be seconded from his duties as a Sanitary Inspector, to devote the whole of his time to the training of volunteers and the organisation of the Casualty Service under the Council's Air Raid Precautions Scheme. Mr. J. W. Marshall, grade "A" Clerk, was appointed temporary Sanitary Inspector, and took over Mr. Pearce's duties. In August, Mr. G. Rollinson resigned his appointment of Sanitary Inspector, which he had held since May, 1935, on obtaining a similar appointment under the Holborn Borough Council, and Mr. J. W. Marshall was appointed to fill the vacancy. Mr. S. R. Coomber, Assistant to the Food Inspectors, was selected to fill the temporary appointment relinquished by Mr. Marshall, and the vacancy for Assistant to the Food Inspectors was filled by the appointment of Mr. A. D. Briggs, in a temporary capacity. During the year Messrs. A. E. Vickers, E.V. Roots, W. H. Jones and A. E. Handley, attended Instructors' Courses at the Government Anti-gas School at Falfield, and obtained First Class Instructors' Certificates. Mr. H. F. Leacock has obtained the Certificate of Meat and other Foods awarded by the Royal Sanitary Institute, 6 Report of the Medical Officer of Health for 1938. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Commenced Duty. Health visitor. Certified Midwife. Sanitary Inspector. Maternity and Child Welfare—14:— Miss E. K. Woods Feb. 1916 Yes No Yes Yes Superintendent Health Visitor. Miss D. S. Collins Mar. 1913 Yes No No Yes „ M. Dean Jan. 1924 Yes No Yes Yes „ D. M. Staniland June 1927 Yes Yes Yes No „ J. E. D. Elder May 1928 Yes Yes Yes No „ H. McCarthy Nov. 1928 Yes Yes Yes No „ J. Pottinger Aug. 1930 Yes Yes Yes No ,, G.Smith Sept. 1930 Yes Yes Yes No „ K. Kenion Sept. 1930 Yes Yes Yes No „ G. Neall May, 1934 Yes No Yes Yes „ C. Hughes April, 1936 Yes Yes Yes No „ N. Hancocks July. 1936 Yes Yes Yes Yes „ R. Jones June 1937 Yes Yes Yes No „ M. Savage Feb. 1938 Yes Yes Yes No Tuberculosis—3 :— 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. 7 On the 18th January, 1938, the Council decided, in view of the increase in the scope of the Maternity and Child Welfare Scheme, to appoint a Superintendent Health Visitor. Miss E. K. Woods, who has been in the service of the Council since February, 1916, was appointed in this capacity, and Miss M. Savage was appointed Health Visitor, to fill the vacancy caused by the promotion of Miss Woods. At the same meeting it was also decided to alter the designation of the Tuberculosis Visitors, who will be designated in future— "Health Visitors (Tuberculosis)." Miss N. Hancocks has been successful in obtaining the certificate of a Sanitary Inspector. 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. One Porter Attendant. One Cook, Six Maids and one Seamstress. 8 Report of the Medical Officer of Health for 1938. OFFICE STAFF. Certificates held. Chief Clerk:— F. Bray San. Insp., and six others. Clerk—Grade C:— P. C. Clark One. Clerks—Grade B:— A. G. Patterson San. Insp., Meat and other Foods, and one other. Clerks—Grade A :— C. E. Gessner - L. L. Parrini Two. S. F. Jennings - A. A. Rees - A. E. Hollis Three. J. B. Peacock Two E. S. Regan - P. P. Leacock - L. V. Webb - Clerks—Grade D:— Miss C. Wellings - Miss H. G. Wright - Miss M. J. Richards Three. Miss B. Newman Nine Certificates and one Diploma. Secretary to the Tuberculosis Care Committee:- Miss M. L. Baptie - Dispenser for the Tuberculosis Dispensaries:— C. Kitchen Registered Pharmacist. Staff. 9 In December, 1937, owing to the increase in the work of the Department, the Council authorised the appointment of an additional Grade "A" Clerk. Mr. P. P. Leacock, who had been in the Borough Treasurer's Department, was appointed. In July, 1938, Mr. A. E. Cooper, the Chief Clerk, who had been in the service of the Council for 47 years, retired. Mr. F. Bray, Grade "C" Clerk in the Department, was promoted to the position of Chief Clerk. The vacancy for a Grade "C" Clerk thus caused was filled by the promotion of Mr. P. C. Clark, who was a Grade "B" Clerk in the Department. The vacancy for a Grade "B" Clerk has not been filled, but an additional Grade "A" Clerk was authorised. MI. J. B. Peacock was appointed to fill this vacancy. On the appointment of Mr. J. W. Marshall, a Grade "A" Clerk, as a Sanitary Inspector, Mr. E. S. Regan, who had been employed as a temporary clerk in the Department, was appointed Grade "A" Clerk to fill the vacancy. Disinfecting Station. Engineer—Mr. 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. F. Pearce. Mr. Pearce was appointed in March, in place of Mr. H. Jarvis. Mortuaries. One whole-time and two part-time Mortuary Keepers. 10 Report of the Medical Officer of Health for 1938. Air Raid Precautions. The responsibility for the training of volunteers under the Council's Air Raid Precautions Scheme has devolved on the Public Health Department. As stated on page 5, Mr. W. G. Pearce, Sanitary Inspector, has been seconded from his ordinary duties and has been put in charge of the training. Four other Sanitary Inspectors and two Inspectors from the Borough Engineer's Department have qualified as Government-trained A.R.P. Instructors. These officers have devoted a large amount of their time, most of it after hours, to the training of A.R.P. personnel. Valuable assistance has also been given by Miss E. M. Jones and Miss K. M. Jones, two civil servants, and Mrs. M. E. Taggart, Commandant, Wandsworth Division, British Red Cross Society, who are also qualified as Government-trained Instructors, and by the following locally-trained Instructors:—Major-General P. Sangster, Mr. E. R. Spiller, Mr. E. M. Brown, Mr. R. J. Goldsworthy, Mr. R. F. Pilgrim and Mr. A. V. Palmer. A large number of volunteers underwent training during the year and 170 courses of lectures in Air Raid Precautions (Anti-gas) have been held. Courses of instruction in First Aid have also been organised for those who have volunteered for service as First Aid Personnel and 20 courses of First Aid Lectures and Demonstrations have been held. In addition to the large amount of time given to the training of personnel, much preliminary work has been carried out during the year in connection with the organisation of First Aid Services in the Borough. In consequence of the increased duties devolving on the Department it has been necessary to engage seven temporary clerks during the year, mainly for Air Raid Precautions duties. A storekeeper has also been engaged to look after A.R.P. stores. 11 GENERAL STATISTICS FOR THE BOROUGH. Area 9,199 acres Population in 1938 340,100 No. of inhabited houses in 1938 81,906 No. of families, or separate occupiers, in 1931 95,383 Rateable value in 1938 £3,412,175 Estimated produce of a penny rate £13,778 Extracts from Vital Statistics. No. of Live Births Males Females Total Legitimate 1991 1836 3827 Illegitimate 127 102 229 Total 2118 1938 4056 Deaths 1819 1983 3802 Birth-rate 11.92 Death-rate—Crude 11.17 Standardised 10.38 Rate per 1,000 total (live and still) births. No. of Stillbirths 122 29.10 Deaths from puerperal sepsis 2 .47 Deaths from other puerperal causes 11 2.63 Total 13 3.11 Infantile mortality per 1,000 live births:— All infants 46 Legitimate infants 45 Illegitimate infants 65 Deaths from Cancer (all ages) 604 „ Measles (all ages) 13 „ Whooping Cough (all ages) 3 „ Diarrhoea (under 2 years of age) 46 Deaths from Tuberculosis:— No, 229 Rate .67 12 Report of the Medical Officer of Health for 1938. 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 14,229 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. 13 1938, the number of men, women and boys and girls over 14 years of age, who were unemployed, was 4,628 compared with 3,790 at December, 1937, an increase of 838. 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 340,100 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 1938 Clapham 60,925 58,667 Putney 34,718 33,447 Balham 53.982 51,941 Streatham 68,435 65,939 Tooting 38,159 36,780 Wandsworth 96,891 93,326 Whole Borough 353,110 340,100 Births. The total number of births occurring in the Borough was 2,328, including 422 non-residents who were born in Institutions. 2,150 births of Borough residents occurred outside the Borough, so that the corrected number of births was 4,056 compared with 3,940 in 1937. 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. 14 Report of the Medical Officer of Health for 1938. TABLE II. Sub-District. No. of Births. Rates. Males. Females. Total. Birth-rate. Natural increase or decrease. Clapham 442 403 845 14.40 +3.02 Putney 185 173 358 10.70 — .66 Balham 372 300 672 12.93 + .48 Streatham 323 299 622 9.44 —2.20 Tooting 190 212 402 10.92 + 1.14 Wandsworth 606 551 1,157 12.39 + 1.90 Whole Borough 2,118 1,938 4,056 11.92 + .75 The birth-rate was 11.92 per 1,000, compared with 11.53 for 1937, and 11.92 the decennial average. The rate for the whole of London during 1938 was 13.4 and for England and Wales, 15.1. 148 illegitimate births took place in the Borough, but only 64 belonged to the Borough. On the other hand 165 illegitimate births belonging to Wandsworth occurred outside the Borough, making a corrected total of illegitimate births belonging to Wandsworth of 229, 47 of these belonged to Clapham, 29 to Putney, 37 to Balham, 46 to Streatham, 24 to Tooting, and 46 to Wandsworth. The percentage of illegitimate births to total births was 5.6. 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 2,158, or 92.69 per cent, of the 2,328 children who were born in the Borough during the year. 1,753 of these notifications were transmitted by midwives, 322 by medical attendants, 20 by parents, and 63 by other persons. Vital Statistics. 15 Deaths. The number of deaths which took place in the Borough during the year was 2,842, but 1,104 of these did not belong to the Borough, while 2,064 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 3,802 of whom 1,819 were males and 1,982 females. The crude death-rate for the year was 11.17 compared with 12.36 in 1937, but after correction has been made by means of a comparability factor devised by the Registrar-General, the corrected death-rate was 10.38. The death-rate for the whole of London for 1938 was 11.4, for England and Wales 11.6, in the 126 County Boroughs and great Towns 11.7, and in the 148 smaller Towns 11.0. 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 318 350 668 11.38 Putney 173 207 380 11.36 Balham 294 353 647 12.45 Streatham 362 406 768 11.64 Tooting 205 155 360 9.78 Wandsworth 467 512 979 10.49 Whole Borough 1,819 1,983 3,802 11.17 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. 16 Report of the Medical Officer of Health for 1938. Table IV.—Causes of, and Ages at Death, during the Year 1938. - Causes of Death. Deaths in or belonging to whole district at subjoined ages. Deaths in or belonging t0 Localities (at all ages)- All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Deaths in public institution etc. Enteric Fever l .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 13 6 7 5 3 4 1 .. .. .. 4 2 .. .. .. 7 7 Scarlet Fever 2 1 1 .. .. .. 2 .. .. .. .. .. 1 .. .. 1 .. 2 Whooping Cough 3 2 1 1 2 .. .. .. .. .. .. 2 .. .. .. .. 1 15 Diphtheria and Membranous Croup 15 10 5 2 .. 6 6 1 .. .. 2 .. 3 5 1 4 2 Influenza 19 8 11 1 3 5 10 1 3 1 6 2 6 2 Erysipelas 2 1 1 1 .. .. .. .. .. .. 1 1 .. .. .. .. 1 2 Cerebro-spinal Fever 2 1 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. 1 .. Other Epidemic Diseases 1 .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 135 Pulmonary Tuberculosis 199 119 80 1 .. 1 .. 40 89 52 16 49 20 26 34 23 47 11 Tuberculous Meningitis 11 6 5 .. 2 1 4 2 1 1 .. .. 1 3 3 4 .. ,i2 Abdominal Tuberculosis 4 4 .. 1 .. .. .. 2 1 .. 1 1 .. 1 1 .. 14 Other Tuberculous Diseases 15 10 5 .. .. 1 1 5 3 4 1 2 1 4 1 2 5 2 Other Tuberculous Diseases 10 6 4 .. .. .. 1 .. 4 5 .. 1 .. 3 4 1 1 397 Cancer, Malignant Disease 604 269 335 .. .. .. .. 1 49 265 289 103 63 101 123 52 162 7 Rheumatic fever 7 ?. 5 .. .. .. 3 1 1 1 1 .. .. 1 .. .. 4 23 Diabetes 38 17 21 .. .. .. 1 l 2 9 25 7 b 10 9 .. 7 30 Other General Disease 46 18 28 .. 1 2 1 1 9 11 21 8 4 11 6 5 12 1 Alcoholism 4 2 2 .. .. .. .. .. .. 4 .. .. .. 1 2 .. 1 .. Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Cerebral Hæmorrhage, Apoplexy 14 9 5 i 3 1 2 .. 4 .. 3 .. 1 5 5 .. 3 44 Convulsions 105 40 65 .. .. .. .. .. 3 37 65 22 10 10 31 6 26 1 Other Diseases of Nervous System 1 1 1 .. .. .. .. .. .. .. 1 .. .. .. 48 Organic Diseases of Heart 67 37 30 .. .. .. 1 5 14 25 22 12 8 10 16 6 15 380 Other Diseases of Circulatory System 971 425 546 .. .. .. 2 21 156 792 180 69 201 187 100 234 250 Bronchitis 497 227 270 1 .. 1 1 8 22 136 328 68 69 84 99 38 139 12 Bronchitis 151 83 68 3 1 .. 1 1 6 28 111 31 7 23 26 15 49 10 Broncho-Pneumonia 140 73 67 17 4 6 1 2 9 28 73 23 21 17 26 15 38 2 Lobar Pneumonia 33 23 10 2 1 .. 2 1 5 12 10 .. 5 5 4 4 15 2 Pneumonia (type not distinguished) 36 20 16 2 1 1 3 2 7 10 10 7 2 .. 6 7 7 a Other Diseases of Respiratory System 20 9 11 .. .. .. .. .. 1 11 8 2 3 2 4 2 13 2 Ulcer of Stomach 33 21 12 .. .. .. .. .. 4 13 16 6 2 3 5 4 1 2 Diarrhœa 22 12 10 22 .. .. .. .. .. .. .. 1 1 7 6 6 7 2 Enteritis 26 9 17 23 1 .. .. .. .. .. 2 5 2 4 8 .. 7 2 Appendictis and Typhlitis 21 9 12 .. .. 1 1 2 3 7 7 4 2 1 3 4 6 2 obstruction of Intestines 27 13 14 .. 1 .. 2 .. .. 9 15 8 6 1 4 2 .. 2 Cirrhosis of Liver 10 7 3 .. .. 1 .. .. .. 4 5 3 3 1 2 1 4 2 Other Diseases of Liver 20 10 10 .. .. .. .. .. 3 8 9 2 1 4 6 3 13 2 OtherDiseases of Digestive Ststem 46 24 1 .. .. 3 1 4 21 16 8 7 5 9 4 32 2 Nephritis and Bright's Disease 119 68 51 .. .. .. 1 5 16 2(5 71 23 14 18 20 12 7 2 Other Diseases of Urinary System 53 41 12 2 .. .. .. .. 2 13 36 11 5 6 16 .. .. 2 Diseases of Generative Ststem 5 5 .. .. .. .. .. 2 2 i 1 1 1 2 .. .. 2 Puerperal FeverPuerperal Fever 2 2 .. .. .. .. 1 1 .. .. 1 .. .. 1 .. 4 2 Other Accidents and Diseases of Pregnancy and Childbirth 11 11 .. .. .. .. 3 7 1 .. 3 1 1 2 .. 12 .. 2 Premature BirthPremature Birth 52 22 30 52 .. .. .. .. .. .. .. 11 1 14 8 .. 8 2 Congenital Debility and Malforma-tion 36 21 15 34 2 .. .. .. .. .. .. 5 6 6 8 3 4 2 Other Diseases of Early Infancy 15 11 4 15 .. .. .. .. .. .. .. 2 .. .. 5 .. 24 2 Old Age 98 31 67 .. .. .. .. .. .. 1 97 18 8 14 27 .. 29 2 Deaths from Accident 106 53 53 3 3 6 9 12 22 51 17 lb 17 23 .. 11 2 Deaths from Suicide 52 31 21 .. .. .. .. 5 16 26 5 9 7 11 11 .. 1 2 Other Violent Deaths 4 2 2 .. .. .. .. 3 1 1 1 1 .. 1 2 Other defined Diseases 11 6 5 .. .. .. 1 2 2 2 4 2 .. 2 1 .. 1 2 Ill-defined Diseases or unknown 2 1 1 .. .. .. .. .. 2 .. .. .. .. 1 .. .. 2 All causes 3802 1819 1983 189 24 29 46 100 333 960 2121 668 380 647 768 360 979 230 Vital Statistics. 17 The number of deaths shown on Table IV. does not agree with that shown on page 113. 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. 1928 13.00 15.9 16.7 10.58 11.6 11.7 1929 13.01 15.7 16.3 12.85 13.8 13.4 1930 13.17 15.7 16.3 10.59 11.4 11.4 1931 12.26 15.0 15.8 11.30 12.4 12.3 1932 11.86 14.2 15.3 11.56 12.3 12.0 1933 10.93 13.2 14.4 11.49 12.2 12.3 1934 10.98 13.2 14.8 10.39 11.9 11.8 1935 11.03 13.3 14.7 10.23 11.4 11.7 1936 11.40 13.6 14.8 10.96 12.5 12.4 1937 11.53 13.3 14.9 11.49 12.3 12.4 Average 10 years 11.92 14.31 15.40 11.14 12.18 12.14 1938 11.92 13.4 15.1 10.38 11.4 11.6 C 18 Report of the Medical Officer of Health for 1938. The number of deaths which occurred in Institutions, etc., inside the Borough was 1,345 but 1,104 of these persons did not belong to the Borough. A total of 2,305 persons belonging to the Borough died in Institutions, 241 occurring in Institutions within the Borough and 2,064 in Institutions outside the Borough. Infantile Mortality. The number of deaths under one year was 189—35 in Clapham, 12 in Putney, 35 in Balham, 41 in Streatham, 22 in Tooting, and 44 in Wandsworth. As the number of births was 4,056, the Infantile Mortality rate was 46 per 1,000 births. This compares with a rate of 62 in the previous year and is the lowest rate ever recorded. The rate is lower than for the whole of London, which was 57 per 1,000 births. For the 10 years ending 1918 the average infantile mortality rate was 87, while for the 10 years ending 1937, the average rate was 56. The number of deaths among legitimate infants was 174 to 3,827 births—a mortality of 45 per 1,000 births, while the number of deaths among illegitimate infants was 15 to 229 births —a mortality of 65 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. 19 TABLE VI. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 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 46 73 69 37 78 70 62 1933 46 75 54 31 65 49 50 1934 58 54 50 67 74 52 58 1935 73 52 47 60 42 49 55 1936 58 55 75 52 56 55 58 1937 62 69 64 49 54 69 62 Average for 10 years 57 56 55 50 61 60 56 1938 41 33 52 65 54 38 46 No. of deaths under 1 year, 1938 35 12 35 41 22 44 189 Maternal Mortality. Eleven deaths occurred from accidents and diseases of pregnancy and two from Puerperal Fever, giving a total of 13 deaths after childbirth. This is equivalent to a rate of 3.11 per 1,000 live and still births, compared with 3.18 in 1937 and 1.72 in 1936. Enquiries into all maternal deaths, which were commenced in 1928 at the instance of the Ministry of Health, have been continued. c 20 INFECTIVE DISEASES. The number of deaths from notifiable infectious diseases, including all forms of Tuberculosis, was 329, compared with 341 in 1937. There were also 19 deaths from Influenza. From all infective diseases the death-rate was 1.02 per 1,000—1.21 in Clapham, .77 in Putney, .06 in Balham, .86 in Streatham, 1.25 in Tooting, and .72 in Wandsworth. The rate in 1933, was 1.75; in 1934, 1.35 ; in 1935, M4; in 1936, 1 17; and in 1937, 1.41. 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 n which they occurred. 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 479 391 88 10 20 26 36 38 197 64 21 42 17 7 1 Scarlet Fever 584 488 96 1 11 26 35 72 266 77 38 41 13 3 1 Measles 3594 3558 36 102 167 202 366 558 2027 136 17 17 2 Whooping Cough 508 504 4 22 52 39 58 105 209 19 4 - Enteric Fever and Paratyphoid Fever 11 2 9 - - - - - 1 1 - 4 3 1 1 Malaria — — — — — Dysentery 179 28 151 4 3 3 5 6 4 3 2 10 6 16 117 Erysipelas 123 8 115 2 3 — — — 1 2 6 15 15 55 24 Puerperal Fever 6 — 6 — — — 6 Puerperal Pyrexia 51 — 51 — — — — — — — — 45 6 Ophthalmia Neonatorum 32 32 — 32 — — Cerebro-spinal Meningitis 16 9 7 — 2 — — 1 4 2 4 — 2 1 Polio-myelitis 9 7 2 1 1 — 1 1 1 2 2 Encephalitis Lethargica Anthrax 1 — 1 1 Pneumonia :— Acute Influenzal 37 3 34 1 — — 2 4 8 5 10 7 Acute Primary 284 94 190 16 13 13 8 9 23 12 17 37 32 60 44 Tuberculosis—All forms 621 69 552 2 3 6 8 3 19 28 79 293 79 85 16 Food Poisoning 5 — 5 — — — — — — — — 1 1 1 2 Total 6540 5193 1347 193 275 315 519 793 2752 346 188 525 179 240 215 Infective Diseases. 21 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 117 24 101 59 49 129 479 475 15 Scarlet Fever 85 40 76 101 87 195 584 511 2 Measles 795 285 429 598 549 938 3594 442 13 Whooping Cough 39 13 120 64 150 122 508 83 3 Enteric and Para-typhoid Fevers 3 4 2 — — 2 11 9 1 Malaria — — — — — — — — — Dysentery 24 6 8 2 127 12 179 144 1 Erysipelas 21 14 8 16 17 47 123 52 2 Puerperal Fever 1 1 — — — 4 6 5 2 Puerperal Pyrexia 15 3 9 11 2 11 51 36 1 Ophthalmia Neonatorum 10 1 4 6 1 10 32 14 — Cerebro-spinal Meningitis 2 — 2 6 1 5 16 16 5 Polio-myelitis 5 — — 1 — 3 9 8 1 Encephalitis Lethargica — — — — — — — — — Anthrax — — — 1 — — 1 1 — Pneumonia—Acute Influenzal 5 7 2 9 4 10 37 — 8 Pneumonia—Acute Primary 63 9 36 27 45 104 284 — 46 Tuberculosis—all forms 138 73 79 100 98 133 621 — 229 Food Poisoning 2 — 2 1 — — 5 — — Total 1325 480 878 1002 1130 1725 6540 1796 329 22 Report of the Medical Officer of Health for 1938. Infective Diseases. 23 The total number of cases was 6,540 compared with 2,383 in 1937. This increase is mainly clue to the inclusion of reported cases of Measles and Whooping Cough. These diseases did not become notifiable until 1st October, 1938. There was also a rise in the number of cases of Diphtheria, Dysentry and Tuberculosis. In 1937 there were 1,017 cases of the latter three diseases, but in 1938 the number was 1,279. 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 1937 and shows the number of children successfully vaccinated for the whole Borough, as well as for the separate sub-districts. 24 Report of the Medical Officer of Health for 1938. TABLE IX. No. of Children. Clapham Putney j Balham | Streatham Tooting | Southfield Springfield Total Successfully Vaccinated 172 133 351 195 66 170 98 1185 Insusceptible of Vaccination 2 4 3 3 — 2 3 17 Had Small-pox — — — — — — — Dead, Unvaccinated 14 7 15 13 7 19 7 82 Exempted under Certificates of Conscientious objection 115 33 271 115 115 95 78 822 Postponed by Medical Certificate 1 1 4 — — 1 — 7 Removed 34 36 32 30 8 12 4 156 Remaining on Books as Un-vaccinated 1 8 — 5 1 1 — 16 No. of Births returned to Vaccination Officers during 1937 339 222 676 361 197 300 190 2285 The percentage of children vaccinated to the total births was 51.8—in Clapham, 50.3; in Putney, 59.9; in Balham, 51.9; in Streatham, 54.0; in Tooting, 33.5; in Southfield, 56.6; and in Springfield, 51.5. This percentage is 0.2 lower than that recorded last year. Diphtheria. 479 cases occurred, compared with 386 in 1937, and 365 in 1936. The number of deaths was 15, compared with 20 in 1937, 23 in 1936, and 14 in 1935. The death-rate for 1938 was .04 and the case mortality was 3.1 per cent. The rate per 1,000 of population was 1.40; 1.99 in Clapham; .71 in Putney; 1.94 in Balham; .89 in Streatham; 1.33 in Tooting; and 1.28 in Wandsworth. Infective Diseases. 25 Of the 479 cases, 475 or 99.1 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, Bradmede Road, Haselrigge Road, Heathbrook Road and New Park Road Schools in Clapham; Convent of the Sacred Heart (Elementary), Hotham Road, Huntingfield Road and Putney Church of England Felsham Road Schools in Putney; Broadwater Road, Hillbrook Road, Oldridge Road, Ravenstone Street, Smallwood Road and Upper Tooting Church of England Schools in Balham; Immanuel and Furzedown Demonstration Schools in Streatham; Defoe Road, Sellincourt Road, Tooting Roman Catholic and Tooting Graveney Schools in Tooting ; All Saints', Brandlehow Road, Garratt Lane, Riversdale, St. Michael's, Waldron Road and Wandle Schools in Wandsworth. Swabs were taken from the throats of some of the children examined. As the result of this swabbing eight cases were found to be positive. All the cases were swabbed again and not readmitted to school until a negative result was obtained. Every positive or suspicious case was visited and all necessary precautions taken to prevent the spread of the disease. During the year 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 11 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. 26 Report of the Medical Officer of Health for 1938. 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 1,134, compared with 1,037 in 1937, 1,205 in 1936, and 1,276 in 1935. In the 11 years during which the two clinics have been open, 10,825 persons have attended. Infective Diseases. 27 7,366 of the total number who attended were given the Initial Schick Test, to see if they were susceptible to Diphtheria, and the remaining 3,459 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 5,140 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 11 years during which the Clinics have been in existence, the number of persons found to require immunisation was 8,599. This number is made up of 5.140 found to be Schick 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 199 3350 1065 2236 2378 4614 340 186 2267 2873 5140 Schick Negative 55 922 667 793 851 IC44 290 204 827 1311 2138 Result not read 5 40 26 30 41 71 13 4 33 55 88 Total 259 4312 1758 3059 3270 6329 643 394 3127 4239 7366 Percentage Positive 79% 78% 61% 73% 73% 73% 53% 47% 72% 68% 70% 28 Report of the Medical Officer of Health for 1933. Infective Diseases. 29 positive after the initial test and the 3,459 young children who were assumed to be susceptible without a test, as they were under five years of age. The subsequent history of these 8,599 persons is given in the following statement No. who were immunised and found to be Protected as shown by a Negative re-Schick Test 6,296 No. who received a course of injections but are not yet protected as the re-Schick Test is still positive 350 No. who received injections, the value of which is not known as they have not attended to be re-tested. 1,879 Schick positive cases who were not injected 74 Total number of Susceptibles 8,599 The age grouping of the 6,296 persons in whom immunity was produced is given in Table XI. Four of the 6,296 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 persons 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 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 2652 2618 753 2872 3151 6023 177 96 2894 3402 6296 30 Report of the Medical Officer of Health for 1938. Infective Diseases. 31 XII, giving this information. The six cases referred to in the previous paragraph are not included in the Table, which deals with 6,290 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 5,451 out of 6,290 were immunised after the first series. (2) 771 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) 4,637 out of 6,290 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 5,773. 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 6,290 persons who have been protected, 350 have completed the first series of injections but cannot be recorded as protected because the last re-Schick test has given a positive result. 100 of these have not attended since this positive re-test. The other 250 have attended the Clinics and have received further injections but have not yet reacted negative to the re-Schick test. 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 1441 20 12 11 1484 34 3 1521 First Series 2 injections 607 870 192 25 1694 67 14 5 2 1782 3 injections 584 779 312 118 1793 98 16 9 1 1917 4 injections 5 5 — 2 12 — — — — 12 Second Series 2 to 6 injections 51 121 105 260 537 143 34 6 1 1 722 Third Series 3 to 8 injections — — 5 4 9 41 6 1 — — 57 Fourth Series 4 to 6 injections — — — 3 3 1 1 — — — 5 Fifth Series 10 injections — — — — — 1 — — — — 1 Total Under 15 2688 1795 626 423 5532 385 74 21 1 4 6017 Adults Over 15. 1 injection 32 8 1 3 44 44 First Series 2 injections 8 44 31 3 86 2 1 1 — 90 3 injections 29 30 14 5 78 5 — 1 — 84 4 injections — 1 — — 1 — — — — 1 Second Series 3 to 6 injections — 2 10 19 31 16 1 1 — — 49 Third Series 3 injections 1 1 1 2 11 injections — — — — — — 1 — — 1 Fourth Series 6 to 8 injections — — — — — 1 1 — — — 2 Total All Ages 2757 1880 682 454 5773 410 78 24 1 4 6290 32 Report of the Medical Officer of Health for 1938. Four cases primary Schick positive, received no series of injections and re-Schick test negative after suffering from Diphtheria. One case primary Schick positive, received no series of injections and re-Schick test negative after one year and nine months. One case primary Schick positive, received no series of injections and re-Schick test negative after three years and three months. Infective Diseases. 33 A further 1,879 persons have been given immunising injections at the Clinics but have not attended to be re-tested, so that it is impossible to determine the value of the injections they have received. This number includes 557 who completed the first series of three injections and 1,322 who only received one or two doses. 74 susceptible persons have not yet commenced a course of injections. In the 11 years during which the Clinics have been open, 10 children who have reacted negative to the primary Schick test have been notified to me as cases of Diphtheria. Three of these showed clinical symptoms of the disease and seven were bacteriological cases with no clinical symptoms. 22 children who had been immunised and reacted negative to the re-Schick test have been notified as cases of Diphtheria. 13 of these were clinical cases. Ten children who had been immunised but were not re-tested have been also notified. Three of these were clinical cases. One child received two injections of T.A.F. and contracted Diphtheria one month after the last injection and later died. 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 30 children have been immunised by them. 14 of these have re-acted negative to the re-Schick test—12 being tested by the practitioners and two by the assistant Medical Officer of Health. Two children were not tested as the parents did not give their consent. Scarlet Fever. 584 cases of Scarlet Fever occurred, compared with 638 in 1937, 644 in 1936 and 721 in 1935. D 34 Report of the Medical Officer of Health for 1938. The decrease in the number of cases has been associated with a general decrease in the incidence of this disease throughout London. Two of the cases died, compared with five last year and none in the previous year. The death-rate was .005 per 1,000 compared with .014 in 1937 and nil. The case mortality was .34. The case-rate per 1,000 of population was 1.71:—1.44 in Clapham; 1.19 in Putney; 1.46 in Balham; 1.53 in Streatham; 2.36 in Tooting ; and 2.08 in Wandsworth. Of the total number of cases, 511 or 87 per cent. were removed to hospital. The Medical Officers of the London County Council made inspections of two 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. 13 cases of Scarlet Fever and four of Diphtheria occurred within one month of the return of a previous case from hospital. The Notification of Measles and Whooping Cough. These two diseases were made notifiable throughout London by The County of London (Measles and Whooping Cough) Regulations, 1938, which came into operation on the 1st, October 1938. Notification is limited to the first case occurring in the household when more than one case occurs within a period of two months, and cases under treatment in a hospital for infectious disease are not notifiable. The following cases have been notified from 1st October, 1938, to the end of the year:—Mealses, eight; Whooping Cough, 143. Measles. The number of cases brought to my notice during the year October 1st, 1937, to September 30th 1938, was 3,741. 13 cases died during the calendar year; the death-rate per 1,000 of the population was .03. 726 cases of German Measles were also reported. TABLE XIII MEASLES—CASES REPORTED AND DEATHS. Period 1st October—30th September. 1928-29 1929-30 1930-31 1931-32 1932-33 1933-34 1934-35 1935-36 1936-37 1937-38 Cases Reported. In a Measles year — 4,046 3,601 — 4,140 — 3,973 — 3,741 In a Non-Measles year 355 — 295 — 589 — 151 — 439 — Deaths. In a Measles year — 46 — 38 — 37 — 24 — 13 In a Non-Measles year 1 — 2 — 2 — 2 — 2 — Period. Calendar Year 1929 1930 1931 1932 1933 1934 1935 1930 1937 1938 Cases Reported 380 3,976 291 3,598 615 4,148 137 3,987 589 3,594 Deaths 1 47 2 37 2 37 2 24 2 13 Infective Diseases. 35 36 Report of the Medical Officer of Health for 1938. Table XIII. 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. 442 cases were removed to hospital, compared with 509 in the epidemic year of 1936. 132 cases requiring special home nursing were referred to District Nursing Associations in the Borough, compared with 109 in 1937, and the nurses made 1,214 visits to these cases, compared with 1,108 in 1937. Puerperal Fever and Puerperal Pyrexia. During the year six cases of Puerperal Fever and 51 cases of Puerperal Pyrexia were notified. There were two deaths. The death-rate was .005 per 1,000 of population and .47 per 1,000 (live and still) births. Ophthalmia Neonatorum. 32 cases were notified. 22 of these recovered without any impairment of vision. Nine of the infants removed from the Borough and the final condition of the eyes was not ascertainable, and one was still under treatment at the end of the year. TABLE XIV. Result of Treatment. Removed from Borough. Still under Treatment. Recovered— Vision not affected. Vision Impaired. Total Blindness. Died. Treatment received:— In Hospital 14 — — — 9 — At Hospital, Out-patient — — — — — — At home 8 — — — — 1 Total 22 — — — 9 1 Infective Diseases 37 Cerebro-Spinal Meningitis. 16 cases of this disease occurred, and five deaths were registered. Two other cases of this disease were notified, but proved not to be cerebro-spinal meningitis. 14 deaths were registered as being caused by Meningitis. Polio-myelitis and Polio-encephalitis. Nine cases occurred, one of which proved fatal. Encephalitis Lethargica. No case of this disease occurred. Influenza. The number of deaths from Influenza was 19 compared with 117 in 1937, 44 in 1936, 38 in 1935, 43 in 1934 and 183 in 1933. The death-rate was .05 per 1,000. Influenzal Pneumonia and Acute Primary Pneumonia. 37 cases of acute Influenzal Pneumonia and 284 cases of acute Primary Pneumonia were notified. Eight of the former and 46 of the latter died. The total number of deaths credited to all forms of Pneumonia during the year was 209, compared with 208 in 1937, 171 in 1936 and 145 in 1935. 4,205 visits were made by the Sanitary Inspectors and Health Visitors to houses where cases of Measles occurred, and 213 premises were disinfected at the request of the occupiers. Whooping Cough. Three deaths from Whooping Cough occured during the year and the death-rate was .008 per 1,000. 508 cases came to the knowledge of the Department during the year, and 83 of the cases were removed to hospital. 38 Report of the Medical Officer of Health for 1938. 403 visits were made by Health Visitors to houses where cases of Whooping Cough occurred, and four premises were disinfected Enteric and Para-Typhoid Fevers. 11 cases, and one death of the above occurred, compared with 12 cases and three deaths in the previous year. Eight of the cases were true Enteric Fever and three were Para-typhoid Fever. Dysentery. 179 cases of Dysentery were notified and one death occurred. Malaria. No cases were notified. Erysipelas. 123 cases were notified and two deaths occurred. Diarrhoea. The number of deaths from Diarrhoea was 48 compared with 49 in 1937, 36 in 1936, and 41 in 1935. Of these, 45, or 93 per cent., were under the age of one year, compared with 81 in 1937. The number of deaths from Diarrhoea, Zymotic Enteritis and Enteritis under one year represents 23.8 per cent. of the total mortality of that age. Other Infective Diseases. 10 deaths occurred, three from Syphilis, five from Septicaemia, and two from Pyæmia. Scabies. The names of 260 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. Infective Diseases. 39 In addition to the above, 323 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 306 cases where consent was obtained, disinfection of the bedding and clothing of the patient was carried out by the disinfecting staff. Cleansing of Persons Act. The names of 25 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 12 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 2,429.—454 in Clapham, 371 in Putney, 464 in Balham, 382 in Streatham, 171 in Tooting and 587 in Wandsworth. Ambulance Service. The London County Council has been responsible for the removal by ambulance of cases of infective diseases to hospitals since April, 1930. They also provide ambulances for persons meeting with accidents, and for parturient women. These services are free. Ambulances are also provided by the same Authority for the conveyance of other cases on payment. Bacteriological Examinations. During the year 3,806 bacteriological examinations were made at the Lister Institute. 40 Report of the Medical Officer of Health for 1938. The following Table shows the number of examinations in each sub-district and for the whole Borough, also the disease for which the examination was made, and the result. TABLE XV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Diphtheria:— Negative 403 415 452 572 522 863 3227 Positive 51 20 59 34 42 55 261 Enteric Fever:— Negative 22 5 5 6 2 4 44 Positive 9 — 3 1 — 1 14 Other Diseases:— Negative 5 19 13 28 3 45 113 Positive 2 28 15 42 6 54 147 Total 492 487 547 683 575 1022 3806 Examinations of Sputum made at the Dispensary are not included in the above figures. Table XVI. shows the number of cases of infective diseases which were reported from schools during the year. TABLE XVI. School. Diseases. Scarlet fever. Diphtheria. Measles. German Measles. Chicken pox. Whooping Cough. Mumps. Ringworm. Other Diseases Totals. Clapham. Bonneville Road 9 7 101 1 7 7 1 3 136 Cavendish Road 4 16 68 1 31 12 4 8 144 Christchurch 1 4 28 — 3 — 6 42 Haselrigge Road 3 10 92 2 44 5 33 — 7 196 Carried forward 17 37 289 4 85 24 44 — 18 518 Infective Diseases. 41 TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 17 37 289 4 85 24 44 — 18 518 Heathbrook, St. Rule Street 2 17 2 3 1 4 29 Henry Thornton, South Side — — 2 1 3 — — 2 8 Larkhall Lane 2 3 26 1 10 4 — 3 49 New Park Road 8 14 102 — 12 1 — 4 141 Parochial, Old Town 9 2 2 12 34 1 — — 60 Parochial, Macaulay Road 1 — — - — — — — 1 St. Mary's, Crescent Lane 1 2 — — 2 — — — 5 St. Mary's, St. Alphonsus Road — 2 — — — — — — 2 Stonhouse Street 5 4 68 1 3 2 1 2 86 Stowey House, Clapham Com. — 1 — — — — — — 1 Telferscot Road 7 2 70 — 1 2 1 — 83 Putney. Church of England, Felsham Rd. 4 1 28 — — — 3 1 37 Church of England Lower Com. - - - - - - 4 - - 4 Convent of Sacred Heart (Ele.) 1 2 8 — — — — — 11 Hotham Road 7 7 58 7 52 27 7 165 Huntingfield Road 2 6 47 5 3 — 1 4 — 68 Parochial, Roehampton — — 7 3 — — — — — 10 St. Agnes', R.C. — — 8 — 2 1 1 — 1 13 Upper Grade, Lacy Road - - - - - - 1 - - 1 Balham. Balham Central 1 4 4 2 4 - 2 17 Bec, The - — — Broadwater Road 3 4 1 — 3 — — 11 Fircroft Road 3 4 38 27 8 10 3 — 6 99 Hearnville Road 5 2 10 1 29 26 7 1 — 81 Holy Trinity — 3 — — — — — - — 3 Nightingale Square, R.C. 6 7 34 1 1 13 — — — 62 Oldridge Road 3 16 28 — 3 1 19 — 1 71 Ravenstone Street 3 5 23 1 20 13 31 — — 96 St. Mary's 3 1 14 3 48 3 15 — — 87 Smallwood Road 13 17 119 21 12 — 42 - 7 231 Streatham. Christchurch 1 - - - - - - - - 1 County Secondary, Welham Rd. 2 1 - - - - - - - 3 Dunraven — — — — — — Eardley Road 11 4 80 55 49 14 5 1 7 226 Furzedown Demonstration 2 12 59 9 — 2 2 1 6 93 Carried forward 122 159 1142 158 385 118 215 7 67 2373 42 Report of the Medical Officer of Health for 1938. TABLE XVI.—continued. School. Diseases. Scarlet Fever. Diphtheria. Measles. German Measles. Chickenpox. Whooping Cough. Mumps. Ringworm. Other Diseases. Totals. Brought forward 122 159 1142 158 385 118 215 7 67 2373 Granton Road 17 19 2 4 2 — — 44 Hitherfield Road 6 3 56 1 4 4 — — — 74 Holy Trinity, Lutheran Place — — — — - - — — — — Immanuel — — 13 — — — — 13 Mitcham Lane 4 2 60 20 2 4 8 — 3 103 St. Andrew's, Coventry Hall — — — — — — — — — — St. Andrew's, Polworth Road 7 — 6 6 5 — 6 — — 30 St. Leonard's — 1 53 5 — — — — — 59 Sunnyhill Road 2 1 65 6 34 2 1 — — 111 Woodmansterne Road 2 2 63 4 1 — 1 — 1 74 Tooting. Defoe (Fountain Road) 3 6 45 1 1 12 5 2 — 75 Ensham 7 5 62 29 4 — 6 — — 113 Enshara Central — — — — — — — — Franciscan Road 3 4 4 25 12 2 2 — 1 53 Hillbrook Road 5 7 81 33 17 4 5 — 5 157 Sellincourt Road 9 5 121 91 38 32 81 — 7 384 Tooting Graveney 3 4 46 15 11 3 3 — — 85 Undine Street, R.C. 1 — 34 5 35 9 4 — — 88 Wandsworth. Allfarthing Lane 32 — 78 4 21 2 10 — 1 148 All Saints' 1 1 19 — — 3 2 — — 26 Brandlehow Road 3 7 19 — 24 — 14 — 1 68 County Secondary, West Hill 1 - - - - - - - - 1 Earlsfield 2 - - - - - - - - 2 Elliott Central 2 3 4 2 1 — 2 — — 14 Eltringham Street 9 1 53 — 18 4 40 — 2 127 Frogmore Special — — 10 2 — — 1 — — 13 Garratt Lane 3 10 28 6 14 — 2 — 6 69 Magdalen Road 11 3 27 7 45 5 1 — — 99 Riversdale 16 9 74 34 3 18 11 2 1 168 St. Ann's 2 9 — 4 1 9 — — 25 St. Faith's 2 3 1 2 13 — 25 — 4 50 St. Joseph's 5 5 6 1 — — — — — 17 St. Michael's 6 I 35 11 — o — — 1 56 St. Thomas' — — — — — — — — — — Swaffield Road 9 5 60 10 9 2 1 — 3 99 Technical Institute — — — — — — — — Waldron Road 14 3 42 14 23 — 1 — 2 99 Wandle 9 3 51 23 4 4 32 — 11 137 Wandsworth — 1 — — — — — — — 1 Warple Way 1 39 1 1 1 1 — 1 45 West Hill 10 3 47 — 19 — 6 — 2 87 Grand Total 329 257 2472 518 752 232 497 11 119 5187 43 43 NON-INFEOTIVE DISEASES. The total number of deaths from Cancer and malignant disease was 604, the number of males being 269 and females 335. The death-rate was 1.77 per 1,000. The number of deaths in 1938 was 20 more than in 1937. The number of deaths from diseases of the Brain and Nervous System was 81. 1,468 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,474 in 1937, 1,440 in 1936 and 1,446 in 1935. 1,120 of these deaths were of persons over 65 years of age. There were 380 deaths from diseases of the Respirator}' System, compared with 490 in 1937, 440 in 1936, and 341 in 1935. The number from Bronchitis was 151 compared with 256 in 1937, and from Pneumonia (all forms) 209 compared with 208 in 1937. Further particulars relative to Pneumonia are given on page 37. The number of infants under two years of age who died from these diseases was 31. 103 deaths, 54 males and 49 females, were registered as due to Premature Birth and Developmental Diseases, compared with 134 in 1937. 98 deaths, 31 males and 67 females, occurred from Old Age. 97 of these were persons over 65 years of age. The number of deaths due to this cause in 1937 was 91. 162 deaths were due to violence, 106 of them being due to accidents, 52 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 eight persons receiving treatment. The cost to the Council for the year 1938 was £28 18s. Od. Pernicious Anaemia. One person is receiving treatment, by the provision of Liver Extract. The cost to the Council for the year 1938 was £7 16s. Od. 44 Report of the Medical Officer of Health for 1938. Inquests. Inquests were held on 326 persons dying in the Borough and on 200 Borough residents who died outside the Borough. The next Table shows the results of the findings of these inquests. TABLE XVII. Inquests. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. Deaths from Natural Causes 52 60 41 44 50 75 322 Accidental:— Falls 8 10 12 7 9 11 57 Knocked down by motor vehicles 4 6 9 6 3 9 37 Falls from a height 1 1 2 — 1 5 Thrown from bicycles 1 — 1 1 3 Burns and scalds 1 1 1 3 Death under anaesthetic 2 1 3 Other 1 1 3 3 3 11 Suicidal:— Poisoning by:— Coal Gas 4 3 6 4 1 5 23 Lysol — — — 1 1 — 2 Hydrocyanic acid 1 — 1 — — — 2 Potassium cyanide — — — 1 1 J eyes' Fluid — — — 1 — 1 Strychnine — — — 1 — 1 Hanging 1 2 3 1 — 2 9 Drowning 1 2 — — 2 1 6 Fall from a height 1 2 — 1 — 1 5 Fall from a train 1 1 — — 2 Cut throat 1 1 2 Strangulation 1 — — — — — 1 Run over by train 1 — 1 Result of war wounds 16 16 Open Verdict:— Found drowned 1 2 1 1 1 2 8 Execution 3 3 Murder — 2 — — — — 2 Totals 78 112 80 73 68 115 526 45 TUBERCULOSIS. Notification.—The total number of new cases of Tuberculosis which came to the notice of the Department during 1938 was 621 as compared with 599 in 1937, 569 in 1936, 658 in 1935 and 621 in 1934. The sources of information regarding the 621 new cases in 1938 were as follows:— Primary notifications on Form A 447 Primary notifications on Form B — Transfers from other Sanitary Authorities 158 Naval and military notifications — Un-notified at death 16 Total 621 Deaths.—The number of deaths certified as due to diseases of a Tuberculous nature was 229. This compares with 225 in 1937, 236 in 1936, 249 in 1935 and 276 in 1934. 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. 46 Report of the Medical Officer of Health for 1938. TABLE XVIII. Age Periods. New Cases. Deaths. Pulmonary. Non- Pulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males. Females. Under 1 year 2 - - - 1 - - - 1—5 4 3 8 5 - 1 2 1 5—10 3 1 6 9 — — 1 — 10—15 7 4 12 5 — 2 2 1 15—20 28 34 8 9 9 12 6 1 20—25 44 59 9 6 9 10 2 25—35 80 72 9 14 31 27 4 2 35—45 49 28 - 2 25 8 — 1 45—55 27 15 1 3 14 7 1 — 55—65 25 10 1 3 21 5 1 3 65 upwards 7 7 2 — 9 8 1 1 Totals 276 233 56 56 119 80 20 10 Table XIX. shows the number of new cases of Nonpulmonary Tuberculosis classified according to the part of the body affected. TABLE XIX. Localisation of Disease. Males. Females. Total. Brain 11 7 4 Glands, Mesenteric 18 7 11 Glands. Cervical 21 7 14 Bones and Joints 32 18 14 Other Parts 30 17 13 Totals 112 56 56 Tuberculosis. 47 Of the 229 deaths from Tuberculosis, 139 were males and 90 females. 199 deaths were due to Pulmonary Tuberculosis and 30 to other forms of Tuberculosis. Further details are given in Table XX. TABLE XX. Localisation. Males. Females. Total. Pulmonary Tuberculosis 119 80 199 Brain 6 5 11 Glands, Mesenteric 4 — 4 Bones and Joints 1 2 3 Other Parts 9 3 12 Totals 139 90 229 In addition to these deaths, which were duly certified in the returns as due to Tuberculosis, 31 persons previously notified as suffering from Tuberculosis died during the year. These deaths, however, do not figure in Table XX. for the reason that:— (a.) Six were certified as dying from diseases other than Tuberculosis. (b.) Twenty-five 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. 48 Report of the Medical Officer of Health for 1938. TABLE XXI. 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Pulmonary Tuberculosis:— No. of Deaths 320 275 288 245 257 235 216 205 197 199 Death-Rate .90 .77 .81 .69 .73 .66 .62 .59 .57 .58 Other Forms:— No. of Deaths 33 33 19 43 48 41 33 31 28 30 Death-Hate .09 .09 .05 .12 .13 .11 .09 .09 .08 .08 Total:— No. of Deaths 353 308 307 288 305 276 249 236 225 229 Death-Rate .99 .86 .86 .81 .86 .78 .72 .68 .65 .67 Tuberculosis. 49 During the year 16 persons, not previously notified, were certified as having died of Tuberculosis. The ratio of un-notified Tuberculosis deaths to total Tuberculosis deaths is therefore 16 to 229. Of the 16 un-notified deaths, eight were certified from Institutions, five by private doctors, while in three cases Tuberculosis was discovered by 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. 63 persons died within one month after notification, 92 within three months and 111 within six months. 621 cases were added to the notification register during the year, and 686 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,072. E 50 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 1938.—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 monary Total Adults M. 157 22 179 50 292 521 F. 140 20 160 55 277 492 Children M. 5 6 11 9 217 237 F. 4 7 11 9 246 266 Totals 306 55 361 123 1032 1516 Dispensaries. 51 The districts of the Borough in which these 1,516 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 90 43 56 52 79 112 432 Private Practitioners 63 49 42 53 58 129 394 Charitable Societies 16 40 11 12 32 86 197 Other Dispensaries 55 29 24 40 45 52 245 L.C.C. Schools 1 — — 1 2 1 5 Ministry of Pensions - - - - - - - Existing Dispensary Patients - 1 3 2 4 14 24 Other Sources 14 16 36 15 34 104 219 Totals 239 178 172 175 254 498 1,516 Contacts.—Of the 1,516 new cases examined, 495 were contacts. 25 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., 1937 New Cases Removed from Register Remaining on Register 31st Dec., 1938 Pulmonary 1147 392 409 1130 Non-Pulmonary 259 67 82 244 Suspected cases 49 123 127 45 Totals 1455 582 618 1419 E2 52 Report of the Medical Officer of Health for 1938. 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 153 2. Number of patients transferred to other areas and cases "lost sight of" 225 3. Died during the year 175 4. Number of cases recovered 91 5. Number of observation cases in which a period of observation exceeds two months 30 6. Number of attendances at the Dispensaries 4815 7. Total number of reports, etc., made in connection with the Dispensaries 4541 8. Number of attendances at General Hospitals or Institutions of patients for:— (a) Light treatment 190 (b) Other special forms of treatment 2151 9. Number of patients to whom Dental Treatment was given in connection with the Dispensary 29 10. Number of Personal Consultations with Medical Practitioners— (a) At Homes cf Patients 242 (b) Otherwise 2420 11. Number of other visits by Tuberculosis Officers to Homes 413 12. Number of visits by Health Visitors or Nurses to homes for Dispensary purposes 5617 13. Number of— (a) Specimens of Sputum, etc., examined 1412 (b) X-ray examinations made in connection with Dispensary work 247 The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1938 was as follows:— (a.) In Hospitals for observation 23 (b.) In Sanatoria 420 (c.) In L.C.C. General Hospitals 125 568 In addition to these many other patients received treatment in private or general hospitals. In August two Wards were opened up in St. John's Hospital, St. John's Hill, S.W. 11, for the accommodation of Tuberculous Tuberculosis Dispensaries. 53 patients and in September all such cases were transferred from St. James' Hospital to these Wards. The Tuberculosis Officer now visits there weekly. 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. 129 cases were treated during the year and 2,102 refills were administered. It is to be noted that this form of treatment is greatly on the increase. The cost to the Council was £1,103 11s. 0d. Two of these cases also received Sanocrysin injections, at a cost of £7 7s. 0d., for 49 injections. The close co-operation between the Dispensary and the School Medical Service instituted by the London County Council has been continued. Dental Treatment.—The agreement with the British Dental Hospital for providing dental treatment, including the provision of dentures, has been in force throughout the year. Twenty-nine patients received dental treatment and 19 of these were supplied with dentures. The attendances at the dentist totalled 100. The amount expended on dental treatment during the year was £12 0s. 0d., and the cost of dentures supplied to patients was £41 10s. 0d., making a total cost of £53 10s. 0d. 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 reason- 54 Report of the Medical Officer of Health for 1938. able 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 an early date. During the year under consideration 143 patients have been granted extra nourishment under the scheme at a cost of £162 16s. 2d. The scheme has been found to be of great help in the treatment of the types of patient mentioned above. 107 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 1938, as far as is known. Table XXVI. refers to cases of Pulmonary Tuberculosis and Table XXVII. to cases of Non-pulmonary Tuberculosis. Tuberculosis Dispensaries. 55 TABLE XXVI. Classification on Initial attendance at the Dispensaries. Condition at the end of 1938. 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. 440 31 87 272 830 1953 967 2920 Adults, F. 506 45 110 270 931 Children 124 10 27 31 192. Class T.B. Plus. Adults, M. 190 69 326 1912 2497 4389 1583 5972 Adults, F. 169 58 253 1363 1843 Children 9 2 6 32 49 56 Report of the Medical Officer of Health for 1938. TABLE XXVII. Classification on Initial attendance at the Dispensaries. Condition at end of 1938. 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-Pumonary Tuberculosis. Bones and Joints Adults, M. 57 6 27 25 115 313 174 487 Adults, F. 28 4 19 11 62 Children 78 8 28 22 136 Abdominal Adults, M. 13 1 4 6 24 105 75 180 Adults, F. 16 1 11 6 34 Children 32 3 6 6 47 Peripheral Glands Adults, M. 24 4 4 5 36 368 170 538 Adults, F. 45 4 8 11 68 Children 222 11 20 11 264 Other Organs. Adults, M. 22 2 8 13 41 138 67 205 Adults, F. 23 3 25 10 61 Children 11 2 3 20 36 Tuberculosis Dispensaries. 57 Bacteriological Examinations.—The number of examinations of sputum made at the Dispensary during the past seven 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 1938 1412 1022 210 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 30 persons who are contacts of cases of Tuberculosis. 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. 58 Report of the Medical Officer of Health for 1938. 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, L.C.C. School Care Committee. Captain R. Grindel, United Services and British Legion. T. H. Hunt, Esq., London Insurance Committee. Miss Jacobs, Streatham, Clapham, Balham and Tooting Invalid Childrens' Aid Association. Mrs. de Wilde, Wandsworth Invalid Childrens' Aid Association. Mr. H. B. Harvey, 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. Dull, J.P. Mrs. Duffell. Mrs. Genge. Dr. E. Higgins. Mrs. H. Jeans. Mrs. Laer. Mrs. MacDonald. Mrs. Marriott. Mrs. Morton Clarke. Mrs. Evans Rees. Tuberculosis Dispensaries. 59 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. Twenty-eight adults were sent away for convalescent treatment during 1938, at a cost of £155 19s. 0d. 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 60 Report of the Medical Officer of Health for 1938. from a relative often does much good, and the patient agrees to continue under treatment. The 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 £132 12s. 3d., this included fares, removal expenses to better housing accommodation, non-payment of rent, arrears of insurance, etc. An important duty of the Committee is to supply patients going to an Institution with clothing. Many of them are short of the clothing requirements of the Institution, and it is frequently a difficult problem to get them fitted out properly. Much time is spent by members of the Committee in collecting articles of clothing from their friends, and a certain proportion of the funds have also been expended in this direction. About 30 per cent. of the cases sent to Institutions were supplied with the articles required from the clothing store. Some of the patients who are being nursed at home are unable to obtain essential articles of medical equipment. Medical and nursing requisites, comprising air and water cushions, bed rests, 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 £54 3s. 0d. 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' Hospital, Balham, St. John's Hospital, Battersea, 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 177 of these patients were visited regularly by the Secretary of the Committee. Many of these patients are in hospital for prolonged periods, and the visits are much appreciated. It is often found when talking to the patients that they are in difficulties over their rent or insurance payments, and may be worried by circumstances at Tuberculosis Dispensaries. 61 their homes. The Secretary inquires into all matters of this nature and is able to assist in smoothing out many of the patients' difficulties. During 1938 the number of visits and interviews made by the Secretary to cases attending the Dispensaries was 2,148. 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 order to enable the patient to receive proper treatment. Pocket money is sent to destitute cases who have to undergo 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 £122 4s. 0d. 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, 62 Report of the Medical Officer of Health for 1938. In March, a Sale of Work was held at the Kensington Town Hall in which other Metropolitan Boroughs took part. Her Majesty Queen Mary visited the Sale and purchased several articles from the Wandsworth stall, and congratulated the Committee on the parchment work. In November a Sale of Work was held in the Dispensary, and the Mayor and Mayoress of Wandsworth (Councillor Wm. C. Bonney and Mrs. Bonney) visited and brought several articles. The Mayor congratulated the patients on the high standard of the work. 63 MATERNITY AND CHILD WELFARE. The Work of the Health Visitors. The staff of Health Visitors under this Council's Maternity and Child Welfare Scheme now consists of a Superintendent and 13 others. As stated on page 7, Miss Woods was appointed Superintendent Health Visitor in January, 1938, and she is responsible for the organisation and supervision of the work of these officers. 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 re-visiting, except in the areas served by the Balham and Putney Park Infant Welfare Centres. At these two 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. 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 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, Ophthalmia Neonatorum, Measles and Whooping Cough arc visited on notification, as well as known cases of 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 64 Report of the Medical Officer of Health for 1938. 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. These officers also 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 Crèches 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. Maternity and Child Welfare. 65 Infant Visiting. TABLE XXVIII. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. No. of children visited:- Under 1 year 725 372 595 577 373 1011 3653 1-2 years — 22 4 — — 43 69 2-5 years — 9 — — 1 20 30 Revisits to:— Infants under 1 year 1357 773 651 981 543 1594 5899 Children 1-2 years 1134 545 471 877 494 1394 4915 Children 2-5 years 1862 771 748 1582 1049 2999 9011 Total visits to children under Notification of Births Act 5078 2492 2469 4017 2460 7061 23577 Other visits—: Foster Mothers 153 143 108 228 124 137 893 Ophthalmia Neonatorum 7 — 3 10 2 8 30 Measles 720 284 471 831 766 1131 4203 Whooping Cough 29 6 79 71 100 118 403 Ante-natal cases 802 449 551 927 393 1131 4253 Puerperal Fever and Pyrexia 5 5 3 4 — 15 32 Miscellaneous 251 229 217 232 196 351 1486 Ineffectual 1538 622 1014 1442 1252 2763 8631 Total Home Visits 8593 4230 4915 7762 5293 12715 43508 The home visiting carried out by the Superintendents of the Balham and Putney Park Centres, who are not officers of the Council, are not included in the above Table. These officers made 2,667 visits—1,057 to children under one year, and 1,610 to children between one and five years of age. F 66 Report of the Medical Officer of Health for 1938. There were 4,056 births during the year, and 3,653 of these, or 90.0 per cent., were visited compared with 84.0 in 1937, 86.5 in 1936 and 90.0 in 1935. It was found that in 279 of the births, doctors had been in attendance, while in 861 the services of midwives had been utilised. 2,718 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 235 245 190 431 390 520 2011 Diphtheria Prevention Clinics — — 55 — — 53 108 Ante-natal Clinics 75 24 31 52 28 114 324 Visits to Crèches — 20 12 — — 16 48 Committee Meetings 7 26 2 3 19 3 60 Infant Welfare Centres. There are 13 Infant Welfare Centres in the Borough. Eleven of these are voluntary institutions administered by their own Committees and two are Municipal Clinics under the direct administration of the Maternity and Child Welfare Committee. The first Municipal Clinic was opened in the Public Health Section of the Municipal Buildings on 1st September, 1937. The second one has been opened during the year under review on the 1st April, 1938, at the Baptist Church Hall, Longley Road, Tooting. It was decided that this additional clinic was required because the area served by the centre at Fairlight Hall was too large. A weekly session is held at the new clinic, and the number of sessions at Fairlight Hall has been reduced from two to one per week. Maternity and Child Welfare. 67 When this centre was opened the boundaries of the areas served by the Centres in Balham, Streatham, Tooting and Springfield were re-adjusted with the object of preventing an excessive number of attendances at any of the sessions held at these Centres. The Council's medical staff conduct the Infant Sessions at the Municipal Buildings Clinic. The Medical Officer of the clinic in Longley Road is Dr. Pickard, who has acted in a similar capacity for the other centres in Tooting for a number of years. Each of the 11 voluntary centres has a Medical Officer, appointed by the Centre Committee, and two 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. There are a number of ladies acting as voluntary workers at the Infant Welfare Clinics in the Borough who assist in keeping the Centre records and in arranging for the purchase of food, drugs and clothing. These ladies work at the Municipal Centres as well as at those which are voluntary and the assistance which they render is much appreciated. There is the closest co-operation between them and those members of the Council's staff who work at the Clinics., There is still ample scope for the services of these ladies at the two Municipal Clinics although they have been relieved of the necessity of raising funds to meet part of the expenditure of the Centre. Christmas parties for mothers were held at both the Municipal Clinics. The programme of dancing and games was much appreciated by the mothers and children. Table XXX. gives the full details of the work carried out at the 13 Infant Welfare Centres in the Borough. The statistics shown for Fairlight Hall Centre include two sessions for the first three months of the year. On the 1st April, 100 infants were transferred from this Centre to the new centre at the Baptist Church Hall, Longley Road. 3,652 new infants were examined during the year, and the total attendances were 61,714. F 2 68 Report of the Medical Officer of Health for 1938. TABLE XXX. No. of Sessions held. No. of new cases. Total attendances. No. of Doctors' Consultations. Infant Clinics:— Wandsworth (formerly Fairfield) 96 446 6793 1612 Southfield 95 242 6010 1967 Springfield 48 227 3994 1122 Putney 95 211 5940 2341 Putney Park 48 32 936 540 Clapham 97 574 8087 2879 Balham 140 505 11411 2969 Streatham 95 327 8146 2112 Blegborough Road 48 97 2676 782 Streatham Hill 95 335 6555 2281 Fairlight 60 245 4355 1296 Beechcroft Road 93 288 4469 1425 Longley Road 37 123 2342 615 Total 1047 3652 71714 21941 Ante-Natal Clinics. District Ante-natal clinics are held at 10 of the 13 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. They 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 September, 1937, all the Maternity Home Clinics were held at that 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 Maternity and Child Welfare. 69 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. Ante-natal clinics are also held at the Maternity Home three times per week, two being 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 and post-natal clinics. 1,448 expectant mothers, of which 1,306 were new cases, attended the clinics, and the total number of attendances was 6,511. Post-Natal Clinics. A weekly post-natal clinic is held at the Maternity Home for women who have been confined there, and post-natal women attend at the district ante-natal clinics for consultation and examination. TABLE XXXI. Ante-natal Clinics. Post-natal Clinics. No. of Sessions held. No. of new cases. Total attendances. No. of Sessions held. No. of new cases. Total Attendances. Maternity Home 187 319 3432 49 237 246 Wandsworth:— Maternity Home Others 74 97 983 — 63 63 119 268 — 23 23 Southfields 12 75 156 — 7 7 Springfield 12 85 125 — — — Putney 22 111 331 — 39 41 Putney Park — — — — — — Clapham 39 132 376 — 3 3 Balham 25 94 272 — 15 17 Streatham 22 113 240 - 16 17 Blegborough Road — — — — — — Streatham Hill 9 41 93 — 7 9 Fairlight Hall 12 69 125 — 17 17 Beechcroft Road 10 51 110 — 12 12 Longley Road — - - — — — Total 424 1306 6511 49 439 455 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:— 70 Report of the Medical Officer of Health for 1938. Address of Clinic. Days and Times of Sessions Infant Welfare Centre. Ante-Natal Clinic. Clapham: Clapham Dispensary 42, Clapham Manor Street, S.W.4 Tuesdays and Wednesdays, at 2 p.m. Each Monday in every month at 2 p.m. Putney: 2, Clarendon Drive, S.W.15 Wednesdays and Thursdays at 2 p.m. Alternate Wednesdays in every month at 10 a.m., at 2, Clarendon Drive. Putney Park: Putney Park House, Roehampton Estate S.W.15 Fridays at 2 p.m. Balham: 91, Bedford Hill. S.W.12 Wednesdays and Thursdays at 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 days 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. 2nd Monday in each month at 2 p.m. Tooting: Fairlight Hall, Fairlight Road. S.W.17 Wednesdays at 2 p.m. 2nd Wednesday in every month at 10.30 a.m. Baptist Church Hall, Longley Road, S.W.17 Thursdays at 2 p.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 10 a.m. and Fridays at 2 p.m. Mondays at 9.30 a.m. Alternate Mondays at 1.30 p.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. Maternity and Child Welfare. 71 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 396 women were admitted to the Home and the average duration of stay was 14.37 days. 331 deliveries were carried out by the midwives, 64 by the medical staff, and one women was confined before she was admitted. In 171 cases it was necessary for the midwives to summon medical assistance in accordance with the requirements of the Midwives Act. Nine cases of Puerperal Pyrexia were notified from the Home, but there were no maternal deaths. Eight of the infants were still-born. One 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 43 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 72 Report of the Medical Officer of Health for 1938. 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 nine 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. 0d. 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. 45 midwives practise in the Borough, of whom 14 reside in neighbouring Boroughs. There are 14 private maternity homes in the Borough, all 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 financial circumstances are such that they are unable to pay the whole of the midwife's fee. Assistance is also granted in paying the fee of a trained maternity nurse when a doctor has been engaged to conduct the confinement. The Council is also prepared to assist in meeting the cost of providing a Home Help for a confinement. Maternity and Child Welfare. 73 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 widwife 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 women who had booked her, has to enter hospital for the confinement. The usual sum paid in compensation is 10/-. The following conditions are required to be satisfied before compensation is payable:— 1. The patient is required to confirm the statements that she had engaged the midwife to attend the confinement and had been referred by the midwife to the ante-natal clinic. 2. The Medical Officer of the clinic must certify that it is necessary for the woman to be confined in an institution. 74 Report of the Medical Officer of Health for 1938. No payment is made to a midwife where the patient herself applied for admission to an Institution. During the year assistance was granted to 80 midwives under this scheme and compensation was paid in five cases. Assistance towards payment of a suitable "Home Help" was made in 58 cases. The total cost of the service was £175 8s. 0d. 32 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 Crèche, 95, Lacy Road. Wandsworth Wandsworth Day Nursery and Training School, 16, Granville Road. Balham Balham Day Nursery, 22, Old Devonshire Road. In March, the Wandsworth Day Nursery was removed from 14, Garratt Lane to the address given above, as the former premises were considered to be unsafe. New premises for this Day Nursery are now under construction on a site adjoining the Municipal Buildings and they are expected to be ready for occupation in the near future. The admissions of children to the Day Nurseries is limited to those whose mothers are obliged to go out to work, who are ill or who for any other reasonable cause are unable to look after their children. The parents' payments vary from 6d. to 9d. per day for one child, a reduction being made when more than one child from the same family is admitted, or when a child is admitted for half a day only. The Day Nurseries are also training schools for nurses intending to take up crèche work who are admitted as probationers and remain for about a year. Practical and theoretical instruction Maternity and Child Welfare. 75 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, 4,657; Balham, 7,830; and Wandsworth, 4,774; a total of 17,261 compared with 19,952 in 1937. 48 inspections of the crèches 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 21 cots for the treatment of infants up to the age of five years. The staff consists of a Matron, one Sister, two Assistant Nurses and three Probationers. A Visiting Medical Officer attends daily. The standard fee is 10s. 6d. per week, but necessitous cases are admitted free, or at a reduced fee, according to circumstances. Medical practitioners can recommend children for admission and are allowed to attend them while in the Hospital. 191 infants were admitted in 1938, 166 from addresses in the Borough and 25 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. 76 Report of the Medical Officer of Health for 1938. Arrangements have been made for medical practitioners to attend at these hostels when necessary, and some of the infants attend the most convenient Infant Welfare Centre. The Council pays grants to the Southwark Diocesan Association for Preventive and Rescue Work, towards the maintenance of unmarried mothers usually resident in the Borough in the institutions of the Association. During 1938, assistance was granted in respect of seven cases at a cost of £34 7s. 2d. Similar grants are made to the Mission of Hope, but no cases were assisted during 1938. Convalescent Treatment. During the year, three mothers and 46 children were sent to Convalescent Homes. The cost of this service was £151 0s. 3d. Wandsworth and Tooting Children's Clinic. This Clinic provides artificial sunlight, massage and electrical treatment for children of all ages. 367 children have been treated during the year and they have made 12,923 attendances. 104 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 1,468 families were supplied with milk under the Milk (Mothers and Children) Order, 1918; 316 in Clapham; 102 in Putney; 292 in Balham; 201 in Streatham; 211 in Tooting; 96 in Southfield; 170 in Fairfield; and 80 in Springfield. The total cost to the Council was £2,907 11s. 1d. 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. Maternity and Child Walfare. 77 During the year £153 1s. 10d. 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. 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 48 cases received dental treatment. All of these were expectant or nursing mothers. 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. 78 Report of the Medical Officer of Health for 1938 During 1938, 97 cases were referred to the County Council for treatment and the cost of the service to the Borough Council was £35 11s. 4d. Minor Ailments. 83 children under school age who were suffering from impetigo, enlarged tonsils, adenoids, etc., were referred to the London County Council. The cost of this service to the Borough Council was £29 9s. 3d. 79 CHILD LIFE PROTECTION. The Medical Officer of Health is the Officer authorised to receive the notices required to be given under Part XIII 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 1938 there were 198 foster-mothers on the Register and the number of foster children for whom they were registered was 301. Nursing Service. Arrangements have been made with various nursing Associations 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 Raynard 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. 986 cases were visited during the year under these arrangements, and 10,636 visits were made. 80 Report of the Medical Officer of Health for 1938. TABLE XXXII. No. of cases occurring. No. of cases visited. No. of visits made. Whooping Cough 508 4 37 Influenza — 30 209 Pneumonia 321 82 1544 Ophthalmia Neonatorum 32 18 261 Measles 3741 132 1214 Puerperal Fever and Puerperal Pyrexia 57 11 111 Infantile Diarrhœa — 1 5 Minor Ailments — 708 7255 Total 4659 986 10636 Home Helps. Three Home Helps are employed by the voluntary Committees of the Infant Welfare Centres. In one instance the Borough Council pays 100 per cent. of the expenditure not exceeding £80 per annum. In the other two instances, the Council pays 75 per cent. of the expenditure incurred. The Borough Council also contributes towards the charges made by other women who assist in the home during confinements if both the Health Visitor and the midwife consider her to be suitable for assisting in this manner. Each case is considered by the Maternity and Child Welfare Committee who decide as to the amount of the grant which should be paid. 81 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 5862 13343 19205 House-to-House inspections 1720 5717 7437 Shop Inspections 949 4 953 Infective Diseases:— Notifiable diseases 1395 592 1987 Other infective diseases 489 44 533 Verminous conditions 219 130 349 No. of Premises Offensive Trades — — - - Piggeries 5 9 — 9 Factories, workshops, etc. 2043 851 209 1060 Houses let in lodgings 164 175 624 799 Rag and bone stores 5 17 — 17 Sanitary conveniences 172 405 24 429 Mews and stables 157 248 65 313 Other inspections 12916 2955 15871 Total 25255 23707 48962 Smoke observations 180 — 180 Legal proceedings, Attendances at Court 28 — 28 g 82 Report of the Medical Officer of Health for 1938. Table XXXIV gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 641 and 719 were cleansed or repaired. The drains of 119 houses were re-constructed. Damp conditions have been remedied in 1,405 premises, and in 84 of these damp courses were inserted. 18 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with sports grounds. Sanitary Inspection of the Borough. 83 TABLE XXXIV. Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 518 361 462 223 680 1040 3284 2. Drains tested 149 64 105 121 88 114 641 3. Drains cleansed or repaired 112 61 97 83 97 269 719 4. Water closets cleansed or repaired 267 203 152 109 232 485 1448 5. Soil pipes repaired 50 67 14 31 29 66 257 6. Waste pipes altered or repaired 132 155 92 99 49 242 769 7. Rainwater pipes repaired 51 53 21 16 29 56 226 8. Roofs and gutters repaired 224 104 107 77 256 391 1159 9. Damp courses inserted 18 22 7 20 1 16 84 10. Damp conditions otherwise remedied 186 194 200 110 147 484 1321 11. Yards drained or paved 115 43 59 24 100 202 543 12. Dust bins provided or repaired 112 47 68 29 80 154 490 13. Water cisterns cleansed, covered or repaired 12 55 7 10 20 105 209 14. Water supply reinstated 7 18 - 2 - 33 60 15. Defective fireplaces remedied 105 74 80 39 83 268 649 16. Defective coppers remedied 30 18 7 11 45 79 190 17. Stables and stable yards drained or paved - 1 - 1 1 1 4 18. Accumulations of manure, etc., removed 5 3 12 17 6 15 58 19. Urinals cleansed or repaired 2 3 31 2 1 3 42 20. Animals improperly kept 3 3 2 1 - 3 12 21. Smoke nuisances — 2 3 4 5 22 36 22. Other nuisances 131 227 94 65 203 169 892 Total 2229 1778 1620 1094 2155 4217 13093 No. of preliminary notices served 872 434 539 328 843 1581 4597 No. of preliminary notices complied with without the service of nuisance notices 624 322 417 266 766 1304 3699 No. of nuisance notices served 189 50 159 84 232 500 1214 No. of nuisance notices complied with 186 48 156 81 188 452 1111 G2 84 Report of the Medical Officer of Health for 1938. Water Supply—Cutting-off Notices. During the year, 64 notices with respect to 66 premises were received from the Metropolitan Water Board, stating that the supply had been withdrawn. In 26 premises the water supply was cut off for non-payment of rates, 24 because of defects in the service, and in 16 the premises became vacant. 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 is 172; 49 in Clapham, 27 in Putney, 13 in Balham, 17 in Streatham, 13 in Tooting and 53 in Wandsworth. 429 inspections were made during the year, and four 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. Owing to the increase in the number of complaints from residents in the Borough of nuisances from rats, the Council Sanitary Inspection of the Borough. 85 decided, towards the end of 1936, to appoint a Rat Catcher and an Assistant Rat Catcher for a period of one year. These appointments were afterwards extended and the work has been carried on during 1938. 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. 931 rat complaints were received during the year. The Rat Catcher made 1,896 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, 5,123 baits were laid during National Rat Week and 3,586 were taken by rats. Shops Act, 1934. 953 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 necessary 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 and one open air swimming bath belonging to the Council, one open air swimming bath owned by the London County Council, one public swimming pool privately owned, and 14 private bathing pools in the Borough. The Queensmere pond on Wimbledon Common has also for many years past been a recognised bathing pond. In four of the Council's swimming baths, the water is purified by a process of continuous circulation through a filtration plant 86 Report of the Medical Officer of Health for 1938. whereby the whole of the water is dealt with every three to 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 continuously circulated and chlorinated automatically the whole time the bath is in use. 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 272 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, three Council houses were found to be infested and were 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 1938 the furniture of 141 families was disinfected by Hydrogen Cyanide gas, and the cost of this service was £427. Sanitary Inspection of the Borough. 87 Rag Flock. There is one factory in the Borough where Rag Flock is manufactured. This factory is inspected periodically. All flock for export is inspected and sampled, and certificates of purity were issued in four instances during 1938. Another industry that has grown considerably is the washing of rags by the Rag and Bag Washers, Ltd., Lydden Grove, Wandsworth. This company are working day and night washing rags for the Army, Navy and Air Force. The rags are disinfected on the firm's premises under the supervision of the Council's Inspector and certificates are issued for which a charge is made. During 1938, 111 certificates were issued, and the amount collected was £27 15s. 0d. 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 83 bodies have been removed to the Wandsworth Mortuary. No bodies were taken to the Mortuaries in Clapham and Streatham. CREMATORIUM, PUTNEY VALE CEMETERY. The Council has erected a Crematorium at the above cemetery and this was completed in the Summer of 1938. On the recommendation of the Council, the Home Secretary appointed me as Medical Referee under the Crematorium Regulations, 1930, for authorising cremations at the Crematorium. Dr. MacDonnell was appointed Deputy Medical Referee. 48 cremations were authorised during the year. 88 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) 7,757 and the number of inspections made 36,643 (2) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 1,720 and the number of inspections made 7,437 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 48 (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 4,508 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 1 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 notice was served requiring repairs One (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners One (b) By Local Authority in default of owners - Housing. 89 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,214 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,111 (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 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 33 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 14 (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 1,143 (ii) Number of families dwelling therein 1,143 (iii) Number of persons dwelling therein 7,159 (b) Number of new cases of overcrowding reported during the year 96 (c) (i) Number of cases of overcrowding relieved during the year 311 (ii) Number of persons concerned in such cases 1,920 90 Report of the Medical Officer of Health for 1938. (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. 1,720 inspections were made compared with 2,034 in 1937 and 2,237 in 1936. Nuisances necessitating the service of sanitary notices were found in 1,358 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 188 158 17 38 49 161 Clapham South 77 50 8 4 13 72 Putney 276 210 11 32 328 113 Balham 223 175 5 74 77 168 Streatham 4 4 1 2 2 2 Tooting 306 232 1 1 119 261 Southfield 193 162 1 4 100 137 Fairfield 171 139 8 23 53 136 Springfield 282 228 8 17 202 187 Whole Borough 1720 1358 60 195 943 1237 Rent and Mortgage Interest Restrictions Acts, 1919-1923. During the year 38 applications were received from occupiers that their houses were not in a reasonable state of repair. In one case the application was withdrawn. In the remaining 37 cases, the applications were acceded to, and Statutory Certificates were granted. Most of the work to put them in a reasonable state of repair was carried out during the year. 91 Housing Act, 1936. The Clearance of Insanitary Houses. The re-development by the Council of the sites of the following insanitary houses has been completed during the year:— Felsham Road Area, Putney, comprising 88 flats. Tooting Grove, No. 1 Area, Tooting, comprising 114 flats. Greyhound Square and Barrow Road Areas, Streatham, which have been developed as one site—42 flats and eight shops have been erected. Wandsworth Plain Area, Wandsworth. All the 91 insanitary houses in this Area, which was declared in January, 1934, have now been cleared, and rapid progress is being made with the development of the remaining section of the site by the Council. 76 more flats are in course of erection, making a total of 149 flats on the site, when the re-development is complete. White Square, Clapham. This site, 4.327 acres in extent, contained five insanitary Areas which were declared in January, 1935. There were 100 insanitary houses in the five areas, and 66 "coloured grey" were added. By the end of the year, 94 of the former and 62 of the latter had been demolished. The site is being developed by the Council and it is proposed to erect 181 flats and six shops on it. Several of the blocks of flats have been erected and are now in occupation. Salvador, No. 1 Area. This Area, containing 23 insanitary houses, was the subject of a Clearance Order made in 1937, as the Council decided not to develop the site. Most of the houses on it have been vacated. Carpenter's Place Area. A Clearance Order was made in respect of this Area, which contained 10 houses, in January, 1937, and eight of the houses have now been vacated. 92 Report of the Medical Officer of Health for 1938. Sadler's Buildings Area, Putney. The Compulsory Purchase Order made on the 19th October, 1937, in respect of this Area of 16 houses, was subject to a Public Enquiry held on 7th February, 1938, and has since been confirmed without modification, by the Minister of Health. Blackford's Cottages Area, Roehampton. A Clearance Order on this Area, which contained eight houses, was made on 19th October, 1937, and this Order has been confirmed by the Minister of Health without modification, after Public Enquiry held on 7th February, 1938. Three of the houses were demolished before the end of the year. Weimar Street Area, Putney. This Area contains 21 insanitary houses, and was represented by me on 1st October, 1937. When the London County Council were approached with regard to it they expressed the desire to deal with the Area themselves and it was declared a Clearance Area by that Council on 20th December, 1938. Point Pleasant, No. 1 Area, Wandsworth. This Area, which contains seven insanitary houses, was represented on 1st October, 1937, and declared on 18th January, 1938, when a Clearance Order was made. No objections were made to the Order, which has been confirmed. The houses have not yet been demolished. Point Pleasant, No. 2 Area, Wandsworth. This Area, which contains five insanitary houses, was declared on 18th January, 1938, and was the subject of a Public Enquiry held on 19th August, 1938. The Clearance Order made on the former date has been confirmed by the Minister of Health without modification. The houses are still standing. Point Pleasant, No. 3 Area, Wandsworth. This Area contained 19 insanitary houses. A Clearance Order was made in respect of it on the same date as for the two previous Areas, and this has been confirmed by the Minister without Public Enquiry as no objections were received. Four of the houses have been demolished during the year. Housing. 93 Cubitt's Cottages Area, Wandsworth. This Area contains 21 insanitary houses. It was declared on 18th January, 1938, when a Compulsory Purchase Order was submitted. The Minister of Health held a Public Enquiry on the Order on 20th July, and subsequently confirmed it without modification. The houses are still occupied. Saxby Street Area, Clapham South. This is a large Area, approximately 3¼ acres in extent, which I represented on 1st December, 1937. Ninety-four insanitary houses, including 10 where businesses were also conducted, were included in the Representation. The Council, having decided to develop the site, added 13 other houses "coloured grey," and three business premises which were not dwelling houses On 18th October, 1938, a Public Enquiry was held on the Compulsory Purchase Order, which was later confirmed by the Minister of Health. Two of the houses—one Red and one Greybeing excluded from the Order. Chesil Place Area, Balham. This is a small Area, containing seven insanitary houses. It was represented on 1st October, 1937, declared on 24th May, 1938, and made the subject of a Public Enquiry on 18th October, 1938. The Clearance Order has since been confirmed by the Minister of Health. Oldridge Road Area, Balham. This Area, which contains 21 insanitary houses, is close to Chesil Place Area. A Representation in respect of it was submitted on 29th March, 1938. The London County Council on being notified of the Borough Council's intention to consider the Area as a Clearance Area, informed the latter that they preferred to deal with it themselves and on 20th December, 1938, the Borough Council resolved accordingly. Greyhound Lane Area, Streatham. This is a small Area, of four houses, which was represented on 13th July, 1938, and declared on 15th November, 1938, when a 94 Report of the Medical Officer of Health for 1938. Clearance Order was submitted to the Minister of Health for confirmation. Bridgefield Grove Area, Wandsworth. This is an Area containing 22 insanitary houses which was represented by me on 18th November, 1938. Demolition Orders. The following 31 houses, in respect of which Demolition Orders were made in 1937, have been demolished during the year:— Clapham— 139, Manor Street 2 houses. 11, Clifton Street Streatliam— 16, Cowper's Row 1 house. Wandsworth— 16-52 Point Pleasant 19 houses. 54 and 58, Warple Way 2 houses. 410, York Road 1 house. 1-6, Potter's Court 6 houses. Demolition Orders have been made on the following eight houses:— 1-5, Cowper's Row Streatham. 14 and 15, Cowper's Row 2, Prescott Place Clapham. The Order on 2, Prescott Place has been complied with, the house having been demolished. Four insanitary houses, viz., 2, 4, 6, 8, High Street, Roehampton, have been demolished by the owners during the year, no action under the Housing Act being required. Housing. 95 Closing Orders and Underground Rooms. I submitted official Representations for Closing Orders to to be made on 14 Underground Rooms, two in each of the following seven houses:— 1, 3, 5, 7, 9, 11, Jews Row and 4, Church Row—All in Wandsworth. Closing Orders were made by the Council and they were complied with before the end of the year. The Closing Orders made in 1937, on 1, 2, 3, and 5, Grove Road Mews, Clapham, have now been complied with and these mews flats are closed. 18 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 Rooms Regulations. 61 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. Henry Prince Estate. This site, approximately 9.88 acres in extent, is being developed by the Council for the re-housing of families in the Borough living under overcrowded conditions, and accommodation will be provided for over 1,700 persons. 21 blocks of flats, four storeys in height, containing 272 dwellings, are being erected. These will consist of:— 4 one room flats. 36 three room flats. 88 four room flats. 132 five room flats. 12 six room flats. Eighty of these flats have now been completed and are in occupation. 96 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 slaughterhouses, 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 occurence 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 3,262. Amongst these are 813 grocery and provisions shops, and reference to the Table will show that a variety of businesses are conducted from these shops. Some Food and Food Premises. 97 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 355 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 561 registered dairymen and 188 registered dairies in the Borough, one of them being also a cowshed. The Food Inspectors made 646 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 967 samples of whole milk reported as genuine was 3.65 compared with 3.66 in 1937, 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 thereof with the Sanitary Authority. During the year 102 applications were submitted to the Council for the purpose of registration under this Act. In each h 98 99 Report of the Medical Officer of Health for 1938. Food and Food Premises. TABLE XXXVI. Nature of Principal Business. No. of Separate Premises. No. of Dairymen registered. Actual Food Businesses Conducted on the Premises Shown in Column 1. Subject to some form of Legal Control. Other Food Businesses. No. of Inspections in 1938. 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. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Dairies 182 182 182 1 — — 36 8 — — — 134 16 — 2 8 3 - 646 — Ice-Cream Vendors 35 — — — — — 35 — - — — — 3 - - — 1 — 558 — Grocers and Provisions 813 355 3 — — 33 82 216 — — — 813 119 21 33 — 13 100 1202 9 Confectioners 665 13 2 — — — 451 — — — — 9 665 — 1 — 37 2 975 5 Butchers 224 - — — — — — 220 — — — 2 — 224 1 1 - — 1029 2 Slaughter-houses 5 - - - 5 - - - - - - - - - - - - - 1151 — Fishmongers 103 - - - - - - 47 8 23 103 1 - 1 — — 2 — 367 2 Fish Fryers 87 - - - - - - 76 87 5 23 - 1 — — — 43 — 390 3 Restaurants 390 11 1 — — — 82 10 3 — 4 4 26 — — — 390 2 501 12 Greengrocers 436 — — - — — — 1 — - 9 3 — — 436 — — — 1554 12 Market Stalls 170 — — — — — 4 4 1 3 10 16 15 11 60 — 8 5 14824 — Food Factories 21 — — — — 1 - 4 — — — 1 6 4 — 21 1 7 44 — Other Premises 131 - - - - - i 2 — — 1 2 1 — — - — 131 209 9 Totals 3262 561 188 1 5 34 691 588 99 31 150 985 852 261 553 30 498 247 23450 54 H 2 100 Report of the Medical Officer of Health for 1938. 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 1,151 visits during the year to these . premises and were present on nearly every occasion when slaughtering took place. The number of carcases examined was 11,345, comprising 251 oxen, 3,614 pigs, 4,388 sheep and 3,092 calves. 4,897 of the animals were also inspected before being slaughtered. One seizure of pig's carcase and head and collar of pig deposited in Slaughterhouse. Case taken to Court. Fined £25 and £5 5s. Od. costs. Multiple Firm, £5 5s. 0d. costs. 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; 19 pairs lungs, 4 heads and tongues, 1 mesentery, 1 liver, 1 kidney. For Fluke; 7 livers, 1 pair lungs. For Abscess; 2 pairs lungs, 1 liver. For Actinomycosis; 1 head and 2 tongues. For Cirrhosis; 3 livers. For Traumatism; 36 stone beef. For Neoplasm; 1 kidney and suet. Pigs:— For Tuberculosis; 60 heads and collars, 37 mesenteries, 1 entire carcase 9 stone and organs, 4 pairs lungs, 4 livers. For Congestion; 179 pairs lungs, 10 plucks. For Pericarditis; 83 hearts. For Cirrhosis; 107 livers. For Abscess; 1 spleen. For Trauma; 100 lbs. of pork. For Traumatism; 1 leg pork, 9 lbs. For Nephritis; 2 kidneys. Food and Food Premises. 101 For Rheumatoid Arthritis; 1 hand and spring, 20 lbs., 3 legs pork. For Emaciation and Dropsy; 1 entire carcase and organs, 64 lbs. Sheep:— For Strongylus Rufescens; 2 pairs lungs. For Cirrhosis; 1 liver. Calves:— For Tuberculosis; 2 plucks. For Abscess; 1 pluck. For Melanosis; 1 liver. For Inflammation; 1 heart, 1 pluck. For Congestion; 1 pluck. At the request of the owners 895 pigs' carcases and offal were examined prior to their distribution to branch shops. These 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; 13 pig plucks, 12 pig's heads and collars, 6 pig mesenteries. For Cirrhosis; 6 pig livers and 1 lb. of pork (bruised). There are 224 butchers' shops in the Borough, the majority of which are subject to registration under the Public Health (London) Act, 1936. 1,029 inspections were made of these shops, and it was found necessary in 14 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 102 Report of the Medical Officer of Health for 1938. 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 31st December, 26 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.:—12 pigs' heads and collars, 10 livers, 6 lungs, 6 hearts, 12 mesenteries, 11 plucks, 1 kidney, 5 boxes pears, 7½ stone herring, 9 boxes cod fillets, 21½ bags potatoes, 20 floats tomatoes, 1 barrel crabs, 1 box imported rabbits, 6½ boxes cabbages, 13 boxes apples, 1 box lemon soles, 2 bags winkles, 2 tins pressed veal, 3 boxes fish roe, 27 bags cauliflowers. 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, Food and Food Premises. 103 The following Orders are now in force:— 1. Gelatine. 16. Meat. 2. Honey. 17. Malt Flour and Malt Extract. 3. Fresh Apples. 4. Tea. 18. Potatoes. 5. Currants. 19. Broccoli. 6. Sultanas. 20. Eggs. 7. Raisins. 21. Glasshouse grown Tomatoes and Cucumbers 8. Eggs in Shell. 9. Dried Eggs. 22. Strawberries. 10. Oat Products. 23. Dressed Poultry. 11. Raw Tomatoes. 24. Cherries. 12. Salmon and Trout. 25. Cider. 13. Butter. 26. Canned Fruits. 14. Apples. 27. Canned Cherries. 15. Wheat Flour 28. Bacon and Ham. 29. Dead poultry. The Food Inspectors report that these Acts and Orders are duly observed by the traders, there being no deliberate evasion of the provisions. One prosecution was taken during the year for incorrect marking of tomatoes. A fine of 40s. was imposed. 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 1938 was 322. The Principal businesses conducted in the premises of these applicants is shown in Table XXXVII. 677 inspections of these premises have been made during the year. 104 Report of the Medical Officer of Health for 1938. TABLE XXXVII.—Part II of Poisons List. Principal Business No. of Premises No. of Inspections Grocers 151 325 Hairdressers 38 70 Drug Stores 32 54 Ironmongers, Paint and Colourmen 95 213 Nurserymen 4 12 Garages 2 3 Total 322 677 Statement of Work Done under the Food and Drugs, (Adulteration) Act, 1928. During the year 2,002 samples of foods and drugs were submitted to the Public Analyst for analysis. Of these 1,002 were submitted as official samples while 1,000 were purchased unofficially as test for informal samples. 46 or 4.5 per cent. of the official samples, and seven or 0.7 per cent. of the unofficial samples were found to be adulterated or not up to standard. The total adulterations reported were 53 or 2.6 per cent. of the samples submitted. Food and Food Tremises. 105 TABLE XXXVIII. RESULT OF ANALYSES OF CERTAIN ARTICLES OF FOOD PROCURED UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928, SHOWING THE PERCENTAGE ADULTERATED IN 1938, AS COMPARED WITH 1933, 1931, 1935, 1936 AND 1937. No. of samples in 1938. Percentage of Samples adulterated, 1934-1937. Examined. Found adulterated or not up to standard Percentage adulterated 1931. 1935. 1936. 1937. Butter 145 1 .68 — — — .57 Cheese 14 — — — — — — Cocoa 21 — — — — — — Coffee and Coffee & Chicory 19 — — — — 3.0 — Confectionery and Jam 18 — — — 1.2 — — Cream 56 — — — — — — Margarine 30 - - - - - - Milk 1013 46 4.54 1.7 1.6 .7 1.19 Separated Milk — — — — 33.3 — — Condensed Milk 10 — — — — — — Tea 23 — — 12.5 - - -— Vinegar 8 — — — 18.0 22.2 — Drugs 102 3 2.94 7.4 4.0 — 5.88 Other Articles 543 3 .55 5.1 4.0 1.6 1.85 All Articles 2002 53 2.64 2.65 2.3 .95 1.4 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. 106 Report of the Medical Officer of Health for 1938. 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 150 3 2.0 156 2 1.28 306 5 5.2 1.63 Putney 167 — — 104 1 .96 271 1 8.1 .36 Balham 122 1 .81 89 1 1.12 211 2 4.0 .94 Streatham 228 1 .43 82 22 26.82 310 23 4.7 7.41 Tooting 162 — — 160 14 8.75 322 14 8.7 4.34 Wandsworth 171 2 1.16 411 6 1.45 582 8 6.2 1.37 Whole Borough 1000 7 .70 1002 46 4.59 2002 53 5.8 2.64 Milk and Milk Supply. The following samples were submitted for analysis:— 1,013 of whole new milk. 10 of condensed milk. Of these 46 were reported against as being adulterated or not up to standard. 40 contained extraneous water, three were deficient in milk fat, two contained extraneous water and were also deficient in milk fat, and one had an odour of pine oil disinfectant. In 22 cases Police Court proceedings were taken, and fines of £16 0s. 0d. with £15 15s. 0d. costs were imposed. In the remaining 24 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. 174 samples of milk were taken from the early morning delivery to hospitals in the Borough, ten on delivery to Wandsworth Prison, and 42 from the milk delivered to the County Council Schools in the Borough. All these samples were reported as genuine, Food and Food Premises. 107 321 samples were taken from milk vendors in the street during the early morning (midnight to 8 a.m.), and of these 13 or 4.04 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 50 Accredited — Pasteurised 48 Total 98 Bacteriological Examination of Milk. 33 samples of milk have been examined at the Lister Institute of Preventive Medicine for the Phosphatase test for Pasteurised milk and all of them were reported to have passed the test. The following samples of Graded Milks procured from schools, hospitals or dairymen, were submitted to the Counties Public Laboratories for bacteriological examination in order to see if the bacterial content was within the prescribed standard for the appropriate grade. Grade. Schools. Hospitals. Dairymen. Total. Tuberculin Tested - - 4 4 Pasteurised 26 9 16 51 Total 26 9 20 55 All these samples complied with the required standards. Butter and Margarine. 145 samples of butter were submitted for analysis during the year. One sample was reported to contain a Boron preservative. Further samples were procured which proved genuine. The remaining 144 samples were reported to be genuine. 108 Report of the Medical Officer of Health for 1938. 30 samples of margarine were submitted for analysis, and all were reported to be genuine. Other Articles. 501 samples were submitted under this heading. The results of the analyses are given in the Public Analyst's Report. 109 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 1938. Number of Inspections, 1938. Number of Notices, 1938. Number of Prosecutions, 1938. Factories:— Factory Laundries .44 30 1 — Factory Bakehouses 70 114 1 — Food Factories entered on Table XXXVI 21 44 - - Other Factories 491 257 11 - Total 626 445 13 — Workshops:— Workshop Laundries 20 6 1 — Workshop Bakehouses 50 89 2 — Other Workshops 756 377 19 — Total 826 472 22 — Workplaces 88 74 2 — Total: Factories, Workshops and Workplaces 1,540 991 37 — Home-workers' premises 524 113 5 — Grand Total 2,064 1104 42 — Further details with regard to homeworkers' premises are given in Table XLI. 110 Report of the Medical Officer of Health for 1938. TABLE XLI. HOME WORK. Nature of Work. Outworkers' Lists. Outwork in unwholesome premises Outwork in infected premises. Lists received from Employers. Notices served on occupiers as to keeping or sending lists. Lists. Outworkers. Instan ces. Notices served. Instan ces. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 26 7 215 26 6 5 51 (2.) Cleaning and washing 3 14 2 1 — — - Paper bags and boxes 4 — 24 1 — — — Toys 2 — 8 — — — — Totals 35 21 249 28 6 5 51 The total number of addresses received from other Councils was 388, and 84 addresses were forwarded to other Authorities. The number of addresses received has decreased by 75, and the number sent in has increased by four. 15 names and addresses were forwarded to this Borough in error. The number of notices sent to employers during the year was 28, and these had a most satisfactory result. During the year 51 cases of infective diseases—24 of Measles, one of German Measles, one of Pneumonia, four of Scarlet Fever, four of Diphtheria, eight of Whooping Cough, seven of Chicken-pox, one of Erysipelas and one of Mumps—were notified as having occurred in the homes of out-workers. In none of these cases was it necessary to make any order under Section 110 of the Factory and Workshop Act. Factories and Workshops. 1ll TABLE XLII. DETAILS WITH REGARD TO REGISTERED WORKSHQPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, are enumerated here. Workshop Bakehouses 50 Workshop Laundries 20 Dressmakers' and Milliners' Workshops 89 Bootmakers 94 Smiths and Engineers 30 Builders 43 Tailors 62 Motor Engineers 76 Upholsterers 22 Hairdressers 47 Other 293 Total number of workshops on Register 826 TABLE XLIII. DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 12 11 - - Want of ventilation — — - - Overcrowding — — - - Want of drainage of floors 1 1 - - Other Nuisances 14 14 - — Sanitary accommodation: Insufficient 1 1 - - Unsuitable or defective 19 18 - - 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 47 45 *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 112 Report of the Medical Officer of Health for 1938. 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. Vital Statistics. 113 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF WANDSWORTH, 1938. (Compiled by the Registrar-General). Causes of Death. Sex. All Ages. 0 - 1 — o 5 — 15- 25— 35— 45— 55— 65— 75- ALL CAUSES M. F. 1831 1977 91 94 17 6 16 13 26 21 58 39 75 72 105 82 169 160 353 277 502 473 419 740 1. Typhoid and paratyphoid fevers M. F. 1 — — — — — — 1 — — — — 2. Measles M. 6 2 2 1 1 F. 6 3 1 2 3. Scarlet fever M. 1 — — — 1 — — — — — — — F. 1 1 4. Whooping cough M. 2 1 1 — — F. 1 — 1 5. Diphtheria M. 10 2 — 5 3 — — — — — — — F. 5 — — 1 3 — — 1 — — — — 6. Influenza M. 9 — 1 — — — o 1 1 1 2 1 F. 13 — 1 1 1 — — 1 2 3 4 7. Encephalitis lethargica M. — — — F. 1 — — — — — — 1 — — 8. Cerebro-spinal fever .. M. 1 F. 3 — 1 1 — — — — — 1 — 9. Tuberculosis of respiratory system M. 124 1 17 29 27 17 23 8 2 F. 81 — 1 — 22 25 10 7 8 5 3 10. Other tuberculous diseases M. 19 3 1 3 5 4 1 1 1 — F. 9 — — 1 2 1 1 — — 4 — — 11. Syphilis M. 4 1 2 1 — F. 2 2 12. General paralysis of the insane, tabes dorsalis M. 10 1 __ 1 2 3 3 — F. 4 — — — — — 2 — 1 — 1 13. Cancer, malignant disease M. 276 _ 1 2 13 32 104 93 31 F. 338 — — — — 1 5 25 50 81 96 80 14. Diabetes M. 22 _ 1 1 1 2 1 9 7 F. 25 — — — — — — 1 — 7 9 8 15. Cerebral haemorrhage, etc. M. 37 1 3 6 15 ]?, F. 73 — — — — — 1 — 5 12 27 28 10. Heart disease M. 563 1 3 9 5 36 87 203 219 F. 653 — — — 1 4 10 10 37 60 168 363 17. Aneurysm M. 18 1 1 2 8 2 4 F. 12 1 1 6 2 2 114 Report of the Medical Officer of Health for 1938. 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. 82 - - - - - - 3 4 23 25 27 F. 136 — — — — — — 2 4 23 43 64 19. Bronchitis M. 67 - 2 - 1 1 1 3 6 10 18 25 F. 53 3 — — — — - — 2 4 15 29 20. Pneumonia (all forms) M. 95 9 4 2 3 3 2 8 10 17 20 17 F. 76 8 1 3 — 1 4 4 5 10 18 22 21. Other respiratory diseases M. 11 - - - - - - 5 2 2 2 — F. 9 — — — — 1 — 1 — 2 3 2 22. Peptic ulcer M. 34 — — — — — 2 3 5 12 9 3 F. 12 — — — — — — 1 — 3 4 4 23. Diarrhœa, etc. M. 22 17 1 — — — 1 — — 1 1 1 F. 33 25 — — — — — — 2 2 4 — 24. Appendicitis M. 8 - — - 1 2 1 — 3 1 — — F. 10 - — 1 — — 1 — 1 1 4 2 25. Cirrhosis of liver M. 10 - - 1 - - - - 2 4 3 — F. 4 — — — - — — — 1 — 2 1 26. Other diseases of liver, etc. M. 9 - — - 1 - - 1 1 2 2 2 F. 12 — - - - - - 1 1 3 2 5 27. Other digestive diseases M. 26 — 1 — 1 1 1 3 3 6 5 5 F. 39 2 — — 5 — 1 4 4 8 6 9 28. Acute and chronic nephritis M. 53 - - - - - 1 6 2 9 26 7 F. 47 — — — — l 1 3 5 9 14 14 29. Puerperal sepsis F. 4 — — — — - 3 1 — — — — 30. Other puerperal causes F. 6 — — — — 3 1 1 1 — — — 31. Congenital debility, premature birth, malformation, etc. M. 56 52 - - 2 - - - 1 1 - - F. 52 50 - — — — 2 - - - - - 32. Senility M. 21 - - - - - - - - - 1 20 F. 40 - - - - - - - - - 1 39 33. Suicide M. 30 — — — — 5 3 6 11 2 2 1 F. 23 — — — — — 4 4 6 6 2 1 34. Other violence M. 57 - - 3 4 7 4 6 10 9 8 6 F. 54 1 — — 2 2 5 — 1 3 12 28 35. Other defined diseases M. 148 7 2 2 4 9 10 12 12 18 43 29 F. 139 2 1 2 6 3 6 10 23 23 32 31 36. Causes ill-defined, or unknown M. - - - - - - - - - - - - F. — — — — — — — — — — — — Police Court Proceedings. 115 POLICE COURT PROCEEDINGS, 1938. Premises. Offence. Result. Fine. Costs. 2, Dingwall Road, Wandsworth Nuisances. Summons adjourned sine die, work being in progress. - - 165, Lower Richmond Road, Putney Ditto. Order made for abatement of nuisances within 14 days. 2, Wiseton Road, Wandsworth Ditto. Summons adjourned sine die, work being in progress. - - 41, Baldry Gardens, Streatham. Ditto. Order made for abatement within 21 days. - - 41, Temperley Road, Balham. Ditto. Order made for abatement within 14 days. - 10/6 3, 7 and 9, Rashleigh Street, Clapham. Ditto. Order made for abatement within 14 days. - 31/6 3 and 7, Rashleigh Street, Clapham. Contravention of L.C.C. Bye-laws. (Houses divided into separate tenements.) Convicted. 80/- - 64, Tonsley Hill, Wandsworth. Nuisances. Order made for abatement within 14 days. 20/- - 87, West Hill, Wandsworth. Ditto. Ditto. 21/- - 96, Gauden Road, Clapham. Ditto. Summons withdrawn work having been done. - 21/- 4a, Zennor Road, Balham. Ditto. Order made for abatement within 21 days. - - 99, Fountain Road, Tooting. Ditto. Summons adjourned sine die, in order that the work carried out might be tested. - - 18a, Radbourne Road, Balham. Ditto. Order made for abatement within 14 days. - - 20, ditto. Ditto. Summons adjourned sine die, on undertaking to complete the necessary work. - - 31 and 35, Hazelhurst Road, Balham, Ditto. Order made for abatement within 14 days. - - 37, ditto. Ditto. Order made for abatement within 21 days. - 42/- 116 Report of the Medical Officer of Health for 1938. POLICE COURT PROCEEDINGS, 1938—continued. Premises. Offence. Result. Fine. Costs. 35 and 37, Hazelhurst Road, Balham. Non-compliance with Nuisance Orders. Convicted. 40/- 42/- 157, Eardley Road, Streatham. Nuisances. Order made for abatement within 14 days. - 10/6 38, ditto. Ditto. Ditto. — 10/6 75, ditto. Ditto. Order made for abatement within 3 days — - 11, Martindale Road, Balham. Ditto. Order made for abatement within 14 days. - 21/- 27, Besley Street, Streatham. Ditto. Ditto. - 10/6 70, The Chase, Clapham. Ditto. Summons withdrawn, work having been done. - 21/- 606, Wandsworth Road, Clapham. Obstructing 2 Sanitary Inspectors in execution of their duty, also assaulting Police Officer who had been called by Sanitary Inspector. Convicted. (Alternative 28 days imprisonment.) 40/- - In Blegborough Road, Streatham. Distributing toys in the course of the business of Rag and Bone dealer. Summons dismissed under Probation of Offenders Act. - 2/- In Besley Street, Streatham. Ditto. Convicted. 5/- - 117 Public Analysts' Annual Report. To the Wandsworth Borough Council. Mr. Mayor, Ladies and Gentlemen, Herewith we have pleasure in submitting to you our report on work performed in this laboratory under the Food and Drugs (Adulteration) Act, 1928, for your Council during the year ended 31st December, 1938. In all, 2,002 samples were submitted and examined under the Act, of which two formal samples of Milk were taken by the Superintendent of Police of the Newbury Division of the County of Berks, whilst the remaining 2,000 were procured by your Council's Food Inspector, half with the necessary formalities required by the Act and half informally. The following statement shows the nature of the samples submitted with the results of analyses, the details of Drugs and "Other Articles" being given subsequently. GENERAL STATEMENT. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Butter - 145 145 - 1 1 Cheese — 10 10 — — — Cheese (Wrapped) - 4 4 — — — Cocoa - 21 21 — — — Coffee — 9 9 — — - Cream — 52 52 — - — Cream, Tinned — 4 4 — — — Jam & Marmalade — 18 18 — — — Flour — 3 3 — - - Flour, Self-raising — 4 4 — — — Lard - 28 28 — — — Margarine — 30 30 — — — Milk 1001 12 1013 45 1 46 Milk, Condensed (Full Cream) - 3 3 - - - Milk, Condensed (Machine Skimmed) - 7 7 - - - Sugar — 17 17 — — — Tea — 23 23 — — — Vinegar — 4 4 — — — Vinegar (Non-brewed) - 4 4 - - - Drugs 1 101 102 1 2 3 Other Articles - 501 501 — 3 3 Total 1002 1000 2002 46 7 53 118 Report of the Medical Officer of Health for 1938. DRUGS. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Acid, Boric - 6 6 - 1 1 Acid, Citric — 3 3 — — — Acid, Tartaric — 6 6 — — — Borax — 3 3 — — — Camphorated Oil — 6 6 — — — Cinnamon and Ammoniated Quinine - 1 1 - - - Cream of Tartar — 4 4 — — — Epsom Salts — 6 6 — — — Essence of Cinnamon and Quinine - 1 1 - - - Friars' Balsam — 3 3 — — — Glauber's Salt — 3 3 — — — Glycerin — 3 3 — — — Oil, Castor — 6 6 — — — Oil, Eucalyptus — 3 3 — — — Ointment, Boric — 6 6 — — — Ointment, Sulphur — 3 3 — — — Ointment, Zinc — 3 3 — — — Powder, Compound Liquorice 1 3 4 1 1 2 Powder, Seidlitz — 9 9 — — — Sodium, Bicarbonate of - 3 3 - - - Tablets, Aspirin — 7 7 — — — Tablets, Sulphur — 3 3 — - — Tincture of Iodine — 6 6 — — — Tincture of Quinine (Ammoniated) — 4 4 — — — Total 1 101 102 1 2 3 Analysts' Annual Report. 119 OTHER ARTICLES (Informal). Nature of Sample. Examined. Adulterated. Arrowroot 6 - Almonds 4 — Almonds, Ground 3 — Baking Powder 7 — Blanc Mange Powder 6 — Biscuits 6 — Cake 3 — Cakes, Sponge 3 — Chicory and Coffee 1 — Cinnamon, Ground 1 — Coffee and Chicory 10 — Coffee and Chicory Essence 6 — Cooking Fat 1 — Cordials 3 — Cornflour 7 — Curry Powder 3 — Custard Powder 13 — Dripping 9 — Egg-substitute Powder 6 — Essence, Flavouring 3 — Fish Paste 11 — Fish, Tinned 17 1 Fruit, Bottled and Tinned 13 — Fruit, Dried 119 1 Gelatin 3 — Ginger, Ground 3 — Herbs, Dried 3 — Honey 4 — Honey, Prepared 2 — Jelly, Table 9 — Lemon Curd and Cheese 3 — Meat Cubes 1 — Meat, Tinned 1 — Meat Paste 11 — Meat, Other 7 — Mincemeat (Fruit) 6 — Mustard, Compound 4 — Oatmeal 6 — Olive Oil 3 — Pea Flour 3 — Peel, Candied 3 — Pepper 6 — Pickles 18 — Rice 13 — Rice, Flaked 3 — Rice, Ground 10 — Sago 9 — Salad Cream 3 — Sauce 6 — Sausages 18 — Sausages, Preserved 31 — Sausage Meat 6 — Spice, Mixed 3 - Suet 5 — Suet, Shredded 7 — Tapioca 10 —- Vegetables, Tinned 14 1 Wheat Preparations 6 — Total 501 3 120 Report of the Medical Officer of Health for 1938. The following table gives, in detail, the nature and extent of the adulteration detected in the formal samples :— Case No. Nature of Sample. Nature of Report. 44 Milk 13½% Extraneous Water. 45 Ditto. 4% Ditto. 46 Ditto. 1% Ditto. 47 Ditto. 14% Ditto. 48 Ditto. 7½% Ditto. 49 Ditto. 9% Ditto. 50 Ditto. 11% Ditto. 51 Ditto. 8½% Ditto. 52 Ditto. 2% Ditto. 53 Ditto. 3½% Ditto. 54 Ditto. 4½% Ditto. 55 Ditto. 4% Ditto. 60 Ditto. 34% Ditto. 172 Ditto. 6% Ditto. 173 Ditto. 6½% Ditto. 174 Ditto. 10% Ditto. 175 Ditto. 9% Ditto. 176 Ditto. 6½% Ditto. 217 Ditto. 6% Ditto. 289 Ditto. 3% Deficient in Fat. 386 Ditto. 2% Extraneous Water. 498 Ditto. 1% Ditto. 535 Ditto. 0.5% Ditto. 536 Ditto. 1½% Ditto. 537 Ditto. 1½% Ditto. 538 Ditto. 1½% Ditto. 539 Ditto. 1½% Ditto. 541 Ditto. 1% Ditto. 542 Ditto. 1½% Ditto. 544 Ditto. 0.5% Ditto. 545 Ditto. 1½% Ditto. 547 Ditto. 1% Ditto. 548 Ditto. 1% Ditto. 596 Ditto. 3% Ditto. 597 Ditto. 3% Ditto. 708 Compound Liquorice Powder. 25% Deficient in sulphur. 709 Milk 5½% Extraneous Water 710 Ditto. 6% Ditto. 711 Ditto. 8% Deficient in Fat. 712 Ditto. 1½% Extraneous Water and 2½% deficient in Fat. 713 Ditto. 3% Extraneous Water and 22 % deficient in Fat 738 Ditto. 28½% Extraneous Water. 739 Ditto. 40% Ditto. 740 Ditto. 38% Ditto. 741 Ditto. 30% Ditto. 893 Ditto. 1% Deficient in Fat. Analysts' Annual Report. 121 The nature of the reports issued in respect to the informal samples, returned as adulterated, is given below:— Case No. Nature of Sample. Nature of Report. 51 Butter Contains Boric Acid. 86 Boric Acid Contains excess Lead. 285 Tinned Sild Contains excess Tin. (378 Compound Liquorice Powder. Deficient in Sulphur. 716 Dried Apricots Contains Maggots. 717 Tinned Spinach Contains Zinc. 819 Milk Contaminated with Pine Oil. Amongst the informal samples examined were six submitted at the request of ratepayers from whom complaints had been received. The samples comprised two each of Tea and Milk and one each of Butter and Tinned Herrings in Tomato Sauce. With the exception of one of the samples of Milk, which possessed an odour of Pine Oil as recorded above, all were found to be normal in every respect and, consequently, returned as genuine. The average water content of the 145 samples of Butter amounted to 14.7 per cent., that in the 30 samples of Margarine being 14.3 per cent. Of the 52 samples of Cream examined, one submitted as "Fruit Cream" contained 35 per cent. fat, eight submitted as "Coffee Cream" possessed an average fat content of 26.9 percent., whilst in the remaining 43 samples the average amount of fat was 59.9 per cent. The average fat content of the four samples of Tinned Cream amounted to 22.9 per cent. The average composition of the samples of Milk submitted during each month of the year and returned as genuine was as under. Report of the Medical Officer of Health for 938. Month Number Total Solids Milk Fat Non-fatty Solids January 35 12.49% 3.74% 8.75% February 58 12.35% 3.61% 8.74% March 106 12.53% 3.78% 8.75% April 92 12.22% 3.44% 8.78% May 100 12.24% 3.44% 8.80% June 94 12.31% 3.53% 8.78% July 102 12.24% 3.52% 8.72% August 98 12.25% 3.54% 8.71% September 24 12.36% 3.63% 8.73% October 99 12.7% 3.86% 8.81% November 84 12.70% 3.91% 8.79% December 75 12.68% 3.88% 8.80% The average composition of the whole of the 967 samples of Milk, received during the year and returned as genuine was as under:— Total Milk solids 12.42 % Milk fat 3.65% Non-fatty solids 8.77 % Finally, we have to report that the adulteration detected during the year 1938 amounted to 4.59 per cent. of the formal samples, to 0.7 per cent. of the informal samples and 2.64 per cent. of all samples submitted. We have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servants, A. H. MUTER, F.I.C., F.C.S., Public Analyst. CHARLES A. HACKMAN, F.I.C., Additional Public Analyst. 325, Kennington Road, S.E. 11. February, 1939. 122 123 INDEX. PAGE Accident, Deaths from 44 Adulteration of Certain Articles, Percentage of, in 1934-1937 105 Agricultural Grading and Marking Act, 1928 102 Air Raid Precautions 10 Ambulance Service 39 Anaemia, Pernicious 43 Analysts, Report of 117 Ante-natal Clinics 68, 71 Ante-natal Women, Treatment of 72 Anti-toxin 25 Area of Borough 11 Artificial Light Treatment of Tuberculosis 52, 53 Artificial Pneumothorax Treatment of Tuberculosis 53 Artificial Sunlight, etc., Treatment 76 Bacteriological Examinations 39, 57 Bacteriological Examination of Milk 107 Bakehouses 109 Balham, House-to-House Inspections in 90 Barrow Road Area 91 Bathing Pools and Swimming Baths 85 Bed Bugs, Eradication of 86 Births 13 Births and Birth-rates in Sub-Districts 14 Birth-rate, Average 10 years, 1928-1937 17 Births, Notification of, Act 14 Blackford's Cottages Area 92 Borough of Wandsworth War Memorial Maternity Home 71 Brain and Nervous System, Diseases of the 43 Bridgefield Grove Area 94 Butchers' Shops 98 Butter and Margarine 107 124 Index. PAGE Cancer 43 Carpenter's Place Area 91 Census, 1931 12 Census, 1921 12 Census, 1911 12 Cerebro-Spinal Meningitis 37 Chesil Place Area 93 Child Birth, Deaths from 19 Child Life Protection 79 Children's Clinic, Wandsworth and Tooting 76 Circulatory Diseases 43 Clapham, House-to-House Inspections in 90 Cleansing of Persons Act 39 Clearance Areas 91 Clinics for Immunisation against Diphtheria 25 Closing Orders 95 Confectioners 98 Conscientious Objections Certificates granted 24 Convalescent Treatment 76 Cowsheds 98 Creches 74 Crematorium 87 Cubitt's Cottages Area 93 Cutting-off-Notices—Water Supply 84 Dairies, Milkshops and Cowsheds 98 Day Nurseries 74 Death, Causes of 16,113. Death-rate, Average 10 years, 1928-1937 17 Death-rate, Corrected 15 Death-rate from Infective Diseases 20 Death-rate, Infantile 18 Deaths, Corrected 15 Deaths, Number of 15 Deaths in Institutions 18 Demolition Orders 94 Dental Treatment 53, 77 Developmental Diseases 43 Index. 125 PAGE Diarrhœ 38 Diphtheria 24 Diphtheria, Attack Rate per 1,000 cases 24 Diphtheria, Immunisation against 25 Diphtheria, "Return Cases "of 34 Diseased or Infirm Persons, Removal of 87 Disinfecting Station Staff 9 Disinfection 39, 86 Dwelling-houses, Inspection of 90 Dysentery 38 Encephalitis Lethargica 37 Enteric Fever 38 Erysipelas 38 Expectant and Nursing Mothers, Institutions for 75 Factories and Workshops 109 Factories, Workshops, etc., Defects found in 1ll Factories, Workshops and Workplaces, Inspection of 81 Families, Number of, Census 1931 11 Felsham Road Area 91 Fishmongers' Shops 98 Fish, Sausages and Preserved Meat, etc., preparation or manufacture of 97 Flies and Mosquitoes 84 Food and Drugs Inspector 4 Food, Prosecutions in connection with 106 Food and Drugs (Adulteration) Act, 1928, Proceedings under 106 Food and Drugs (Adulteration) Act, 1928, Statement of Work under 104 Food and Food Premises 96 Food Factories 98, 109 Food Places, Inspection of 98 Foster-parents 79 Fried Fish Shops 98 Greengrocers' Shops 98 Greyhound Lane Area 93 Greyhound Square Area 91 Grocery and Provision Shops 98 126 Index. PAGE Health Visitors 6 Health Visitors, Work of 63 Henry Prince Estate 95 Home Helps 74, 80 Home Work 110 Hospital Treatment for Ante-natal Women 72 Hospitals, etc., for Expectant and Nursing Mothers 75 House Refuse, Removal of 84 House-to-House Inspections, Summary of 90 Houses and Premises Inspected 81 Houses Let in Lodgings 81 Housing Act, 1936 88, 91 Housing Consolidated Regulations, 1925, Houses Inspected, etc 88 . Housing Statistics 88 Hydrogen Cyanide Disinfection 86 Ice Cream Premises 98 Ice Cream, etc., Sale and Storage of 97 Illegitimate Children, Births of 14 Immunisation against Diphtheria 25 Imported Produce, Marking of 102 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1919-1923 90 Infant Life Protection 79 Infant Visiting 65 Infant Welfare Centres 66, 70 Infant Mortality 18 Infantile Mortality, 10 years, 1928-1937 19 Infective Diseases 20 Infective Diseases, Cases of 21, 22 Infective Diseases, Death rate from 20 Infective Diseases, Number of Cases Notified from Elementary Schools 40 Infirm or Diseased Persons, Removal of 87 Influenza, Deaths and Death-rates 37 Influenzal Pneumonia and Acute Primary Pneumonia, Cases Notified 37 Inhabited Houses, Number of 11 Inquests44 Index. 127 PAGE Insanitary Areas 91 Inspections, Details of 81 Institutions for Expectant Mothers, etc.75 Insulin Treatment 43 Laundries, Inspection of 109 Malaria 38 Margarine 107 Markets and Stalls 98 Maternal Mortality 19 Maternity and Child Welfare 63 Maternity and Child Welfare Centres 66 Maternity Home, Borough of Wandsworth War Memorial 71 Maternity Home Staff 7 Maternity Outfits 73 Measles 34 Measles and other Non-notifiable Diseases reported from Schools 40 Measles and Whooping Cough, the Notification of 34 Meat 100 Merchandise Marks Act, 1926 102 Mews and Stables 81 Mice and Rats Destruction 84 Midwives 72 Midwifery Service 72 Milk Analysis 105 Milk, Bacteriological Examination of 107 Milk (Mothers and Children) Order 6 Milk Premises, Cowsheds, etc., on Register 98 Milkshops, Cowsheds, etc., Inspections of 99 Milk (Special Designation) Order, 1923 107 Milk Supply 76, 97, 106 Minor Ailments, Treatment of 78 Mission of Hope, Grant to 76 Mortuaries 9, 87 Mosquitoes 84 128 Index. PAGE Natural Increase, Rate of 14 Nervous System, Diseases of the 43 Non-Infective Diseases, Deaths from 43 Notification of Births Acts 14 Notification of Infective Diseases 20 Nursing Arrangements 79 Nursing Mothers, Institutions for 75 Obstetric Consultants 2 Obstetric Consultant Service 71 Offensive Trades 81 Old Age 43 Oldridge Road Area 93 Ophthalmia Neonatorum 36 Ophthalmic Consultant 2 Other Infective Diseases, Deaths from 38 Outworkers 109, 110 Overcrowding 89, 95 Para-Typhoid Fever 38 Pernicious Anaemia 43 Pharmacy and Poisons Act, 1933 103 Physical Features, etc., of the Borough 12 Piggeries 81 Pneumonia 37, 43 Point Pleasant, Nos. 1, 2, 3 Areas 92 Police Court Proceedings 115 Polio-Myelitis and Polio-Encephalitis 37 Population 11-13 Population of Sub-Districts 13 Post-Natal Clinics 69 Premature Birth 43 Pregnancy, Deaths from Accidents and Diseases of 19 Preserved Meat, Fish and Sausages, etc., preparation or manufacture of 97 Provisions and Grocery Shops 98 Public Analyst 2 Public Vaccinators 2, 3 Puerperal Fever 36 Index. 129 PAGE Puerperal Pyrexia 36 Pulmonary Tuberculosis, Notification of Cases of 46 Putney, House-to-House Inspections in 90 Pyaemia, Deaths from 38 Rag and Bone Stores 81 Rag Flock Act, 1911, Work done under 87 Rateable Value 11 Rats and Mice Destruction 84 Rent and Mortgage Interest (Restrictions) Acts, 1919-1923 90 Respiratory Diseases 43 Restaurant Kitchens 98 Return Cases of Scarlet Fever and Diphtheria 34 Sadler's Buildings Area 92 Salvador No. 1 Area 91 Samples Formal and Informal, Number of 106 Sanitary Conveniences, Inspection of 81, 84 Sanitary Inspection of the Borough 81 Sanitary Inspectors 4 Sanitary Operations, Table of 83 Sausages, Preserved Meat and Fish, etc., manufacture of 97 Saxby Street Area 93 Scabies 38 Scarlet Fever 33 Scarlet Fever, Attack Rate per 1,000 Cases 34 Scarlet Fever, "Return Cases" of 34 Septicaemia, Deaths from 38 Shelters for Tuberculosis Patients 54 Shops Act, 1934 85 Slaughter houses 98 Slaughter of Animals Act, 1933 102 Small Pox 23 Smoke Nuisances 81 Social Conditions 12 Southwark Diocesan Association, Grant to 76 Sputum Examinations 57 130 Index. PAGE Staff 1-9 Statistics for the Borough 11 Streatham, House-to-House Inspections in 90 Suicide, Deaths from 44 Swimming Baths and Bathing Pools 85 Syphilis, Deaths from 38 Tooting and Wandsworth Children's Clinic 76 Tooting, House-to-House Inspections in 90 Tooting Grove, No. 1 Area 91 Tuberculosis 45 Tuberculosis, Artificial Light Treatment of 52, 53 Tuberculosis, Artificial Pneumothorax Treatment of 53 Tuberculosis Dispensaries 57 Tuberculosis Care Committee 57 Tuberculosis, Handicraft Class 61 Tuberculosis, Institutional Treatment 52 Tuberculosis, Open Air Shelters 54 Tuberculosis, Sanocrysin Treatment 53 Tuberculosis, Investigation by "The Prophit Trust" 57 Tuberculous Diseases, Extra Nourishment provided 53 Underground Rooms 95 Unhealthy Areas 91 Unmarried mothers, Institutions for 75 Unsound Food 102 Vaccination 23 Vaccination Officers 3 Vaccination Returns 24 Violence, Mortality from 43 Vital Statistics of Whole Borough 11 Wandsworth and Tooting Children's Clinic 76 Wandsworth, House-to-House Inspections in 90 Wandsworth Plain Area 91 Water Supply, Cutting-off Notices 84 Weimar Square Area 92 Index. 131 PAGE White Square Area 91 Whooping Cough 37 Whooping Cough and Measles, the Notification of 34 Workshops, Number of 81,109,111 Young Children, Institutions for 75 Zymotic Diseases 20 • .