WAN 77 LIBRARY Metropolitan Borough of Wandsworth. Annual Report of the Medical Officer of Health for the Year 1940, by F. G. CALEY, M.A., M.B., B.Ch., D.P.H., together with the Report of the Public Analyst. CONTENTS. page Foreword 1 Civil Defence Services 3 Statistics and Social Conditions 5 Vital Statistics 6, 12 Staff of the Health Department 7 Infective Diseases 16 Disinfection: Bacteriological examinations ; Nursing Services ; Ambulance Service. Non-Infective Diseases 21 Inquests. Immunisation against Diphtheria 22 Tuberculosis 26 Cases ; Deaths ; Dispensaries i Care Committee. Maternity and Child Welfare 34 Including the work of the Health Visitors. Sanitary Supervision of the Borough 44 Work of the Sanitary Inspectors ; House refuse ; Vermin ; Rats and Mice ; Mortuaries ; Crematorium. Housing 50 Slum Clearance ; Overcrowding. The Supervision of Food 53 Pharmacy and Poisons Act, 1933. Factories and Workshops 58 Police Court Proceedings 61 Report of the Public Analyst 62 REPORT of the Medical Officer of Health for the Year 1940. 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 health of the Borough for the year 1940, including an account of the Health Services administered by the Council and incorporating the Report of the Public Analyst. The health of the Borough during the year has been good and apart from the effects of enemy air activity there has been no undue increase in mortality calling for special comment. Actually in some respects the reverse is the case. There has been a marked reduction in the number of the common infectious diseases of childhood with a corresponding fall in the number of deaths. The bi-ennial epidemic of measles due in the winter of 1939-1940 never materialised. The infantile mortality was 45 per 1,000 births, the lowest ever recorded. It is reasonable to assume that this reduction in the incidence of disease in childhood is a direct result of the evacuation of many children into country areas during the early part of the war. On the other hand, there were 816 more deaths of Borough residents than in the previous year. Much of this increase is accounted for by deaths from enemy action, 500 persons having died from this cause during the year, but there has also been an increased number of deaths from cancer, tuberculosis and diseases of the respiratory system. According to the Registrar General's estimate, the population, on which the birth and death rates are calculated, shows a reduction of over 68,000 on the previous year, an effect produced by evacuation and enlistment in the Forces. Calculated on this reduced population, both the birth rate and the death rate are shown as materially higher than they have been in recent years, but it is as well not to place too much reliance on these statistics 2 Report of the Medical Officer of Health for 1940. for purposes of comparison, in view of the difficulties in arriving at a correct estimate of the population under present conditions. All the health services provided by the Council have been in operation throughout the year, although in some respects there has not been the same demand for them as in peace time. There has, for instance, been a reduction in the number of complaints received from householders and most of the work under the Housing Acts has ceased. As a result of evacuation there are fewer mothers and children resident in the Borough and this has lessened the demand on the Maternity and Child Welfare Services. For these reasons there has been some falling off in the peace time routine activities of the Sanitary Inspectors and Health Visitors, but additional duties have been thrown on these officers in connection with the war effort, and during the enemy activity in the autumn they were hard put to it to carry out these extra duties. At that time the Sanitary Inspectors were called upon to assist in finding houses for the homeless and in making rapid surveys of houses damaged by bombs. Their services were also required for the inspection of air raid shelters. The Health Visitors visited many homes in connection with the evacuation scheme and to find billets for refugees. They also visited rest centres and several of them were on duty with the Mobile Units when these were despatched to Air raid incidents. As the Health Department is responsible for the organisation and control of certain sections of the Civil Defence Scheme it is inevitable that many members of the staff should have been called upon to shoulder additional duties and responsibilities, often involving considerable periods of overtime. The whole of the staff have given me their full co-operation throughout the year and have carried out the many additional duties which they have been asked to perform in a manner which has been a credit to all concerned. I am, Sir, Ladies and Gentlemen, Your obedient servant, F. G. CALEY, Medical Officer of Health, 3 CIVIL DEFENCE SERVICES. The Civil Defence Services for the administration and control of which the Department is responsible are as follows:— 1. The Casualty Service, comprising five Stretcher Party Stations, eight First Aid Posts and five Mobile Units, with a personnel of about 1,000 men and women and over 80 vehicles. 2. The Medical and Nursing Service in shelters, comprising 16 Medical Aid Posts situated in the large shelters or serving groups of shelters. Each post has one or more nurses on duty throughout the night and is visited nightly by a doctor. Arrangements have also been made for doctors to visit those shelters not served by the Medical Aid Posts should their services be required. 3. The Cleansing Service for the decontamination of persons who may become gas casualties and their clothing. There are cleansing centres for casualties at each of the eight First Aid Posts and further centres are being established for the cleansing of casualties and their clothing. 4. The Gas Identification Service. 5. The collection and transportation of Civilian War Dead from incidents to one of the three mortuaries which have been provided. 6. The Operational Control of the above Services organised on a rota basis. For this purpose a Medical Officer and two Clerical Officers of the Department are available for duty in the Control Room at any hour of the day or night. 7. The supervision of the Food Supplies under war conditions by the Food Inspectors. 8. The local arrangements, in co-operation with the Ministry of Health and the London County Council, for the evacuation of children, expectant mothers, aged and infirm persons, 4 Report of the Medical Officer of Health for 1940. 9. The medical inspection of the Rest Centres and the supervision of children when accommodated at the Centres. 10. The arrangements for the medical and nursing inspection of war refugees. The Training of Civil Defence Personnel. Another important service for which the Public Health Department has become responsible is the training of the personnel of all sections of the Civil Defence Services under the control of the Council. The Department has carried out these duties since organised training was instituted in the early months of 1938, and in June, 1940, the Council appointed me as Training Officer. The training staff consists of a Chief Instructor, seven other Government-trained instructors and eleven who have been trained locally. Mr. W. G. Pearce, the Chief Instructor, was seconded from his duties as Sanitary Inspector in 1939 and now devotes the whole of his time to Civil Defence duties. He is Chief Instructor and also acts as Quartermaster for the Services for which the Department is responsible. The other Government-trained Instructors are officers of the Council. They are Messrs. A. E. Vickers, E. V. Roots, W. H. Jones, A. E. Handley and A. F. Saunders, Sanitary Inspectors, and Messrs. L. F. Morgan and W. H. Michael, of the Borough Engineer's Department. The locally-trained Instructors are Messrs. E. M. Brown, E. H. Goff, H. L. Marshall, R. W. Martin, A. V. Palmer, J. B. Privett, C. H. Rowe, C. T. Searle, E. R. Stead, B. L. Shurgold and J. F. Wray. All the instructors devote a large amount of their time to their training duties, much of it after office hours. A large number of Civil Defence volunteers have undergone training in the last three years. During the year 180 courses of lectures in Anti-Gas and 148 courses in First Aid have been given, 5 STATISTICS AND SOCIAL CONDITIONS. Area 9,199 acres Resident population in 1940 271,340 No. of inhabited houses in 1940 approx. 76,000 No. of families, or separate occupiers, at Census in 1931 95,383 Rateable value in 1940 £3,479,668 Estimated produce of a penny rate £13,252 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,199 acres which includes a number of open spaces with a combined area of 1,202 acres. The population is a varied one, as the Borough contains residential neighbourhoods in addition to several working-class districts. The chief industries carried on are the manufacture of gas, electricity and motor accessories, laundries and general engineering. There is no trade which has any particular affect on the health of the workers or residents. At December, 1940, the number of unemployed was 2,274, a decrease of 5,213 on December, 1939. 6 Report of the Medical Officer of Health for 1940. Extracts from Vital Statistics. No. of Live Births. Males. Females. Total. Legitimate 1850 1662 3512 Illegitimate 78 72 150 Total Live Births 1928 1734 3662 No. of stillbirths 61 50 111 No. of Deaths 2269 2321 4590 Birth-rate 13.49 Death-rate:— Crude 16.91 Standardised 15.21 Rate per 1,000 (Live and Still) Births. Deaths from puerperal and post-abortive sepsis 5 1.32 Deaths from other puerperal causes 4 1.06 Total 9 2.38 Infantile mortality, per 1,000 live births:— All infants 45 Legitimate infants 44 Illegitimate infants 66 Deaths from Cancer 622 „ Measles 2 ,, Whooping Cough 1 ,, Diarrhoea, under 2 years of age 4 „ Tuberculosis 242 Tuberculosis death-rate .89 There has been no unusual or excessive mortality during the year aud no noteworthy outbreaks of illness have occurred. 7 STAFF OF THE HEALTH DEPARTMENT. M edical Officer of Health :— F. G. Caley, MA., M.B., B.Ch., 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. Dr. Trott has acted throughout the year as First Aid Commandant, having been seconded from his ordinary duties on the outbreak of war. Dr. W. Dodd, who was engaged on a sessional basis, in October, 1939, to perform Dr. Trott's duties, was appointed, temporarily, as Assistant M.O.H. and Assistant Tuberculosis Officer on 19th March, 1940. He resigned on 9th November and his place was taken by Dr. C. R. Stevenson, who took up his duties on 16th December. Obstetric Consultants :— A. Morris Johns, M.D., Ch.B., M.C.O.G. F. W. Roques, M.A., M.D., M.Ch., F.R.C.S., M.C.O.G. W. R. Winterton, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. W. N. Searle, M.B., Ch.B., F.R.C.S., M.C.O.G. Ophthalmic Consultant to The Maternity Home :— J. D. M. Cardell, M.B., B.S., F.R.C.S. Public Analyst:— A. H. M. Muter, F.I.C., F.C.S. Dental Surgeon :— G. Tester Thompson, L.D.S. 8 Report of the Medical Officer of Health for 1940. Public Vaccinators:— for Balham Dr. T. Stokes. for Clapham Dr. J. Kennish. for Putney Dr. M. D. Cowan. for Streatham Dr. A. B. Plant. Tooting No. 1 District Dr. P. A. Carrie. Tooting No. 2 District Dr. E. G. Housden. Wandsworth No. 1 District Dr. C. F. Kirwan. Wandsworth No. 2 District Dr. J. W. M. Little. for Swaffield Road Institution Dr. J. W. M. Little. Vaccination Officers :— for Putney Mr. C. L. Taylor. The Medical Officer of Health is Vaccination Officer for the rest of the Borough. The Staff of the Maternity Home. This Home is now closed and is a First Aid Post. Four members of the staff are employed as trained nurses in units of the First Aid Services, viz., Miss A. Crump, Matron-, Miss R. Strudwick, Senior Sister; Miss G. Maben, Sister; and Miss H. E. Roberts, Midwife. Disinfecting Station. Engineer: Mr. R. E. Gale. Two motor drivers. Seven Disinfecting Attendants. Mr. P. P. Leacock, a Grade "A" Clerk, was appointed temporary Sanitary Inspector for the supervision of public air raid shelters on 17th December, 1940. Mr. A. K. Gale is acting temporarily as Assistant to the Food Inspectors in place of Mr. S. R. Coomber who joined H.M. Forces in September, 1939. 9 Staff of Public Health Department. 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 — A. F. Saunders Jan. 1938 ,, Yes One †A. W. Lock Jan. 1938 ,, Yes — J. W. Marshall Oct. 1938 ,, No — †E. J. Newton Aug. 1939 ,, Yes One Food and Drugs (1) 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 Temporary Sanitary Inspector: P. P. Leacock Dec. 1940 ,, No — Assistant to Food Inspectors *S. R. Coomber April, 1935 Joint Board Ex. — — *Mr. Pearce is seconded for duty as Chief Instructor for Civil Defence Personnel, and Mr. Coomber has joined H.M. Forces. 10 Report of the Medical Officer of Health for 1940. HEALTH VISITORS. Name. Commenced Duty. Certificates held. Health Visitor. Trained Nurse. Certified Midwife. Sanitary Inspector. Maternity and Child Welfare—14:— Miss E. K. Woods Feb. 1916 Yes No Yes Yes Superintendent Health Visitor. Miss 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 „ S. M. Wilkinson Aug. 1940 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 Miss D. S. Collins, Health Visitor, was superannuated on account of ill-health in October, 1940, after 27½ years' service with the Council. Miss S. M. Wilkinson, who had been acting in a temporary capacity since August, was appointed Health Visitor to fill the vacancy. 11 Staff of Public Health Department. Office Staff. Mr. F. Bray, Chief Clerk. Mr. P. C. Clark, Grade " C " Clerk. Mr. A. G. Patterson, Grade " B " Clerk. Grade "A" Clerks :— Messrs. C. E. Gessner, L. L. Parrini, S. F. Jennings, *A. E. Hollis, *A. A. Rees, *J. B. Peacock, E. S. Regan, *L. V. Webb. Grade " D " Clerks :— Miss C. Wellings, Miss H. G. Wright, Miss M. J. Richards, Miss B. L. Newman. Secretary to the Tuberculosis Care Committee :— Miss M. L. Baptie. Dispenser for the Tuberculosis Dispensaries :— Mr. C. Kitchen. Temporary Clerks :— Messrs. S. Austin, A. D. Briggs, A. T. Cheesman, F. Chislett, W. J. Coppack, A. N. Crapnell, D. J. FitzSimons, *A. J. Green, F. A. Hoppins, A. E. Kew, G. Low, R. E. Parker, W. C. Pitman, F. E. Pyne, R. S. Richards, J. P. Smith, D. Trimlett, *E. S. Tungate, S. G. Walters, Miss E. Giles, Miss P. M. Greene, Mrs. D. M. Grimwade, Miss H. Lamboll, Miss J. W. Matthews, Mrs. B. Peel, Miss J. Snell, Mrs. L. Woodroffe. Assistant Store Keeper :— Mr. T. Lambkin. *foined H.M. Forces. Rat Catchers. Rat Catcher : A. Moon. Assistant Rat Catcher : H. F. Pearce. Mr. Pearce joined H.M. Forces on 17th June, 1940. His post was not filled. Mortuaries. Mr. A. S. Seeley is whole-time Mortuary keeper for Wandsworth, and the Borough Engineer provides the part-time staff for the Mortuaries in Clapham and Streatham. 12 VITAL STATISTICS. Population. The resident population at the middle of the year was estimated by the Registrar-General to be 271,340. This is a reduction of 68,760 on the population estimated for 1938, the fall being due to enlistment in H.M. Forces and evacuation as a result of the war. 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 1940 Clapham 60,925 46,817 Putney 34,718 26,678 Balham 53,982 41,481 Streatham 68,435 52,687 Tooting 38,159 29,323 Wandsworth 96,891 74,454 Whole Borough 353,110 271,340 13 Vital Statistics. Births. The number of births which took place in the Borough was 1,831. This figure includes 290 non-residents who were born in Institutions. 2,121 births of Borough residents occurred outside the Borough. The corrected number of births was therefore 3,662. This is a reduction of 404 on the number for 1939 which was 4,066. In spite of this fall in the number of births the birth-rate has to be recorded as having increased from 11.92 in 1938 and 11.99 in 1939 to 13.49. The reason for this is that the rate is calculated on a much smaller population. The rate for the whole of London for 1940 was 13-7 and for England and Wales, 14.6. The number of illegitimate births was 150, compared with 218 in 1939. Of the 1,831 births which took place in the Borough, 1,691 or 92.35 per cent, were notified under the Public Health (London) Act, 1936. 1,499 of these notifications were transmitted by midwives, 114 by medical attendants, 67 by parents and 11 by other persons. Deaths. The number of deaths which took place in the Borough during the year was 3,803, but 1,432 of these did not belong to the Borough, while 2,219 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,590, of whom 2,269 were males and 2,321 females. In 1939 there were 3,774 deaths, so that the number of deaths has increased by 816 over the previous year. The major portion of this increase is accounted for by deaths from enemy action, exactly 500 Borough residents having died from this cause during the year. The number of persons who died from diseases of the respiratory system has increased by 125, and there have been 47 more deaths from cancer and 21 more from tuberculosis. 14 Report of the Medical Officer of Health for 1940. The crude death-rate for the year was 16.91 compared with 11.75 in 1939, but after correction has been made by means of a comparability factor devised by the Registrar-General, the standardised rate becomes 15.21, as against 10.92 for 1939. Two factors have contributed to the large increase in the general death-rate over that of the precious year, viz., the material increase in the number of deaths recorded and the large reduction in the estimated population on which the rate is calculated. The death-rate for the whole of London for 1940 was 17.8 and for England and Wales, 14.3. Table II. 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. Of the 2,435 Borough residents who died in institutions, etc., 216 took place in institutions within the Borough and 2,219 in institutions outside. Infantile Mortality. The number of deaths under one year was 168, the infantile mortality rate being 45 per 1,000 births. This, the lowest rate ever recorded, compares with rates of 47 and 46 for the two previous years and an average of 55 for the last 10 years. For the 10 years ended 1918 the average rate was 87. The rate for the whole of London was 50 per 1,000 births. Maternal Mortality. Nine deaths occurred from accidents and diseases of pregnancy and childbirth. This is equivalent to a rate of 2.38 per 1,000 births, 15 Vital Statistics. Table II.—Causes of, and Ages at Death, during the Year 1940. Causes or Death. Deaths in or belonging to whole district at subjoined ages. Deaths in or belonging to Localities (at all ages). All Ages. Males. Females. Under 1 year. 1 and under 2. 2 and under 6. 6 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Clapham. Putney. Balham. Streathain. Tooting. Wandsworth. Deaths in Public Institutions, Nursing Homes, etc. Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 9 4 5 2 .. 2 .. .. 1 4 .. 2 1 2 .. 1 3 8 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Diphtheria 7 1 6 .. .. 3 2 1 1 .. .. .. 1 .. 2 1 3 6 Tuberculosis of Respiratory System 219 124 95 .. .. .. 2 39 94 66 18 49 15 31 38 27 59 157 Other forms of Tuberculosis 23 12 11 2 1 2 3 5 5 4 1 6 1 2 6 2 6 20 Syphilitic Disease 81 24 7 .. .. .. .. .. 2 16 13 6 1 5 5 9 5 20 Influenza 62 34 28 .. .. .. .. .. 6 25 30 9 10 12 16 3 12 18 Measles 2 2 .. .. .. 1 .. .. .. .. 1 1 .. .. .. .. 1 1 Acute Poliomyelitis and Polioencephalitis 2 1 1 .. .. .. 1 .. .. .. 1 .. .. .. 2 .. .. 1 Acute Infectious Encephalitis 2 2 .. .. .. .. .. .. 2 .. .. .. 1 1 .. .. .. 1 Cancer and other Malignant Tumours 622 304 318 .. .. .. .. .. 49 253 320 95 76 102 134 58 157 378 Diabetes Mellitis 43 17 26 .. .. .. .. 1 4 13 25 11 2 3 12 7 8 29 Cerebral Hæmorrhage, etc. 249 90 119 .. .. .. 2 .. 5 73 169 35 30 43 59 24 58 128 Diseases of Heart 1167 539 628 .. .. 1 1 5 35 211 914 202 83 219 226 140 297 585 Other Diseases of Circulatory System 215 96 119 .. .. .. .. .. 2 39 174 44 29 30 40 11 57 117 Bronchitis 237 130 107 5 2 1 .. 7 63 159 50 18 33 42 28 66 79 Pneumonia (all forms) 257 127 130 26 2 5 3 3 11 58 149 51 29 46 43 25 62 155 Other Diseases of Respiratory System Ulceration of Stomach 30 17 13 1 .. 1 1 .. 3 13 11 8 3 4 6 2 7 9 49 41 8 1 .. .. .. 1 5 26 16 7 5 17 4 2 14 38 Diarrhœa 5 2 3 3 1 .. .. 1 .. .. .. .. .. 2 1 .. 2 5 Appendicitis 14 6 8 .. .. 1 .. 3 4 3 3 3 2 2 4 1 2 12 Other Digestive Diseases 84 36 48 7 .. .. .. 2 12 21 42 14 6 20 19 7 18 62 Nephritis 82 39 43 .. 1 1 1 1 4 30 44 22 13 10 14 4 19 40 Puerperal and Post-abortive Sepsis 5 .. 5 .. .. .. .. 3 2 .. .. 1 2 1 .. .. 2 5 Other Maternal Causes 4 .. 4 .. .. .. .. .. 4 .. .. 1 .. .. 1 1 1 5 Premature Birth 52 30 22 52 .. .. .. .. .. .. .. 13 4 6 11 6 12 40 Congenital Malformations 58 38 20 55 .. .. 2 .. 1 .. .. 11 3 12 11 7 14 44 Suicide 54 32 22 .. .. .. .. 6 11 26 11 7 7 5 11 5 19 22 Road Traffic Accidents 36 23 13 .. .. 1 3 6 2 5 19 5 5 11 6 2 7 31 Other Violent Causes 584 308 276 7 3 14 19 68 168 182 123 186 50 94 90 23 141 215 All Other Causes 385 183 202 6 .. .. 6 8 38 83 244 65 39 56 93 32 100 203 All causes 4590 2269 2321 168 12 33 45 153 478 1214 2487 905 436 769 900 428 1152 2435 16 INFECTIVE DISEASES. The number of deaths from notifiable infective diseases, including all forms of Tuberculosis, was 302, compared with 296 in 1939. There were also 62 deaths from Influenza, but there were only 10 deaths from Scarlet fever, Diphtheria, Measles and Whooping cough. The death-rate from all infectious diseases was 134 per 1,000. Table III. gives the number of cases of the notifiable infective diseases reported, arranged in age groups and showing for each disease how many were admitted to hospital. There has been a marked reduction during the year in the incidence of the notifiable infective diseases. The number of cases of these diseases has fallen from 3,600 in 1939 to 1,649 in 1940, a reduction of more than half. This reduction has been chiefly evident in the infectious diseases of childhood and to a certain extent has been brought about by the evacuation of large numbers of children to reception areas in the country. The number of cases of diphtheria has fallen from 249 to 165, scarlet fever from 535 to 195, whooping cough from 1,599 to 48 and erysipelas from 102 to 58. On the other hand, cases of measles have increased from 149 to 230 and cerebro-spinal meningitis from 11 to 74. Small-pox. No case of small-pox occurred during the year. Vaccination. 2,202 births were notified to the Vaccination Officers during 1939. 918 children were vaccinated successfully and 666 were exempted under declarations of conscientious objection. The percentage of children vaccinated to total births was 41.6. Diphtheria. 165 cases occurred, compared with 249 in 1939 and 479 in 1938. There were seven deaths compared with two in 1939, and 15 in 1938. The death-rate was .03 and the case mortality was 4.2 per cent, 17 Infective Diseases. TABLE III. Notifiable Diseases. No. of CASES of Infective Diseases grouped in Age Periods. Total Cases occurring. Number admitted into Hospital. Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 | 36—45 45—65 65 and upwards Small-pox — — — — — — — — — — — — — — Diphtheria 3 11 9 19 11 33 15 24 30 8 1 1 165 151 Scarlet Fever — 11 14 21 15 51 19 24 30 6 4 — 195 153 Measles 20 20 39 28 37 42 9 15 17 1 2 — 230 47 Whooping Cough 7 12 11 6 2 9 — — 1 1 — — 48 Enteric Fever and Paratyphoid Fever — — — 1 1 1 — 3 5 1 1 — 13 9 12 Malaria — — — — — — — — — — — — — — Dysentery 2 2 2 — — 3 3 — 3 1 10 5 31 11 Erysipelas 1 — — 1 — 1 — 1 5 7 30 12 58 39 Puerperal Fever — — — — — — — — 15 1 — — 16 9 Puerperal Pyrexia — — — — — — — 3 6 1 — — 10 19 Ophthalmia Neonatorum 34 — — — — — — — — — — — 34 13 Cerebro-spinal Meningitis 11 2 5 3 3 3 7 14 13 4 8 1 74 74 Polio-myelitis — — — — 1 — — — — — — — 1 1 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia:— Acute Influenzal 1 1 — — — — — 1 7 10 18 11 49 2 Acute Primary 15 10 3 1 4 9 1 6 22 28 57 44 200 35 Tuberculosis—All forms 4 4 3 5 4 7 11 63 241 74 82 24 522 — Food Poisoning — — 1 — — — — — 2 — — — 3 — Total 98 73 87 84 78 159 65 154 397 143 213 98 1649 575 18 Report of the Medical Officer of Health for 1940. During the year 50 tubes of anti-toxin were issued to medical practitioners for the treatment of cases of diphtheria. Measles. There was no epidemic of measles in 1940. The number of cases reported was 230 and there were two deaths. Table IV. gives the number of cases and deaths from the disease during the last 10 years. TABLE IV. 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 Cases Reported 291 3598 615 4148 137 3987 589 3594 149 230 Deaths 2 37 2 37 2 24 2 13 — 2 Enteric and Para-typhoid Fevers. 13 cases and no deaths of the above occurred, compared with nine cases and two deaths in the previous year. Four of the cases were true Enteric Fever and nine were Para-typhoid Fever. Dysentery. 31 cases of Dysentery were notified but no deaths occurred. Puerperal Fever and Puerperal Pyrexia. During the year six cases of Puerperal Fever and 10 cases of Puerperal Pyrexia were notified. There were nine deaths. The mortality rate was 2.38 per 1,000 (live and still) births. Ophthalmia Neonatorum. 34 cases were notified. 26 of these recovered without any impairment of vision. Seven of the infants removed from the Borough and the final condition of the eyes was not ascertained. One infant died. Cerebro-Spinal Meningitis. There were 74 cases of this disease notified and nine deaths occurred. Two other cases were notified, but proved not to be cerebro-spinal meningitis. 14 deaths were registered as being caused by Meningitis, 19 Infective Diseases. Influenza and Pneumonia. The number of deaths from Influenza was 62 compared with 61 in the previous year. 49 cases of acute Influenzal Pneumonia and 200 cases of acute Primary Pneumonia were notified. The total number of deaths credited to all forms of Pneumonia during the year was 257. Scabies. The names of 167 school children suffering from Scabies for which they were under treatment at the London County Council cleansing stations were forwarded to me by the County Medical Officer of Health. A further 471 cases were reported to me and were treated at the Council's disinfecting station. The clothing and bedding of all the cases were collected from the homes and disinfected. Cleansing of Persons Act. The homes of 15 children, found to be in a verminous condition at the London County Council schools, were visited by the Inspectors. In five cases the clothing and bedding which was also verminous was disinfected. Disinfection. The total number of rooms disinfected after the occurrence of cases of infective diseases was 1,005. Bacteriological Examinations. 1,101 bacteriological examinations were made at the Lister Institute and 1,116 specimens of sputum were examined at the Tuberculosis Dispensaries. The results of these examinations were as follows:— Positive. Negative. Total. For Diphtheria 78 980 1058 For Enteric Fever — 3 3 Miscellaneous 9 31 40 Sputum for Tuberculosis 188 928 1116 20 Report of the Medical Officer of Health for 1940. Nursing Service. This service is carried out by the Nursing Associations in te Borough, whose nurses, when requested, attend patients suffering from Measles, Whooping Cough, Malaria, Dysentery, Pneumonia, Influenza, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea. They also visit the homes of children suffering from minor ailments who are in need of nursing attention. A fee of Is. 3d. is paid for each visit by a District Nurse and the Council also makes grants to several Nursing Associations. The number of cases visited, with the total number of visits made by the nurses, is given in Table V. TABLE V. No. of cases occurring. No. of cases visited. No. of visits made. Measles 230 13 132 Whooping Cough 48 — — Influenza — 53 486 Pneumonia 249 61 944 Ophthalmia Neonatorum 34 10 128 Puerperal Fever and Puerperal Pyrexia 26 8 90 Infantile Diarrhœa — 3 39 Minor Ailments — 369 4044 Total 487 522 5863 Ambulance Service. This service is administered by the London County Council who provide free ambulances for accidents and for the removal of cases of infectious disease and parturient women to hospitals. Ambulances are also provided by the same Authority for the conveyance of other cases on payment, 21 NON-INFECTIVE DISEASES. The number of deaths from Cancer and malignant disease was 622—males 304, females 318. The death-rate was 2 29 per 1,000. There were 47 more deaths from this cause than in 1939. 1,631 deaths occurred from diseases of the Heart and Circulatory System, compared with 1,575 in 1939. 1,257 of these deaths were of persons over 65 years of age. There were 524 deaths from Pneumonia, Bronchitis and other diseases of the Respiratory System, an increase of 125 over the number in 1939 which was 399. 32 infants under two years of age died from these diseases. 674 deaths were attributed to violence. 500 of these were caused by enemy action and 36 by road accidents. There were 54 suicides. Insulin Treatment. There are now three persons receiving treatment for Diabetes at the Council's expense. The cost for the year 1940 was £8 8s. Pernicious Anaemia. One person has been provided with Neo-hepatex by the Council at a cost of £2 14s. Inquests and Deaths Certified by the Coroner. Inquests were held on 134 persons who died in the Borough and on 139 Borough Residents who died elsewhere. In 38 of these a verdict of death from Natural Causes was returned, in 138 death was accidental, in 14 due to "misadventure" and five were "found drowned."; there were 70 suicides, three executions, two deaths from manslaughter and three from war wounds. 296 deaths which occurred in the Borough were certified by the Coroner without inquest and a similar procedure was adopted in respect of 79 Borough Residents who died elsewhere. 362 of these deaths were due to Natural Causes, nine were accidental and four were due to "misadventure." 22 IMMUNISATION AGAINST DIPHTHERIA. The Council holds two clinics, opened in January, 1928, for the testing and immunisation of children and young persons against Diphtheria. A weekly session is held at each Clinic and the work is carried out by the Council's staff. The addresses and times of the Clinics are as follows :— The Clinic, Municipal Buildings, Fairfield Street, Wandsworth. Every Wednesday from 2 to 3.30 p.m. 91, Bedford Hill, Balham. Every Friday from 2 to 3.30 p.m. Procedure at the Clinics. A Schick test is performed on all persons over five years of age presenting themselves at the Clinics to see if they are susceptible to Diphtheria and therefore in need of immunisation. Unless there is a special reason to the contrary it is assumed that children under five years of age are susceptible, the initial immunising injection being given at the first attendance. The Immunising Agent. The solution now used for routine immunisation is Alum Precipitated Toxoid (A.P.T.) and two injections of ½ c.c. each are given at weekly intervals. For persons over the age of 15, two injections each of 1 c.c. of Toxoid Antitoxin Floccules (T.A.F.) are given. On the opening of the Clinics in 1928 the agent used for immunisation was Toxoid Anti-toxin Mixture (T.A.M.), three doses of 1 c.c. each being administered at weekly intervals. 23 Immunisation against Diphtheria. In 1932 T.A.F. was brought into use. It was found that by giving two injections of this substance better results were obtained than with three doses of T.A.M. The use of T.A.M. was accordingly discontinued. A.P.T. was first used in 1935, a single dose of 1 c.c. being given, but in 1937 it was decided to revert to the use of T.A.F., giving two injections at weekly intervals. In 1939 A.P.T. was brought into use again for immunising children, two £ c.c. doses being given instead of one dose of 1 c.c. Attendances. Only 318 persons attended the Clinics during the year. This is the smallest number who have attended in any one year since the Clinics were opened 13 years ago. The total attendances since that date have been 11,834. The reduction in 1940 is probably accounted for by the smaller number of children resident in the Borough due to evacuation. The Initial Schick Test. 128 persons were given this test during the year, 75 of them showing a positive result, indicating that they were susceptible to Diphtheria. The number of persons tested in this manner since the Clinics were opened in 1928 is 7,791 and of these 5,448, or 70 per cent., have reacted positive to the Test. 6,672 of the persons tested were under the age of 15 years. Number of Persons Immunised. Immunity takes some little time to develop after the immunising injections have been given, the actual period varying in different people. It is only possible to say with certainty that immunisation has been successful by giving the person concerned a further test and obtaining a negative result. This test is known as the Re-Schick Test. It has been found that the best time to carry it out is some three or four months after the injections have been given. Parents are advised to bring their children to the Clinics at the appropriate time to have them re- 24 Report of the Medical Officer of Health for 1940. tested and most of them do so. Should the Re-Schick Test give a positive result, further immunising injections are given until a negative result is obtained. Although it cannot be said with certainty that a person has been successfully immunised unless the Re-Schick Test is negative, it is reasonable to assume, in the absence of a Re-Schick Test, that when immunising injections have been given, the person receiving them has received benefit from them and is at least partially immunised. Many of these people have not been retested because they have failed to attend at the appropriate time for that purpose. If they had done so, it is probable that a large proportion would have reacted negative to the Re-Schick Test. In the absence of this information it is only possible to classify them as partially immunised. During 1940 the number of persons who reacted negative to the Re-Schick Test and can therefore be classified as successfully immunised was 156. The number partially immunised, as defined above, was 96. Since the Clinics were opened 13 years ago, the number of persons requiring immunisation was 9,491, made up as follows:— Under 15. 15 and over. Total. Reacted positive to the initial Schick Test 4871 577 5448 Children mostly under 5 years of age, not tested, but assumed to be susceptible on account of their age 4034 9 4043 Total 8905 586 9491 As shown by the following statement, 6,879 of these have been successfully immunised and 2,527 have been partially immunised. In a few of the latter the Re-Schick Test was positive, but the large majority of them have not attended to be re-tested:— 25 Immunisation against Diphtheria. 25 Under 15. 15 and over. Total. Successfully Immunised Re-Schick Test negative 6564 315 6879 Partially Immunised No Re-Test 2195 221 2416 Re-Schick Test positive 78 33 111 Not Immunised 68 17 85 Total number of susceptibles 8905 586 9491 Six of the children included above among those successfully immunised acquired protection without receiving any immunising injections; four of them through an attack of diphtheria contracted shortly after they had reacted positive to the initial test and two of them spontaneously. These two reacted positively to the initial test, did not report for immunisation, but attended two to three years later when they were tested and reacted negative. Diphtheria in Children Tested ok Injected. Since the Clinics have been in operation, 10 children who reacted negative to the primary Schick Test, and 22 in whom the Re-Schick Test was negative after they had been immunised, have been notified to me as cases of Diphtheria. 16 of these 32 cases showed clinical symptoms of the disease. Ten children who had been immunised but were not re-tested have also been notified. Three of these were clinical cases. One child who had been given two injections of T.A.F. contracted Diphtheria one month after the last injection and died. General Practitioners and Immunisation. Five years ago the Council decided to supply immunising material, free of charge, to general practitioners for immunising and testing Borough residents. 14 doctors have availed themselves of these facilities and a total of 53 children have been immunised by them, 16 having reacted negative to the Re-Schick Test. 26 TUBERCULOSIS. Notification. The number of new cases of tuberculosis which came to the notice of the Department during 1940 was 522 as compared with 535 in 1939 and 621 in 1938. The sources of information regarding the new cases in 1940 were as follows :— Primary notifications on Form A 347 Notifications from H.M. Forces 19 Unnotified at death 23 Transfers from other Sanitary Authorities 133 Total 522 Deaths. The number of deaths certified as due to diseases of a Tuberculous nature was 242. This compares with 221 in 1939, 229 in 1938, 225 in 1937 and 236 in 1936. Particulars of the new cases of Tuberculosis and of the deaths from the disease during the year classified by sexes and in age groups are given in Table VI. TABLE VI. New Cases. Deaths. Age Periods. Pulmonary. NonPulmonary. Pulmonary. Pulmonary. Males. Females. Males. Females. Males. Females. Males. Females. Under 1 year - 1 2 1 - - 2 - 1—5 3 1 4 8 1 2 5—10 1 2 4 1 1 10—15 — 2 4 5 1 2 15—20 31 26 3 3 11 14 — — 20—25 37 45 5 8 7 20 1 3 25—35 57 71 6 12 29 24 2 3 35—45 49 22 1 2 22 13 1 - 45—55 25 12 1 2 21 12 2 55—65 27 10 3 2 23 5 1 1 65 upwards 13 5 4 2 11 5 1 — Totals 243 197 37 45 124 95 12 11 27 T uberculosis Table VII. gives a classification of new cases and deaths from non-pulmonary Tuberculosis according to the part of the body affected. TABLE VII. Localisation of Disease. New Cases. Deaths. Males Females Total Males Females Total Brain 5 7 12 5 7 12 Glands, Mesenteric — 5 5 1 2 3 Glands, Cervical 8 10 18 — — — Bones and Joints 9 15 24 1 — 1 Other Parts 15 8 23 5 2 7 Totals 37 45 82 12 11 23 Of the 242 deaths from Tuberculosis, 130 were males and 106 females. 219 deaths were due to Pulmonary Tuberculosis and 23 to other forms of the disease. In addition to the 242 deaths duly certified in the returns as due to the disease, 20 persons previously notified as suffering from Tuberculosis are known to have died during the year. These deaths are not classified as due to Tuberculosis for one of the following reasons:— (a) 10 were certified as dying from some other disease. (b) 10 had left the Borough and died in other districts. 23 of the deaths had not been previously notified. Ten of these were certified from Institutions, five by private doctors, while in eight cases Tuberculosis was discovered by post-mortem examinations. In no case was it found necessary to take proceedings for wilful neglect or refusal to notify. 522 cases were added to the Notification Register during the year and 531 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 2,186. 28 Report of the Medical Officer of Health for 1940. In Table VIII. a comparative statement is given showing the number of deaths and the death-rate from Pulmonary Tuberculosis, non-Pulmonary, and the total from All Forms of the disease, for the past 10 years. TABLE VIII. Year. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. All Forms of Tuberculosis. No. of Deaths. DeathRate. No. of Deaths. DeathRate. No. of Deaths. DeathRate. 1931 288 .81 19 .05 307 .86 1932 245 .69 43 .12 288 .81 1933 257 .73 48 .13 305 .86 1934 235 .66 41 .11 276 .78 1935 216 .62 33 .09 249 .72 1936 205 .59 31 .09 236 .68 1937 197 .57 28 .08 225 .65 1938 199 .58 30 .08 229 .67 1939 194 .60 27 .08 221 .68 1940 219 .80 23 .08 242 .89 29 TUBERCULOSIS DISPENSARIES. There are two Dispensaries in the Borough and sessions are held on the days and at the times shown below. (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. Saturday: Morning (for school children). (b) At the Branch Dispensary, 11, 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. The evening sessions at both Dispensaries were discontinued during November and December owing to the sparse attendance due to air raids. New Cases in 1940. 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 IX. Tuberculosis Suspected Tuberculosis. Ncn Tuberculous. Totals. Pulmonary. Non-Pulmonary. Total. Adults Male 132 10 142 38 401 581 Female 117 10 127 26 231 384 Children Male 2 6 8 5 89 102 Female 1 2 3 5 75 83 Totals 252 28 280 74 796 1150 30 Report of the Medical Officer of Health for 1940. Table X. classifies the 1,150 new cases under the districts of the Borough in which they live and shows on whose recommendation they attended for examination. TABLE X. Recommended to attend Dispensary by Cl?pham. Putney. Balham. Streatham. Tooting. Wandsworth. Total. The Council's Officers 46 27 21 37 48 72 251 Private Practitioners 20 32 32 41 43 102 270 Charitable Societies 3 4 2 2 15 31 57 Other Dispensaries 60 13 28 40 27 53 221 Existing Patients 5 2 6 4 8 14 39 Other Sources 36 20 25 46 39 146 312 Totals 170 98 114 170 180 418 1150 Contacts. Of the 1,150 new cases examined, 207 were contacts. 20 of these were found to be suffering from Tuberculosis. Dispensary Register. Table XI. 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 XI. Type of Case. On Register end of 1939. New Cases. Removed from Register. On Register Dec. 31st, 1940. Pulmonary 1147 320 347 1120 Non-Pulmonary 248 38 31 255 Suspected Cases 96 183 205 74 Totals 1491 541 583 1449 31 Tuberculosis Dispensaries. Institutional Treatment. The number of patients who received institutional treatment under the London County Council's Tuberculosis Scheme during 1940 was as follows:— (a) In Hospitals for observation 17 (b) In Sanatoria 301 (c) In L.C.C. General Hospitals 173 491 In addition to the above, a few patients were treated in private and voluntary hospitals. Further details of the work carried out during the year are given below:— 1. Number of patients transferred from other areas, including " lost sight of " cases returned 133 2. Number transferred to other areas or " lost sight of " 226 3. Number who died . 242 4. Number of cases recovered 52 5. Number under observation for more than two months 74 6. Total attendances at the Dispensaries 3865 7. Number of reports, etc., made on patients 3895 8. Attendances of patients at Institutions for :— (a) Light treatment 254 (b) Other special forms of treatment 2840 9. Number of patients given Dental Treatment 33 10. Number of Personal Consultations with Doctors :— (a) At Homes of Patients 407 (b) Otherwise . 1531 11. Number of other home visits by Tuberculosis Officers 600 12. Number of home visits by Health Visitors 4668 13. Number of Specimens of Sputum, etc., examined 1116 14. Number of X-ray examinations made 376 Co-operation with other Institutions. Two wards are set aside in St. John's Hospital for the accommodation of Tuberculous patients and the Tuberculosis Officer visits the patients in these wards every week. Cases requiring special investigation which can be carried out in an Out-Patients' Department and those needing treatment by artificial light or X-rays are referred to St. Thomas's Hospital. 32 Report of the Medical Officer of Health for 1940. Artificial pneumo-thorax treatment of Dispensary patients is carried out at several hospitals by arrangement. The number of cases receiving this form of treatment is increasing. 173 cases were treated during the year and 2,840 refills were administered. The cost to the Council was £1,456 16s. 6d. Dental Treatment. This is provided by the British Dental Hospital and includes the provision of dentures. 33 patients received treatment which cost £17 7s. 6d. and 20 were supplied with dentures at a cost of £66 3s. 6d. The total cost for the year was £83 lis. Extra Nourishment is granted to patients suffering from Tuberculosis on medical grounds as part of the treatment of the patient under Section 219 of the Public Health (London) Act, 1936. It is limited to the slighter cases where there is reasonable probability that the additional food will increase the chances of recovery or will enable the patient to remain at work or to return to work at an early date. During the year 138 patients have been granted extra nourishment under the Scheme at a cost of £217 12s. Id. 38 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. Tuberculosis Care Committee. This Committee, which meets on the first Friday in every month at 3 p.m., is constituted of members of the Borough Council, representatives of authorities and organisations interested in the welfare of persons suffering from Tuberculosis and ladies and gentlemen who have a special interest in the work. Activities of the Care Committee. Details of the home conditions and financial circumstances of patients who are to receive institutional treatment are investigated. The Committee also decide how much patients should contribute towards the cost of dental treatment provided by the Borough Council. 33 Tnberculosis Dispensaries. # All persons found to be suffering from Tuberculosis are interviewed by the Secretary who is able to give them advice and assistance in many directions. She also pays regular visits, which are much appreciated, to patients who are being nursed at their homes or in one of the London County Council's General Hospitals. 193 patients were visited during the year. The Committee controls a Fund, maintained by voluntary contributions, from which grants are made to patients who are ineligible for assistance from other organisations. Assistance from the Fund is granted to relatives to enable them to visit patients undergoing treatment in institutions. Patients are also assisted with their removal expenses to better housing accommodation and with arrears of rent and insurance payments. Clothing is supplied when required and medical and nursing requisites are lent to those who need them. An amount of £93 4s. 4d. was spent in this manner during the year. Until recently this Fund has been able to provide convalescence for cases who were in need of this special form of treatment, and maintained a small Convalescent Home at Lancing until June, 1940, when the Home had to be closed on account of the war. The cost of convalescent treatment during the year was £109 0s. 6d. Handicraft Class. The Committee maintains a Handicraft Class where patients suffering from Tuberculosis are taught to make articles which they can sell. The class meets at the Wandsworth Dispensary every Monday morning from 10.30 to 12.30. Prior to the outbreak of war a trained instructress conducted the class, but it has not been possible to obtain her services since, so it is now conducted under the supervision of the Secretary of the Committee with assistance from those patients who have become proficient in the work. The crafts taught include the making of articles in pewter, leather and parchment; embroidery, knitting, rug-making and painting on glass. 34 MATERNITY AND CHILD WELFARE. The Work of the Health Visitors. The staff of Health Visitors consists of a Superintendent and 13 Health Visitors. These officers perform all first visits to Infants and are also responsible for revisiting, except in the area of the Balham Infant Welfare Centre, where the revisiting of those infants who are in regular attendance at the Centre is carried out by the Trained Superintendent, an officer appointed by the Committee of the Centre. The Health Visitors visit all cases of Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum, Measles and Whooping Cough on notification, as well as known cases of Diarrhoea in children under five. They also visit the homes 'of women attending the ante-natal Centres in the Borough and of those who apply for admission to maternity hospitals and homes, or are applicants for Milk, Convalescent or Dental treatment. Visits are also made to see if homes are suitable for children to return to after minor operations at general hospitals. Day Nurseries and other Institutions for mothers and children are also visited, when they are operating. One or more of the Health Visitors attends at each of the infant and ante-natal sessions held at the Centres throughout the Borough. Each Health Visitor has been appointed Infant Life Protection Visitor for her district and performs the duties relating to Child Life Protection under Part XIII. of the Public Health (London) Act, 1936. They also make the necessary enquiries required to secure compliance with the Vaccination Acts for the whole Borough, except in Putney where Mr. Taylor is the Vaccination Officer, 35 Maternity and Child Welf are. At the present time one or more of the Health Visitors is on duty each night to relieve the trained nurses of the three Mobile Units stationed at the Municipal Buildings under the Council's Civil Defence Scheme. They are also called upon to visit the Rest Centres when these are occupied by children rendered homeless by enemy action. The Superintendent makes regular visits to the First Aid Posts. Table XIII. gives details of the home visiting carried out by the Health Visitors during the year in the six divisions of the Borough. The number of attendances at Clinics, &c., are shown in Table XTT TABLE XII. Wandsworth. Putney. Clapham. Balham. Streatham. Tooting. Whole Borough. Attendances at Clinics :— Infant Welfare 451 168 168 79 312 272 1450 Ante-natal 116 45 63 20 84 36 364 Dental 82 — — — — — 82 Diphtheria Prevention 44 — — 45 — — 89 Committee Meetings 4 3 2 — — 6 15 Visits to Rest Centres 81 5 18 65 28 45 242 Visits to First Aid Posts 20 13 14 21 10 23 101 Intant Visiting. Of the 3,662 births which occurred during the year 3,094 or 84.49 per cent. were visited. It was found that in 107 of the births, doctors had been in attendance, while in 1,463 the services of midwives had been utilised. 1,524 infants were born in hospitals and other institutions. 36 Report of the Medical Officer of Health for 1940. TABLE XIII.—HEALTH VISITING. Wandsworth. Putney. Clapham. Balham. Streatham. Tooting. Whole Borough. Children under 1 year :— First visits 875 301 571 404 484 459 3094 Revisits 1308 445 883 821 795 306 4558 Children 1-5 years:— All visits 3976 1065 2382 1433 1822 876 11554 Total 6159 1811 3836 2658 3101 1641 19206 Other visits:— Expectant mothers 890 379 573 490 674 317 3323 Foster mothers 62 36 48 44 96 45 331 Ophthalmia Neonatorum 11 1 2 - 2 10 26 Measles 51 16 39 46 24 35 211 Whooping Cough 21 3 7 12 4 7 54 Puerperal Fever and Pyrexia 3 1 1 2 1 3 11 Finding billets for foreign refugees 100 170 314 67 209 160 1020 For evacuation of children 979 695 1363 210 167 1781 5195 Miscellaneous 106 36 331 140 314 158 1085 Ineffectual 2393 954 1524 785 1723 742 8121 Total Home Visits 10775 4102 8038 4454 6315 4899 38583 Included in the above Table are 1,375 visits made by the Superintendent of the Balham Centre, who is not an officer of the Council. 498 of these were revisits to children under 1 year, 679 to children between 1 and 5 years and 198 to expectant mothers. 37 Maternity and Child W elfare.. TABLE XIV.—PARTICULARS OF CLINICS. Address of Clinic. Days and Times of Sessions. Infant Welfare Clinics. Ante-Natal Clinics.[.###] Central Wandsworth: Municipal Buildings, Fairfiekl Street. Wednesdays at 10 a.m. 1st, 3rd and 5th Mondays at 1.30 p.m. southfield: St. Michael's Memorial Hall', Merton Road. Fridays at 2 p.m. 1st Friday in every month at 10 a.m. Springfield : Congregational Church Hall, Earlsfield Road, S.W. 18. Tuesdays at 2 p.m. 4th Tuesday in every month at 11 a.m. Putney: St. Mary's Church Schools, Felsham Road. Wednesdays at 2 p.m. Alternate Wednesdays in every month at 10 a.m. Clapham: Clapham Dispensary, 42, Clapham Manor Street. Wednesdays at 2 p.m. 1st, 2nd, 3rd and 5th Mondays in every month at 2 p.m. Balham: 91, Bedford Hill. Tuesdays and Wednesdays at 1.30 p.m. 1st, 3rd and 5th Fridays in every month at 9.45 a.m. StreatHam: 37, Riggindale Road. Tuesdays at 1.30 p.m. 1st and 3rd Wednesdays in every month at 10 a.m. Streatham Hill: Baptist Church Hall, New Park Road. Tuesdays at 10 a.m. 2nd and 4th Mondays in each month at 2 p.m. Tooting: St. Peter's Church Hall, Beechcroft Road. Baptist Church Hall, Longley Road. Tuesdays at 2 p.m. Thursdays at 2 p.m. 2nd and 4th Wednesdays in every month at 10.30 a.m. Dental Clinic. Municipal Buildings, Fairfield St., S.W. 18. Eveiy Monday and 1st and 3rd Fridays each month at 1.30 p.m. 38 Report of the Medical Officer of Health for 1940. Child Life Protection. The number of foster-mothers on the register at the end of 1940 was 143, but only 26 of these were at that time receiving children for reward, many of the others having evacuated. The number of foster-children was 42. Maternity and Child Welfare Centres. There are now 10 of these Centres operating in the Borough. The addresses of the Infant and Ante-natal Clinics held at the centres, with the days and times when they meet, are given in Table XIV. Particulars of the Dental Clinic are also included in this table. The Centre at the Municipal Buildings and the two Centres in Tooting are under the direct control of the Council. The other seven are voluntary institutions, administered by their own Committees who appoint the Medical Officers. At the Centre in Balham the Superintendent is also appointed by the Centre Committee. The duties of Superintendent at the other nine Centres are carried out by the Council's staff of Health Visitors. Infant Welfare Clinics. Infant Clinics are held at all the 10 Welfare Centres. The Clinic at the Municipal Buildings, which is under the direct control of the Council, is conducted by Dr. Trott, Assistant M.O.H. and those held at the two centres in Tooting, which are also directly under the Council, by Dr. Ellen Pickard. The Medical Officers of the voluntary Clinics are:— Southfield Dr. Ivy Haslam. Springfield Dr. W. M. Paul. Putney Dr. Hilda Page. Clapham Dr. Marguerite Stewart. Balham Dr. Janet McGill. Streatham Dr. Kathleen M. Cogan. Streatham Hill Dr. Janet Gillison. At both the voluntary and the Municipal Centres there are a number of ladies acting as voluntary workers who assist with the keeping of records and arrange for the purchase 39 Maternity and Child Welfare. and distribution of food, drugs and clothing. The assistance which these ladies give is much appreciated and there is the closest co-operation between them and those members of the Council's staff who work at the Clinics. Table XV. gives details of the work carried out at the Infant Welfare Centres during the year. TABLE XV. No. of Sessions held. No. of new cases. Total attendances. No. of Doctors' Consultations. Infant Clinics:— Central Wandsworth 83 330 4368 832 Southfield 83 228 3643 1091 Springfield 48 170 1751 703 Putney 84 286 3513 1442 Clapham 80 434 1716 1617 Balham 101 385 5798 1909 Streatham 86 421 4553 1817 Streatham Hill 84 338 4184 1764 Beechcroft Road 79 352 2636 1190 Longley Road 48 175 1814 520 Total 776 3119 33976 12885 Ante-Natal and Post-Natal Clinics. Ante-natal Clinics are now held at nine of the Welfare Centres in the Borough, i.e., at all the Centres except the one in Longley Road, Tooting. No special Post-natal Clinics are held, but post-natal women are encouraged to attend the Ante-natal Clinics for consultation and examination. The details of the work carried out at the Clinics are given in Table XVI. The Ante-Natal Clinics at the Municipal Buildings and at Beechcroft Road are conducted by a rota of four Medical Practitioners, who are Dr. V. Harcourt Ellis, Dr. Helen Gray, Dr. E. G. Housden and Dr. A. C. Nicol. The Medical Officer of the Streatham Clinic is Dr. Eileen Saxton. The other Antenatal Clinics are conducted by the same doctors who take the corresponding Infant Clinics. 40 Report of the Medical Officer of Health for 1940. TABLE XVI. Ante-natal Clinics. Post-natal Cases. No. of Sessions held. No. of new cases. Total attendances. No. of new cases. Total attendances. Central Wandsworth 28 153 288 15 15 Southfield 23 83 158 6 6 Springfield 13 67 109 1 1 Putney 25 128 326 16 16 Clapham 30 151 368 3 3 Balham 28 177 421 11 11 Streatham 27 140 354 19 19 Streatham Hill 23 97 299 14 18 Beechcroft Road 24 189 338 — — Total 221 1185 2661 85 89 Obstetric Consultant Service. The Council has made provision for an Obstetric Consultant to meet medical practitioners in consultation as required, at any stage during pregnancy, at confinement or in the lying-in period. The fee paid for each consultation is three guineas. The consultant has been called on two occasions this year. 41 Maternity and Child Welfare. The Council grant financial assistance to women who have engaged trained midwives, other than the Muncipal midwives of the London County Council, to attend them at their confinements in their own homes, when they are unable to pay the whole of the midwife's fee. The maximum grant payable is £1 15s. Grants up to a maximum of £1 are also made to assist a woman to pay the fee of a trained maternity nurse when a doctor has been engaged to conduct the confinement. Sterile maternity outfits are supplied when required. The amount of assistance to be granted is determined by a Sub-Committee of the Maternity and Child Welfare Committee, after the details of the family income have been investigated. Assistance is only granted when the home conditions are suitable for a confinement to take place there. The midwife must give her patient adequate ante-natal supervision and must arrange for her to attend an ante-natal Clinic as required. No unsuitable handwoman is allowed to be in attendance on the patient. During the year assistance was granted to 15 women under this scheme and 10 maternity outfits were supplied. In suitable cases the Council pays compensation to a midwife who loses the case because her patient has to enter hospital for the confinement. The usual sum paid in compensation is 10s. No applications for compensation were received in 1940. Home Helps. Up to this year the voluntary Committees of three of the Infant Welfare Centres have each employed Home Helps, the Council paying the whole of the cost in two instances and a grant of 75 per cent, of the expenditure in the third case. It has been found unnecessary to keep this scheme in being thoughout 1940, owing to lack of demand. The Council also contributes towards the charges made by other suitable women who assist in the home during confinements. The amount of grant to be paid is fixed by the Sub-Committee. Assistance was granted in 53 cases in 1940 at a cost to the Council of £143 14s. 42 Report of the Medical Officer of Health for 1940. Day Nurseries. The three Day Nurseries belonging to the Borough have been evacuated since the outbreak of war. Institutions for Mothers and Young Children. The Council's Maternity Home and the Streatham Babies' Hospital were closed on the outbreak of war. Formerly there were five institutions where unmarried expectant mothers were received for their confinements, remaining as a rule for some months after the birth of their infants. Two of these were closed or removed on the outbreak of war and a third was closed in September, 1940. The remaining two institutions are still open. The Council pays grants to the Southwark Diocesan Association for Preventive and Rescue Work towards the maintenance in their institutions of unmarried mothers usually resident in the Borough. During 1940 assistance was granted ill respect of five cases at a cost of £59 7s. Sd. Similar grants are made to the Mission of Hope, one case being assisted at a cost of £6 10s. 43 Maternity and Child Welfare. Dental Treatment. The Dental Clinic which was opened with a weekly session at the Municipal Buildings on 6th March, 1939, has proved a great success. There has been a progressive increase in the numbers of expectant and nursing mothers and children attending for treatment and in September it was decided to hold two additional sessions each month, on Friday afternoons, for cases requiring an anaesthetic. Dr. A. C. Nicol was appointed as anaesthetist for these sessions. Patients attending the Clinic are required to pay one shilling each time they attend. This charge covers all treatment found to be necessary, except the cost of dentures, for which an assessment is made based on the family income in accordance with a scale approved by the Council. During the year 458 patients have received treatment at the Clinic. This is twice the number treated in the previous year, when 193 patients attended in the ten months for which the Clinic was operating. Supply of Milk. During the year 867 families were supplied with milk or special foods under the Milk (Mothers and Children) Order, 1918. The cost to the Council was £1,561 lis. 8d. The National Milk Scheme under the control of the Ministry of Food came into operation in July, 1940, and as a consequence there has been a reduction in the number of applicants for milk under the Council's scheme. 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, unless there is some good reason for their non-attendance. It is quite evident from the records kept at the Centres that the granting of additional nourishment under the scheme has brought about improvement in the health of many of the infants and has enabled many nursing mothers to prolong the period of lactation. 44 Report of the Medical Officer of Health for 1940. TABLE XVII. Inspections. ReIn- spections. Total. No. of houses inspected:— (o) To investigate complaints 3737 7423 11160 (6) For voluntary work 969 383 1352 (c) House-to-House inspections 99 1169 1268 (d) Houses let in Lodgings 11 91 102 (e) Miscellaneous complaints 205 840 1045 Shop inspections 219 — 219 Infective Diseases 699 157 856 Verminous conditions 102 38 140 No. of premises Factories, workshops, etc.. . 2017 538 67 605 Rag and bone stores 6 34 - 34 Sanitary conveniences 168 237 3 240 Mews and stables 139 172 2 174 Piggeries 9 10 8 18 Public Air Raid Shelters 2793 111 2904 Premises damaged by enemy action 6219 4 6223 Billeting of Refugees, etc. 5065 148 5213 Miscellaneous 3773 514 4287 Total 24882 10958 35840 Smoke observations 56 — 56 Legal proceedings, Attendances at Court 11 — 11 45 SANITARY SUPERVISION OF THE BOROUGH. Work of the Sanitary Inspectors. On the outbreak of war there was a material reduction in the number of complaints received from householders and the number received during 1940 was considerably lower than it was in 1938. Much of the work in connection with housing has ceased. On the other hand the inspectors have been called upon to perform important new duties which have more than counterbalanced this reduction in the ordinary work and has involved considerable periods of overtime. During the period of intense enemy activity over London in the autumn, half the Sanitary Inspectors acted as billeting officers, finding homes for the homeless. All of them have assisted in the routine inspection of public air raid shelters and in rapid surveys, after air raids, of houses damaged by enemy action. During most of the year 19 inspectors have been available, in place of the normal number of 20, but in December Mr. P. P. Leacock was appointed in a temporary capacity for the inspection of air raid shelters. A summary of the inspections made by the Sanitary Inspectors is given in Table XVII. and details of the sanitary operations carried out by them are given in Table XVIII. Water Supply—Cutting-off Notices. Notices were received from the Metropolitan Water Board that the water supply had been withdrawn from 171 premises. In four cases the supply was cut off for non-payment of rates, in 46 for defects in the service, in 119 because the premises had become vacant and in two at the owners' request. 46 Report of the Medical Officer of Health for 1940. TABLE XVIII.—SANITARY OPERATIONS Clapham. Putney. Balham. Streatham. Tooting. Wandsworth. Whole Borough. 1. Premises cleansed and repaired 135 137 171 107 184 336 1070 2. Drains tested 29 64 44 28 42 43 250 3. Drains cleansed, repaired or reconstructed 59 42 43 45 43 132 364 4. New water clcsets provided 4 37 2 22 16 16 97 5. Water closets cleansed or repaired 110 59 59 45 74 238 585 6. Soil pipes altered or repaired 16 34 11 9 3 24 97 7. Waste pipes provided, altered or repaired 35 48 33 16 23 100 255 8. Rainwater pipes repaired 7 26 25 6 15 39 118 9. Roofs and gutters repaired 83 73 76 45 105 204 586 10. Damp courses inserted 1 24 4 8 1 38 11. Damp conditions otherwise remedied 67 52 79 67 66 205 536 12. Yards drained or paved 20 7 13 4 11 48 103 13. Dust bins provided 23 26 43 12 21 35 160 14. Water cisterns cleansed, covered or repaired 7 8 1 12 8 9 45 15. Water supply reinstated 38 10 14 7 23 57 149 16. Defective stoves and fireplaces remedied 28 25 27 29 30 65 204 17. Defective coppers remedied 10 10 8 3 6 13 50 18. Stables and stable yards drained or paved - 1 1 - - 2 4 19. Accumulations of manure, etc., removed 1 4 - 7 1 6 19 20. Urinals cleansed or repaired 2 2 - 3 2 - 9 21. Animals improperly kept _ 2 - - - - 2 22. Smoke nuisances — — — — 23. Other nuisances 19 123 17 34 23 101 317 Total 694 814 671 509 697 1673 5058 47 Sanitary Supervision of the Borough. Sanitary Conveniences. The number of Sanitary Conveniences is 168. 240 inspections were made during the year and one notice, for cleansing, was served and complied with. 10 privies and earth closets are known to be in existence in the Borough, and all of these are in connection with sports grounds. Removal and Collection of House Refuse. The method of removal and collection of house 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 the refuse is taken down the River Thames by barge from two riverside wharves in the Borough and disposed of below Barking. Eradication of Bed Bugs. The methods employed for freeing infested houses include the stripping of all paper from the walls, the removal of wooden 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 by steam. During the year 46 houses were found to be infested with bed bugs, and notices were served in each case on the persons responsible for the infestation. All the premises were disinfested. 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 48 Report of the Medical Officer of Health for 19-10. is used for the disinfestation of the furniture, which is placed in special vans constructed for the purpose, the process being carricd out by a Contractor. Bedding is not subjected to Hydrogen Cyanide but is disinfested by steam at the Council's Disinfecting Station. During 1940 the furniture of 36 families was disinfested by Hydrogen Cyanide gas, and the cost of this service was £95. Swimming Baths and Bathing Pools. The Borough Council owns four swimming baths and one open air bathing pool. The Clapham and Streatham Baths were closed on the outbreak of war and taken over as First Aid Posts. The London Count}' Council owns an open air swimming pool in the Borough, another is privately owned and there are 11 private bathing pools. 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 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 the water is emptied as often as necessary and replaced with fresh water, which circulates continuously and is chlorinated automatically the whole time the bath is in use. Most of the other swimming pools have a chlorination plant installed, but in one of them cleansing is effected by changing the water. Rags and Rag Flock. No rag flock is now manufactured in the Borough, but there is a rag washing factory, where rags are washed and disinfected. The process is supervised by the Council's Inspectors and certificates are issued for which a charge is made. This company are now working day and night washing rags for the Army, Navy and Air Force. During 1940, 48 certificates were issued, and the amount collected was £12 17s, 49 Sanitary Supervision of the Borough. Rats and Mice (Destruction) Act, 1919. 854 rat complaints were received during the year. The Rat Catcher made 1,642 visits and a number of rats were destroyed. Rat baits are laid in the sewers periodically throughout the year. A total of 11,475 baits were laid and 6,287 were noted as taken by rats. Shops Act, 1934. 219 inspections of shops have been made to ascertain if the provisions of the above Act respecting ventilation, temperature and sanitary conveniences were complied with. In one case it was necessary for a notice to be served for an infringement, and this has been complied with. 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 248 bodies have been removed to the Wandsworth Mortuary. No bodies were taken to the Mortuaries in Clapham and Streatham. Crematorium, Putney Vale Cemetery. As Medical Referees under the Crematorium Regulations, 1930, Dr. MacDonnell and I have authorised 201 cremations during the year at this Crematorium, which was completed in 1938, 50 HOUSING. There have been large reductions in the work associated with Housing during the year on account of the war. The number of dwelling-houses inspected for defects, under both the Public Health and Housing Acts, was 4,816 The number of inspections made of them was 13,882 The number of houses found not in all respects reasonably fit for human habitation was 2,485 The number of houses rendered fit without the the service of any notice was 514 Action under the Public Health (London) Act, 1936. The number of houses which were remedied by service of intimation notice only was 1,467 The number of houses where the service of a nuisance notice was necessary was 504 The number of houses in which defects were remedied after service of nuisance notices (including any where the notice was served in a previous year):— (a) by the Owners 652 (b) by the Council 1 Action under the Housing Act, 1936. 99 of the houses inspected for defects were house to house inspections made and recorded under the Housing Consolidated Regulations, 1925, and the total number of inspections made under these Regulations was 1,268. No houses were found unfit for habitation and no notices to execute repairs were served under Section 9 of the Act. Demolition and Closing Orders. No Orders were made during the year. No houses were demolished and no separate tenements or underground rooms were closed following Orders made in previous years. 51 Housing. The Demolition Orders in respect of the following houses are still outstanding and the houses have not been demolished :— 78 to 84, Point Pleasant 4 houses — Demolition Order made 19th October, 1937. 90 to 110, Point Pleasant 11 houses — Demolition Orders made 19th October, 1937. 1 to 5, Cowpers Row 5 houses — Demolition Orders made 18th January, 1938. The Closing Order on the flat known as 4, Weir Road Mews, made on 14th December, 1937, has not been complied with, the flat still being occupied. The Clearance of Insanitary Areas. The Clearance of the following insanitary areas has been completed daring the year by the demolition of all the houses, the sites being left with the owners to develop :— Point Pleasant No. 1 Area 7 houses—Clearance Order made on 18th January, 1938. Point Pleasant No. 2 Area 5 houses—Clearance Order made on 18th January, 1938. Point Pleasant No. 3 Area 19 houses — Clearance Order made on 18th January, 1938. Bridgefield Grove Area 22 houses — Representation o i 18th November, 1938; not declared a Clearance Area, but the houses have now been demolished by the owners. The development of the following Areas has not yet bee l completed, mainly on account of the war:— Carpenter's Place Area 10 houses; Clearance Order made on 19th January, 1937. Weimar Street Area 21 houses; represented by me on 1st October, 1937; declared a Clearance Area by the London County Council on 20th December, 1938; two of the houses demolished during 1940. Cubitts Cottages Area 21 houses; Compulsory Purchase Order made on 18th January, 1938, confirmed by the Minister of Health, 52 Report of the Medical Officer of Health for 1940. Saxby Street Area 93 "Red" and 12 "Grey" houses, Compulsory Purchase Order made on 22nd March, 1938, confirmed by the Minister of Health. Chesil Place Area 7 houses; Clearance Order mad'on 28th May, 1938 ; confirmed. Greyhound Lane Area 4 houses; Clearance Order made on 15th November, 1938 ; confirmed. North Passage Area 26 houses; Clearance Order made on 27th June, 1939 ; not confirmed by the Minister. Putney Bridge Road, Frogmore Area 6 houses; Clearance Order made on 27th June, 1939 ; not confirmed. Putney Bridge Road Area 14 houses; represented on 14th June, 1939 ; no further action taken. Oldridge Road Area 21 houses; represented by me on 29th March, 1938; declared a Clearance Area by the London County Council on 21st August, 1939. Overcrowding. 233 dwellings were recorded as overcrowded at the end of the year. This cannot be taken as an accurate indication of the extent of overcrowding in the Borough, as no comprehensive survey has been made in recent years. These dwellings were occupied by 233 families, consisting of 1,541 persons. In 55 of the families some of the children have been evacuated, so that the overcrowding has been relieved though not abated. 166 cases of overcrowding representing 1,086 persons have been abated during the year and 25 new cases have come to light. No cases of dwellings again becoming overcrowded after the Council had taken steps for the abatement of overcrowding have been discovered. Rent and Mortgage Interest Restrictions Acts, 1919-1923. 14 applications were received from occupiers alleging that their houses were not in a reasonable state of repair and Statutory Certificates were granted in each case. 53 THE SUPERVISION OF FOOD. There are four Inspectors engaged in the supervision of the Food Supply. The Food and Drugs Inspector procures samples of food and drugs for analysis by the Public Analyst. The three Food Inspectors supervise premises where food is sold, stored, manufactured or prepared for sale and inspect the slaughterhouses. They also carry out the duties required under Part II. of the Pharmacy and Poisons Act, 1933. On the outbreak of war, Messrs. W. H. Jones, Food and Drugs Inspector, and A. E. Handley, Food Inspector, were seconded for duty under the Food Controller. On 6th October, 1940, officers of the Ministry of Food took over these Food Control duties and Messrs. Jones and Handley returned to the Department. The inspection of food premises is not confined to those businesses which are subject to some form of legal control, but in order to ensure adequate supervision of foodstuffs sold in the Borough and because it is a common occurrence for more than one food business to be conducted on the same premises, all premises where food is sold or prepared for sale are inspected. A register is kept giving the essential particulars about each of the premises and indicating the nature of the food businesses conducted from them. The number of separate food premises, particulars of which are entered on the register, is 2,779, and the number of inspections made during 1940 was 19,114. Milk and Milk Supply. There are 164 registered dairies in the Borough and 464 registered dairymen. About two-thirds of the latter are registered for the sale of milk in bottles or cartons, registration of 54 Report of the Medical Officer of Health for 1940. the premises as dairies not being required when the milk is sold in sealed receptacles. There are no cowsheds in the Borough. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies, and its quality is good. Of 743 samples submitted for analysis, 731 were genuine and showed an average fat content of 3 55. The 12 samples reported against were formal samples. Nine contained extraneous water, varying from 1½ to 3½ per cent. and three were found to be 8, 28 and 34 perc ent. deficient in fat respectively. Police Court proceedings were taken in the last two cases. These were dismissed under the Probation of Offenders Act on payment of £2 2s. costs in each case. In the other 10 cases the Public Health Committee decided to warn the vendors. 75 samples were taken from milk vendors in the street during the early morning hours, 91 on delivery to hospitals in the Borough and four on delivery to Wandsworth Prison. All these samples were reported as genuine. Milk utensils and barrows used in the delivery of milk are inspected regularly in the streets. The Milk (Special Designations) Order, 1936. 67 licences for the sale of designated milks were granted during the year—39 for Tuberculin Tested Milk and 28 for Pasteurised Milk. Meat. There are still four private slaughterhouses licensed in the Borough, but three of them were closed early in 1940, as the slaughtering of animals has been centralised by the Government. The remaining slaughterhouse only operates for killing pigs. The inspectors continued to visit the slaughterhouses as long as animals were killed there. 85 animals were inspected before slaughter and 440 carcases after slaughter; 67 of these were oxen, 77 calves, 274 sheep and 22 pigs. The number of animals and carcases examined shows a large reduction on the 55 The Supervision of Food. previous year, when 2,703 animals were inspected prior to slaughter and 7,069 carcases after slaughter. The only organs found to be diseased in the carcases inspected were a pair of lungs, affected with tuberculosis, and 12 cirrhotic livers, all in oxen. The diseased organs were surrendered and destroyed. No. 23 Wholesale Meat Depot. Since the outbreak of hostilities the London Wholesale Meat Trade Association in conjunction with the Ministry of Food have established a Wholesale Meat Depot at 666, Garratt Lane for the reception and distribution of meat slaughtered outside the Borough. This Depot is visited daily by the Food Inspectors and as a result of these visits considerable quantities of meat were found to be unfit for human consumption. Most of it was in this condition as a result of decomposition caused by delays in transportation from the places where the animals were slaughtered. All the meat found to be unfit for food was surrendered and released for industrial purposes. The quantities surrendered were as follows:— Oxen. Sheep. 4,005 lbs. beef. 325 lbs. mutton. 19 livers. 460 heads. 2 heads. 649 pairs lungs. 42 pairs brains. 960 livjsrs. 48 pairs lungs. 302 lbs. sweetbreads. Lambs. 272 spleens. 984 lbs. lamb. 22 tails. 574 livers. 137 sweetbreads. Calves. 19 kidneys. 36 lbs. veal. 50 lbs. sweetbreads. Pigs. 37 heads. 22 carcases. 35 plucks. 8 heads and collars. 56 livers. 276 lbs. pork. 159 plucks. Corned Beef. 193 livers. 4 tins. 162 mesenteries. 56 Report of the Medical Officer of Health for 1940. Slaughter of Animals Act, 1933. During the year 18 applications were received from persons desirous of acting as slaughtermen and the necessary licences were granted. There were no infringements against the provisions of this Act. Other Food Premises. There are in the Borough 34 wholesale margarine dealers, 76 fishfryers and 24 fish curers. 608 premises are registered for the sale, manufacture or storage of ice-cream and 534 premises for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food stuffs. There are 32 food factories, 428 restaurant kitchens and 149 markets and stalls. The markets are subjected to special supervision and they are inspected frequently at all hours when they are open, both during the week and on Saturdays and Sundays. Food and Drugs (Adulteration) Act, 1928. 1,776 samples were procured for analysis during the year. 743 of these were samples of milk, 850 were other foodstuffs and 183 were drugs. Only 15 of the samples were found to be adulterated, viz., 12 formal samples of milk, already referred to, one informal sample of sugar, which contained 14 per cent. of ground rice, and two samples of syrup of senna, which were deficient in sugar. Merchandise Marks Act, 1926, Agricultural Grading and Marking Act, 1928, and Orders Made Thereunder. The amount of foodstuffs sold under these Orders is less than in the years before the war. The provisions of the Orders are duly observed by the traders in the Borough. 57 The Supervision of Food. Unsound Food. 111 consignments of foodstuffs of all kinds were examined at the request of the owners and found to be unsound. After the articles had been destroyed or rendered unsaleable, the owners were granted certificates to this effect. Pharmacy and Poisons Act, 1933. The number of applications received for entry in the Council's Register of listed sellers of those poisons which are included in Part II. of the Poisons List was 285. The principal businesses conducted on the premises of these applicants is given in Table XIX. TABLE XIX.—Part II of Poisons List. Principal Business No. of Premises No. of Inspections Grocers 137 279 Hairdressers 32 66 Drug Stores 25 57 Ironmongers, Paint and Colourmen 88 178 Nurserymen 2 5 Garages 1 2 Total 285 587 58 FACTORIES AND WORKSHOPS. « The number of factories, workshops, workplaces and home workers' premises is shown in Table XX., together with the number of inspections made. TABLE XX. Class of Works. Number of Places on Register at end of 1940. Number of Inspections, 1940. Number of Notices, 1940. Number of Prosecutions, 1940. Factories :— Bakehouses 118 101 Metalworkers, Carpenters, etc. 112 37 2 – Engineering 88 27 — – Bootmakers 78 19 Car and Cycle Repairers 76 17 Laundries 50 15 1 Printers and Paper Manufacturers 37 15 – – Clothing 33 6 – Food 32 77 1 Builders and Contractors 25 9 Others 62 18 — — Total Factories 711 341 4 — Workshops 676 182 Workplaces 80 28 1 1 Total: Factories, Workshops and Workplaces 1,467 551 5 1 Home-workers' premises 550 54 – — Grand Total 2,017 605 5 1 A classification of workshops in the Borough is given in Table XXI., and details about homeworkers' premises in Table XXII. The number and nature of the defects found in the factories, workshops and workplaces are enumerated in Table XXIII. 59 Factories and Workshops. TABLE XXI. DETAILS OF REGISTERED WORKSHOPS. Workshops on the Register at the end of the year. Number. (1) (2) Clothing 175 Smiths and Motor Engineers 90 Bootmakers 86 Builders and Contractors 49 Hairdressers 42 Laundries 29 Upholsterers and Furniture Makers 29 Carpenters 19 Metal Workers 18> Other 139 Total number of Workshops on register 676 TABLE XXII. HOME WORK. Nature of Work. Outworkers lists received from Employers. Notices served on occupiers as to keeping or sending lists. Premises unwholesome Premises infected. Lists. Outworkers. Instan ces. Notices served. Instan ces. Contrac tors. Workmen. Wearing Apparel:— (1.) Making, etc. 33 24 197 38 1 — 4 (2.) Cleaning and washing 3 16 3 4 – — Paper bags and boxes 2 — 13 4 — — — Totals 38 42 213 46 1 — 4 The number of outworkers' addresses received from other Councils was 288, and 164 addresses were forwarded to other Authorities. 60 Report of the Medical Officer of Health for 1940. One case of Pneumonia, two of Scarlet Fever and one of Whooping Cough were notified as having occurred in the homes of outworkers. In no case was it necessary to make any order under Section 110 of the Factories Act, 1937. TABLE XXIII. 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 11 10 Want of ventilation Overcrowding Want of drainage of floors Other Nuisances 11 9 Sanitary accommodation: – – Insufficient 2 2 – – Unsuitable or defective 15 14 Not separate for sexes — — — — Offences under the Factories Act — — – — Total 39 35 — — 61 POLICE COURT PROCEEDINGS. Proceedings at the Police Court were instituted, under Section 282 of the Public Health (London) Act, 1936, for nuisances at the premises specified below:— 87 and 91, Selkirk Road Order made for abatement of nuisances within 21 days. 53, Laitwood Road Order made for abatement of nuisances within 14 days. Costs to the amount of £1 Is. were imposed. 2, Dingwall Road Summons withdrawn as nuisances had been abated. Costs to the amount of 10s. 6d. were imposed. 198a and 198b, Beechcroft Road. 3 and 4, Acre Square. 124, Lyliam Road. 67, Fieldend Road. 16b and 16c, Treport Street. 11, Criffel Avenue. 15, Khartoum Road. 14, Melrose Road. 777, Garratt Lane. Summonses withdrawn as the nuisances had been abated when the cases were heard. 62 REPORT OF THE PUBLIC ANALYST FOR 1940. Mr. Mayor, Ladies and Gentlemen, Herewith I have pleasure in handing you my thirtieth report on work performed in the laboratory for your Council under the various Acts and Regulations relating to the sale and adulteration of Food and Drugs during the year ended 31st December, 1940. In doing so, I deeply regret that the signature of Mr. C. A. Hackman, F.I.C., my partner and your additional Public Analyst, will not be found against mine at its conclusion, as he died just before the year under review ended. Your Council has appointed Mr. J. E. Woodhead, B.Sc., F.I.C., Ph.C., to act as my deputy and I feel confident that should I, at any time, be prevented from carrying out my duties, his long experience in the laboratory will enable him to perform these duties in a manner which will give complete satisfaction. Owing to war conditions and to the fact that your Food and Drugs Inspector has been engaged upon other important national duties, the usual number of samples (2,000) has not been submitted, the total in the year being 1,776. 736 of these were procured formally as official samples and 1,040 as informal samples. 735 of the formal samples were milk and one was a sample of sugar. The total of 1,776 samples analysed during the year is made up of :—samples of milk, 743 ; other foodstuffs, 850; drugs, 183, 63 Report of the Public Analyst for 1940. Milk. 743 samples were examined, 735 being formal and eight informal. 731 were genuine ; 12, all formal samples, were found to be adulterated, the details of the adulteration being as under:— Case No. Nature of Report. 119 1½ % extraneous water. 120 1½ % extraneous water. 194 2½ % extraneous water. 195 2½ % extraneous water. 229 28 % deficient in fat. 279 3½ % extraneous water. 280 3½ % extraneous water. 331 1½ % extraneous water. 361 34 % deficient in fat. 362 8 % deficient in fat. 634 2 % extraneous water. 635 2 % extraneous water. The average composition of the milk analysed during the year was:— Total milk solids 12.27 Milk fat 3.55 Non-fatty solids 8.82 Other Foodstuffs. 850 samples were analysed, one sample of sugar being taken formally; 849 were informal samples. The only adulteration found was in one informal sample of sugar, which contained 14 per cent, of ground rice. Samples of the following substances were analysed:— arrowroot, 4 samples; barley, 4; bread, 9; butter, 4; cake, 12; cereals, 41; cheese, 26; cocoa, 24; coffee, 24; cornflour, 15; cream, 11; dripping and lard, 12; essences, 13; fat, 13; fish, canned, 36; fish paste, 27; flour, 29; food powders, 78; fruit, canned and bottled, 15; fruit, dried, 71; ginger, 4; herbs, 5; honey, 10; jam and marmalade, 17; jelly, 18; lemon and orange curd, 3; lentils, 11; margarine, 25; meat products, 39; milk, condensed, 10 ; mustard, 8 ; oatmeal, 10 ; olive oil, 5; pepper, 7; 64 Report of the Medical Officer of Health for 1940. pickles and sauces, 33; rice, 30; sage, 5; salad oil, 7; salt, 10; spice, 8; sponge mixture, 2; soup, canned, 7; suet, 14; sugar, 3; tapioca, 13; tea, 11; treacle, 1; vegetables, canned and dried, 48 ; vinegar, 8; yeast, 10. The average water content of the four samples of butter proved to be 13 5 per cent.; that of the 25 samples of margarine, 14.8 per cent. Six of the samples were submitted for analysis on the complaint of ratepayers, viz., three samples of butter, one of canned fish, one of sugar and one of black treacle. The sample of sugar was the one found to be adulterated with 14 per cent. of ground rice. The other five samples were genuine. Drugs. 183 samples of drugs were analysed. Two only were adulterated, viz.:— No. 584, Syrup of Senna: Devoid of sugar. No. 691, Syrup of Senna: 52 per cent. deficient in sugar. In conclusion I have to report that the adulteration detected during 1940 amounted to 1.63 per cent. of the formal samples, to 0.29 per cent. of the informal samples and to 0 84 per cent. of all samples submitted. The cost of the above analyses was covered by the Analyst's salary of £900 per annum. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A. H. MUTER, F.I.C., F.C.S., Public Analyst. 325, Kennington Road, London, S.E. 11,