WIM 043 Borough of Wimbledon Annual Report OF THE ACTING MEDICAL OFFICER OF HEALTH For the Year 1919. TOGETHER WITH THE REPORT of the SCHOOL MEDICAL OFFICER AND THE SANITARY INSPECTOR. Knapp, Drewett & Sons Ltd., Kingston and Wimbledon.—W1499. Borough of Wimblebon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT OF THE ACTING MEDICAL OFFICER OF HEALTH FOR THE Year ended 31st December, 1919. PUBLIC HEALTH COMMITTEE, 1918. Chairman. Councillor H. E. Hickox. Vice-C hairman. Councillor A. E. Everett. Members. The Mayor (Alderman L. Allen). Alderman J. S. H. Abbott. Councillor T. Oates. D. Stuart. „ J. T. Morris. „ G. Clement. „ W. M Russell. Councillor G. ralls. „ P. W. Daffen. ,, H. Dormer. H. G. King, STAFF. Medical Officer of Health; School Medical Officer; Medical Supt. of Isolation Hospital; Bacteriologist and Analyst. Elwin H. T. Nash, D.P.H. Acting Medical Officer of Health, School Medical Officer and Supt. of Isolation Hospital. D. A. Belilios, D.P.H. Assistant Medical Officer of Health, and Assistant School Medical Officer. Vacant. Chief Inspector. * † Henry Johnson. Inspectors. * † R. T. Avis. * † D. H. Pickard, M.C. * † D. F. S. Flynn. Health Visitors. * § || Miss F. Hulse. § || Miss M. Giles. ‡ Miss H. Hurst. Clerks. A. S. Allen. * + E. Partridge. * Certificate of the Royal Sanitary Institute for Inspector of Nuisances, † Certificate of the Royal Sanitary Institute for Inspector of Meat and other Foods § Certificate of the Central Midwivcs Board. || Certificate of the Royal Sanitary Institute for School Nurse and Health Visitor. ¶ Certificate of Sanitary Inspectors' Examination Board for Sanitary Inspector, ‡ Health Visitor's Diploma, Battersea Polytechnic, Borough of Wimbledon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT OF THE ACTING MEDICAL OFFICER OF HEALTH FOR THE Year ended 31st December, 1919. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Gentlemen, As required by the General Orders of the Local Government Board of December, 1910, I beg to present the Annual Report for the year 1919. The returns of vital statistics and infectious diseases are appended in Tables I., II., III., and IV. Population.—The calculations for the deaths and other rates in the Tables of this Report are based on an estimated population of 62,283 for the birth-rate, and 59,791 for the 3 death-rate, which are the figures given by the RegistrarGeneral. The population at the Census of 1911 was 54,875. Population, Birth and Death Rates for each Ward, 1919. WARD. Factor. Population. Birth Rate. Death Rate. For Death Rate. For Birth Rate. Wimbledon Park 4.19 10762 11211 9.9 10.03 St. Mary's St. John's 4.68 5381 5606 7.4 10.5 Cottenham Park 4 .34 7175 7474 10.1 9.8 North Wimbledon 4.34 23318 24291 9.4 10.1 Dundonald 4.11 7773 8097 11.3 10.6 Trinity 4.59 12556 13079 15.06 10.5 South Park 4.36 16144 16810 20.8 11.3 Haydon Park South Wimbledon 4.25 36473 37992 16.8 10.9 Whole District 4.36 59791 62283 13.9 10.6 Physical Features and General Character of the District. —Broadly speaking the district is divided into a north and south portion by the main line of the London and South Western Railway. The northern area is mainly of larger houses whereas the southern portion is mainly populated by the working classes. There are no particular occupations which would exercise any influence on public health. Area.—The area of the Borough (exclusive of the area covered by water) is 3,173 acres. Births.—Tlie number of births registered was 869 (438 males, 431 females), which is 90 more than last year, and equal to a birth-rate of 13.9, which shows an increase on last year's figure 13.6, and is 2.9 below the average for the previous five years. The corrected birth-rate, produced by transferable births notified to us by the Registrar-General, is 13'8. The corresponding rate for England and Wales for the same period is given as 18.5. 4 5 The rates for the respective Wards of the district were as follows: — Wimbledon Park and St. Mary's 9.9 St. John's 7.4 Cottenham Park 10.1 Dundonald 11.3 Trinity 15.06 South Park and Haydon Park 20.8 As will he seen from the birth-rates for the respective Wards, the highest rates are recorded in the Wards where most of the working classes are housed. Deaths.—The total number of deaths registered in the district was 512 (221 males, 291 females), equal to a deathrate of 8.5 per thousand of the population per annum. This is lower than last year's figure (12.01). The deaths occurring outside the district of persons belonging to this Borough were 186, viz.: — Kingston Union Infirmary 54 Brookwood Asylum, Woking 10 Nelson Hospital, Merton 20 Others 102 186 The deaths occurring within the district of persons not belonging thereto were 64, viz.: — Atkinson Morley Convalescent Hospital 4 North Wimbledon Hospital 3 Isolation Hospital 1 Others 56 64 After taking these into account, the total number of deaths properly belonging to the district is found to be 634, and the death-rate 10'6. The rate for England and Wales for the same period was 13.8. The standardised death-rate for the year is 10.8. This is obtained by multiplying the net death-rate by the factor for correction, l.0196, which is supplied by the RegistrarGeneral as the result of the last Census. This factor is provided so as to make the death-rate comparable with that of other districts, and the country as a whole on the basis of a similar age and sex distribution for Wimbledon. Apart from the transferable deaths, 33 deaths of children under one year of age were registered, and this infantile mortality is represented by a ratio of 37 deaths per thousand registered births, this being- a decrease of 23 per thousand on last year, and 24 per thousand on the average for the past five years. The rate for England and Wales was 89. In addition to the deaths from Zymotic Diseases, the principal causes of death were as follows: — Pneumonia (all forms) 40 Bronchitis 57 Other Respiratory Diseases 8 Cancer 80 Phthisis 42 Other Forms of Tuberculosis 9 Nephritis and Blight's Disease 24 Congenital Debility and Malformation (including Premature Births) 18 Organic Heart Disease 65 For the purpose of comparison the following Table is compiled from the returns of the Registrar-General: — Vital Statistics for 1919 (Provisional Figures). Annual Rates per 1,000 living. Infant Mortality of infants under 1 year per 1,000 Births. Births. Deaths from all Causes. England and Wales 18.5 13.8 89 96 Great Towns 19.0 13.8 93 148 Smaller Towns 18.3 12.6 90 WIMBLEDON 13.8 10.6 49 Table A shows the births, deaths, and death-rates, and deaths at certain ages and for specified causes for the past five years. Table B shows for the same years the number of infectious cases notified, and the deaths from each disease. Table C shows the death-rate from Zymotic Diseases, Phthisis, and other forms of Tuberculosis for the past ten years. For the past nine years the figures given in these Tables are those obtained after correction by exclusion of "NonResidents" and the inclusion of "Residents" beyond the district. 6 Table A. 1919 1918 1917 1916 1915 1914 Births 861 759 868 1011 1000 1109 Deaths 634 742 658 619 496 606 Death-rates 10.6 14.5 12.1 11.1 8.7 10.1 DEATHS— Under 1 year 43 58 74 74 60 77 Over 1 year and under 65 years 315 439 339 290 243 261 Above 65 years 276 245 245 255 193 268 From Measles 2 5 35 4 9 4 „ Scarlet Fever 1 0 0 2 1 2 „ Small Pox 0 0 0 0 0 0 ,, Diphtheria 8 7 12 9 8 7 ,, Diarrhœa 5 10 16 10 22 26 ,, Whooping Cough 0 12 1 6 5 6 ,, Enteric Fever 0 1 3 2 2 0 ,, Puerperal Fever 2 1 1 1 0 3 „ Erysipelas 2 1 0 0 1 3 ,, Influenza 62 144 16 9 16 6 Table B. 1919 1918 1917 1916 1915 1914 DISEASES. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 0 0 0 0 0 0 4 0 0 0 Diphtheria. 86 8 111 7 82 12 129 9 118 8 85 7 Erysipelas 20 2 13 1 18 0 21 0 29 1 41 3 Scarlet Fever 119 1 73 0 43 0 52 2 187 1 275 2 Enteric Fever 14 0 12 1 9 3 4 2 13 2 6 0 Puerperal Feyer 5 2 4 1 1 1 2 1 2 0 8 3 Totals 244 13 213 10 153 16 208 14 353 12 415 15 7 Table C. Year. Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhœa. Phthisis and other T uberc'los Diseases. 1910 .49 - - .03 .03 .2 .06 .15 .6 1911 1.9 — .01 .1 .01 .1 .77 .79 .81 1912 .58 — .01 .05 .03 .17 - .29 .95 1913 1.2 — .01 .1 .06 .05 .36 .68 1.08 1914 .75 — .03 .1 - .1 .06 .43 .78 1915 .83 — .01 .14 .03 .08 .1 .39 .62 1916 .59 — .03 .16 .03 .1 .07 .18 .82 1917 1.25 — — .2 .05 .01 .65 .29 1.36 1918 .68 — — .13 .01 .23 .09 .19 1.27 1919 .26 — .01 .13 — - .03 .08 .8 8 Small-Pox.—No cases were notified during the year. Scarlet Fever.—The total number of cases notified during the year was 119 from 100 houses, as against 73 and 43 for 1918 and 1917 respectively. The attack rate was 1.9 per thousand of the population. In one house there were 5 cases, in two houses 3, in eleven houses 2, and in the remainder 1 each. There was one death corresponding to a death-rate of .01 per thousand of the population. The disease occurred in the following numbers at the various ages: — Under one 1 One to five 13 Five to fifteen 84 Fifteen to twenty-five 9 Twenty-five to forty-five 11 Forty-five to sixty-five 1 The following was the Ward incidence: — Wimbledon Park 8 Removed to Hospital 7 Attack Rate 1 St. Mary's 5 „ ,,3 ,, ,, St. John's 3 ,, ,, 3 ,, „ .5 Cottennam Park 12 ,, „ 9 „ „ 1.6 Dundonald 8 „ „ 8 ,, „ .9 Trinity 26 „ „ 25 ,, ,, 1.9 South Park 28 ,, ,, 23 „ ,, Haydon Park 29 ,, ,, 29 ,, ,, 119 107 1.9 0 Percentage of cases : North Wimbledon 23.5%. South Wimbledon 76.5%. The average attack and death-rates for the last five quinquennial periods were as follows: — Attack Rate. Death Rate. 1891-1895 4.8 0.2 ) per thousand of the population. 1896-1900 3.3 .04 | 1901-1905 .23 .02 1- 1906-1910 4.07 .05 | 1911-1915 3.03 .01 One hundred and five, or 88'2 per cent, of the patients were treated at the Isolation Hspital. Seventy per cent. of the cases notified were children of school age, five to fifteen years, and of these 82 attended the following schools: — Cottenham Park School 2 Effra Road Girls' and Infants' Schools 15 Durnsford Road Mixed and Infants' Schools 2 Queen's Road Girls' and Infants' Schools 15 Queen's Road Boys' School 8 Pelham Road Boys' School 2 Pelham Road Girls' and Infants' Schools 5 Haydons Road Girls' and Infants' Schools 7 Haydons Road Boys' School 3 Central Mixed School 1 Central Infants' School 2 Dundonald Road Boys' School 1 Dundonald Road Girls' and Infants' Schools 4 Private Schools 11 Schools outside the district 4 82 Diphtheria.—The total number of cases notified during the year was 86 from 73 houses, as against 111 and 82 for 1918 and 1917 respectively. The attack rate was 1.3 per thousand of the population. There were eight deaths, corresponding to a death-rate of T3 per thousand of the population. In one house there were 6 cases, in one house 4 cases, in one house 3 cases, in four houses 2 cases, and in the remainder 1 each. 9 The cases occurred in the following numbers at the various ages: — Under one 0 One to five 19 Five to fifteen 49 Fifteen to twenty-five 11 Twenty-five to forty-five 7 The following was the Ward incidence: — Wimbledon Park 2 Removed to Hospita 1 Attack Rate 1 .5 St. Mary's 4 ,, ,, 1 ,, ,, St. John's 14 ,, ,, 13 ,, ,, 2.4 Cottenham Park 11 ,, ,, 10 ,, ,, 1.4 Dundonald 8 ,, ,, 8 ,, ,, .9 Trinity 29 ,, ,, 29 ,, ,, 2.2 South Park 13 ,, ,, 11 ,, ,, 1.07 Haydon Park 5 ,, ,, 4 ,, ,, 86 ,, ,, 77 ,, ,, 1.3 Percentage of cases : North Wimbledon 36%. South Wimbledon 64%. Seventy-six, or 86 per cent. of the patients were treated in the Isolation Hospital. Fifty-seven per cent. of the cases notified were children of school age, five to fifteen years, and of these, 47 attended the following schools: — Queen's Road Girls' and Infants' Schools 2 Queen's Road Boys' School 3 Haydon's Road Boys' School 2 Haydon's Road Girls' and Infants' Schools 10 Cottenham Park School 1 Central Mixed School 2 Dundonald Road Girls' and Infants' School 1 Dundonald Road Boys' School 1 Durnsford Road School 1 Effra Road Girls' and Infants' Schools 3 Russell Road Schools 3 Pelham Road Boys' School 2 Private Schools 10 Schools outside the district 6 47 10 Fifty-seven per cent, of the cases notified were children of school age, five to fifteen years, and of these, 47 attended the following schools: — Queen's Road Girls' and Infants' Schools 2 Queen's Road Boys' School 3 Haydon's Road Boys' School 2 Haydon's Road Girls' and Infants' Schools 10 Cottenham Park School 1 Central Mixed School 2 Dundonald Road Girls' and Infants' School 1 Dundonald Road Boys' School 1 Durnsford Road School 1 Effra Road Girls' and Infants' Schools 3 Russell Road Schools 3 Pelhana Road Boys' School 9 Private Schools 10 Schools outside the district 6 47 10 Year. Total Cases. Cases treated in Hospital. Deaths in Hospital. Percentage of Deaths in Hospital. Cases treated at Home. Deaths at Home. Percentage of Deaths at Home. Attack Rate. Case Mortality Rate. 1890 10 3 2 66.6% 7 3 42.8% .4 50% Durnsford Lodge used for all Infectious Diseases except during 1893 when, owing to the prevalence of Scarlet Fever, Diphtheria patients could not be admitted. It was closed on Oct. 10th, 1895, because of its insanitary condition. 1891 16 2 1 50% 14 6 42.8% .5 43.7% 1892 18 2 1 50% 16 8 50% .6 50% 1893 39 Nil. Nil. - 39 4 10.2% 1.3 10.2% 1894 44 24 6 25% 20 4 20% 1.4 22.7% 1895 39 27 8 29.6% 12 10 83.3% 1.1 46.1% 1896 30 Nil. Nil. — 30 3 10% .9 10% Bacteriological examination and the use of Anti -Toxin first adopted in Wimbledon. Iron Hospital, Durnsford Road, in use except for Diphtheria. 1897 43 Nil. Nil. — 43 7 16.2% 1.1 16.2% 1898 60 Nil. Nil. 60 7 11.6% 1.5 11% 1899 64 Nil. Nil. — 64 12 18.7% 1.5 18.7% 1900 64 2 Nil. Nil. 62 10 16.1% 1.4 15.6% 1901 60 38 3 7.9% 22 3 13.6% 1.4 10% Present Hospital, Gap Road, opened December, 1900. 1902 80 29 6 20.7% 51 1 1.9% 1.8 8.7% 1903 58 35 1 2.8% 23 i) 13% 1.2 6.9% 1904 36 27 5 18.5% 9 1 11.1% .7 16.6% 1905 39 25 2 8% 14 Nil. Nil. .8 5.1% 1906 55 28 3 10.7% 27 6 22.2% 1.1 16.3% 1907 83 59 6 10.1% 24 Nil. Nil. 1.6 7.2% 1908 94 66 7 10.6% 28 2 7.1% 1.7 9.5% 1909 90 67 3 4.4% 23 4 17.3% 1.5 7.7% 1910 65 46 1 2.1% 19 1 5.2% 1.1 3.07% 1911 99 62 4 6.4% 37 2 5.4% 1.7 6.06% 1912 67 57 3 5.2% 10 Nil. Nil. 1.1 4.4% 1913 129 106 5 4.7% 23 1 4.3% 2.2 4.6% 1914 85 67 6 8.9% 18 1 5.5% 1.4 8.2% 1915 118 102 9 7.6% 16 Nil. Nil. 2.09 7.6% 1916 129 109 10 9.1% 20 1 5% 2.3 7.7% 1917 82 72 11 15.2% 10 1 10% 1.5 14.6% 1918 111 90 7 7.7% 21 Nil. Nil. 2.1 6.3% 1919 86 77 7 9-09% 9 1 111% 1.3 9.3% 1890—1895 Average Attack Rate .8 Average case Mortality Rate 37.1% 1896-1900 „ „ „ 1.2 „ „ „ " „ 14.3% 1901-1910 „ „ „ 1.2 „ „ „ „ 9.1% 1911-1919 „ „ „ 1.7 „ „ „ „ 7.5% 11 12 Enteric or Typhoid Fever.—During the year 14 persons in eleven different houses were notified as suffering from this disease, equal to an attack rate of '22 per thousand of the population. The following was the Ward incidence: — St. Mary's 2 Trinity 5 Haydon Park 7 The cases occurred at the following times: — May 1 July 3 August 1 September 3 October 1 November 3 December 2 There were no deaths. Puerperal Fever.—Five cases were notified during the year, which is equal to an attack rate of 08 per thousand of the population. Three of the cases were treated at the Isolation Hospital and recovered. There were two deaths, corresponding to a death-rate of .03 per thousand of the population. Whooping Cough. — There were no deaths from this disease. Erysipelas.—There were 20 cases notified during the year from 20 houses, corresponding to an attack rate of .32 per thousand of the population, and there were two deaths which is equal to a death-rate of 03 per thousand of the population. Influenza.—This disease was certified as the cause of 62 deaths, corresponding to a death-rate of 1.03 per thousand of the population. Last year there were 144 and in 1917 there were 16. The deaths were distributed through the Wards as follows: — Wimbledon Park 6 St. Mary's 8 St. John's 7 Cottenham Park 4 Dundonald 7 Trinity 10 South Park 14 Haydon Park 6 Forty-five cases of Influenzal Pneumonia were notified, corresponding to an attack rate of .7 per thousand of the population. Ten of these were taken into the Borough Isolation Hospital, of whom one died. Measles.—There were two deaths from Measles during the year, which is equal to a death-rate of .03 per thousand of the population, as compared with 5 deaths last year and 35 the previous year, with a death-rate of 09 and .65 respectively. Eighty-five cases were notified during the year corresponding to an attack rate of 1.3 per thousand of the population. Twenty-seven cases of German Measles were notified during the year which is equal to an attack rate of '4 per thousand of the population. Phthisis and other Tuberculous Diseases were the assigned causes of the deaths of 51 persons (26 males, 25 females) during the year, equal to a death-rate of .85 per thousand of the population. Last year there were 65 deaths, and the previous year 73. The total number of cases notified during the year was 138: — 48 being primary notifications of Pulmonary Tuberculosis. 5 being primary notifications of other forms of tuberculosis. 85 being secondary notifications. The following was the age incidence: — Under 1 1-5 5-15 15-25 25-45 45-65 Over 65 All Ages. Pulmonary — — 3 16 23 5 1 48 Other forms — 1 2 1 1 - - 5 The following was the Ward incidence: — Wimbled'n Park. St. M'ry's St, John's Gott enham Park. Dundon'ld Trinity South Park. Haydon Park. Total Pulmonary 8 3 6 3 10 8 5 5 48 Other forms 1 - — 1 — 1 — 2 5 13 The following- particulars were found on investigation, concerning the cases notified: — Sputum examined 60.3 per cent. Positive 50 per cent. Negative 12.5 per cent. Result not known 37.5 per cent. History of consumption in family 33.9 per cent. Patient working at time of notification 301 per cent. In regular work 02.4 per cent. Irregular 37.6 per cent. Average size of house, 5.3 rooms. Average population per house, Adults 3, Children 1.5. The treatment which had been obtained previous to notification was: — PULMONARY. Private Practitioners 27 Private Practitioner and Hospital 1 Private Practitioner and Sanatorium 5 Infirmary 2 Hospital 13 Other forms of Tuberculosis: — Private Practitioner 2 Private Practitioner and Hospital 1 Hospital In-patient — Hospital Out-patient 2 The other forms of Tuberculosis notified were: — Hip 1 Brain 2 Cervical Glands 2 INSURED PATIENTS. Men. Average age 29.7 years Married 14 Average age of those receiving Sanatorium treatment 29 years Women. Average age 26.1 years Married 13 Average age of those receiving Sanatorium treatment 29.3 years 14 Anthrax.—No cases were notified during the year. Ophthalmia Neonatorum.—Four case's occurred during the year, one of which was treated at the Isolation Hospital. The other three were visited by the Health Visitors. They were all under treatment by medical practitioners in the district and the vision was unimpaired. Encephalitis Lethargica. — Three cases were notified during the year, equal to an attack rate of .04 per thousand of the population. Malaria.—Twenty-five notifications were received during the year, which is equal to an attack rate of .4 per thousand of the population. Infection in all these cases was contracted abroad. Dysentery.—Two notifications were received during the year, which is equal to an attack late of .03 per thousand of the population. In both instances infection was contracted abroad. Meningitis. — One notification was received during the year, which is equal to an attack rate of .01 per thousand of the population. Cancer.—During the year 80 deaths have been registered as due to the different forms of malignant disease or Cancer (29 males, 51 females). The death-rate for the year was 1.3, as against 1.05 last year, and 1.2 in 1917, the average for the past five years being 1.1. The distribution of the deaths through the Wards was as follows: — Wimbledon Park 8 Attack Rate ) 1.07 St. Mary's 4 „ ,, St. John's 13 ,, ,, 2.3 Cottenham Park 10 ,, ,, 1.3 Dnndonald 13 ,, ,, 1.6 Trinity 15 ,, ,, 1.1 South Park 9 ,, ,, 1.01 Haydon Park 8 ,, ,, 15 The following table shows the different parts of the body invaded, and the age incidence: — Part Affected. Male. Female. Total. Age Incidence. Male. Female. Total.  Stomach and Bowels 12 15 27 Under 35 years 1 1 2 Liver 5 10 15 35 to 40 „ 1 2 3 Urinary and Generative Organs 8 7 15 40 to 45 ,, 1 4 5 Tongue, Neck and Throat 4 1 5 45 to 50 „ 2 3 5 50 to 55 „ - 6 6 Breast - 11 11 55 to 60 „ 5 10 15 Other Parts - 7 7 60 to 65 „ 4 5 9 65 to 70 ,, 5 2 7 70 to 75 „ 1 9 10 75 to 80 „ 7 5 12 80 and upwards 2 4 6 Total 29 51 80 Total 29 51 80 Ward. Male. Female. Total. Wimbledon Park 2 6 8 St. Mary's 2 2 4 St. John's 7 6 13 Cottenham Park 4 6 10 Dundonald 2 11 13 Trinity 7 8 15 South Park 3 6 9 Haydon Park 2 6 8 Total 29 51 80 16 17 Diarrhœa and Enteritis were responsible for 5 deaths, corresponding to a death-rate of .08 per thousand of the population. The deaths were distributed through the Wards as follows: — Wimbledon Park 1 St. Mary's 0 St. John's 0 Cottenham Park 1 North Wimbledon 2 Dundonald 1 Trinity 1 South Park 0 Haydon Park 1 South Wimbledon 3 Infantile Mortality.—There were 43 such deaths during the year (including transferable deaths), or 50 per thousand registered births, showing a decrease of 26 on last year's rate, when there were 57 deaths and a rate of 76. The previous year there were 74 deaths, and the rate was 85. The average for the past five years is 73. The infantile mortality rates for the different Wards are as follows: — Wimbledon Park 35.08 St. Mary's 55.5 St. John's 47.6 Cottenham Park 52.6 Dundonald 76.08 Trinity 15.2 South Park 51.7 Haydon Park 84.03 Thirteen babies, or 302 per cent. of the total deaths, failed to survive the first week of life, and 22 the first month. Notification of Births Act, 1907.—During the year 783 births were notified by the following persons:—Parents 125. Midwives 548, Doctors 103, and other persons 7 During the same period 869 births were registered. 17 The number of infants visited was 430 and occurred in the following' Wards: — Wimbledon Park 10 St. Mary's 4 St. John's 7 Cottenham Park 12 Dundonald 57 Trinity 195 South Park 33 Haydon Park 112 The number of re-visits made was 4,890. Average size of house visited, 5.4 rooms. Average rental, 9s. 6d. per week. Visits paid by Health Visitors: — Tuberculosis Visits 272 Ophthalmia Neonatorum 2 Measles 69 Puerperal Fever 2 Influenzal Pneumonia 23 Malaria 21 Special Visits 813 Ineffectual Visits (unanswered calls) 760 MATERNITY AND CHILD WELFARE. Infant Feeding:— Breast fed 347 Mixed feeding 24 Artificially fed 59 REPORTS OF INFANT WELFARE CENTRES. Wandle Park House. Number of infant consultations held 51 Total number of attendances 2164 Total number seen by doctor 1154 Average number of attendances 42.4 Number of new cases under one year 152 Number of new cases over one year 56 Classes for Mothers. Number of classes held 45 Total number of attendances 883 Average number of attendances 17.4 Subjects taught: — Mothercraft. Home Nursing. Sewing and cutting out. 18 DUNDONALD HALL. Number of infant consultations held 49 Total number of attendances 908 Total number seen by doctor 664 Average number of attendances 18.5 Number of new cases under one year 55 Number of new cases over one year 18 Classes for Mothers. Number of classes held 30 Total number of attendances 161 Average number of attendances 5.3 Subjects taught:— Mothercraft. Physiology. Milk (Mothers and Children) Order, 1918.—Milk has been supplied under this Order to necessitous cases. In every instance investigations have been made as to their income and an order has been sent to the milkman supplying the household for varying amounts of milk at either less than cost price or free according to the circumstances of the case. The number of families supplied during the year was 114. Isolation Hospital. — The following Table gives the number of patients treated in the Hospital for each disease during the year. Cases Admitted in 1919. Over 5 years. Under 5 years. Total. Deaths. Remarks. Over 5 years. Under 5 years. Total. Scarlet Fever 97 11 108 - - - Daily average number of cases 27. Diphtheria 69 14 83 2 5 7 Enteric Fever 10 — 10 — — — Puerperal Fever 3 — 3 — — — German Measles 2 — 2 — — — Pneumonia and Influenza 11 1 12 1 1 Ophthalmia Neonatorum 1 1 2 - - - Chicken Pox 1 - 1 — - - Enteric Fever Staff.. 1 — 1 — — — Scarlet Fever—Staff 2 — 2 — - —. Diphtheria—Staff 1 — 1 — — — Influenza—Stall 2 — 2 - - - Concussion—Staff 1 - 1 — — — Average number of days in Hospital 45. 201 27 228 3 5 8 Carried over from 1918 Scarlet Fever 9 5 14 - - - Diphtheria 11 2 13 - 1 1 Phlebitis—Staff 1 — 1 — — — Total number of cases treated during 1919 222 34 256 3 6 9 19 Disinfestion.— The following Table shows the number of rooms and articles disinfected: — Disease. Bedding Disinfected. Clothing. No. of Rooms Disinfected. Total Mattresses Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Dresses. Suits. Other Articles Scarlet Fever 171 105 29 291 612 55 21 1904 104 3292 Diphtheria 153 129 47 347 638 51 21 1858 119 3363 Typhoid Fever 47 15 5 90 138 9 3 230 10 547 Erysipelas 2 6 4 12 16 2 — 35 3 80 Puerperal Fever 1 2 1 6 7 1 — 38 2 58 Tuberculosis 35 21 15 72 75 3 — 251 45 517 Cancer 14 14 6 66 21 2 18 333 17 491 Measles 42 18 11 104 385 7 7 538 20 1132 Pneumonia and Influenza 29 20 46 83 188 4 — 198 24 592 Scabies 3 — 184 157 817 — 9 107 123 1400 Vermin 15 9 9 29 147 — 5 275 9 498 Sundries 56 14 543 355 2135 12 7 522 245 3889 Totals 568 353 900 1612 5179 146 91 6289 721 15859 Diagnostic Tests.—The number of specimens of serum, sputum and blood submitted for bacteriological examination during the year in doubtful cases of Diphtheria, Pulmonary Tuberculosis and Typhoid Fever, and the results of such examinations are given below. Forty bottles of anti-diphtheritic serum were supplied through the Public Health Department for use by medical practitioners for the treatment of Diphtheria. The antitoxin syringe which is kept at the Fire Station was borrowed on two occasions by medical practitioners in the district. 20 Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 140 866 1006 Phthisis (Sputum) 14 105 119 Wasserman Tests - - - Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 12 24 36 Specimens were submitted for the following: — Positive. Negative. Total. Cerebro Spinal Meningitis — 7 7 Malaria — 2 2 Mortuary. — From information received from the Superintendent of the Cemetery, there were 54 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 43 bodies, equal to 8 4 per cent., of all deaths registered in the Borough. Factories and Workshops.—In the Tables below is shown the work done in the supervision of workshops and workplaces. Premises. Inspections. Written Notices. Prosecutions. Factories 76 4 — Workshops 402 19 — Workplaces 33 1 — Total 511 24 — 21 Defects found. Nature. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 10 10 — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — ' — Other Nuisances 14 14 — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 23 23 — — Not Separate for Sexes - — — — Breach of Special Sanitary Requirements for Bakehouses 1 1 — — Other Offences Total 48 48 - - HOME WORK. Lists received: — Twice in the year 7 Number of Out-workers 39 Once in the year 6 Number of Out-workers 14 Number of addresses received from other Councils 73 Number of addresses forwarded to other Councils 12 Notices served on occupiers as to keeping or sending lists — Prosecutions—Failing to keep Out-workers lists — Prosecutions—Failing to furnish lists — Inspections of Out-workers premises 52 Number of unwholesome premises 11 Notices served to remedy 11 22 REGISTERED WORKSHOPS. The following are the principal classes of workshops on the register at the end of the year: — Boot Repairing 53 Dressmaking 52 Bakehouses (including three Factory Bakehouses) 26 Laundries 53 Tailoring 25 Millinery 22 Dining Rooms 17 Cycles 10 Other Trades 147 405 OTHER MATTERS. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of Act 1 Action taken in matters referred to H.M. Inspector as remedial under the Public Health Acts Notified by H.M. Inspector 2 Reports of action taken sent to H.M. Inspector 2 Underground Bakehouses in use at the end of the year 3 Food Poisoning.— No cases of food poisoning were notified during the year. Water Supply.— Information was received that the water supply had been withdrawn during the year from 18 houses for the following reasons:—Eight by request, 5 owing to arrears of rates, and 5 for other reasons. Supervision of the Erection of New Houses.—This is under the control of the Surveyor, and there is a special inspector who supervises the erection of new houses and additions. Premises and Occupations which can be controlled by Bye-laws. — Particulars as to these will be found in the Report of the Chief Sanitary Inspector (Mr. Henry Johnson). 23 Slaughter-houses.—The number of registered slaughterhouses remains as last year, viz.:—Six. The Bye-laws as to the periodical limewashing of walls and the removal of garbage, offal, etc., have been complied with, no neglect in this respect having been found. Dairies, Cowsheds and Milkshops Order.—On the 31st December, 1919, there were 5 Cowkeepers, 54 Dairymen, and 26 Purveyors only, on the Register. Milk Supply.—Practically the whole of the milk supply is imported into the district, and so far as investigations go, no cases of infectious disease have been found to be due to the milk supply. Closet Accommodation.—Practically the whole district is supplied with water closets connected to the main sewerage system. Scavenging.— The arrangements are under the Borough Surveyor (Mr. Joseph Bowen). He informs me that a weekly system of collection obtains through the whole of the district. Schools.—Apart from the routine medical inspection, the School Clinic at Southey Hall is open every day between the hours of 9 and 10 a.m. All scholars about whom there is any doubt as to any infectious disease, whether notifiable or not, are examined personally by me and action is taken as to exclusion. As necessity arises, the children are also examined in the schools. All the public elementary schools were disinfected during the summer vacation. Poor Law Relief.—The following information has been furnished by the Acting Clerk to the Kingston Union respecting Poor Law Relief in this district: — Amount of Out-relief paid during the year ended 3.1st December, 1919 £2,663 4 11 Average weekly number of persons in receipt of relief 198 Number of persons admitted to the Guardians Institutions from the Wimbledon Area 227 24 Housing, and Housing Town Planning Act, 1909-1919. —Particulars under this heading1 will be found in the Report of the Chief Sanitary Inspector (Mr. Henry Johnson). Sanitary Inspection of District.—The following is a statement showing the number and nature of inspections made, the number of informal and statutory notices served, with the result of such notices for the year 1919, as reported by the Sanitary Inspector: — REASON OF VISIT. No. Infectious Disease 948 House Inspection 3267 Houses let in Lodgings, Inspection 385 Inspection of Factories, Workshops, Workplaces and Outworkers' premises 511 Common Lodging Houses, Inspection 25 Dairies and Cowsheds, Inspection 144 Inspections under Shop Acts 163 Application of Tests to Drains 277 Inspections under Diseases of Animals Acts and Gooseberry Mildew Order 304 Obtaining samples of Food and Drugs 64 Miscellaneous (including inspections of food, slaughter-houses, mews, stables, caravans, smoke observations, measuring up, Petroleum Acts, water supply, etc.) 1935 8023 One thousand and thirty-two preliminary or informal notices were served in respect of 960 houses. One hundred and forty-five statutory notices were served in respect of 156 houses. The necessary work was executed in all but 43 cases, which were not completed by the end of the year. Table V. gives a summary of the nuisances abated, and sanitary improvements carried out under the supervision of the Inspectorial Staff. 25 LOCAL ACTS, SPECIAL LOCAL ORDERS OR GENERAL ADOPTIVE ACTS IN FORCE IN THE BOROUGH. Infectious Diseases (Notification) Act, 1889—16th October, 1889. Infectious Diseases (Prevention) Act, 1890—17th December, 1890. Public Health Acts (Amendment) Act, 1890 : (Parts II., III. and V.)—17th December, 1890. Housing of the Working Classes Act, 1890 : (Part III.)—7th June, 1899. Notification of Births Act, 1907—26th July, 1909. The Public Health Acts (Amendment) Act, 1907 : (Parts VII.—except Sections 82 and 83, Section 81 modified, VIII. and IX.)—21st December, 1908. Part II. (Sections 25, 27, 30 adapted); Sections 52, 53, 54, 55, 56, 57, 58, 59 adapted; 60, 61, 62, 63, 64, 65, 67 and 68 comprised in Part IV.; Part V. (Section 75 adapted); Part VI. (Section 76 adapted); Sections 92, 93 and 95 comprised in Part X. 28th July, 1913. The Wimbledon Corporation Act, 1914—7th August, 1914. Bye-laws, Regulations, etc. : Bye-laws with respect to Houses let in Lodgings. Ditto, ditto Common Lodging Houses. Ditto, ditto Slaughter-houses. Ditto, ditto Nuisances. Ditto, ditto Tents, vans, sheds and similar structures. Ditto, ditto the keeping of water closets supplied with sufficient water for flushing. Regulations with respect to Dairies, Cowsheds and Milkshops. Provisional and other Orders affecting the Borongh :— Croydon and Wimbledon Joint Small-Pox Hospital Order, 1898. Ditto, ditto, ditto, 1903. Ditto, ditto, ditto, 1908. Ditto, ditto, ditto, 1912. 26 Order of Home Office declaring certain parts and sections of the Public Health Acts (Amendment) Act, 1907, to be in force. Dated 21st December, 1908. Order of the Local Government Board declaring certain parts and sections of the Public Health Acts (Amendment) Act, 1907, to be in force. Dated 9th June, 1913. Older of Local Government Board under the Public Health Acts (Amendment) Act, 1907, declaring certain trades to be offensive. Dated 14th January, 1914. Order of Town Council under Shops Act, 1912, relating to Second-hand Clothes Dealers. Dated 5th November, 1913. My thanks are due to Mr. Johnson, your Chief Sanitary Inspector, for the very efficient help he has rendered me. I am, Gentlemen, Your obedient Servant, DAVID A. BELILIOS, Acting Medical Officer of Health. 27 Borough of Wimbledon. SANITARY DEPARTMENT. ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE Year ended 31st December, 1919. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Gentlemen, I beg to submit to you my Report of the work carried out in my Department for the year ended 31st December, 1919. Table V. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—One thousand and thirty-two Preliminary Notices or intimations were served during the year in respect of 960 houses, and it was only found necessary to serve 145 Statutory Notices upon the owners or occupiers of 156 houses. In three instances the owners failed, after repeated informal requests, to comply with the Statutory Notices requiring the remedying of certain nuisances. As a consequence, 29 legal proceedings were taken before the local Magistrates, the result being: — For failing to abate nuisance caused by— Defective guttering and roofs at two houses: Ordered to abate nuisance, and fined £5 and £2 2s. 0d. costs. Defective soil and ventilating pipe, improper discharge of sink waste pipes and improper ventilation of indoor W.C.: Ordered to abate nuisance, and fined £7 18s. 0d. and £2 2s. 0d. costs. Improper keeping of animals, and absence of a proper manure receptacle: Ordered to abate nuisance, and fined £2 2s. 0d. costs. Opening up of Drains under Section 41 of the Public Health Act, 1875.—As the result of applications of the smoke or chemical test, it was found necessary to exercise the powers with respect to the opening up of ground and exposing of drains granted to the Local Authority by this Section at 13 houses, authority first having been obtained from the Council, and due written notices given to the occupier in each case. The conditions found were duly reported to the Public Health Committee, and notices served on their instructions, requiring the reconstruction or amendment of the defective drains, etc., as the circumstances required. House Drainage.—The drainage systems and sanitary arrangements of 22 houses have been entirely reconstructed, and extensive amendments or repairs were carried out at 51 other houses. House to House Inspection.—In consequence of two of the Inspectorial Staff being on Military Service during part of the year, and to the constant changes in the temporary clerical staff, no systematic house to house inspection could be undertaken. Nuisances and defects discovered were dealt with under the Public Health Acts. House Inspection.—There are 11,976 houses in the district, about 9,250 being occupied by the working-classes. It is estimated that about 300 more houses are required to meet existing conditions, and the erection of these houses is included in a Housing Scheme now under consideration. 30 Either as the result of inspections made on complaint, in consequence of the occurrence of infectious disease, requests by occupiers, and other general inspections, sanitary works were executed at 789 houses (see Table V.). Overcrowding. — Owing to the total cessation of the erection of dwelling-houses, there is undoubtedly overcrowding of some houses which were formerly occupied by one family and have become occupied by two or more families. The Council has in contemplation a Housing Scheme, which provides for the erection of about 300 dwelling houses. Houses Let in Lodgings.—There are 67 of these houses on the Register, and 385 visits of inspection were made during the year. Verminous Rooms.—This matter has continued to receive the attention of the department during the year, fourteen rooms having been dealt with. As previously, the necessary notices were served upon the person responsible, whether occupier or owner. Every assistance has been given to those who were anxious to free their premises from vermin, and fumigants have been supplied at cost price, or fumigation carried out by the disinfector at the owner's expense after the walls had been stripped, as required. Common Lodging Houses—There are only two Common Lodging Houses in the district, viz., Nos. 42 and 188, High Street, South Wimbledon, for which Annual Certificates of Registration were granted from 1st January to 31st December, 1919. Inspections of these premises have been made from time to time at irregular intervals, and I am pleased to report that all the provisions of the Bye-laws were rigidly observed. Van Dwellings.—At irregular intervals throughout the year inspections were made of the vans occupied as dwellings. With one or two exceptions these dwellings have been found clean and well-kept, and the provisions of the Bye-laws relating to tents, vans and sheds complied with. In the few instances mentioned, a verbal warning was sufficient to obtain compliance. Dairies, Cowsheds and Milkshops. — Eight applications were received during the year from persons desirous of being registered under the Dairies, Cowsheds and Milkshops Orders. Periodical inspections have been made of all the premises of dairymen and purveyors of milk in the district, during which two matters were discovered which required to be dealt with by the Department. 31 Infectious Disease and Disinfection.—During the year visits for the purpose of investigating cases of notifiable infectious disease were made to 252 houses. Special visits were also made, as required, for the purpose of following up and inquiring after the health of persons who had been passengers on vessels coming to this country, on which cases of infectious disease had occurred, and of which notice had been received from the Port Sanitary Authorities concerned. The information obtained was handed to the Medical Officer of Health. At 109 houses from which cases of notifiable infectious disease had been reported, defective drains, or other insanitary conditions were found to exist, all of which were subsequently remedied under the supervision of the officers of the Department. Disinfection of rooms, bedding, clothing, etc., was duly carried out after the removal to hospital or recovery of each patient. Where necessary the walls of the rooms from which the cases had been removed were stripped and re-papered or distempered. The number of rooms disinfected was 595, and the number of articles, bedding, wearing apparel, etc., 13,940, full details of which are given in the Report of the Medical Officer of Health under the heading of " Disinfection." School Disinfection.—All the Public Elementary Schools in the district were thoroughly disinfected during the summer vacation. Yard Paving.—In the course of the inspections made during the year, 24 yards were found to be in an unsatisfactory state, due either to the absence of any paving or the defective condition of that which did exist. The power to deal with this class of nuisance has been greatly strengthened by the adoption of Section 25 of the Public Health Acts (Amendment) Act, 1907. Stable Refuse.—Continued attention has been paid to the mews and stable yards in the district, 300 visits having been made to such premises during the year. Inspections under the Factory and Workshop Act, 1901. —Seventy-six inspections of factories were made during the year and four written notices served referring to sanitary conveniences or other nuisances. There are 405 workshops and work-places on the Register, to which 435 visits of inspection were made. 32 Twenty-five workshops and work-places were found to be closed and thirty-two new ones opened during the year. A table required to be furnished to the Home Office showing details of work carried out under the provisions of the Factory and Workshop Act is given on pages 21 and 22 of the Medical Officer of Health's Report. Shops Acts, 1912-1913. — One hundred and sixty-three visits were made to the occupied shops in the' district to ascertain if the provisions of the Acts were being complied with. Early in the year a petition was received from 16 hairdressers in the district asking that the Wimbledon Barbers' and Hairdressers' Closing Order, 1916, be revoked and a new Order be made altering the closing hours. The hairdressers were interviewed, and 18 out of a total of 22 affected signified their acquiescence to the making of the Order. Subsequently, on the 27th October, 1919, the following Order came into operation :— Borough of Wimbledon. SHOPS ACT, 1912. Notice is hereby given that the Secretary of State, on the twenty-seventh day of October, 1919, revoked the Wimbledon Barbers' and Hairdressers' Closing Order, 1916, and confirmed the Wimbledon Barbers' and Hairdressers' Closing Order, 1919, a copy of which is as follows: — Shops Act, 1912. Whereas the Town Council of Wimbledon have, in pursuance of the provisions of the Shops Act, 1912, made and submitted to me a Closing Order relating to Barbers' and Hairdressers' Shops in the Borough : And whereas it appears to me that the Order should be confirmed with amendment: Now, therefore, in pursuance of the powers vested in me by the said Act, I hereby amend and confirm the Order as hereinafter set forth: — 33 Borough of Wimbledon. Shops Act, 1912. Closing Order. It is hereby ordered that— 1. This Order, which may be cited as "The Wimbledon Barbers' and Hairdressers' Closing Order, 1919," applies to all shops in the Borough of Wimbledon in which the trade or business of a Barber or Hairdresser is carried on. 2. All shops to which this Order applies shall be closed for serving customers on the several days of the week at and after the following hours respectively: — Monday 8 p.m. Tuesday 8 p.m. Wednesday, weekly half-holiday—shops closed at 1 p.m. Thursday 8 p.m. Friday 8 p.m. Saturday 9p.m. Provided (a) that the closing hour fixed above shall not apply on the Thursday immediately preceding Good Friday or on the day (not being the day of the weekly half-holiday) immediately preceding Christmas Day, and (b) that where the occupier of a shop elects to close his shop for the weekly half-holiday on Saturday instead of on Wednesday the closing hour on Wednesday shall be 8 p.m. Note.-—It is provided by Section 4 (5) of the Act that if a shop is closed throughout the whole of a Bank Holiday, and the Bank Holiday does not fall on the day fixed for the weekly half-holiday, the shopkeeper may keep his shop open EITHER on the half-holiday before OR on the half-holiday after the Bank Holiday. 3. Where any trade or business other than the trade or business of a Barber or Hairdresser is carried on in any shop to which this Order applies, such shop may, subject to the provisions of any other Order for the time being in force, be kept open after the closing hour mentioned in Article 2 of this Order, for the purpose of the first-mentioned trade or business alone, provided that (a) after the said closing hour there shall be exhibited in some conspicuous places on the 34 exterior and in the interior of the shop notices in letters of not less than two inches containing the following words: — "SHOPS ACT, 1912. THIS SHOP IS CLOSED FOR TO-DAY EXCEPT FOR (THE SALE BY RETAIL OF ) or (THE TRADE OR BUSINESS OF )"; and (6) so far as reasonably practicable no goods in connection with the trade or business for which the shop is required to be closed shall be exhibited either inside or outside the shop. E. Shortt, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 27th October, 1919. The above Order is now in force. If any person contravenes the provisions thereof he will be liable to a fine not exceeding (a) in the case of a first offence ONE POUND; (b) in the case of a second offence FIVE POUNDS; and (c) in the case of a third or subsequent offence TWENTY POUNDS; but he will not render himself liable to any penalty for serving after the closing hour any customer who was in the shop before the closing hour. A. STEELE SHELDON, 31st October, 1919. Town Clerk. Slaughter-houses and Food Inspection. — Two hundred and seventy inspections of the six registered slaughter-houses in the district have been made during the year, and I have so arranged these visits that they have taken place whilst slaughtering was in progress, and that as far as possible all animals killed in the town can be examined prior to being exposed for sale. Frequent visits have been made not only to slaughter-houses but also to shops of butchers, fishmongers and fruiterers, and other places where food is prepared or exposed for sale, and the following were surrendered and destroyed as trade refuse, being unfit for human food: — Bacon, 588£lbs. Beef, 1221bs. Bread, 92 loaves. 35 Butter 139½lbs. Calf (unborn), 1. Carcases : Cows, 2 Sheep, 4 12. Pigs, 6 Cheese, 141bs. Currants, 2241bs. Dates, l,4561bs. Eggs, 1,022. Fish, 1851bs. Liver, 1721bs. Milk (condensed), 179 tins. Milk and cocoa, 2 tins. Poultry, 1181bs. Rabbits, 240. Raisins, 501bs. Rice, 141bs. Sugar, 2 tons, 1 cwt. Sultanas, 501bs. Tinned Meat, 121bs. Proceedings were instituted in one case. The defendant, an itinerant vendor from an adjoining district, was found to be selling rabbits which were quite unfit for human consumption. He was convicted by the local Magistrates, a fine of £5 and £3 15s. 0d. costs being imposed. Sale of Food and Drugs Acts, 1875 to 1907.—The following table shows the number and nature of articles purchased and submitted for analysis during the year. The preliminary or test samples were examined by the Council's Analyst. Particulars of Samples of Food and Drugs taken and submitted for Analysis. Year ended 31st December, 1919. ARTICLES. Test Samples. No. Genuine. Adulterated or Inferior. Slightly inferior or Deteriorated. Milk 36 25 8 3 Butter 1 — — 1 Meat Pie 1 1 — — Total 38 26 8 4 36 A large number of samples which would ordinarily have been included in the above were obtained and submitted for analysis at the instruction and expense of the Food Control Committee. Petroleum Acts. — Forty-six applications were received for permission to keep petroleum, 29 being for the renewal of existing licences, and 15 for new ones. One hundred and eleven inspections were made of the various premises in respect of which licences had been issued. No breach of these Acts was discovered during the year. Diseases of Animals Acts, 1894 1911. Parasitic Mange.- Notifications as required by the above Acts were received in eleven cases, seventeen horses being affected with the disease. Four of the infected horses were killed, one died and the remaining twelve recovered. In each case the premises were kept under strict observation and the necessary disinfection and cleansing carried out at the completion of the case. Notices requiring detention, disinfection, etc., were served, and the usual returns rendered to the Board of Agriculture. In one case, the diseased animal was moved without the permission of the Local Authority. On the matter being reported to the Committee it was decided that proceedings should be instituted. This was done, and the Magistrates convicted defendant, imposing a penalty of £2 2s. 0d., to include costs. I accompanied your Veterinary Inspector when making his quarterly inspections of all dairy cows in the borough. In no instance was any animal found to be affected with any disease covered by the Tuberculosis Order, 1913. Staff. Early in the year Mr. Avis, Chief Assistant Inspector, and Mr. Pickard, Second Assistant Inspector, were demobilised and recommenced their duties in February and April respectively. 37 Mr. Partridge, Clerk, was demobilised and recommenced his duties in March. In October, having been appointed Assistant Sanitary Inspector at Swindon, he resigned his position here. Since that time the vacancy thereby caused has been temporarily filled by a female clerk. At the close of the year the Staffing Committee still had before it the matter of the appointment of a permanent clerk. On 29th December, 1919, Mr. Allen, Clerk, recommenced his duties after demobilisation. Owing to the many changes and to the temporary character of the clerical staff during the war and up to the present time, the General Register, Plan Book and other records have not been kept up to date, and it is now impossible to complete them. I have much pleasure in testifying to the loyal support given me by my Staff, and to acknowledge the kind co-operation at all times by my colleagues of other departments. I remain, Gentlemen, Your obedient Servant, HENRY JOHNSON, F.S.I.A., M.R.S.I. 38 40 BOROUGH OF WIMBLHDON. TABLF 1. Vital Statistics of Whole District during 1919 and Previous Years. YEAR, Population estimated to Middle of each Y ear. Births. Totai. Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett.. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rale per 1000 Nett Births. Number. Rate. Number. Rate. l 2 3 4 5 6 7 8 9 10 11 12 13 1914 55,598 1079 1109 18.6 471 7.9 28 163 77 69 606 10.1 1915 56,409 1000 1091 17.7 496 8.7 23 157 71 71 630 11.1 1916 60,333 Birth-rate 55.451 1007 1011 16.7 484 8.7 33 168 71 70 619 11.1 Death-rate 1917 59,678 Birth-rate 53,536 866 868 14.5 511 9.5 17 164 74 85 658 12.2 Death-rate 1918 57,155 Birth-rate 51,0 9 779 759 13.2 613 12.01 51 180 57 76 742 14.5 Death-rate 1919 62,283 Birth-rate 59,791 869 861 13.8 512 8.5 64 186 43 50 634 10.6 Death-rate Area of District in acres (land and inland water) 3221 Total families or separate occupiers (at Census of 1911) 12,604 Total population at all ajres (at Census of 1911) 54,875 41 BOROUGH OF WIMBLEDON. TABLE II. Cases of Infectious Disease Notified during the Year 1919. NOTIFIABLE DISEASE. Number of Cases Notified. Total Cases Notified in Each Locality (e.g. Parish or Ward) of the District. Total Cases removed to Hospital. At all Ages. At Ages—Years. Wimbledon Park Ward. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Haydon Park Ward. Under L 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards 1 2 3 4 5 6 7 8 Small-pox - - - - - - - - - - - - - - - - - Cholera (c) Plague (p) - - - - - - - - - - - - - - - - - Diphtheria (including Membranous croup) 86 - 19 49 11 7 — - 2 4 14 11 8 29 13 5 77 Erysipelas 20 - 1 1 3 7 7 1 - 2 1 — 1 8 3 5 — Scarlet fever 119 1 13 84 9 11 1 - 8 5 3 12 8 26 28 29 107 Typhus fever — - — — — — — - — — — — — — — — — Enteric fever 14 - — 5 4 4 1 - — 2 — — — 5 — 7 11 Relapsing fever - - - - - - - - - - - - - - - - Continued fever - - - - - - - - - - - - - - - - Puerperal fever 5 — — — 3 2 — - — — — — — 1 4 — 3 Cerebro spinal Meningitis 1 - - 1 - - - - 1 - - - - - - - - Poliomyelitis — - — — — — - - — — — — — — — — — Pulmonary Tuberculosis 48 - — 3 16 23 5 1 8 3 6 3 10 8 5 5 — Other forms of Tuberculosis 5 - 1 2 1 1 - - 1 — — 1 — 1 — 2 — Ophthalmia Neonatorum 4 4 — — — — — - 1 1 — — 1 1 — — 1 Encephalitis Lethargica 3 — - — — 1 2 - — — 2 — — — 1 — 1 Measles & German Measles.. 112 1 36 57 9 7 2 - 9 8 8 9 8 44 18 8 — Influenza & Pneumonia 45 — 2 6 6 22 7 2 5 3 3 — 5 9 17 3 10 Malaria 25 — - — 4 19 2 — 3 — 2 2 4 11 2 1 — Dysentery 2 — — — 1 1 — — — 1 — — — — — 1 — Meningitis 1 - - 1 - - - - - - - - - - - 1 - Totals 490 6 72 209 67 105 27 4 38 29 39 38 45 143 91 67 210 Isolation Hospitals:—Borough Isolation Hospital, Gap Road, Wimbledon; Croydon and Wimbledon Joint Small-pox Hospital, Cheam, Surrey. 42 BOROUGH OF WIMBLEDON. TABLE III Causes of, and Ages at, Death during the year 1919. CAUSES OF DEATH. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. Total Deaths whether of Residents ' or "NonResidents' in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 634 43 6 22 24 28 101 134 276 74 Uncertified — — — — — — — — - — Enteric Fever — — — — — - — - - Small-pox — — — — — — — — - - Measles 2 — - 1 1 — - - - - Scarlet Fever 1 — - — — — 1 - - 1 Whooping Cough — - - — — — — — — — Diphtheria and Croup 8 - — 6 2 — — — — 8 Influenza 62 1 — 3 5 2 24 13 14 6 Erysipelas 2 — — — — — 1 1 — — Phthisis (Pulmonary Tuberculosis) 42 — — 1 — 8 22 9 2 — Tuberculous Meningitis 3 — — 2 1 — — — — — Other Tuberculous Diseases 6 — — - — 1 1 3 1 — 43 Cancer, malignant disease 80 - - - - 1 9 35 35 10 Rheumatic Fever 1 — — — 1 — — — — — Meningitis 2 — — 1 1 — — — — 1 Organic Heart Disease 65 — — — 1 — 5 18 41 4 Bronchitis 57 5 1 l — 1 2 6 41 2 Pneumonia (all forms) 40 5 3 5 2 4 9 5 7 1 Other Diseases of Respiratory organs 8 1 — — — — 2 1 4 — Diarrhoea and Enteritis 5 4 1 — — — — — — — Appendicitis and Typhlitis 4 — — — 2 1 — 1 — — Cirrhosis of Liver 1 — — — — — 1 — — — Alcoholism 1 — — — — — 1 — — — Nephritis and Bright's Disease 24 — — — 1 — 4 5 14 5 Puerperal Fever 2 — — — — — 2 — — 1 Other accidents and diseases of Pregnancy and Parturition 1 - - - - 1 - - - 1 Congenital Debility and Malformation, including Premature Birth 18 17 1 - - - - - - 1 Violent Deaths, excluding Suicide 22 1 — 2 1 3 2 3 10 2 Suicides 3 — — — — — 1 2 — — Other Defined Diseases 173 8 — — 6 6 14 32 107 31 Diseases ill-defined or unknown 1 1 — — — — — — — — Totals 634 43 6 22 24 28 101 134 276 74 Sub-entries included in above figures. Cerebro-spinal Meningitis - - - - - - - - - - Poliomyelitis — — — — — — — — — — Bronchopneumonia 12 2 l 2 — — 3 2 2 - 44 BOROUGH OF WIMBLEDON. TABLE IV. Infant Mortality during the Year iqiq. Nett Deaths from stated Causes at various ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3 4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Y ear. All Causes Certified 14 4 1 3 22 3 8 8 2 43 Uncertified — — — — — — — — — — Small-pox — — — - — — — — — - Chicken-pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet fever — — — — — — — — — — Whooping-cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — 45 Convulsions — — - - — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — — — — 1 3 1 5 Pneumonia (all forms) — — — — — — I 3 1 5 Diarrhœa — — — — — - 1 — — 1 Enteritis — 1 — 1 2 — 1 — — 3 Gastritis — — — 1 1 — — — — 1 Syphilis — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlying . — — — — — — — —- — — Injury at Birth — — — — — — — — — — Atelectasis — — — — — — — — — — Congenital Malformations 1 — — — 1 — — — — 1 Premature Birth 6 1 - 1 8 — - — — 8 Atrophy, Debility and Marasmus 3 2 — — 5 1 — — — 6 Other causes 4 — 1 - 5 2 4 2 — 13 Totals 14 4 1 3 22 3 8 8 2 43 ( legitimate ... 814. | legitimate infants ... 34. Nett Births in the year ' Nett deaths in the year of -! ^ illegitimate... 47. V illegitimate infants ... 9. TABLE V. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision ot the Inspectorial Staff:— Accumulations Removed 21 Cisterns Provided 3 Cisterns Repaired, Cleansed or Covered 25 Drains, New Provided 22 Drains, Repaired or Altered 51 Drains, Stoppage Removed 67 Dustbins Provide 147 Flushing Boxes, New Provided 28 Flushing Boxes, Repaired 120 Manure Receptacles, Provided 1 Overcrowding Nuisances Abated 2 R.W. Pipes Disconnected 12 Roofs Repaired 76 Rooms Disinfected 595 Rooms Stripped and Cleansed 549 Soil Pipes, New Provided 8 Soil Pipes, Repaired or Altered 10 Ventilating Pipes, New Provided 20 Ventilating Pipes, Repaired or Altered 16 Waste Pipes, New Provided 28 Waste Pipes, Repaired, Disconnected, or Trapped 34 Water Closets, New Provided 67 Water Closets, Repaired or Ventilated 32 Water Services Restored 29 Yards Cleansed 4 Yards Paved 24 Guttering Repaired 87 Floors Ventilated 32 Nuisances Abated from Damp Walls 108 Water taken direct from Main 1 Other Nuisances 429 Total 2,648 46 Borough of Wimbledon. EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1919. To the Members of the Education Committee of the Ho rough of Wimbledon. Ladies and Gentlemen. I beg to present my Annual Report for tlie year 1919 with regard to the Medical Work accomplished in the Public Elementary Schools in Wimbledon. Tlie Age-Groups examined have been:— 1. Entrants, ages 5 or over; 2. Intermediates, ages 8-9; 3. Leavers, ages 12 or over. The Staff. On 28th April, Nurse Cracknell and Nurse Holman resumed their duties after four years' service in the Army. The work in connection with the treatment and inspection of children and the increased work in the Dental and Ophthalmic Departments have taken up a considerable amount of time, and I think it will be necessary at no distant date to give some extra nursing assistance in order that the following up of cases may be fully carried out. Mrs. Potts now gives her whole time to tlie examination of heads and bodies for nits and vermin. 119 cases were cleaned by her and returned to school. 47 General description of the arrangements which have been made for the co-relation of the School Medical Service and the Public Health Service and for the organization and supervision of Medical Inspection and an account of the methods adopted. (a) Dr. Nash, the Medical Officer of Health and School Medical Officer, returned from his services in the Army in April last and kept his post till October, when he resigned his appointment. The medical work in connection with the schools was carried out by me during the whole year. (b) Metlwd of Inspection.-The Inspection took place at the schools except— 1. Haydon's Road School; 2. Russell Road School; where no suitable accommodation for Medical Inspection is provided. Children from these schools were examined at the School Clinic, Southey Road. Parents of those children who were found to have serious defects on Medical Inspection and who failed to attend at the examination had Appointment Cards sent them, asking them to come to the Clinic to see me. Others were referred to the School Nurses in order to get the necessary treatment carried out. The Clinic was open every morning between 9 and If) o'clock for routine treatment, and any additional cases were referred by the school teachers for diagnosis. Thursday afternoons were devoted to Special Examinations and to children kept under observation for various diseases. (c) The following table shows the number of children in attendance at the Clinic during the year:— Complaint. No. of Cases. Tonsils and Adenoids 127 Defective Vision 149 Skin Diseases 429 Ringworm, X-ray 18 Head and Body 57 Ear Disease 99 External Eye Disease 76 Malnutrition (including pre-Tubercular) 126 Heart Disease 65 Other Complaints 585 1,731 48 Of course these figures do not represent the actual attendances at the Clinic. Special treatment was carried out for Teeth, Eyesight and Ringworm. There is no arrangement at present for treating cases of enlarged Tonsils and Adenoids; they are, however, referred to the local hospitals. One hundred and thirty-two were treated, and at the end of the year seventy were outstanding. In my opinion some arrangement should l>e made either with the local hospitals or with practitioners who are willing to undertake these operations for the prompt treatment of these cases. Ceneral statement of the extent and scope of the School Medical Inspection carried out during the year. 1. Visits paid to the Schools—171. 2. The following groups of children were examined:— (a) Entrants under the Code; Leavers under the Code; Intermediates under the Code; Children at the Special School. (b) Children whose names appear in the Medical Officer's Book in each class and who have been seen at Classroom Inspection. 3. The number of children medically examined during the year was—2,324. 4. Time occupied by Inspection.—The average number of children examined per hour is 10. Facts disclosed by Medical Inspection under the headings contained in the Schedule to Circular 974, are shown in the Return. 1. Clothing and Footgear.—I am glad to say that on the whole the average condition of the above was good in tlie Wimbledon Schools. 2. Cleanliness and Condition of Head and Body.—There seems to be a distinct improvement in the standard of cleanliness and condition of heads and bodies. 49 METHODS EMPLOYED OR AVAILABLE FOR THE TREATMENT OF DEFECTS FOUND. The same agencies were available in tlie district during 1919 as in the previous year. I Review of the methods adopted and the adequacy of such methods for dealing with the Blind, Deaf, Mentally Defective and Epileptic Children under the Acts, 1893 and 1899. Mentally Defective. The School for Mentally Defective Children at Queen's Road has been full during the year. The admission number was 14. Mental Deficiency Act, 1913. The following number of children were certified under the Act: — Schedule B.—9 boys and 5 girls. 2 children were passed on to the ordinary elementary school; 1 boy was passed out under Schedule D; 2 children were granted permission to leave school; 1 child left without permission and was notified to the Local Authority; 2 children left on reaching the school age. Oplitlialm ic Department. Dr. Cowie has devoted one afternoon each week to this work during the School terms. On an average six new cases were seen every week. In the first instance the cases were referred by the School Medical Officer. Number of cases referred for treatment 276 for whom glasses were provided 235 for whom other treatment was provided 6 for whom treatment was not necessary 4 who refused treatment 5 left school and district 26 carried to next year 88 50 Dental Department. The following table shows the work carried out during the year:— Total number of children inspected (ages 5-14) 1,364 Xumber of children referred for treatment ... 1,2.17—89.22% ,, sound 147—10.78% ,, who refused treatment 156—12'8 % ,, referred to hospital 1— .07% Number of Extractions. 1. Permanent Teeth 315 2. Temporary Teeth 3,388 Number of Fillings. 1. Permanent Teeth 414 2. Temporary Teeth 319 The number of cases carried to next year was 87. I am, Your obedient Servant, D. A. BELILIOS, School Medical Officer. 51 TABLE I. NUMBER OF CHILDREN INSPECTED (1st Jan.31st Dec., 1919.) A.— "Code" Groups. Ages. Entrants 5-7. Intermediates 8-9. Leavers 12-14. Grand Total. Boys 437 414 337 1,188 Girls 407 356 373 1,136 T otal 844 770 710 2,324 B.—Groups other than "Code." Special Cases. Re-examinations. Boys 354 — Girls 430 - Totals 784 3,592 52 TABLE II. TREATMENT OF DEFECTS OF CHILDREN FOUND AT MEDICAL INSPECTION. 1919. CONDITION. No. of defects found. No. of defects treated, receiving treatment, or under observation. No. of defects not treated, or parents refuse treatment. Percentage of defects treated. Nutrition 58 53 5 91.55 Nose and Throat 248 132 116 53.83 External Eye Disease 13 13 - 100.0 Vision and Squint 344 135 209 39.24 Ear Disease 20 20 — 100.0 Hearing 17 17 — 100.0 Heart and Circulation. 114 65 49 57.01 Lungs 52 23 29 44.23 Nervous System 6 — 6 — Skin 8 8 — 100.0 Rickets 6 — 6 - Deformities 14 4 10 28.57 Tuberculosis (non-pulmonary) 16 12 4 75.0 Speech 20 1 19 5.0 Total 936 483 453 The small percentage of treatment for eases of Defective Vision and Squint, and Nose and Throat, is mainly due to the number carried forward to 1920. TABLE III. 1. The total number of children Medically Inspected (irrespective of " Code " Groups) 2,324 2. The number of children in (1) suffering from defects, who quire to be kept under observation (but not referred for treatment) ... ... ... ... ... ... ... 295 3. The number of children in (1) who were referred for treatment 651 4. The number of children in (3) who received treatment for one or more defects ... ... ... ... ... ... ... 318 53 RETURN OP MEDICAL INSPECTION, 1919. Condition. Entrants. Intermediates. Leavers. Total. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Percent. Boys. Girls. Total. Per Cent. TOTAL INSPECTED 437 407 844 — 414 356 770 — 337 373 710 1188 1136 2324 - UNCLEAN- LINESS. 1. Head 1 17 18 213 5 14 19 2.47 4 9 13 183 10 40 50 2.15 2. Body 16 24 40 4-74 25 12 37 4.8I 12 11 23 3-24 53 47 100 - SKIN. Ringworm 1 Head - - - - 1 - 1 0.13 - - - - 1 - 1 0.04 2. Body — 1 1 0.12 1 1 0.04 Scabies - - - - - - - - - - - - - - - - Impetigo 2 — 2 0.24 - - — — 1 — 1 0.14 3 — 3 0.13 Other Disease 1 1 2 0.24 1 — 1 0.13 — — — — 2 1 3 0.13 NUTRITION. Satisfactory 422 404 826 97.87 393 352 745 96.75 328 367 695 97.89 1143 1123 2266 97.5 Unsatisfactory 15 3 18 2.13 21 4 25 3.25 9 6 15 2.11 45 13 58 2.5 EYES. Def ecti ve Vision 10 13 23 2.71 61 53 114 14.81 62 83 145 20.42 133 149 282 13.85 Squint 11 15 26 3.08 8 12 20 2.6 10 6 16 2.25 29 33 62 2.67 External Eye Disease 1 4 5 0.59 — — — — 5 3 8 112 6 7 13 0.56 EARS. Defective Hearing 2 3 5 0.59 3 1 4 0.52 4 4 8 1 12 9 8 17 0.77 Ear Disease 8 4 12 1.42 4 3 7 0.9 — 1 1 0.14 12 8 20 0.86 NOSE. THROAT. EnlargedTonsils 42 37 79 9.36 42 27 69 8.96 19 12 31 4.37 103 76 179 7.7 Adenoids 18 21 39 4.62 14 11 25 3.25 4 1 5 0.7 36 33 69 2.97 SPEECH. Defective 5 2 7 0.83 9 - 9 117 2 2 4 0.56 16 4 20 0.86 HEART. Organic 8 7 15 1.78 10 9 19 2.47 5 6 11 1.55 23 22 45 1.93 Functional 6 3 9 1.07 10 6 16 2.08 — 1 1 0.14 16 10 26 1.12 Anaemia 9 7 16 1.89 2 13 15 1.96 2 10 12 1.69 13 30 43 1.85 LUNGS. Tuberculosis 1. Suspected 4 — 4 0.47 1 — 1 0.13 1 1 2 0.13 6 1 7 0.3 2. Definite — — — — — 1 1 0.13 — — - — — 1 1 0.04 Bronchial Catarrh 19 9 28 3.31 5 6 11 1.43 3 1 4 0.56 27 17 44 1.89 Other Diseases - - - - - - - - - - - - - - - - NERVOUS SYSTEM. Epilepsy 1 - 1 012 - - - - 1 — 1 0.14 2 — 2 0. 09 Chorea 1 1 2 0.24 — 1 1 0.13 — — - — 1 2 3 0.13 Other Diseases - - - - - - - - 1 — 1 0.14 1 1 0.04 TUBERCULOSIS (NON. PULMONARY). Glandular 3 1 4 0.47 2 - 2 0.26 3 2 5 0.7 8 3 11 0.47 Bones & Joints 1 — 1 0.12 2 — 2 0.26 — — — — 3 — 3 0.13 Other Forms — 1 1 0.12 — 1 1 013 — — — — — 2 2 0 09 Rickets marked 2 1 3 0.36 2 - 2 0.26 — 1 1 0.14 4 2 6 0.26 Deformities present 3 1 4 0.47 3 1 4 0.52 4 2 6 0.84 10 4 14 0.64 Other Diseases and Defects 15 12 27 3.2 7 7 14 1.82 6 9 15 211 28 28 56 2.41