WIM 44 Borough of Mimblebon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year ended 31st December, 1920. PUBLIC HEALTH COMMITTEE, 1919. Chairman. Councillor H. E. HlCKOX. Vice-Chairman. Councillor j. T. MORRIS. Members. The Mayor (Alderman D. Stuart). Alderman J. S. H. Abbott. Councillor T. Oates. „ G. Clement „ Miss G. Richardson Evans. Councillor G. Ralls. „. nunneley. H. Dormer. „ t. Bell. „ D. McNeil. „ G. Porter. STAFF. Medical Officer of Health; School Medical Officer; Medical Supt. of Isolation Hospital; Bacteriologist and Analyst. David A. Belilios, D.P.H. Assistant Medical Officer of Health, and Assistant School Medical Officer. Effie Craig, M.B., Etc. Chief Inspector. * † Henry Johnson. Inspectors. * † R. T. Avis * † D. H. PICKARD, M.C. * † D. F. S. Flynn. Health Visitors. * §|| Miss P. Hulse. § || •1 Miss M. Giles. I Miss H. Hurst. Temporary Clerks. Miss D. L. PlCKNELL. Miss N. Low. MATERNITY AND CHILD WELFARE DEPARTMENT. Clerk. Miss M. A. Weller. * 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 Midvvives Board. II Certificate of the Royal Sanitary Institute for School Nurse and Health Visitor. •1 Certificate of Sanitary Inspectors' Examination Board for Sanitary Inspector. : Health Visitor's Diploma, Batteraea Polytechnic. Borough of Wimblebon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE Year Ended 31st December, 1920. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Ladies and 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 1920. The returns of vital statistics and infectious diseases are appended in Tables I., II., III., and IY. Population.—The calculations for the deaths and other rates in the Tables of this Report are based on an estimated population of 62,311 for the birth-rate, and 62,174 for the 3 Population, Birth and Death Rates for each Ward, 1920. WARD. Factor Population. Birth Rate. Death Rate. For Birth Rate. For Death Rate. Wimbledon Park 419 11216 11191 12.3 7.4 St. Mary's St. John's 4.68 5608 5596 11. 05 8.2 Cottenham Park 4.34 7478 7461 12.01 9. 2 North Wimbledon 4.34 24302 24248 11.9 8.1 Dundonald 4.11 8100 8083 17.1 9. 03 Trinity 4 .59 13085 13056 22. 08 10.4 South Park 4.36 16824 16787 24. 07 8.8 Haydon Park South Wimbledon 4.25 38009 37926 21.9 9.4 Whole District 4.36 62311 62174 18. 03 8.9 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.—The number of births registered was 1,124 (593 males, 531 females), which is 255 more than last year, and equal to a birth-rate of 18'03, which shows an increase on last year's figure 13'9, and is 2 83 above the average for the previous five years. The corrected birth-rate, produced by transferable births notified to us by the Registrar-General, is 18'3. The corresponding rate for England and Wales for the same period is given as 25'4. 4 death-rate, which are the figures given by the RegistrarGeneral. The population at the Census of 1911 was 54,875. The rates for the respective Wards of the district were as follows: — Wimbledon Park and St. Mary's 123 St. John's 11.05 Cottenham Park 12.01 Dundonald 17.1 Trinity 22.08 South Park and Haydon Park 24.07 As will be 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 462 (208 males, 254 females), equal to a death rate of 7 4 per thousand of the population per annum. This is lower than last year's figure (8'5). The deaths occurring outside the district of persons belonging to this Borough were 153, viz. :— Kingston Union Infirmary 66 Brookwood Asylum, Woking 4 Nelson Hospital, Merton 10 Others 73 153 The deaths occurring within the district of persons not belonging thereto were 58, viz.:— Atkinson Morley Convalescent Hospital 2 North Wimbledon Hospital 3 Isolation Hospital 3 Others ... 50 58 After taking these into account, the total number of deaths properly belonging to the district is found to be 557, and the death-rate 8 9. The rate for England and Wales for the same period was 12'4. The standardised death-rate for the year is 9 07. This is obtained bv multiplying the net death-rate by the factor for correction, 10196, 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. 5 In addition to the deaths from Zymotic Diseases, the principal causes of death were as follows:— Pneumonia (all forms) 39 Bronchitis 33 Other Respiratory Diseases 8 Cancer 62 Phthisis 40 Other forms of Tuberculosis 5 Nephritis and Bright's Disease 10 Congenital Debility and Malformation (including Premature Births) 34 Organic Heart Disease 66 For the purpose of comparison the following Table is compiled from the returns of the Registrar-General: — Vital Statistics for 1920 (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 25 .4 12.4 80 96 Great Towns 26.2 12.5 85 148 Smaller Towns 24.9 11.3 80 WIMBLEDON 18.3 8.9 62 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. 6 Table A. 1920 1919 1918 1917 1916 1915 Births 1144 861 759 868 1011 1000 Deaths 557 634 742 658 619 496 Death-rates 8.9 10.6 14.5 12.1 11.1 8.7 DEATHS— Under 1 year 71 43 58 74 74 60 Oyer 1 year and under 65 years 279 315 439 339 290 243 Above 65 years 207 276 245 245 255 193 From Measles 6 2 5 35 4 9 ,, Scarlet Fever 2 1 0 0 2 1 „ Small Pox 0 0 0 0 0 0 ,, Diphtheria 12 8 7 12 9 8 ,, Diarrhoea 7 5 10 16 10 22 „ Whooping Cough 2 0 12 1 6 5 „ Enteric Fever 0 0 1 3 2 2 ,, Puerperal Fever 0 2 1 1 1 0 „ Erysipelas 2 2 1 0 0 1 „ Influenza 8 62 144 16 9 16 Table B. DISEASES. 1920 1919 1918 1917 1916 1915 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 0 0 4 0 Diphtheria 123 12 86 8 111 7 82 12 129 9 118 8 Erysipelas 30 2 20 2 13 1 18 0 21 0 29 1 Scarlet Fever 230 2 119 1 73 0 43 0 52 2 187 1 Enteric Fever 3 0 14 0 12 1 9 3 4 2 13 2 Puerperal Fever 3 0 5 2 4 1 1 1 2 1 2 0 Totals 389 16 244 13 213 10 153 16 208 14 353 12 7 Table C. Year Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria " Fever." Whooping Cough. Measles. Diarrhoea. Phthisis and other Tuberc'los Diseases. 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 .02 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 1920 .46 — .03 19 — .03 .09 .11 .72 The figures given in these Tables are those obtained after correction by exclusion of " Non-Residents " and the inclusion of "Residents" beyond the district. Small-pox.—No cases were notified during the year. Scarlet Fever.—The total number of cases notified during the year was 230 from 184 houses, as against 119 and 73 for 1919 and 1918 respectively. The attack-rate was 3'6 per thousand of the population. In one house there were 5 cases, in three houses 4, in nine houses 3, in fourteen houses 2, and in the remainder 1 each. There were two deaths, corresponding to a death-rate of .03 per thousand of the population. The disease occurred in the following numbers at the various ages:— Under one 2 One to five 30 Five to fifteen 147 Fifteen to twenty-five 30 Twenty-five to forty-five 17 Forty-five to sixty-five 4 The following was the Ward incidence:— Wimbledon Park 11 Removed to Hospita 9 Attack Rate 21 St. Mary's 13 „ „ 6 St. John's 9 „ „ 7 1.6 Cottenham Park 9 „ „ 6 1.2 Dundonald 27 „ „ 27 3.3 Trinity 74 „ „ 70 5.6 South Park 38 „ „ 30 5.1 Haydon Park 49 „ „ 49 ft u 230 „ „ 204 3.6 Percentage of cases : North Wimbledon 18.3%. 1 South Wimbledon 81.7% 8 The average attack and death-rates for the last six quinqueunial periods were as follows:— Attack Rate. Death Rate. 1891-1895 4. 8 .02 per thousand of the population. 1896-1900 3.3 .04 1901-1905 2.3 .02 1906-1910 4. 07 .05 1911-1915 3. 03 .01 1916-1920 1.8 .01 Two hundred and one, or 87.3 per cent, of the patients were treated at the Isolation Hospital. Sixty-four per cent, of the cases notified were children of school age, five to fifteen years, and of these 142 attended the following schools:— Cottenham Park School 1 Effra Road Girls' and Infants' Schools 12 Durnsford Road Mixed and Infants' Schools 2 Queen's Road Girls' and Infants' Schools 15 Queen's Road Boys' School 8 Pel ham Road Boys' School 4 Pelham Road Girls' and Infants' Schools 13 Haydon's Road Girls' and Infants' Schools 27 Haydon's Road Boys' School 17 Central Mixed School 1 Central Infants' School 1 Dundonald Road Boys' School 1 Dundonald Road Girls' and Infants Schools 6 Russell Road Mixed School 6 Russell Road Infants' School 4 Private Schools 18 Schools outside the district 6 142 Diphtheria.—The total number of cases notified during the year was 123 from 97 houses, as against 86 and 111 for 1919 and 1918 respectively. The attack-rate was 1.9 per thousand of the population. There were twelve deaths, corresponding to a death-rate of .19 per thousand of the population. In two houses there were 4 cases, in three houses 3, in fourteen houses 2, and in the remainder 1 each. 9 The cases occurred in the following numbers at the various ages :— Under one 2 One to five 26 Five to fifteen 69 Fifteen to twenty-five 17 Twenty-five to forty-five 7 Forty-five to sixty-five 2 The following was the Ward incidence:— Wimbledon Park 7 Removed to Hospital 5 Attack Rate 1.1 St. Mary's 6 „ „ 4 „ „ St. John's 8 „ „ 7 „ „ 1.4 Cottenham Park 18 „ „ 14 „ „ 2.4 Dundonald 8 „ „ 7 „ „ .9 Trinity 36 „ „ 36 „ „ 2.7 South Park 16 „ „ 16 „ „ 2.03 Haydon Park 24 „ „ 24 11 „ 123 113 1.9 Percentage of cases : North Wimbledon 31 7 per cent. ; South Wimbledon 68 3 per cent. One hundred and nine, or 88'6 per cent, of the patients were treated in the Isolation Hospital. Fifty-six per cent, of the cases notified were children of school age, five to fifteen years, and of these, 61 attended the following schools:— Queen's Road Girls' and Infants' Schools 8 Queen's Road Boys' School 3 Haydon's Road Boys' School 1 Haydon's Road Girls' and Infants' Schools 16 Central Infants' School 1 Central Mixed School 2 Dundonald Road Girls' and Infants' School 3 Dundonald Road Boys' School 1 Durnsford Road School 4 Effra Road Girls' and Infants' Schools 5 Russell Road Schools 2 Pelham Road Boys' School 1 Private Schools 12 Schools outside the district 2 61 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% 50% 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% 1897 43 Nil. Nil — 43 7 16.2% 11 16.2% 1898 60 Nil. Nil. - 60 7 11. 6% 15 11% 1899 64 Nil.; Nil. — 64 12 18.7% 1.5 18.7% 1900 64 2 Nil. Nil. 62 10 16.1% 14 15.6% 1901 60 38 3 7. 9% 22 3 13. 6% 14 10% 1902 80 29 6 20. 7% 51 1 1.9% 1.8 8.7% 1903 58 35 1 2.8% 23 3 13% 1 2 6.9% 1904 36 27 5 18.5% 9 1 11.1% .7 166% 1905 39 25 2 8% 14 Nil Nil. 8 5.1% 1906 55 28 3 l0.7% 27 6 22.2% 11 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% 17 9.5% 1909 90 67 3 4. 4% 23 4 17.3% 16 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. 11 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. 209 7 6% 1916 129 109 10 9.1% 20 1 5% 2.3 7.7% 1917 82 72 11 15.2% 10 1 10% 15 146% 1918 111 90 7 7 7% 21 Nil. Nil. 2.1 6.3% 1919 86 77 7 909% 9 1 111% 13 93%; 1920 123 113 12 106% 10 Nil. Nil. 19 9.7%| 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. Bacteriological examination and the use of Anti-Toxin first adopted in Wimbledon. Iron Hospital, Durnsford Road, in use except for Diphtheria. Present Hospital, Gap Rond, opened December, 1900. 1890—1895 Average Attack Rate .8 Average case Mortality Rate 371% 1896-1900 „ „ „ 1. „ „ „ „ 14.% 1901-1910 „ „ „ 1.2 „ „ „ „ 91% 1911-1920 „ „ „ 1.1 „ „ „ 7.5% 11 Enteric or Typhoid Fever.—-During the year three persons in three different houses were notified as suffering from this disease, equal to an attack-rate of "04 per thousand of the population. The following was the Ward incidence:— St. Mary's 1 Dundonald 1 South Park 1 The cases occurred at the following times:— January 1 May 1 December 1 There were no deaths. Puerperal Fever.—Three cases were notified during the year, which is equal to an attack-rate of '04 peT thousand of the population. Two of the cases were treated at the Isolation Hospital and recovered. There were no deaths. Whooping Cough.—There were two deaths from this disease, corresponding to a death-rate of .03 per thousand of the population. Erysipelas.—There were 30 cases notified during the year, from 30 houses, corresponding to an attack-rate of .48 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 eight deaths, corresponding to a death-rate of 12 per thousand of the population. Last year there were 62 and in 1918 there were 144. The deaths were distributed through the Wards as follows:— Wimbledon Park 0 St. Mary's 3 St. John's 1 Cottenham Park 1 Dundonald 2 Trinity 0 South Park 0 Haydon Park 1 12 Influenzal or Acute Primary Pneumonia.—Eleven cases were notified during the year, corresponding to an attack-rate of 17 per thousand of the population. Measles.—There were six deaths from measles during the year, which is equal to a death-rate of .09 per thousand of the population, as compared with 2 deaths last year and 5 the previous year, with a death-rate of 03 and .09 respectively. The deaths occurred at the following times:— April 1 May 2 June 2 November 1 The following was the Ward incidence:— Dundonald 1 Trinity 3 South Park 1 Haydon Park 1 Phthisis and other Tuberculous Diseases were the assigned causes of the deaths of 45 persons (23 males, 22 females) during the year, equal to a death-rate of .72 per thousand of the population. Last year there were 51 deaths, and the previous year 65. The total number of cases notified during the year was 165:— 79 being primary notifications of Pulmonary Tuberculosis. 7 being primary notifications of other forms of Tuberculosis. 79 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 — — 4 25 38 11 1 79 Other forms — — 4 1 2 — 7 The following was the Ward incidence:— Wimbled'n Park. St. M'ry's St. John's Uottenham Park. Dundon'ld Trinity South Park. Haydon Park. Total Pulmonary 4 13 5 5 18 19 6 9 79 Other forms 1 — — — 2 2 1 1 7 13 The following particulars were found on investigation concerning the cases notified:— Sputum examined 60.7 per cent. Positive 33.4 per cent Negative 22'9 per cent. Result not known 43.8 per cent History of consumption in family 20.2 per cent. Patient working at time of notification 15.06 per cent. In regular work 13.9 per cent. Irregular 1.2 per cent. Average size of house 51 rooms. Average population per house, Adults 3 3, Children 12. The treatment which had been obtained previous to notification was : — PULMONARY. Private Practitioners 32 Private Practitioner and Hospital 15 Private Practitioner and Sanatorium 13 Infirmary 1 Hospital 11 OTHER FORMS OF TUBERCULOSIS. Private Practitioner 3 Private Practitioner and Hospital 4 The other forms of Tuberculosis notified were:— Knee 1 Lupus 2 Cervical Glands 2 Kidney 1 Spine1 INSURED PATIENTS. Men. Average age 32.3 years. Married 17 Average age of those receiving Sanatorium treatment 32.6 years. W omen. Average age 28.5 years. Married 10 Average age of those receiving Sanatorium treatment 27.3 years. 14 Anthrax.—No cases were notified during the year. Ophthalmia Neonatorum.—Six cases occurred during the year, one of which was treated at the Isolation Hospital. The other five were visited by the Health Visitors. They were all under treatment by medical practitioners in the district and in no case was the vision impaired. Encephalitis Lethargica.—One case was notified during the year, equal to an attack-rate of .01 per thousand of the population. There was one death, corresponding to a death-rate of 01 per thousand of the population. Malaria.—Twelve notifications were received during the year, which is equal to an attack-rate of .19 per thousand of the population. Dysentery.—No notifications were received during the year. Meningitis.—No notifications were received during the year. Poliomyelitis.—One case occurred during the year, corresponding to an attack-rate of 01 per thousand of the population. There was one death, corresponding to a death-rate of '01 per thousand of the population. Cancer.—During the year 62 deaths have been registered as due to the different forms of malignant disease or Cancer (19 males, 43 females). The death-rate for the year was '99, as against 1'3 last year and 105 in 1918, the average for the past five years being 1'2. The distribution of the deaths through the Wards was as follows:— Wimbledon Park 6 Attack Rate 1.1 St. Mary's 7 „ „ St. John's 9 „ „ 1.6 Cottenham Park 7 „ „ .9 Dundonald 4 „ „ .49 Trinity 10 „ „ .76 South Park 16 „ „ 1.1 Haydon Park 3 „ „ 15 The following table shows the different parts of the body invaded, and the age incidence:— Part Affected. M ale. Female. Total. Age Incidence. Male. Female. Total. Stomach and Bowels 9 16 25 Under 35 years - 1 1 Liver 2 4 6 35 to 40 „ - - Urinary and Generative Organs 1 6 7 40 to 45 ,, 1 3 4 Tongue, Neck and Throat 5 1 6 45 to 50 ,, 2 7 9 50 to 55 ,, 2 6 8 Breast - 10 10 55 to 60 ,, 1 4 5 Other Parts 2 6 8 60 to 65 ,, 4 7 11 65 to 70 ,, 5 7 12 70 to 75 „ 2 2 4 75 to 80 ,, 2 2 4 80 and upwards 4 4 Total 19 43 62 Total 19 43 62 Ward. Male. Female. Total. Wimbledon Park 1 5 6 St. Mary's '2 5 7 St. John's 2 7 9 Cottenham Park 3 4 7 Dundonald 3 1 4 Trinity 4 7 11 South Park 4 12 16 Haydon Park - 2 2 Total 19 43 62 16 Diarrhœa and Enteritis were responsible for 7 deaths, corresponding to a death-rate of .11 per thousand of the population. The deaths were distributed through the Wards as follows:— Wimbledon Park 0 St. Mary's 1 St. John's 0 Cottenliam Park 0 North Wimbledon 1 Dundonald 0 Trinity 2 South Park 3 Haydon Park 1 South Wimbledon 6 Infantile Mortality.—There were 71 such deaths during the year (including transferable deaths), or 62 per thousand registered births, showing an increase of 12 on last year's rate, when there were 43 deaths and a rate of 50. The previous year there were 57 deaths, and the rate was 76. The average for the past five years is 70. The infantile mortality rates for the different Wards are as follows:— Wimbledon Park 67.8 St. Mary's 75.9 St. John's 32.2 Cottenham Park 76.9 Dundonald 79.1 Trinity 62.2 South Park 32.3 Haydon Park 94.9 Twenty-five babies, or 35.2 per cent, of the total deaths, failed to survive the first week of life, and 40 the first month. Notification of Births Act, 1907.—During the year 941 births were notified by the following persons:—Parents 128, Midwives 677, Doctors 106, and other persons 30. During the same period 1.124 births were registered. 17 The number of infants visited was 658, in the following Wards:— Wimbledon Park 9 St. Mary's 2 St. John's 14 Cottenham Park 16 Dundonald 115 Trinity 290 South Park 49 Haydon Park 163 The number of re-visits made was 5,924. Average size of house visited, 5'4 rooms. Average rental, 12s. 4d. per week. Visits paid by Health Visitors:— Tuberculosis visits 135 Ophthalmia Neonatorum 7 Measles 0 Puerperal Fever 3 Influenzal Pneumonia 3 Malaria 11 Special visits 854 Still-birth and death from premature birth inquiries 14 Ineffectual visits (unanswered calls) 750 MATERNITY AND CHILD WELFARE. Infant Feeding:— Breast fed 522 Mixed feeding 50 Artificially fed 76 REPORTS OF INFANT WELFARE CENTRES. Wandle Park House. Number of infant consultations held 51 Total number of attendances 2081 Total number seen by doctor 1200 Average number of attendances 40.8 Number of new cases under one year 181 Number of new cases over one year 39 Classes for Mothers. Number of classes held 44 Total number of attendances 1080 Average number of attendances 24.5 Subjects taught:— Motliercraft. Elementary Physiology. Moral training of boys and girls. Health talks (general). 18 DUNDONALD HALL. Number of infant consultations held 51 Total number of attendances 1546 Total number seen by doctor 978 Average number of attendances 30.8 Number of new cases under one year 136 Number of new cases over one year 22 Classes for Mothers. Number of classes held 46 Total number of attendances 373 Average number of attendances 8.6 Subjects taught:— Mothercraft. Moral training of boys and girls. Home nursing. DENTAL CLINIC. During the year the following work was carried out: — Number of Dental Clinics held 38 Mothers. Children. Total number of attendances 161 67 Number treated 14 33 Number refused treatment 4 5 Number of times treated with local anaesthetics 59 Number of times treated with gas 25 33 Number carried forward 4 7 Dental treatment had been undertaken for children under five years of age, but treatment was extended to expectant and nursing mothers on 13th September, 1920. ANTE-NATAL CLINIC. The Clinic was opened on September 28th, 1920, at Wandle Park House. Total number of attendances 18 Average number of attendances 2.3 19 Milk (Mothers and Children) Order, 1919—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 194. Isolation Hospital.—The following Table gives the number of patients treated in the Hospital for each disease during the year:— Cases Admitted in 1920 Over 5 years. Under 5 yea rs. Total. DEATHS Remarks. Over 5 years. Under 5 years. Total. Scarlet Fever 248 41 289 2 1 3 Diphtheria 131 27 158 9 4 13 Daily average number of cases 49. Enteric Fever 3 — 3 - - — Puerperal Fever 2 - 2 — — — Measles 3 1 4 — — — Ophthalmia Neonatorum 1 1 - - - Uraemia 1 — 1 1 - 1 Scarlet Fever—Staff 1 — 1 — — — 389 70 459 12 5 17 Carried over from 1919 Average number of days in Hospital 39. Scarlet Fever 26 1 27 — — Diphtheria 14 1 15 — 1 1 Enteric Fever—Staff 1 — 1 — — Scarlet Fever—Staff' 1 1 — — — Total number of cases treated during 1920 431 72 503 12 6 18 By an arrangement with the Kingston Corporation cases of Scarlet Fever and Diphtheria were admitted to the Hospital during the year, 84 cases of Scarlet Fever and 50 cases of Diphtheria being treated. 20 Disinfection.— 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 558 507 96 892 1775 126 122 5564 294 9934 Diphtheria 115 126 55 285 496 41 13 1367 138 2636 Typhoid Fever 5 3 1 12 35 3 3 109 1 172 Erysipelas 12 14 5 24 42 2 — 156 14 269 Puerperal Fever 9 3 1 17 36 5 6 169 3 249 Tuberculosis 27 21 14 61 68 3 7 342 43 586 Cancer 16 10 10 79 30 2 - 72 11 230 Measles 26 10 - 28 74 3 1 220 7 369 Pneumonia and Influenza 9 4 3 18 18 — — 52 7 111 Scabies 4 1 1 7 88 1 13 54 2 171 Vermin 28 11 2 46 300 2 56 435 21 901 Sundries 26 9 7 58 74 4 4 288 252 722 Totals 835 719 195 1527 3036 192 225 8828 793 16350 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-nine bottles of anti-diphtheritic serum were supplied through the Public Health Department for use by medical practitioners for the treatment of Diphtheria. The anti-toxin syringe which is kept at the Fire Station was borrowed on one occasion by a medical practitioner in the district. 21 Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 324 1669 1993 Phthisis (Sputum) 16 114 130 Wasserman Tests 2 1 3 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 3 16 19 Mortuary.— From information received from the Superintendent of the Cemetery, there were 57 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 46 bodies, equal to 9.9 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 15 1 - Workshops 62 10 — Workplaces 23 3 — Total 100 14 — 22 Defects found. Nature. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 4 3 — — Want of Ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 15 14 — — Sanitary Accommodation— Insufficient 1 1 — — Unsuitable or Defective 7 7 — — Not Separate for Sexes - — — - Breach of Special Sanitary Requirements for Bakehouses - — — - Other Offences 1 1 — - Total 29 27 - — HOME WORK. Lists received:— Twice in the year 20 Number of Out-workers 36 Once in the year 24 Number of Out-workers 28 Number of addresses received from other Councils 46 Number of addresses forwarded to other Councils 16 Notices served on occupiers as to keeping or sending lists Prosecutions—Failing to keep Outworkers lists — Prosecutions—Failing to furnish lists Inspections of Out-workers' premises 25 Number of unwholesome premises 3 Notices served to remedy 2 23 REGISTERED WORKSHOPS. The following are the principal classes of workshops on the register at the end of the year:— Boot Repairing 49 Dressmaking 39 Bakehouses (including three Factory Bakehouses) 27 Laundries 42 Tailoring 20 Millinery 18 Dining Rooms 13 Cycles 13 Other trades 136 357 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 0 Action taken in matters referred by H.M. Inspector as remedial under the Public Health Acts Notified by H.M. Inspector 1 Reports of action taken sent to H.M. Inspector 0 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 21 houses for the following reasons:— 5 by request, 9 owing to arrears of rates, and 7 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). 24 Slaughter-houses:— In 1914. Jan., 1920. Dec., 1920. Registered 6 6 6 Licensed — 1 1 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, 1920, there were 3 Cowkeepers, 48 Dairymen, and 13 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 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 Clerk to the Kingston Union respecting Poor Law Relief in this district:— Amount of Out-relief paid during the year ended 31st December, 1920 £3284 13 6 Average weekly number of persons in receipt of relief 233 Number of persons admitted to the Guardians Institutions from the Wimbledon area 239 25 Housing, and Housing Town Planning Acts, 1909-1919.- Particulars under this heading 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 1920, as reported by the Sanitary Inspector:— Reason of Visit. No. Infectious Disease 892 House Inspection 3671 House to House Inspection 1953 Houses let in lodgings: Inspection 429 Inspection of Factories, Workshops, Workplaces and Outworkers' Premises 215 Common Lodging Houses: Inspection 32 Dairies and Cowsheds: Inspection 31 Inspections under Shop Acts 34 Application of Tests to Drains 235 Inspections under Diseases of Animals Acts 148 Obtaining Samples of Foods and Drugs 10 Miscellaneous (including inspections of food, slaughter-houses, mews, stables, caravans, smoke observations, measuring up, Petroleum Acts, water supply, 850 8,500 One thousand and fifty-two preliminary or informal notices were served in respect of 1,452 houses. Eighty-seven statutory notices were served in respect of 97 houses. The necessary work was executed in all but 44 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. Mv 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, Medical Officer of Health. 26 Borough of Wimblebon. SANITARY DEPARTMENT. ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE Year ended 31st December, 1920. 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, 1920. Table V. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.— One thousand and fifty-two Preliminary Notices or intimations were served during the year in respect of 1,452 houses. It was only found necessary to serve 87 Statutory Notices upon the owners or occupiers of 97 houses. In one instance only the owner failed, after repeated informal requests, to comply with the Statutory Notice requiring the remedying of certain nuisances. As a consequence, 27 legal proceedings were taken before the local Magistrates, the result being:— For failing to abate nuisance caused by— Defective roof and floor: Ordered to abate nuisance, and pay £2 2s. Od. costs. Opening up of Drains under Section 41 of the Public Health Act, 1875.— As the result of applications of the smoke or chemical tests, 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 11 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 re-construction or amendment of the defective drains, etc., as the circumstances required. House Drainage.— The drainage systems and sanitary arrangements of 15 houses have been entirely reconstructed, and extensive amendments or repairs were carried out at 38 other houses. House to House Inspection.— During the year house to house surveys were carried out at 544 houses. The following list shows the particular streets and the number of houses inspected in each:— Beehive Buildings 52 houses. Cowper Road 82 „ Church Road 60 „ Deburgh Road 99 „ Laburnum Road 34 „ Lancaster Cottages 8 „ Leyton Road 93 „ Oldfield Road 15 „ Ridgway 7 „ Sunnyside 5 „ Wandle Road 70 „ West Place 14 „ West Court 5 „ 544 „ In no case was it found necessary to serve a closing order: a list of the work carried out at the houses is included in Table V., p. 40. 28 House Inspection.- Either as the result of inspections made on complaint, in consequence of the occurrence of infectious disease, requests by occupiers and other general inspections, 835 houses were visited. Table V. shows a list of sanitary works executed at these houses, together with defects remedied during house to house inspection. Overcrowding.— Many houses formerly occupied by one family are now occupied by two or more families, and a considerable number of cases of overcrowding exist, but owing to the total cessation of the erection of dwelling houses it was impossible to take any steps other than the better distribution of the occupants in the respective rooms. Houses Let in Lodgings.— There are 67 of these houses on the Register, and 429 visits of inspection were made during the year. Verminous Rooms.— This matter has continued to receive the attention of the department, during the year 36 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, via., Nos. 42 and 188, High Street, South Wimbledon, for which Annual Certificates of Registration were granted from 1st January to 31st December, 1920. 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 most instances a verbal warning was sufficient to obtain compliance. Dairies, Cowsheds and Milkshops.— Six 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 five matters were discovered which required to be dealt with by the Department. 29 Infectious Disease and Disinfection.— During the year visits for the purpose of investigating cases of notifiable infectious disease were made to 399 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 98 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 408, and the number of articles, bedding, wearing apparel, etc., 15,557, 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, 92 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, 64 visits having been made to such premises during the year. Inspections under the Factory and Workshop Act, 1901.— Thirty inspections of factories were made during the year and one written notice served referring to sanitary conveniences and other nuisances. There are 357 workshops and work places on the Register, to which 185 visits of inspection were made. Seventy-four workshops and work-places were found to be closed and twenty-six new ones opened during the year. 30 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 22 to 24 of the Medical Officer of Health's Report. Shops Act, 1912-1913.— Thirty-four visits were made to the occupied shops in the district to ascertain if the provision of the Acts were being complied with. Slaughter-houses and Food Inspection.— The number of registered slaughter-houses remains the same as last year, viz., six. Two of these, however, have not been used for some considerable time. One licence for a new slaughter-house was granted for twelve months to the Borough Surveyor for a portion of the premises at the Council's Depot, Queen's Road, as empowered by Section 29 of the Public Health Acts (Amendment) Act, 1890. One hundred and ninety-two inspections have been made during the year whilst slaughtering was in progress, and as far as possible all animals killed in the town have been examined prior to being exposed for sale. In addition four hundred and twelve visits have been made 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, 385¾lbs. Beef, 1 hindquarter. Beef, 12st. 21bs. Brussel Sprouts, 561bs. Butter, 5671bs. Calves (unborn), 3. Carcases, 3 sheep. Cheese, 501bs. Condensed milk, 182 tins. Corned beef, 37¾lbs. Crabs, 16. Eggs, 180. Fish. 112st. 10lbs. Ham, cooked, 51bs. Lambs (unborn), 8. Liver, 1051bs. Lungs (cow's), 1. Mutton, 1621bs. Pig's pluck and fat, 1. Pork, 161bs. Potatoes, 2cwt. 231bs. Rabbits, 31. Salmon, 1 tin. Tomatoes, 4 boxes. Udder, 1. Winkles, 2 bags. 31 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, 1920. ARTICLES. Test Samples. No. Genuine. Adulterated or Inferior. Slightly inferior or Deteriorated. Milk 7 7 - - Butter 3 3 — — Total 10 10 — — 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, up to the middle of the year. Petroleum Acts.— Fifty-one applications were received for permission to keep petroleum, 46 being for the renewal of existing licences, and 5 for new ones. Fifty-eight 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 ten cases, sixteen horses being affected with the disease. Five of the infected horses were killed and the remaining eleven 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. 32 Swine Fever.— In October, illness occurred at the Council's piggeries at Durnsford Road. Two of the animals died, and on examination by the Veterinary Surgeon he certified them as being affected with Swine Fever. Information was promptly given to the Board of Agriculture, who confirmed the diagnosis and declared the premises an "infected place." As illness continued, after conference with the officers of the Board it was decided that fifty-one should be slaughtered. This was done, all the carcases examined, the healthy ones sold, and the affected ones destroyed by burning at the destructor. The remainder were inoculated, and from time to time as they became fit for slaughter were killed, examined and sold. At the end of the year forty-two healthy animals remained on the premises. 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. Rent (Restrictions) Act.— Under this Act, which only came into operation towards the end of the year, seven applications were received from occupiers of premises for inspections to be made of their premises, as they alleged that the premises were not in all respects reasonably fit for human habitation, or were otherwise not in a reasonable state of repair. Inspections of the premises were made and certificates granted in six cases. The necessary works were carried out in every instance, and no resort to the County Court by the tenant was necessary. 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. 33 BOROUGH OF WIMBLEDON. TABLE 1. Vital Statistics of Whole District during 1920 and Previous Years. YEAR. Population estimated to Middle of each Year. Births. Total 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. Rate per 1000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1915 56,409 1000 1001 17.7 496 8.7 23 157 71 71 630 11.1 1916 60,333 1007 1011 16.7 484 8.7 33 168 71 70 619 11.1 Birth-rate 55,451 Death-rate 1917 59,678 866 868 14.5 511 9.5 17 164 74 85 658 12.2 Birth-rate 53,536 Death-rate 1918 57,155 779 759 13.2 613 12.01 51 180 57 76 742 14.5 Birth-rate 51,009 Death-rate 1919 62,283 869 861 13.8 512 8.5 64 186 43 50 634 10.6 Birth-rate 59,791 Death-rate 1920 62,311 1124 1144 18.3 462 7.4 58 153 71 62 557 8.9 Birth-rate 62,174 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 ages (at Census of 1911) 54,875 34 BOROUGH OF WIMBLEDON. TABLE II. Cases of Infectious Disease Notified during the Year 1920. 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. 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. der 1. 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) 123 2 26 69 17 7 2 - 7 6 8 18 8 36 16 24 113 Erysipelas 30 2 2 3 5 6 9 3 6 1 2 3 2 12 2 2 2 Scarlet fever 230 2 30 147 30 17 4 — 11 13 9 9 27 74 38 49 204 Typhus fever — — — — — — — - — — — — - - - - - Enteric fever 3 — — — — 2 1 - — 1 — — 1 — 1 — 2 Relapsing fever — — — — — — — — — — — — — — — — - Continued fever — — — — — — — — — — — - - — - - - Puerperal fever 3 — — — 2 1 — - — — — — 1 2 — — 2 Cerebro-spinal Meningitis — — — — — — — — — — — — — — — — — Poliomyelitis 1 — — — 1 — — — — — — — — — 1 — — Pulmonary Tuberculosis 79 — — 4 25 38 11 1 4 13 5 5 18 19 6 9 - Other forms of Tuberculosis 7 — — 4 1 2 — - 1 - - - 2 2 1 1 - Ophthalmia Neonatorum 6 6 — — — — — - 1 — — — - 3 — 2 - Encephalitis Lethargica 1 — — — — — 1 — — — — 1 — — — — - Pneumonia 5 — 1 2 — 1 — 1 4 1 — — - — - - - Influenzal Pneumonia 4 — — — 2 1 1 - - 2 - - 1 - - 1 - Malaria 12 - - - 4 8 - - 3 - 3 3 2 1 - - - Dysentery — — — — — — — — — — - - - - - - - Meningitis — — — — — — — — — — — — — — — — — Totals 504 12 59 229 87 83 29 5 37 37 27 39 62 149 65 88 323 Isolation Hospitals:— Borough Isolation Hospital, Gap Road, Wimbledon ; Whitmoor Hospital, Surrey. 35 BOROUGH OF WIMBLEDON. TABLE III. Causes of, and Ages at, Death during the year 1920. CAUSES OF DEATH Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of "Residents" or "Non"Residents" 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 557 71 10 12 25 29 62 141 207 44 Uncertified — — — — — — — — — — Enteric Fever — — - — — — — — — — Small-pox — — — — — — — - — — Measles 6 — 2 1 3 — — - — — Scarlet Fever 2 — — - 2 — — — — 2 Whooping Cough 2 1 — 1 — — — — — — Diphtheria and Croup 12 - 1 6 5 — — - — 12 Influenza 8 — — — — 2 1 2 3 — Erysipelas 2 2 — — — — — — — — Phthisis (Pulmonary Tuberculosis) 40 — — — 1 12 15 10 2 1 Tuberculous Meningitis 4 — — — 1 1 1 1 — — Other Tuberculous Diseases 1 — — — 1 — — — — 1 36 Cancer, malignant disease 62 — — — — — 5 33 24 3 Rheumatic Fever 2 — — — — — — — 2 — Meningitis 2 — — — — — 1 1 — 1 Organic Heart Disease 66 — — — — 2 2 19 43 4 Bronchitis 33 4 — 1 — — 1 2 25 1 Pneumonia (all forms) 39 8 — 2 — 2 7 13 7 — Other Diseases of Respiratory organs 8 1 1 — — 1 2 3 — 1 Diarrhœa and Enteritis 7 6 1 — — — — — — 1 Appendicitis and Typhlitis 10 — - 1 4 1 2 1 1 2 Cirrhosis of Liver 4 — - — — — 1 3 — — Alcoholism 2 — — - — - — 2 — — Nephritis and Bright's Disease 10 — - — — 1 2 3 4 1 Puerperal Fever — — - - — - — — — — Parturition apart from Puerperal Fever 2 - - - - 1 1 — — — Congenital Debility and Malformation, including Premature Birth 34 34 - - - - — — — 2 Violent Deaths, excluding Suicide 20 1 2 — 2 2 4 4 5 2 Suicides 5 — — - — - 3 2 — — Other Defined Diseases 172 14 2 — 6 4 14 41 91 10 Diseases ill-defined or unknown 2 — 1 — - — — 1 — — Totals 557 71 10 12 25 29 62 141 207 44 Sub-entries included in above figures. Cerebro-spinal Meningitis - - - - — — — — — — Poliomyelitis 1 — — — — 1 — — — — Encephalitis Lethargica 1 — - — — — — 1 — — 37 BOROUGH OF WIMBLEDON TABLE IV. Infant Mortality during the Year 1920. 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 Year. All Causes Certified 25 3 5 7 40 12 9 8 2 71 Uncertified — — - — — — — — — — Smallpox - - - - - - - - - - Chicken-pox — — — - — - - - - - Measles — — — — — - - - - — Scarlet fever — — — - — - - - - — Whooping-cough — — — — — — — 1 — 1 Diphtheria and Croup — — — — — — — — - — Erysipelas — — — — — 1 1 - — 2 Tuberculous Meningitis — — - — — — — — - — Abdominal Tuberculosis — — — - — - - - - — Other Tuberculous Diseases — — — - — - - - - — Meningitis (not Tuberculous) — - - - - — — — - - 38 Convulsions 3 1 — 2 6 1 — — - 7 Laryngitis — — — — — — — — — — Bronchitis 1 — 1 2 4 — — — — 4 Pneumonia (all forms) — — — — — 1 3 2 2 8 Diarrhœa — — — — — - 1 1 — 2 Enteritis — — — — — 1 1 1 — 3 Gastritis — — — — — 2 1 — — 3 Syphilis — — - — — 1 — — — 1 Rickets — — — — — — — — — — Suffocation, overlying — — — — — — — — — — Injury at Birth — — — — — — — — — - Atelectasis 2 — — — 2 1 — - - 3 Congenital Malformations — - — — — — — — — — Premature Birth 14 — — — 14 1 — — — 15 Atrophy, Debility and Marasmus 3 — 1 1 5 2 2 — — 9 Other causes 2 2 3 2 9 1 - 3 - 13 Totals 25 3 5 7 40 12 9 8 2 71 Nett Births in the year legitimate 1091. illegitimate 53. Nett deaths in the year of legitimate infants 68. illegitimate infants 5. 39 TABLE V. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision of the Inspectorial Staff:— Accumulations removed 20 Cisterns provided 3 Cisterns repaired, cleansed or covered 49 Drains, new, provided 15 Drains repaired or altered 38 Drains, Stoppage removed 68 Dustbins provided 265 Flushing Boxes, new, provided 28 Flushing Boxes repaired 149 Manure receptacles provided 1 Overcrowding nuisances abated 2 R.W. Pipes disconnected 5 Roofs repaired 232 Rooms disinfected 793 Rooms stripped and cleansed 1123 Soil pipes, new, provided 3 Soil pipes repaired or altered 10 Ventilating pipes, new, provided 12 Ventilating pipes repaired or altered 35 Waste pipes, new, provided 22 Waste pipes repaired, disconnected or trapped 65 Water Closets, new, provided 70 Water Closets repaired or ventilated 45 Water services restored 15 Yards cleansed 5 Yards paved 92 Guttering repaired 220 Floors ventilated 80 Nuisances abated from damp walls 149 Water taken direct from main 1 Other nuisances 1267 4,882 40 HOUSING CONDITIONS. Statistics. Year ended 31st December, 1920. 1.—GENERAL. (1) Estimated population 62,311 (2) General death-rate 8.9 (3) Death-rate from tuberculosis .72 (4) Infantile Mortality 62 (5) Number of dwelling-houses of all classes 11,976 (6) Number of working-class dwelling-houses (approximate) 8,757 (7) Number of new working-class houses erected 2.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,540 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 544 (3) Number of dwelling-houses found to be in a state so dangerous' or injurious to health as to be unfit for human habitation — (41 Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,452 II.—Remedy of Defects without service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,365 III.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were dered fit— (a) By owners - (b) By Local Authority in default of owners — 41 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close - (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 106 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 94 (b) By Local Authority in default of owners - (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders - (2) Number of dwelling-houses in respect of which Closing Orders were made - (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit - (4) Number of dwelling-houses in respect of which Demolition Orders were made - (5) Number of dwelling-houses demolished in suance of Demolition Orders - 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to improvement schemes under (a) Part I., or (b) Part II., of the Act of 1890:— (1) Name of area (2) Acreage (3) Number of working-class houses in area Nill (4) Number of working-class persons to be displaced. IV.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, etc., Act, 1919. V.—Staff engaged on housing work with, briefly, the duties of each officer. 42 Borough of Wimbledon. EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1920. To the Members of the Education Committee of the Borough of Wimbledon. Ladies and Gentlemen, I beg to present my Annual Report for the year 1920 with regard to the Medical Work accomplished in the Public Elementary Schools in Wimbledon. The Staff. The Staff is composed of School Medical Officer and Assistant School Medical Officer. who are respectively Medical Officer of Health and Assistant Medical Officer of Health. Dr. Effie Craig, Assistant Medical Officer of Health and Assistant School Medical Officer, commenced her duties on September 1st. There are two fully-trained certificated nurses, Miss Holman and Miss Walker. Besides these, Miss Fowler assists at the Dental Clinic and Mrs. Potts undertakes the cleansing of selected cases of verminous heads and bodies. 43 Co-ordination. There is intimate connection between the general Health Services, as will be noted from the fact that the Medical Officer of Health and his Assistant are the School and Assistant School Medical Officers respectively. The School Medical Service in relation to Public Elementary Schools. School Hygiene. The condition of the schools is of a fair average standard. The attention of the Committee was, however, drawn to the type of desks in the Haydon's Road Girls' School, where the lighting was also defective. Action has already been taken with a view to remedying these defects. There is ample water supply both for washing and drinking purposes. Medical Inspection. The age groups examined have been 5 years, 8 to 9 years and 12 years, besides which medical inspection was undertaken twice of all the children in the classes with a view to ascertaining any defects in those who did not underg'o examination at the Routine Medical Inspection. Any abnormalities noted by the teachers were sent for special examination to the School Clinic. Findings of Medical Inspection and Treatment. Uncleanliness. Most schools were specially visited weekly as to uncleanliness of the children. All found with vermin and a large number of nits were excluded for varying periods. Some of the cases were treated at the Cleansing Department of the Clinic. 100 were cleansed and returned to school. Minor Ailments. The Clinic was open every morning during the school sessions. Parents have attended in large numbers and children found to have more serious defects have been referred for further appropriate treatment. Tonsils and Adenoids. Arrangements were made with the two local hospitals for treatment of these cases. Patients were sent with a form to the hospital and were treated in turn. A charge was madp according to the means of the patient, and the balance was defrayed by the Committee. 44 106 cases were treated, and there were still outstanding at the end of the year 171; these were instances where the parents had either not given the necessary consent or who had not had time for treatment. These, however, were visited regularly. T uberculosis. The majority of these cases were sent to the Tuberculosis Officer, unless it was found that they were already being treated. Some of the slight glandular cases were kept under observation at the Clinic. My thanks are due to the Tuberculosis Officer for his co-operation. Eye Disease—External and Defective Vision. Serious cases of external eye disease were either referred to the special hospitals or to their own doctors. Dr. Cowie took into the Nelson Hospital four cases requiring operative treatment. Such diseases as mild Conjunctivitis were treated at the Clinic. During the year under review Dr. Cowie paid two visits a week, and it will be noted that 425 children were submitted for Refraction, of whom 405 had glasses provided. Ear Diseases. Out of the 101 children referred, 96 received treatment. Dental Diseases. An appointment of a whole-time dentist was made in June last, and the service commenced on September 1st and went on till the end of the year. During this period special inspections were made of the age groups 6 to 8 years. Infectious Diseases. All contacts with cases of Infectious Diseases were excluded from school for varying periods from the date of their last contact. Notices of these exclusions were sent to the head teachers of the schools concerned. All suspicious cases were examined, and, if necessary, excluded and isolated. Head teachers have sent to the Clinic doubtful cases for examination. Following-up. All defects discovered in Routine Medical Inspection or School Class Inspection were either referred for further observation to the Clinic or to their own doctors or a hospital. The School Nurse in charge of the particular district made out record cards on which notes were made as to what was being done. 45 The School Nurses have paid 666 visits to homes in connection with the following-up of cases. Co-operation of parents and teachers. Invitations were sent by the head teachers to all parents whose children were subjected to Routine Medical Inspection, and in case they were unable to be present, another form asking them for particulars of their medical history or any observations they might wish to make. If any condition was discovered requiring any subsequent treatment, a visit was made by the School Nurses. These cases were followed up in the usual manner. Co-operation of School Attendance Officers. All exclusions made on medical grounds were notified to the School Attendance Officers. If the children failed to attend again at the Clinic after the period during which they were to stay away from school, the School Attendance Officers visited the homes. They also sent cases to the Clinic when reasons were given by the parents that failure to attend school was on medical grounds. Mr. Bellman, the Head School Attendance Officer, reports as follows:— Exclusions for U ncleanliness. During the past year it was found necessary to bring the parents of sixty-one children before the School Attendance Sub-Committee owing to their children being sent to school in an unclean condition. Verminous Clothing, etc. Unclean Heads. Total. 12 49 61 In respect of the above, 46 summonses were issued and heard, with the following results:— 4 fines of 2s. 6d. 10 ,, ,, 5s. Od. 16 „ „ 10s. Od. 4 ,, ,, 20s. Od. 2 Attendance Orders made. 4 committed to Industrial Schools. 2 adjourned sine die. 4 withdrawn on payment of costs. total 46 46 Queen's Road Special School. During the year the admissions were as follows:— Boys. Girls. Total. 9 7 16 and the following children left:— Boys. Girls. Total. 5 3 8 I am, Ladies and Gentlemen, Your obedient servant, D. A. BELILIOS, Medical Officer of Health and School Medical Officer. 47 TABLE I. NUMBER OF CHILDREN INSPECTED, 1st January, 1920, to 31st December, 1920. A.—Routine Medical Inspection. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys — 285 52 19 356 Girls — 2 269 84 41 396 Totals — 2 554 136 60 752 Age. Intermediate Group. Leavers. Other Ages. Total. Grand Total. 8 12 13 14 Hoys 308 289 43 4 50 694 1050 Girls 328 337 46 2 53 766 1162 Totals 636 626 89 6 103 1460 2212 B.—Special Inspections. Special Cases. Re-Examinations (i.e. No. of Children Re-Examination). Boys 814 — Girls 898 - Totals 1712 4977 C.—Total Number of Individual Children Inspected by the Medical Officer, Routine and Special Cases. No. of Individual Children Inspected. 3257 48 TABLE II. RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION IN 1920. DISEASE OR DEFECT. Routine Inspections. Specials. Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Malnutrition 37 — — — Uncleanliness—Head 166 — — — Body 143 — — — Skin Ringworm— Head — — 41 — Body — — 20 — Scabies 2 — 34 — Impetigo — — 35 — Other Diseases(non-tubercular) — — 12 5 Eye Blepharitis 7 — 1 — Conjunctivitis — — 1 — Keratitis 1 — — — Corneal Ulcer — — — — Corneal opacities — — 1 — Defective Vision 122 145 9 — Squint 31 - - — Other Conditions 2 - 4 — Ear Defective Hearing 28 — 13 — Otitis Media 16 - 20 — Other Conditions 4 — — — Nose and Throat Enlarged Tonsils 130 217 27 7 Adenoids 15 2 10 3 Enlarged Tonsils & Adenoids 102 40 64 — Other Conditions - — 11 102 Enlarged Cervical Hands (non-tubercular 487 104 2 19 Defective Speech 5 — — — Lungs Bronchitis 34 — 3 8 Other non-tubercular Diseases — — — — Tuberculosis Pulmonary— Definite 4 Suspected 5 — 11 1 Non-pulmonary— Glands 12 — 6 4 Spine — — 1 — Hip 1 — — — Other Bones and Joints 2 — 1 — Skin - — — — Other Forms a — — — Nervous System Epilepsy 1 3 1 5 Chorea — 3 — Other Conditions 2 — 5 2 Deformities Rickets 9 — — — Spinal Curvature 5 — 2 2 Other Forms 11 — 2 2 Other Defects or Diseases 50 — 90 81 Number of Individual Children having Defects which required Treatment or to be kept under observation 2765 49 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA, 1920. Boys. Girls. Total. Blind (including partially blind) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools Attending Certified Schools for the Blind 1 1 2 Not at School 1 - 1 Deaf and Dumb (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools - - - Attending Certified Schools for the Deaf 3 4 7 Not at School 1 1 2 Mentally Deficient Feeble Minded Attending Public Elementary Schools 4 - 4 Attending Certified Schools for Mentally Defective Children 26 22 48 Notified to the Local Control Authority by the Local Education Authority during the year Not at School 3 1 4 Imbeciles At School - - - Not at School - — - Idiots — — — - Epileptics Attending Public Elementary Schools - 2 2 Attending Certified Schools for Epileptics - 1 1 In Institutions other than Certified Schools - - - Not at School - 1 1 50 TABLE III.—continued. Boys. Girls. Total. Pulmonary Tuberculosis Attending Public Elementary Schools 1 3 4 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools - - - Not at School - - - Crippling due to Tuberculosis Attending Public Elementary Schools 3 - 3 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools - - - Not at School - - - Physically Defective Crippling due to causes other Attending Public Elementary Schools 3 6 9 than Tuberculosis, i e. Paralysis, Rickets, Attending Certified Schools for Physically Defective Children 3 1 4 Traumatism In Institutions other than Certified Schools - - - Not at School - 1 1 Other Physical Defectives, e.g. delicate and other children suitable for admission to Open Air Schools and children suffering from severe Heart Disease Attending Public Elementary Schools 3 6 9 Attending Open - Air Schools - - - Attending Certified Schools for Physically Defective Children other than Open-Air Schools - - - Not at School - - - Dull or Backward Retarded two years 13 22 35 Retarded three years - - - 51 TABLE IV. (a). TREATMENT OF MINOR AILMENTS. Number of Children Treated. DISEASE OR DEFECT. Referred for Treatment. Under Local Education Authority's Scheme. Otherwise. Total. SKIN. Ringworm—Head 41 37 4 41 Body 20 18 2 20 Scabies 36 8 28 36 Impetigo 270 283 7 270 Minor Injuries 91 79 2 81 Other Skin Diseases 28 26 2 28 Ear Disease 101 91 5 96 Eye Disease (external or otherwise) 46 40 1 41 Miscellaneous 182 102 58 160 Total 815 664 109 773 52 63 TABLE IV. (b). TREATMENT OF VISUAL DEFECT. Number of Children. Referred for Refraction. Submitted to Refraction. For whom Glasses were Prescribed. For whom Glasses were Provided. Recommended for Treatment other than by Glasses. Received other forms of Treatment. For whom no Treatment was considered necessary. Under Local Education Authority's Scheme. By Private Practitioner or Hospital. Otherwise. Total. 465 425 12 28 465 405 405 7 7 15 TABLE IV. (c). DEFECTS OF NOSE AND THROAT. Number of Children. Referred for Treatment. Received Operative Treatment. Total. Received other forms of Treatment. Local Education Authority's Scheme, Hospital. By Private Practitioner or Hospital. 348 72 34 106 6 Cases not Treated—Insufficient time 171 Various reasons 65 54 TABLE IV. (d.l). TREATMENT OF DENTAL DEFECTS. Number ok Children Dealt With. Age Group 5 6 7 8 9 10 11 12 13 14 Specials Total Inspected by Dentist 129 337 357 224 114 122 144 191 107 38 8 1741 Referred for Treatment — — - - - - - - - - — 1396 Actually Treated — - - - - — - - - - - 968 Re treated as Result of Routine Inspection — — - - - — — — — — — 122 Number carried torward from 1919 treated in 1920 74 ,, Sound 345 ,, not treated, insufficient time 224 ,, treated privately 38 ,, refused treatment 143 ,, left School or District 23 55 TABLE IV. (d.2). PARTICULARS OP TIME GIVEN AND OP OPERATIONS UNDERTAKEN. No. of Half Days devoted to Inspection. No. of Half Days devoted to Treatment. Total No. of Attendances made by the Children at the Clinic. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. No. of Administrations of General Anaesthetics included in (4) and (6). No. of other Operations. Extracted. Filled. Extracted. Filled. Permanent Teeth. Temporary Teeth. 1 2 3 4 5 6 7 8 9 10 11 57 174 2217 484 679 2994 129 822 890 30 20 TABLE IV. (e). TREATMENT OP UNCLEANLINESS. A statement relating to the above is included in the body of the Report and gives full particulars of the work carried out. TABLE IV. (f). TREATMENT OP ALL OTHER DEFECTS. A statement based on Table II. is included in the body of the Report and gives particulars of measures adopted and treatment obtained. 56 TABLE V. SUMMARY OP DEFECTS AS SHEWN IN TABLE IV. A., B., C., D. AND F. DISEASE OR DEFECT. Referred for Treatment. Number or Children. Treated. Under Local Authority's Scheme. Otherwise. Total. Minor Ailments 815 664 109 77S Visual Defects 485 425 12 437 Defect of Nose and Throat 348 72 34 106 Dental Defects 1396 968 38 1006 Other Defects 187 56 81 137 Total 3211 2185 274 2459 TABLE VI. SUMMARY RELATING TO CHILDREN INSPECTED AT THE ROUTINE INSPECTION DURING THE YEAR 1920. (l) Total number of Children medically inspected at Routine Inspection 2212 (2) Number of Children in (1) suffering from defects (other than Uncleanliness and Defective Clothing or Footgear) who require to be kept under Observation but not referred for Treatment 375 (3) Number of Children in (1) suffering from:— Malnutrition 37 Skin Disease 2 Defective Vision (including Squint) 153 Eye Disease 10 Defective Hearing 28 Ear Disease 20 Nose and Throat Disease 247 Enlarged Cervical Glands (non-tubercular) 487 Defective Speech 5 Dental Disease — Heart Disease— Organic 33 Functional 15 Ansemia 19 Lung Disease (non-tubercular) 34 Tuberculosis— Pulmonary, Definite — Suspected 5 Non-Pulmonary 20 Diseases of Nervous System 7 Deformities 25 Other Disease or Defect 50 (4 Number of Children in (1) who were referred for Treatment (excluding Uncleanliness, Defective Clothing, etc.) 778 (5) Number of Children in (4) who received Treatment for one or more Defects (excluding Uncleanliness, Defective Clothing, etc.) 395 57