BARN 62 The Urban District Council of Barnes. THE ANNUAL REPORT For 1905 OF THE Medical Officer of Health, F. GRAHAM CROOKSHANK, M.D., Lond. Bartnes, S,W. R. W. Simpson & Co., Ltd., Printers, 15 High Street, 1906 The Sanitary Department, Council House, High Street, Mortlake, S.W. January, 1906. Mr. Chairman and Gentlemen, I beg to submit my fifth Annual Report. During the past year a constant water supply has been provided; the re-organisation and completion of the Hospital has progressed; and a considerable amount of routine work has been accomplished. The district continues to grow in population, but at the same time zymotic disease is becoming less than formerly. The statistical reports of the County Medical Officer of Health (Dr. Seaton) shew that our position in the County is, relatively to other districts, better than was, till recently, the case. I am, Gentlemen, Obediently yours, F. GRAHAM CROOKSHANK. The Chairman and Members of the Urban District Council of Barnes. THE Urban District Council of Barnes. Sanitary Committee, 1905=6. Chairman: E. VORLEY NEW, Esq. The Chairman of the Council: S. W. LAMBERT, Esq., J P. The Vice=Chairman of the Council: J. WHITCOMBE Esq., J.P. Messrs. ATKINS, BARTON, BATES, BULL, BUNKER, COLLIER, DAVENPORT, FIRMSTON, HAINES, KITLEY, LANGDON, RANDALL, SEAL, SLATTER, SMITH and SPENCER. Medical Officer of Health and Medical superintendent of Isolation Hospital: F. GRAHAM CROOKSHANK, M.D. Lond. Inspector of Nuisances: Mr. T. GRYLLS. Assistant Inspector of Nuisances: Mr. C. H. ROBINSON. Matron of Isolation Hospital: Miss M. BAXTER CLARK. CONTENTS. page GENERAL SUMMARY 9 Vital Statistics 11 Housing: Sewerage, Drainage, &c. 14 Water Supply 20 Nuisances 21 Places over which the Council has Supervision 21 Infectious Disease 22 Hospital Accommodation 26 School Hygiene 31 Mortuary: Baths, Wash-houses, Cemetery, &c. 33 Midwives Act 34 Appendix A: Special Report under Factories and Workshops Act, 1901 35 Appendix B: Tables of the Local Government Board 38 Appendix C: Other Statistical Tables 46 Infectious Disease 47 General Work of Sanitary Department 49 Food and Drugs Act 53 Vaccination 54 GENERAL SUMMARY. The Urban District of Barnes:— Area—exclusive of water 2,400 acres Population—Census, 1901 17,821 Population—(estimated) Midsummer, 1905 24,250 Inhabited Houses—Census, 1901 3,403 Inhabited Houses—Midsummer, 1905 4,685 Rateable Value—Agricultural Land £2,281 Other Hereditaments £212,751 £215,038 Assessable Value £189,120 14 0 General District Rate 4/0 Poor Rate—Parish of Barnes 3/3 Poor Rate—Parish of Mortlake 3/3 Birth Rate—Per 1,000 estimated population 24.7 Death Rate—Per 1,000 estimated population 10.4 Corrected Death Rate—Per 1,000 estimated population 11.9 Infantile Mortality—Per 1,000 births 120 For ease of comparison the statistical tables relative to this Report have, for the most part, been placed in Appendices. Appendix A deals with those matters which, under the Factory and Workshop Act of 1901, it is a duty of every Medical Officer of Health to refer to annually; Appendix B consists of those Tables prescribed by the Local Government Board; and Appendix C consists of Tables of more local interest, including, amongst other things, the detail of the work of the Sanitary Department. 11 Vital Statistics. (Appendix B. Tables I., II., III., IV. and V.) The first and most important matter is the just estimation of the population at Midsummer of last year. In former years I have pointed out the reasons why the official method of estimating populations during inter-censal periods has, for this district, so little validity. It is sufficient therefore to indicate now that, as shown by the subjoined table, the inhabited houses in Mortlake have during the last four and a quarter years increased by more than 50 per cent., and those in Barnes by more than 25 per cent. At the present time the inhabited houses in the two parishes are of almost equal number and, assuming that the number of persons per house has remained fairly constant, it is reasonable to estimate the present population of Barnes at about 12,250, that of Mortlake at 12,000, and that of the whole district at 24,250. That this estimate is for the whole district a fair one appears from the fact that the birth rate, calculated on this estimate, works out at 24.7, or slightly above the average for the last 10 years. If the population were over-estimated the birth rate would be less than the average for the last 10 years. It should be noted moreover that the total births during 1905 were 18 less than during 1904, and that the birth rate is apparently now as high in Mortlake as in Barnes. That this is so is explained by the fact that the greater increase in "villa residents" has lately been in Mortlake. Birth rates are high in "new" districts and "estates"; low in old ones. 12 TABLE. Showing the yearly increase for the whole district, and for the constituent parishes, in the number of houses inhabited. Date of Computation. Number of Houses Inhabited. Barnes (Urban). Barnes. Mortlake. 1901 March (Census) 3403 1893 1510 1902 (Midsummer) 3814 2051 1763 1903 (Midsummer) 4036 2167 1869 1904 (Midsummer) 4435 2315 2120 1905 (Midsummer) 4685 2377 2308 Increase in 4¼ years 1282 484 798 Increase in last year 250 62 188 The death rate for 1905 is so low as 10.4 per thousand of the estimated population, or, when "corrected" by the computation of the deaths of "residents" in public institutions (such as Brookwood Asylum and Richmond Infirmary) outside the district, 11.9 per thousand. This "correction," required by official usage, is, however, very nearly balanced by the number of "deaths registered in the district," which is really the number of persons, at no time residents of Barnes and Mortlake, whose bodies were found in the river between Kew and Putney. 13 The "uncorrected" death rate of 10.4 per thousand then more nearly expresses the actual death rate than does the so-called "corrected" rate. The infantile mortality, that is to say, the relation which the number of deaths during 1905 of infants under one year of age bears to the number of births during 1905, is expressed as 120 per 1,000 births. These figures are, of course, absolute, and have nothing to do with "estimates." An infantile mortality rate of 120 is still too high, but it is considerably below the average for the last ten years. In my last report some allusion was made in detail to the causes of infantile mortality, and it may perhaps be said here that there is reason to hope that in the next few years the operation of various sanitary measures will tend to still further reduce its local incidence. In Table V., which appears for the first time this year, the causes assigned for the deaths of infants during 1905 are analysed in some detail. It should be noted that in certain columns of Table II., Table IV. and Table V. it has been necessary to include deaths in the workhouse of infants from Mortlake and Barnes. These deaths, not having been registered in the district, are not included in the figures given in cols. 5 and 6, Table I. Again, however, it has to be pointed out that the construction of the official tables does not allow any indication being made of those infantile deaths which have been, through accidental circumstances only, registered in the district. In Table IV. the causes of and ages at death of persons dying during 1905 are set forth. It will be seen that Phthisis and other tubercular diseases account for about one-eighth of the total deaths. This is an increase on the records of late years. In part 14 it is no doubt accounted for by increasing urbanization, by the steady decrease in the size of bed and living rooms, and by the lessened curtilage to dwelling houses. It is an odd reflection that what sanitation has gained on the one hand has been thrown away on the other. The higher standard required in drain work, closets, bathrooms, and so on has led to an economy in air and light. Whatever be the indecency of overcrowding in parts of London, there is no overcrowding so unhealthy as that which occurs amongst many middle-class families living in small flats and double tenements, even though each person be allotted a separate bedroom. There is no doubt at all but that very many cases of phthisis amongst servants, shop girls and clerks, are directly related to the tiny rooms allotted them for sleeping in dwellings which a builder would describe as "replete with modern and up-to-date sanitary arrangements." The deaths from pulmonary diseases other than phthisis during 1905 were below the average. Probably one reason for this is that there was so little serious influenza. Deaths from zymotic diseases other than those tubercular were also relatively few. So, too, were the deaths between 15 and 65 years of age. Housing. The Workmen's Dwellings constructed by the Council are kept in excellent condition, are keenly sought after, and all are tenanted. Several proposals and schemes for increasing the provision of Workmen's Dwellings have been considered during the year, but no definite steps have been taken. 15 In considering the necessity for ensuring such provision the character of the district has to be taken into account. It would seem likely that in a few years the population will lose, to a great extent, its old residential character and will be largely a population made up of (1) persons engaged in London, and their families; (2) tradespeople and their families. As the district becomes filled up and building activities slacken, many of the working class will undoubtedly emigrate; and there are few signs of any development of local industries. As a result of consistent observation of all parts of the district I am bound to say that it appears to me there is far less difficulty for the working man in securing housing than there was five years ago. With perhaps one exception:—the elderly labourer who, having no children, does not need, or cannot afford a whole house, is often badly accommodated in lodgings. If new dwellings are provided by the Council I sincerely trust that some airy tenements with two or three good-sized rooms each will be provided for families of two, or at most, three persons. The question of tenements and flats designed for the social strata immediately above those of the artizan and labourer is very important. Building bye-laws are urgently needed to control the blocking of suburban areas by rows of double tenements and maisonettes. As has been ably pointed out by Dr. Sykes and others of late, in Germany arterial roads are made to widen in passing from the centres of town and cities to the outskirts. A system of zonification is in fact enforced, and, as in Paris, the social strata occur vertically. In this country (as in London) the widest roads are in the centres of cities, and on the outskirts they are narrowed and 16 choked, while the social strata are dispersed horizontally. All this has a very important bearing on national physique, and obviously the stimulus for a reversion to better methods must come, not from central authorities, but from suburban councils on the outskirts of the great cities. Sewerage. The increase in the number of houses and streets has thrown great stress on the existing sewers and surface water drains. In consequence of an exhaustive report by Mr. Tomes, Surveyor to the Council, who kindly furnished me with the accompanying plan, works of some magnitude, designed to cope with the present situation and eventualities of no very distant date, are already in progress. As the main sewer, which runs along the towing path, is found to be becoming inadequate to carry off the amount of sewage with which it now has to deal, it is proposed to direct the Mortlake sewage from it into the main sewer of the Joint Sewerage Board at Kew Lane. This will allow the sewer by the towing path to collect the Barnes sewage only, and will be accomplished by laying a new sewer—shown by a long dotted line on the plan. As a rapid development of building estates is occurring south of the Upper Richmond Road and east of Sheen Lane, severely taxing the capacity of the sewer which at present deals with this part of the district, it is proposed to put in a relief sewer (shown by a round dotted line on the plan) which will take the sewage from this locality by a new route to the Joint Sewerage Board's main sewer. The new sewers have in all cases been designed of capacity sufficient to fully cope with the future development of the various localities. 17 18 The importance of this scheme is very great, and it is a matter for congratulation that the situation has been so boldly treated. That the present outlay, large as it may seem, will prove of the truest economy, there can be no doubt. Drainage: Cesspools, &c. As will be seen by reference to the table given on page 51, Appendix C., in several instances defective drains have been reconstructed or amended during 1905. The subject of cesspools, earthclosets and ashpits has been again considered (cf., reports 1902—4) and the proposed bye-laws set out below have received the provisional assent of the Local Government Board and will shortly come into operation. BYE=LAWS made by the URBAN DISTRICT COUNCIL OF BARNES with respect to the Cleansing of Earthclosets, Privies, Ashpits, and Cesspools in the urban district council ok barnes. The Cleansing of Earthclosets, Privies, Ashpits, and Cesspools belonging to any premises. 1. The occupier of any premises shall, once at least in every three months, cleanse every earthcloset belonging to such premises and furnished with a fixed receptacle for fœcal matter and with suitable means or apparatus for the frequent and effectual application of dry earth to such matter. 19 2. The occupier of any premises shall, once at least in every week, cleanse every earthcloset belonging to such premises and furnished with a movable receptacle for fœcal matter and with suitable means or apparatus for the frequent and effectual application of dry earth to such matter. 3. The occupier of any premises shall, once at least in every week, cleanse every privy, belonging to such premises and furnished with a fixed receptacle for fcecal matter. 4. The occupier of any premises shall, once at least in every week, cleanse every privy belonging to such premises and furnished with a movable receptacle for fœcal matter. 5. The occupier of any premises shall, once at least in every week, cleanse every ashpit belonging to such premises, and used only as a receptacle for ashes, dust, and dry refuse. 6. The occupier of any premises shall, once at least in every week, cleanse every ashpit belonging to such premises and used in connection with a privy as a receptacle for fcecal matter, together with ashes, dust, and dry refuse. 7. The occupier of any premises shall, once at least in every twelve months, cleanse every cesspool belonging to such premises. Penalties. 8. Every person who shall offend against any of the foregoing Bye-laws shall be liable for every such offence to a penalty of Five Pounds. Provided, nevertheless, that the Justices or Court before whom any complaint may be made, or any proceedings may be taken in respect of any such offence may, if they think fit, ajudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this Bye-law. 20 The Common Seal of the Urban District Council of Barnes was, in pursuance of a Resolution, hereunto affixed at a Meeting of the said Council, held on Tuesday, the 13th day of February, 1906, in the presence of STAMPA W. LAMBERT, Chairman. JOHN EUSTACE ANDERSON, Clerk of the Council. Water Supply. In my last annual report it was stated that, after consideration of a special report presented by me in November, 1904, the Council unanimously resolved that a Constant Water Supply was desirable for this district. Further, the resolution of the Council empowered the Clerk and Medical Officer of Health to take all necessary steps to secure the same. In consequence, the Water Board were approached, and most courteously responded, enabling the necessary inspections to be made at a relatively trifling expense to the Council. By March 1st, 1905, 4953 houses (all those not in possession of a constant water supply) had been inspected, and 2,319 had been found to require some alteration to the fittings. On re-inspection later in the year of these 2,319 houses, the issue of 844 additional notices was found necessary. Before the end of September the Water Board were informed that the district was ready for the installation of the constant water supply, and very shortly afterwards the Board was enabled to provide the same. The readiness and public spirit with which the ratepayers responded to the demands which it was necessary to make were no 21 less gratifying than remarkable. But it is only right to state that the happy result of this having been carried through without the least resort to legal proceedings was largely due to the tact and energy of Mr. Goodale, the Assistant Clerk, on whom the whole organization of the work devolved. It is worth mentioning that the secondary results of the carrying through of this matter have been in themselves valuable enough, inasmuch as practically a house-to-house inspection of the whole district has been made for the Sanitary Department, and not a few incidental defects in drains, etc., have been discovered and amended. Nuisances (Appendix C). The general work usually referred to as that in connection with nuisances, has, as in past years, been ably and systematically conducted by Mr. Grylls. That during 1905 practically no serious nuisances occurred is sufficient evidence of the thoroughness with which the work has, in former years, been done. The tables given in Appendix C, on pages 50 and 52, shew, perhaps, better than I can here explain, how greatly the routine work has of late increased, and how much attention has been paid to the smaller, but not unimportant details of sanitary administration. Places over which the Council has supervision. Those places over which special supervision is exercised by the Sanitary Officers of the Council are Dairies, Milkshops, Cowsheds, Slaughterhouses, Bakehouses and Petroleum Stores. The statistical particulars relating to Dairies, Milkshops, Cowsheds, Slaughterhouses and Petroleum Stores, will be found in 22 the tables on Pages 49 and 52. Appendix C, and those relating to Bakehouses in the special report under the Factories and Workshop's Act of 1901 (Appendix A). I have found, on my frequent visits to these places, that the general improvement noted in my last report is fully maintained. Some of the tradespeople are eager and willing to respond to suggestions made to them, and I do not think that any of them have regretted the expenditure they have incurred in making better and more suitable arrangements. But there is still a tendency on the part of many to "muddle along" with chaotic backyards and unclean appurtenances. If the customers of milksellers in particular, instead of succumbing straightaway to the allurements of ornamental shop fronts, would ask to see the places where milk is stored and milk cans washed, there would be very much less sickness amongst infants and children. Infectious Disease. As will be seen by reference to the table on Page 47 (Appendix C), the total number of cases of Scarlet Fever, Diphtheria and Typhoid Fever notified during 1905 was 52, exactly the number notified during 1904, and almost exactly half the average number notified during the years 1895-1904, when the population was much less than it is now. Put in another way the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever notified per 1,000 of the population was, in 1904, 2.2 ; and in 1905, 2.1; while the average for the 10 years, 1895-1904, was 5.5. These figures, which have been carefully verified by comparison with the County Medical Officer of Health's returns, indicate, I think, that we have normally much less of these diseases than in past years. [See accompanying Charts]. CHARTS Shewing the number of cases of Scarlet Fever and Diphtheria notified weekly during certain years. 1902. CHARTS Shewing the number ot cases of Scarlet Fever and Diphtheria notified weekly during certain years. 1904. 25 Of course, however, at any time an undetected case of* Scarlet Fever or Diphtheria at school may cause an outbreak. The figures which I have given relate to "cases notified" and this is not the same thing as "cases occurring." Medical men not infrequently, and most properly, in the interests of both the patient and the public, notify cases which in the end are found not to be cases of the disease at first suspected. But as a rule a Medical Officer of Health is not justified in publishing, at a year's end, lists of " cases that have occurred " based on a revision of the " cases notified." Such "revisions" appear in practice to consist in the elimination of every "case notified" the history of which does not, in the opinion of the Hospital Superintendent or other person, bear out the original notification. This proceeding, of course, results in a table of "cases which occurred" particularly favourable to the district concerned. For it takes no account of the number of unascertained and unascertainable cases which escape notification. As a rule these undetected cases fairly balance those which are notified in pardonable error, and therefore the publication of lists of "cases notified" as such, is the best and fairest way to determine in various districts the relative prevalence of cases of notifiable disease. The procedure with regard to disinfection has been so recently stated in detail that no reference is now required. It is encouraging to note, however, that the principle of disinfection after death in cases of phthisis has been eagerly accepted by the public and has been carried into effect into almost every instance 26 With regard to notification it may be said that the advantages offered by the Council in the matter of examining bacteriologically cases of sore throat, etc., have been made use of with greater freedom and with valuable results. No serious difficulties have been met with during the year in connection with the notification of cases of infectious disease. Medical men in practice can facilitate the work of Sanitary Officials very greatly by a tactful and judicious paving of the way when speaking to relatives of the patients. Such courteous smoothing of the rough paths is always appreciated, and when coupled with early and prompt notification, and it may be an explanatory note referring to any unusual circumstances, does much to assist officials who have but to carry out statutory duties, and are in nowise anxious to exceed their proper province. When dealing with cases of uncertain nature the best course undoubtedly is to notify the case provisionally, explaining to relatives why this is done. The notification can then be either confirmed or withdrawn as occasion arises. In such instances the action of the Sanitary Officers is always in accordance with the exigences and circumstances of the case. Hospital Accommodation. During the year 1905 forty cases of Scarlet Fever and Diphtheria—or nearly 80 per cent, of the cases notified—were sent to the Mortlake Isolation Hospital. This is the highest percentage yet reported, and demonstrates sufficiently the appreciation by the ratepayers of the provision made by the Council. A table given in Appendix C. shews the case mortality for the last, and four previous years. 27 That the mortality for 1905 was somewhat greater than the average is explained by the fact, that of the fourteen cases of diphtheria and croup actually admitted four were serious cases of laryngeal disease requiring tracheotomy. Of these two recovered. Of the two fatal cases, one was complicated by a peculiar congenital malformation of the larynx, and one was admitted too late for more than temporary relief to be afforded. The period of detention in hospital of the cases of Scarlet Fever and Diphtheria was much shorter than in past years, and in consequence the " average number of patients daily " was, during 1905, very low. For this, as also for the immunity from complications enjoyed by the patients, thanks are due to the nursing skill of Miss Clark, the Matron, whose abilities, both nursing and administrative, have been of the greatest assistance. It was stated in my report for 1904 that considerable progress had been made towards the re-organization of the hospital, first suggested in 1901 and 1902. Early in 1905 a report was submitted urging the desirability of at once augmenting the quite insufficient accommodation for the staff, and of building a ward block suitable for the reception of cases of typhoid fever. A Sub-committee was appointed, which, after careful consideration, approved the principle of the recommendations made, but advised the postponement, for the time, of the building of a typhoid block. The report of the Sub-committee was adopted, and the Surveyor to the Council prepared an admirable design for additions to the administrative cottage, which will afford proper and seemly accommodation for the nurses and domestic servants. 28 These plans are being rapidly carried into effect under Mr. Tomes' superintendence, and will, with the addition of the very efficient system of electric lighting and telephonic communication devised by Mr. Davidson, add very materially to the efficiency of the Hospital. As Medical Officer of Health, I cannot of course but regret that financial considerations should have led to the postponement of the typhoid pavilion being built; but the necessity for such a block has been recognized, and I am confident that the Council will, at the earliest possible moment, take steps to realize a project the necessity of which, before very long, will be patent to every ratepayer. The district is growing rapidly ; many hundreds of flats and tenements and small dwellings are imminent, and the difficulty of securing the admission of typhoid patients to general hospitals is, every summer, becoming greater. Hospital provision for infectious disease should be anticipatory; like a fire brigade, an isolation hospital is a safeguard; it is most useful when least used. No one would say that expenditure on an efficient fire brigade is wasteful when, in the district served by it, dangerous or fatal fires do net occur. Yet many think that an isolation hospital is extravagant unless it is full, or in other words, unless it is failing to perform its function—the prevention of disease. The necessary expenditure on what is called maintenance, and which includes the payment of rates, water rates, insurance and other inevitable charges, cannot, in small isolation hospitals, vary much with the number of patients under treatment. This is so because the expense of maintenance (after payment of rates, insurance premiums and other recurring charges), depends chiefly on the number of wards in use. 29 This number is determined not so much by the number of patients under treatment, as by the necessity for separating:—- (a) Patients of different sex. (b) Patients suffering from different diseases. The admission of four persons may, and frequently does, in this way compel the opening and staffing of four separate wards. For these and other reasons, the cost of small Isolation Hospitals is usually considered by those conversant with the subject not in respect of the "average number of patients present daily," but (a) With reference to the population and character of of the district served. (b) With reference to the extent to which the primary purposes of such Hospital are effected. The primary purposes of Isolation Hospitals are (a) To reduce the normal prevalence of certain diseases. (b) To afford security in times of epidemic increase in the prevalence of these certain diseases. The criteria of the efficiency of Isolation Hospitals are, therefore, perfectly obvious. The Local Government Board, some years ago, laid it down that, as a rule, the minimum provision that should be made is that of one patient's bed per thousand of the population. This minimum standard will be, for the first time, reached in this district when the works now in progress at the Hospital are completed. The first year in which no patients were admitted to the Council's Hospital from the "added area" was that corresponding to the financial year ending March 31, 1900, 30 The population was then 17,000; the attack rate from Scarlet Fever and Diphtheria seven per thousand; the cost of "maintenance" £1,369 9s., and the total (annual) cost of the Hospital (including repayment, &c., of loans) £1,850 17s. 3d. This involved a charge on the rates of more than fourpence in the pound. In the year corresponding to the last financial year the population was 23,200; the attack rate from Scarlet Fever and Diphtheria 1-8 per 1,000; the cost of "maintenance" £1,233, and the total (annual) cost of the Hospital (including interest on and repayment of loans) was £1,929. This involved a charge on the rates of less than threepence in the pound. During the last five years, therefore, the population has increased by 35 per cent.; the attack rate from Scarlet Fever and Diphtheria has dropped to a quarter of what it was ; the cost of maintenance, in spite of larger expenditure from revenue on permanent improvements, has diminished by 10 per cent., and the charge on the rates has fallen from more than fourpence to less than threepence in the pound. The additional expense now being incurred by the provision for the staff (which will raise the wards to the minimum standard of the Local Government Board) will be more than balanced by the increase in the population and rateable value now accruing. It is very unlikely that the cost of the Hospital for this and the next financial year will, with payment of interest and instalments of all loans, exceed twopence halfpenny in the pound. The Small Pox Hospital Order (see report, 1904, p. 42) has been confirmed, but I have no knowledge of further steps having been taken. 31 School Hygiene. In my report for 1903 the arrangements which had been made with the local bodies, then managing Public Elementary Schools, with the aim of checking the spread, at these schools, of various infective disorders, were detailed. During 1904 these arrangements worked admirably, the school attendances reaching a hitherto (for this district) unprecedented percentage. During the latter part of 1904 I was enabled, by arrangement, to examine scholars suspected of disease, and not already under medical observation. These examinations proved very valuable, and co-ordinated easily and advantageously with the arrangements previously made. At the beginning of 1905, however, the Local School Attendance Committee made other plans for the carrying out of the medical examination of scholars, and later in the year the County Education Committee appointed as their adviser on medical subjects a special Education Medical Officer. As a result of the policy adopted by the Surrey Education Committee before this appointment was made, local Medical Officers of Health have now no official duties or status in connection with the health of scholars and the hygienic arrangements of public elementary schools. In the recent able and exhaustive report of the County Education Medical Officer, it is true that the advisability of school teachers communicating with and asking the advice of local Medical Officers of Health is plainly urged. But the practical outcome in this district has been that one no longer receives the notifications, arranged for in 1903 from teachers, of children suffering from suspected disease. And the 32 father absurd situation results that, although the Sanitary Department continues to afford to schools and school teachers such information as is possible as to children suffering from notifiable disorders, yet the Medical Officer of Health, who alone can, by reporting to his Authority, secure the compulsory closing, in time of need, of public elementary schools, has practically no regular source of information as to the health of scholars other than the reports in the public press of the quarterly meeting of local school attendance committees. I am strongly of opinion, that in the interests of public health and education, as well as financial economy, advantage should be taken of the local knowledge of Medical Officers of Health, and that they should have, in respect to these questions, powers and duties recognized by Education Committees, co-ordinated it may be with or controlled by the County Education Medical Officer, whether he be the County Medical Officer of Health, or an Officer specially appointed. This is the position adopted successfully in many counties, and is, of course, in principle that taken up by practically every Local Authority which is also an Education Authority. Unless some such scheme be adopted it becomes a matter of necessity that a medical staff of some magnitude should be appointed to act under the County Education Medical Officer. That the appointment of such a special staff is a matter wasteful both financially and physically is fully obvious. That the officer specially appointed to advise a local sanitary authority on, amongst other subjects, the control of infectious disease and the necessity for hospital accommodation, should have, in regard to elementary schools, absolutely no recognised powers or duties other than the ability to recommend, on belated information, the closing of a school or schools, seems almost ludicrous when it is remembered that more than 90 per cent, of the cases entering 33 isolation hospitals, and so involving a charge on the rates, are either school children or the infected brothers and sisters of school children. I need hardly say, however, that such assistance as can at any time be given, by reason of local knowledge or propinquity, to County the Education Medical Officer will always be most readily forthcoming. But the disadvantage of not having recognised status and the power to act promptly and decisively, if necessary, without appealing to a distance, cannot be balanced easily, and 1 do not anticipate that the freedom from disease amongst scholars which we have lately enjoyed will continue. Mortuary and Coroner's Court. The alterations that have been made to these places have proved both convenient and suitable. I hope that something may be done shortly to improve the internal arrangements of the Mortuary which, now that the hospital buildings approach it so nearly, leave a good deal to be desired. Thirty-three inquests were held during 1905. Of these 16 were on the bodies of residents, and 17 on the bodies of non. residents, almost all of which were recovered from the river. The verdicts were, in 11 cases, "Found drowned" or "Found dead"; in 5 cases "Suicide"; and in 2 cases (those of infants whose bodies were found on the Common) " Wilful murder." 10 deaths were found due to natural, and 5 to accidental causes. Baths and Washhouses. No further steps have been taken in regard to this matter. 34 Cemetery. The new cemetery provided by the District Council in part of the so-called " added area " bas been opened formally and already used for interments. The cemetery at Mortlake is not yet full, but it is stated that that on Barnes Common has not very much space left available for burials. The Midwives' Act, 1902. Extract from the Report for 1905 of the Medical Officer of Health for Barnes, to the Local Supervising Authority—the Surrey County Council. "(2) The certified midwives said to practice in this district, of whom I have obtained information, are six in number. I have repeatedly during the year visited their residences, and have obtained such information relative to their mode of practice, and their compliance or otherwise with the Act as has been possible. "(4) There are several midwives in the district who are not certified or registered. They are fully aware that there is, under the Act, no power to deal with them at present, so long as they do not incorrectly describe themselves. "(5) No steps have been taken to instruct the midwives who are registered more particularly than can be done viva voce by myself at my visits, inasmuch as there are only two that need instruction, and of these one is totally illiterate. "(6) No difficulties have arisen with respect to the payment of fees to medical men, and no case of irregularity or disease has been brought to my notice as having occurred in the practice of any of the midwives, registered or unregistered, during the past year." 35 Appendix A. Special Report under the Faetory and Workshop Act, 1901. The various places which in this district are, so far as the Local Sanitary Authority is concerned, under the operation of this Act, have been, during the past year, frequently visited by myself and the Sanitary Inspectors. The tables required by the Home Office immediately follow this note, and, in Appendix C, some further particulars are afforded on pages 50 and 52. It will be seen that, though continued and careful attention has been paid to the working of the Act, no very serious matters have required attention, and the written notices served have been in all cases complied with. I have again, however, to record the statement that no steps have been taken to make bye-laws " providing for means of escape from fire in the case of any factory or workshop," or to see that, as the Act directs, " every factory and workshop in the district is provided with sufficient means of escape from fire." 36 Annual Report for 1905 of the Medical Officer of Health for the Urban District of Barnes on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES' AND HOMEWORK. I.-INSPECTION. Inspections made by Sanitary Inspectors Premises. Number of Inspections. Written Notices. Frosecutiors. Factories (Including Factory Laundries) 26 3 — Workshops (Including Workshop Laundries) 200 23 — Workplaces 25 1 — Homeworkers' Premises 12 — Total 263 27 — 2.—DEFECTS FOUND. Particulars. Number of Defects Number OF tions. Found. Remedied. Referred to H.M . Inspector Nuisances under the Public Health Acts :— Want of cleanliness 12 12 — Want of ventilation — Overcrowding 2 2 — — Want of drainage of floors 2 2 — — Other nuisances 11 11 — — Sanitary accommodation insufficient — — unsuitable or defective — — — not separate for sexes — — — — Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Failure as regards lists of ou workers (S. 107; - - - Giving out work to be done in premises which are unwholesome (S. 108) - infected (S. 110) — — — — Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S 109) - - - - Other offences — - - - Total 27 27 - - 37 3.—OTHER MATTERS. Class Number. Matters notified to H.M. Inspectors of Factories :— - Failure to affix Abstract of the Factory and Workshop Act (S. 133) - Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspectors - Reports (of action taken) sent to H.M, Inspectors - Other — Underground Bakehouses (S. 101): — Certificates granted during the year — In use at the end of the year 5 Homework : Number of Lists of Outworkers (S. 107): — Lists. Outworkers. Lists received - — Addresses of outworkers ' forwarded to other Authorities . - - received from other Authorities 6 17 Homework in unwholesome or infected premises :— Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) Cases of infectious disease notified in homeworkers' premises - - Orders prohibiting homework in infected premises (S 110.) — — Workshops on the Register (S. 131) at the end of the year Important classes workshops, sushs workshop bakehouses, may be enumerated i ere. Workshop Laundries 14 Dressmakers' Premises 29 Shoemakers' Premises 15 Bakehouses 10 Total number of workshops on Register 124 38 Appendix B. Tables of the Local Government Board. I.— Vital Statistics of whole District during 1905 and previous years. II.— Vital Statistics of Localities during 1905 and previous years. III.—Cases of Infectious Disease notified during 1905. IV.— Causes of, and ages at, death during 1905, V.—Infantile Mortality. 39 TABLE I. Vital Statistics of whole District during 1905 and previous Years. Name of District -Barnes Urban. Year. Population estimated to Middle of each Year Births. Total Deaths Registered in the District. Total. Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residnts registered in Public Institutions beyond the District. Nett Deaths at all ages Beloning to 'the District. Number. Rate*. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895. 15950 397 24.1 51 128.4 218 13.6 7 ... 6 224 14.1 1896. 16200 404 24.9 61 140.9 191 11.7 4 ... 7 198 12.2 1897. 16450 370 22.5 54 145.9 196 11.9 2 ... 5 201 12.2 1898. 16700 351 210 64 182.3 203 12.1 5 ... 3 207 12.4 1899. 17000 458 26.9 58 126.5 225 13.2 5 ... 4 229 13.4 1900. 17400 416 23.9 56 134.6 220 12.7 1 ... 3 223 12.8 1901. 17900 420 23.5 56 133.3 214 12.5 3 ... 24 238 13.2 1902. 19900 501 25.1 57 113.7 257 12.9 7 ... 27 286 14.2 1903. 21150 513 24.2 57 111.1 220 10.3 5 ... 27 247 11.6 1904 Averages for Years 1895-1904. 23200 618 26.6 83 134.3 237 10.2 0 ... 24 261 11.2 18185 444.8 22.4 59.7 134.4 218.1 11.9 39 ... 13 231.4 12.7 1905. 24250 600 24.7 72 120 254 10.4 3 ... 35 289 11.9 Area of District in acres (exclusive of area covered by water). 2,400. *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated, population. Total population at all ages Number of inhabited houses Average number of persons per house 17.821 3,403 5 236 At Census of 1901. 40 TABLE II. Vital Statistics of Separate Localities in 1905 and previous years. Names of Localities 1. BARNES (URBAN). 2. BARNES, 3. MORTLAKE. Year Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under I year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to micdle of each year. Births regis t red Deaths at all ages. Deaths under 1 year. a b c d a b c d a b c d 1895 15950 397 224 51 8950 226 107 25 7000 171 117 26 1896 16200 404 198 61 9100 217 104 30 7100 187 94 31 1897 16450 370 201 54 6230 218 101 26 7220 152 100 28 1898 16700 351 207 64 9350 193 126 42 7350 158 81 22 1899 17000 458 229 58 9500 286 123 36 7500 192 106 22 1900 17400 416 223 56 9750 230 107 26 7650 186 116 30 1901 17900 420 238 57 10100 258 127 27 7800 162 110 30 1902 19900 501 286 60 10700 259 140 32 9200 242 146 28 1903 21150 513 247 59 11250 263 133 32 9900 250 114 27 1904 23200 618 261 86 12000 293 134 43 11200 325 127 43 Averages of Years 1895 to 1904 . 18185 444 231 60 9993 244 120 31 8192 200 111 28 1905 24250 600 289 74 12250 310 138 26 12000 290 151 48 TABLE III. Cases of Infectious Disease notified during the Year 1905: Name of District—Barnes Urban. Notifiable Disease. Cases Notified in Whole District. Total Casec Notified in each locality. Number of Cases removed to Hospital from each locality. At all Ages. At Ages Years. 1 2 1 2 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65 65 and Upwrds Barnes Mortlake. Barnes. Mortlake. Small Pox — — — — — — — — — — — Cholera — — — — — — — — — — — Diphtheria 17 — 4 7 3 3 — 8 9 6 8 Membranous croup 1 — 1 — — — — — 1 — 1 Erysipelas 10 — — — 2 8 — 6 4 — 2 Scarlet Fever 31 — 9 19 2 1 — 21 10 19 6 Typhus Fever — — — — — — — — — — — Enteric Fever 4 — — — 1 3 — 2 2 — — Relapsing Fever — — — — — — — — — — — Continued Fever — — — — — — — — — — — Puerperal Fever 1 — — — 1 — — — 1 — — Plague — — — — — — — — — — — Totals 64 — 14 26 9 15 — 37 27 25 17 41 TABLE IV. Causes of, and Ages at, Death during Year 1905. Causes of Death. Deaths at the Subjoined Ages of " Resident'' whether occurring in or beyond the District. Deaths at all Ages of Residents' belonging to Localities whether occurring in or beyond the District. total Deaths whether of Residen s or NonResidents in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Barnes, Mortlake, Smallpox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever 1 — 1 — — — — — 1 1 Whooping-cough 6 3 3 — — — — 2 4 — Diphtheria and membranous croup 4 — 3 — — 1 — 2 2 2 Croup — — — — — 1 — — — — Fever . Typhus — — — — — — — — — — Enteric 1 — — — — 1 — — 1 — Other continued — — — — — — — — — — Epidemic influenza 1 — — — — — — — 1 — Cholera — — — — — — — — — — Plague — — — — — — — — — — Diarrhœa 9 9 — — — — — 2 7 — Enteritis 3 2 — — — — 1 1 2 — Puerperal fever — — — — — — — — — — 42 Erysipelas 1 — — — — 1 — 1 — — Other septic diseases 1 — — — — — 1 — 1 — Phthisis (Pulmonary Tuberculosis) 30 2 3 — 1 20 4 17 13 — Other tubercular diseases 9 2 6 1 — — — 5 4 — Cancer,malignant disease 22 — — — 1 10 11 12 10 — Bronchitis 11 2 1 — — 3 5 5 6 — Pneumonia 18 5 6 — — 7 — 9 9 — Pleurisy 2 — — — — 2 — 1 1 — Other diseases of Respiratory Organs 2 — — 1 1 — — 1 1 — Alcoholism Cirrhosis of Liver 7 — — — — 6 1 3 4 — Venereal diseases — — — — — — — — — — Premature Birth 11 11 — — — — — 2 9 — Diseases and accidents of parturition — — — — — — — — — — Heart Diseases 21 3 — — 2 9 7 10 11 — Accidents 6 3 1 1 — — 1 2 4 Suicides 5 — — — 2 1 2 4 1 — All other causes 118 32 — 1 6 25 54 59 59 — All causes 289 74 24 4 13 87 87 138 151 3 43 TABLE V. Infantile Mortality during the Year 1905. Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 year. All Causes Certified 15 2 3 5 25 14 2 5 7 1 3 2 4 6 3 2 74 Uncertified — — — — — — — — — — — — — — — — — Common Infectious Diseases Smalt-pox — — — — — — — — — — — — — — — — — Chicken-pox — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — Diphtheria : Croup — — — — — — — — — — — — — — — — — Whooping Cough — — — — — 1 1 — — — — — — — — 1 3 Diarrhœal Diseases Diarrhœa, all forms — — 1 1 3 1 2 1 1 9 Enteritis (not Tuberculous) — — — — — — — 1 1 — — — — — — — 2 Gastritis, Gastrointestinal Catarrh — — — — — — — — — — — — — — — — — Wasting Diseases. 'Premature Birth 6 1 1 1 9 2 — — — — — — — — — — 11 Congenital Defects 1 1 1 — 3 1 — — — — — — — — — — 4 Injury at Birth — — — — — — — — — — — — — — — — — Want of Breast Milk — — — — — — — 1 1 — — — — 1 — — 3 Atrophy. Debility, Marasmus 1 — — 2 3 4 1 2 1 — 1 — — — — — 12 44 Tuberculous Diseases. Tuberculous Meningitis — — — — — — — — — — — — — — 1 — 2 Tuberculous Peritonitis: Tabes Mesenterica — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — 1 1 — — — 2 Erysipelas — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — 1 — — — — 2 — — 3 Convulsions 1 — 1 — 2 1 — — — — 1 — — — — — 4 Bronchitis — — — — — — — — 1 — — — 1 — — — 2 Laryngitis — — — — — — — — — — — — — — — — — Pneumonia — — — — — 1 — — 1 1 — — 1 1 — — 5 Suffocation, overlaying — — — 1 1 — — 1 1 — — — — — — — 3 Other Causes 6 — — — 6 1 — — — — — 1 — — 1 — 9 15 2 3 5 25 14 2 5 7 1 3 2 4 6 3 2 74 District: —Barnes. Population (estimated to middle of 1905), 24,250. Births in the year, 600. Deaths from all causes at all ages, 289. 45 46 Appendix C. Tables. Infectious Disease. General Work of the Sanitary Department. Food and Drugs Act. Vaccination. 47 TABLE Shewing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever, notified during 1905 and in the 10 previous years, with the estimated population, and number of cases per 1,000 estimated population, for each year. Year. Estimated Population. Cases Notified. No. of cases per 1,000 estimated population. Scarlet Fever. Diphtheria and Croup. Typhoid Fever. Total. 1895 15,950 53 43 10 106 6.5 1896 16,200 66 28 10 104 6.4 1897 16,450 41 44 7 92 5.7 1898 16,700 73 38 12 123 6.9 1899 17,000 90 24 9 123 7.2 1900 17,400 32 26 5 63 3.6 1901 17,900 31 75 12 118 6.5 1902 19,900 75 61 8 144 7.2 1903 21,150 30 55 8 93 4.3 1904 23,250 31 14 7 52 2.2 Averages 18,185 52.2 40.8 8.8 101.8 5.5 1905 24,250 31 17 4 52 2.1 TABLE. Showing the Case Mortality at the Isolation Hospital, Mortlake, since January 1st, 1901. Year. SCARLET FEVER. DIPHTHERIA AND CROUP. TOTALS. Admissions. Deaths. Mortality per cent. Admissions. Deaths. Mortality per cent. Admissions. Deaths. Mortality per cent. 1901 18 0 0.0 56 1 1.71 74 1 1.35 1902 56 1 1.71 46 6 13.04 102 7 6.86 1903 21 1 4.76 45 3 6.57 66 4 6.06 1904 21 0 0.0 9 0 0.0 30 0 0.0 1905 24 1 4.16 14 2 14.2 38 3 7.89 Totals 140 3 2.11 170 12 7.05 3.10 15 483 Of the 14 cases of diphtheria admitted in 1905, four had laryngeal complications (in one instance congenital) necessitating tracheotomy. 48 49 TABLE Showing the work done by the Sanitary Inspectors during 1905, having relation to the Housing of the Working Classes. BARNES. MORTLAKE. TOTALS. Houses found unfit for habitation 0 0 0 Overcrowding 1 2 3 Premises cleansed by owners 32 64 96 Visits made to dwelling houses 1666 2255 3921 TABLE Showing the number of certain places under the Council's supervision, and the visits made to them by the Sanitary Inspectors during 1905. BARNES. MORTLAKE. TOTALS. No. Visits. No. Visits. No. Visits. Dairies and milk shops 9 36 11 44 20 80 Other places where milk is sold 3 6 9 18 12 24 Cowsheds 1 4 1 6 2 10 Slaughterhouses 1 3 3 11 4 14 Places where petroleum is stored 4 8 8 16 12 24 TABLE Showing the work done by the Sanitary Inspectors during 1905 with relation to infectious diseases. BARNES. MORTLAKE. TOTALS. Visits to cases of notifiable disease 41 29 70 Visits to cases of non-notifiable disease 40 11 51 Disinfections performed 39 29 68 Lots disinfected by steam 24 22 46 Premises cleansed under Infectious Diseases Prevention Act 8 8 16 50 TABLE Showing the work done by the Sanitary Inspectors during 1905 with regard to places under the Factory and Workshops Act, 1901. BARNES. MORTLAKE. TOTALS. No. Visits. No. Visits. No. Visits A.—FACTORIES. Sawmills 1 2 1 2 1 2 Electric Lighting Works 1 1 1 2 2 3 Printers' 1 1 4 4 5 5 Coachbuilders' ... ... 1 2 1 2 Cricket Ball Makers' 1 2 ... ... 1 2 STEAM LAUNDRIES— Over 40 employees 1 3 ... ... 1 3 Under 40 employees 2 6 2 7 4 13 B.—WORKSHOPS. Wall Paper Designers' ... ... 1 1 1 1 Blindmakers' 1 1 ... ... 1 1 Tailors' 4 4 4 5 8 9 Dressmakers' 17 21 12 13 29 34 Shoemakers' 8 10 7 9 15 19 Cycle and Motor 4 4 3 4 7 8 Saddlers' 1 2 2 2 3 4 Confectioners' 1 1 ... ... 1 1 Photographers' ... ... 3 3 3 3 Paving Works 1 2 ... ... 1 2 Smiths' l 1 3 5 4 6 HAND LAUNDRIES— Over 40 employees ... ... ... ... ... ... Under 40 employees 5 14 9 23 14 37 BAKEHOUSES— 4 12 6 18 10 30 C.—DOMESTIC WORKSHOPS. Dressmakers' 9 15 6 6 15 21 Family Laundries 4 10 8 18 12 28 D.-WORKPLACES. Stable Yards 5 8 2 3 7 11 Restaurants 3 6 5 8 8 14 Totals 75 126 79 133 154 259 51 TABLE Showing the number and kind of general nuisances discovered and remedied during 1905. Barnes. Mortlake Total. Defective drains amended 15 27 42 Defective drains reconstructed 7 24 31 Defective soil pipe ventilators 9 9 18 Defective closet pans, etc. 74 52 126 Defective closet fittings 1 4 5 Defective waste pipes — 8 8 Defective light and ventilation to closets 6 5 11 Defective flushing cisterns 36 63 99 Cisterns cleansed and covered 11 34 45 Dustbins replaced 41 61 102 Yards paved 10 22 32 Mica valves made good 5 37 42 Nuisances from animals 6 2 8 Foul accumulations 0 2 2 Rain water pipes disconnected 4 5 9 Defective gutterings 8 11 19 Totals. 233 366 599 Statutory notices served 47 Summonses taken out 1 52 TABLE Showing the general work done in the Sanitary Department during 1905, and in the four preceding years. Nature of Work Done. 1901 1902 1903 1904 1905 Inspections of houses and premises made 2391 2750 3642 4142 4454 Notices served for abatement of defects 397 458 615 764 681 Houses and Premises cleansed and repaired 22 28 129 220 96 Houses disinfected 85 126 90 53 68 Defective drains (amended) 30 35 47 42 42 Defective drains (reconstructed) 7 4 8 22 31 Defective soil pipe ventilators 15 28 6 15 18 Defective closet pans and traps (replaced) 21 20 50 114 126 Dustbins (replaced) 85 56 141 125 102 Defective flushing cisterns 116 139 180 182 99 Cisterns cleansed and covered 32 53 71 56 45 Premises on which animals causing nuisance 3 2 5 7 8 Foul accumulations (removed) 8 1 6 4 2 Defective roofs and eaves gutterings 11 6 50 55 19 Insanitary Yards paved 35 18 9 69 32 Defective Mica Valves ... 10 18 66 42 Burst pipes repaired ... 9 8 2 ... No proper receptacle for manure or offal ... ... 3 9 ... Overcrowding (abated) 7 6 6 11 3 Houses found unfit for habitation 5 15 2 1 ... Bakehouses inspected 11 11 13 11 10 Cowsheds and Dairies inspected 14 17 20 23 22 Licensed slaughter-houses inspected 5 5 4 4 4 Factories and Workshops inspected ... ... 128 140 154 Number of visits to notifiable diseases ... ... 116 108 70 Number of visits to non-notifiable diseases ... ... 42 154 51 Premises licensed for storage of Petroleum 3 6 9 11 12 Complaints received ... ... ... 33 45 Summonses for abatement of Nuisances 1 ... 1 3 1 TABLE. Shewing the Proceedings taken during 1905, under the Food and Drugs Act, by the County Inspector, Mr. Houghton. Articles Purchased. Samples taken. Found Genuine. Slightly Adulterated etc. Cases in which proceedings taken. Connections obtained. Fines Inflicted. Milk 21 15 2 4 3 £15 4 6 Butter 9 9 — — — — Spizits 2 1 — 1 1 £2 4 6 Coffee 1 1 — — — — Cheese 4 4 — — — — Margarine 2 2 — Under Margarine Act. 1 £1 14 0 Vinegar 1 1 — — — — Olive Oil 1 1 — — — — Totals 41 34 2 6 5 £19 3 0 53 TABLE Showing the administration of the Vaccination Acts in the Mortlake Registration Sub-District (which includes the parishes of Barnes and Mortlake) according to the return made by Mr. Umney, Clerk to the Richmond Guardians. Return for the period January lst to December 31 st, 1904. Registration Sub-District Comprised in the Vaccination Officer's District. No. of Births returned in the Birth List Sheets as registered. Number of these Births duly entered by 31st January, 1906, in Cols. 1, 2, 4, & 5 of the Vaccination Register (Birth List Sheets), viz : Number of these Births which on 31st Jan , 1906, remain unentered in the Vaccination Register on account (as shown by Report book) of Number of these Births remaining on 31st Jan.. 1906, neither duly entered in the Vaccination Register (Cols. 3, 4, 5, 6, & 7 of this return) nor temporarilly accounted for in the Report Book (Cols. 8, 9, & 10 of this Return.) Number of Certificates of Conscientious Objectionactually received, by the Vaccination Officer irrespective of the dates of Births of the Children to which they relate during the year 1905. Total number of Certificates of successful Primary Vaccination at all ages received during the calendar year 1905. COL 1. Column 2. COL 4. COL. 5. Postpone ment by Medical Certificate. Removal to Districts the Vaccination Officer of which has been duly apprised. Removal to place unknown or which cannot be reached and cases not having been found. Successfully Vaccinated. Insusceptible of Vaccin" ation. Had Small Pox. Number in respeet of whom Certificates of Conscientious Objection have been received. Dead unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 MORTLAKE 743 660 3 — 7 54 — 7 12 none — 683 Return for the Period January-June, 1905. (Supplementary). MORTLAKE 376 331 2 — 5 27 4 1 6 none 12 — 54