BARN 56 Urban district Council of Barnes. Annual Report on the Health, Sanitary Conditions, etc., OF THE URBAN DISTRICT OF BARNES, tor the Year i 9 14. by B. C. Stevens, m.d., f.r.c.s.e., d.p.h., Medical Officer of health. Barnes, S.W. R, W. Simpson & Co-, Ltd., Printers, 15 High Street. 1915. The Council House, Morti.ake, S.W. The Chairman and Members of the Urban District Council of Barnes. Gentlemen,— In accordance with the requirement of the Local Government Board, I beg to submit my Annual Report for the year 1914. 1 gratefully acknowledge the assistance given me by the Clerk and the Surveyor. I desire also to acknowledge the help and co-operation of the Chairman of the Public Health Committee, and wish to place on record the great assistance he has been to the district by the energetic and fair-minded way in which he has taken up the many important matters affecting the public health during the year. 1 desire also to record the good services rendered by the Chairman of the Hospital Committee. In conclusion I desire to thank the Chairman of the Council and the Councillors for their support in discussions on public health matters. I am, gentlemen, Yours obediently, B. C. Stevens, Medical Officer of Health. January, 1915, INDEX. PAOR Bacteriological Examinations 84 Birth Rate 39 Diphtheria 82 Death Rate 34 Drainage and Sewerage 23 Epidemic Diarrhoea 35 Enteric Fever 84 Factory and Workshops Acts, 1901 62 Hospital Administration 78 Housing Acts 76 Infectious Diseases 78 ,, ,, Work done in relation to 75 Infantile Death Rate 35 Legal Summary 9 Relief, Poor Law and Charitable 15 ,, Gratuitous 17 Maternity and Child Welfare 30 Meteorology 18 New Roads and Buildings 77 Physical Features 14 Public Hospitals, Deaths in 39 Population 37 Refuse, Removal and Disposal of 30 Report of Sanitary Inspectors 61 Sale of Food and Drugs Act 7.2 Sanitary Work 65 Scarlet Fever 80 School Work 43 School Notes 57 Statistical Summary 11 Tuberculosis 86 Vital Statistics 33—98 Water Supply 29—64 Weather 23 Vaccination Returns 42 THE Urban District Council of Barnes. Cubltc Dealtb Committee. Mr. Bates „ Brackley „ Day „ Pirmston „ Hampton ,, Hinton Mr. Jackson „ Jones (Chairman) ,, Kitley „ Lambert „ Maynard „ Medus Mr. Moon an ,, Powell „ Pike „ Shearman „ Sparkes Hospital Sub-Committee. Mr. Bates „ Jones Mr. Day (Chairman) ,, Kitley Mr. Maynard „ Powell luberculosig Subcommittee. Mr. Jones (Chairman) Mr. Kitley Mr. Medus Medical Officer of Health, Medical Superintendent of Isolation Hospital, Tuberculosis Officer, etc. Bertram Crossfield Stevens, F.K.C.S. (Edin.), D P.H (Oxon.). M.D M S (Dunelm), L.H.C P. (Lonri.) As?istant School Medical Officer Surrey Kducation Committee. Sanitary Inspector and Inspector of Housing. T. Grylls, Senior Assistant Sanitary Inspector and Assistant Inspector of Housing. C. H. Robinson, R.P.C., Cert. San. Insp. Exam. Board. Hons. Pract, Plumbing. Hons. Building Construction, Junior Assistant Sanitary Inspector. C. W. Sladk, a.r.S.i. Matron of the Hospital. Miss Carothers, Health Visitor, Tuberculosis and School Nurse. Miss Williams. Xcoal Summary. GENERAL ACTS. Public Health Act 1875. Dairies, Cowsheds and Milkshops Order, 1885. Infectious Diseases Notification Act 1889. Factory and Workshops Acts Act 1901. Tuberculosis Regulations 1911 and 1912. Housing of the Working Classes Acts 1890 to 1903. Housing and Town Planning, etc., Act 1909. ADOPTED ACTS. Infectious Diseases (Prevention) Act 1890. Public Health Acts Amendment Act 1890. Parts II. and III. Private Street Works Act 1892. Public Health Acts Amendment Act 1907. Parts of, with modifications. Small Dwellings Acquisition Act 1899. Notification of Births Act 1907. BYE-LAWS RELATING TO PUBLIC HEALTH. Common Lodging Houses, 1894. Nuisances, 1894. Slaughter Houses, 1894. Management of a Mortuary, 1895. Dairies, Cowsheds, and Milkshops, 1903. Houses let in Lodgings, 1912. Removal of Filth through Streets, 1912. Fish Fryers, 1913, New Streets and Buildings, 1913. Tents, Vans, Sheds, etc., 1897. Swings, Roundabouts, etc., 1894. Servants' Registry, 1909. Clearance of Snow, etc., 1894. Statistical flftemoranfca for 1914. Area—Barnes 1,067 acres „ Mortlake 1,583 „ 2,650 Tidal waters of foreshore 133 2,517 Population 34,745 Birth Rate 21.7 per 1,000 Residential Dhath Rate for 1914 7.9 ,, District Death Rate for 1914 After adding deaths of residents dying outside the district and deducting those of non-residents dying in the district 9.6 Zymotic Death Rate 0.4 „ Pulmonary Tuberculosis (Residents only) 0.7 „ Infantile Death Rate 63-6 per 1,000 births Inhabited Houses 8,272 Persons per Inhabited House 4.2 Census Population, 1901 17,900 1911 30,377 Rateable Value—Agricultural land £1,762 „ ,, Other Hereditaments £275,948 Assessable Value £255,875 General District Rate 4/- Poor Rate—Barnes 3/5 „ „ Mortlake 3/7 Id. in the £ for District Rate purposes produces £1,000. ANNUAL REPORT. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. The Urban District of Barnes possesses charms in the shape of river, park, commons, and open fields, and is at the same time an up-to-date suburban one. The attractions of the district are its river, Richmond Park, Barnes, Sheen and Palewell Commons, while in the vicinity are Kew Gardens and Wimbledon Common. The river runs along the whole northern side of the district. The towing-path running from Hammersmith to Kew forms a stretch of four miles. 600 acres of Richmond Park are in the parish of Mortlake. 126 acres of Barnes Common extend on the east of the district. 52 acres of East Sheen Common „ south ,, 15 acres of Palewell Common „ south-east „ The district is situated in the north-western part of the county of Surrey, within the Metropolitan Police and the London Postal Area, bounded on the north by the River Thames, on the south and east by the Roehampton part of the Metropolitan Borough of Wandsworth, and on the west by the Borough of Richmond. The surface of the ground on the eastern side of the district rises with a gradual slope from the river towards the south, proceeding westwards the slope of the ground gets more marked, 14 Physical Features. till at Vicarage and Christ Church Roads the highest level is reached, which is almost 64 feet above the tide. In addition to the fine and permanent stretches of open spaces, there are several large recreation grounds for polo, golf, football, cricket, tennis, hockey, etc. There is also a large number of country houses with extensive grounds attached. Mention should be made, also, of several market gardens and nurseries. The soil is gravelly over the London Clay, which latter outcrops in the vicinity of Palewell Park. Owing to the gentle slope up from the river to East Sheen, Richmond Park and Roehampton, surface water gets away very quickly and the ground soon dries. The district is growing rapidly and many new houses are being erected, but at the same time the rural charms of the place are not disappearing and probably never will. It would be difficult to find any district so near London with more town facilities and more country advantages. As a result of building operations some of the old estates are disappearing, but at the same time good roads are being opened up and houses are being built on orderly lines, and some of the narrow streets and lanes are being widened. By this means a fair amount of old property has been demolished, especially in or about the High Street, Barnes. The population has increased from 17,900 in 1901 to 34,745 in 1914, i.e., nearly doubled itself. There are no occupations in the district which could adversely influence the public health. The majority of the male inhabitants are business and city men ; a large brewery employs many men, and several large laundries employ many young women. A large number of men also are employed by the London General Omnibus Company and by the London & South Western Railway, also by contractors and builders. The Hospitals supplying this district are the West London at Hammersmith, the Putney and Richmond Hospitals. The Poor Law Hospital is Poor Law Relief. 15 the Richmond Infirmary, while for infectious diseases, the Council's Isolation Hospital, containing 50 beds, provides for infectious cases in the district and for Tuberculosis locally and throughout the County. POOR LAW AND CHARITABLE RELIEF. Poor Law Relief During 1914. 182 orders were issued for Medical Attendance as against 250 in 1913. 158 orders were issued for Admission to Workhouse as against 175 in 1913. 31 deaths occurred among Barnes and Mortlake cases in the Workhouse. The average number per week in receipt of out-door relief was 21 males, 67 females and 78 children = 166 as against 166 in 1913. The Barnes, Mortlake and East Sheen Philanthropic Society was established with the charitable object of seeking out and relieving cases of distress, and rendering pecuniary assistance where such assistance may promote the future welfare of the recipient. The following table shows how the poor were relieved during 1914:— Expenditure. £ s. d. Monetary Relief 4 0 0 Grocery Tickets 16 11 0 Coal Tickets 16 9 10 Bread Tickets 4 9 0 Meat Tickets 4 12 0 Milk Tickets 0 14 6 Boots 4 1 6 Coke 7 0 0 57 17 10 i6 Poor Law Relief. Other forms in which Charitable relief is undertaken are by means of the Barnes Children's Shoe Club for children attending the elementary schools. Payments of 2d. to 6d. are made weekly, and a percentage is added from voluntary subscriptions. Orders for boots are made on local tradesmen. There is also a Coal Club, a Clothing Club, and a Women's Boot Club, also a Women's Provident Society; the members paying a small weekly subscription, and getting 5/- a week during sickness. There is also a Girls' Aid Society, which has existed for 27 years, the object of which is to rescue girls from bad surroundings and to send them to suitable training homes. The Barnes Women's Help Association has a membership of 70 working women and meets every .Monday for needlework. By paying small weekly instalments members can obtain household linen or personal clothing, &c. Hedgeman's School Charity gives boots and clothing to very poor children attending the Barnes Elementary Schools. The money was left in the hands of Trustees, and the distribution is made once a year, in December. A Soup Kitchen with dinners for children is opened during the winter months at St Michael's Church House on four days a week, and is supported by voluntary contributions; a small charge is made for the soup, and the children pay |d. for the dinner. For the above information 1 am indebted to Miss Attwell, who takes a prominent part in local charities, is a member of the Education Committee, and is a zealous and capable worker. The charities particular to Mortlake are:— The Mortlake Nursing Association, employing two qualified women, one for gratuitous attendance on the poor, the other to render skilled help to " small villa " residents for a small fee. Relief Gratuitous. 17 The Mortlake Relief Committee, having for its object the prevention of overlapping of Charitable and Poor Law Relief, and deals with cases which ought not to be left to the Poor Law. A Clothing Club, to encourage thrift by small weekly payments, entitling contributors to an order for clothing plus a bonus. There is also a Boot and Shoe Club run on similar lines. A Coal Fund supplies coals in winter to poor families, who subscribe during the summer. A Friendly Society for Women, which entitles one class of members to annuities at the age of 60 and another class to the benefits of a medical club. There are three almshouses in the Barnes and Mortlake District, accommodating three to four old persons in each. For this information I am indebted to the Rev. Horace Monroe, Vicar of Mortlake THE WAR AND THE PUBLIC HEALTH. About 100 Belgian refugees are quartered in different parts of the district, and many have been housed and provided for by voluntary contributions. The Barnes and Mortlake Patriotic Association has collected a good sum of money, and has done good work in relieving distress among those families where the wage earner has gone to the war. This Association has made the district independent of the Prince of Wales' Fund, but it is affiliated to the same. Thirty-eight of the Council's employees have joined the colours, but the Public Health Staff has not been affected. Up to the present no case of infectious disease has occurred among the Belgian refugees, and great pains have been taken to secure sufficient sanitary living room and offices for them. A large body of troops occupy the Ranelagh Club Grounds i8 Meteorology. and the Roehampton Club Grounds, but it has not been found that their presence is a menace to the health of the district. Troops are also billeted in the district. The premises in the Ranelagh Club Grounds have been inspected and found satisfactory. Another house on Barnes Common occupied by troops was not found so satisfactory, owing to deficient water and latrine arrangements. This has now been put into a satisfactory condition after communicating with the officer in command. DISTRESS. In view of possible distress from the shortage of money in the district, the population in the poorer parts have been instructed by leaflet and lectures on how to live with economy, and how to get the best food value for money paid. It is not intended that the actual sum mentioned, viz., 12s. 9d. a week, will suffice in all cases, as many foodstuffs have risen in price lately, but it is argued, with complete confidence, that the basis and general principles embodied in the leaflet are economically sound and will serve a useful purpose. The small-pox hospital at Clandon having been offered to the Crown as a military hospital, Barnes cases will have to go to the hospital at Whitmoor by arrangement with Guildford, Godalming, and Woking Joint Hospital Board. A health week was to have been instituted last year with lectures, demonstrations, &c., but was cancelled owing to the war. METEOROLOGY. Local weather conditions are usually interesting, and Mr. Manley, Head Teacher of the Church of England Schools at Mortlake, has kindly given me his records for the year. These observations are made personally, and are also used as a source of knowledge and interest for the scholars. I have checked Mr. Manley's figures against those taken by the Royal Botanic Society at Regent's Park and find that in the rpain they agree. M VO RAINFALL WIND TEMPERATURE. Meteorology. 19 OBSERVATIONS taken at Mortlake Church of England School, 1914: BAROMETER. Average Ht. Total. Highest in 24 hours. Average per day. Rain days. Dry days. N. N.E. E. 8.E. S. s.w. w. N.W. Calm Highest Max. Lowest Max. Highest Min. Lowest Min. Average Mean. January 30.02 42 .16 .01" 8 23 1 7 3 2 — 8 4 4 2 60° 36° 54° 208 40.8 February 29.63 2.17 .48 .07 i3 15 — — 1 3 7 12 3 1 1 60 44 52 3o 46-25 March 29.49 3.92 .78 .12 26 5 — 3 — 3 4 8 9 4 — 60 44 54 32 4601 April 30.00 .78 .17 .026 8 22 — 9 - 5 4 4 5 — 76 50 56 35 53.5 May 30.00 1.75 .77 .056 7 24 5 6 — 1 — 8 7 4 — 84 50 62 38 56.96 June 29.92 1.67 .81 .055 11 19 1 9 — 6 1 — 5 8 — 86 60 62 42 60.31 July 29.77 1.64 .25 .052 14 17 1 2 — 9 1 6 4 8 — 90 66 64 50 64.2 August 29.90 1.79 .37 .057 13 18 1 4 2 4 1 8 5 6 — 84 68 68 58 64.0 September 29.99 .92 .24 .03 7 23 1 3 4 4 2 4 o 10 — 83 68 64 35 60.35 October 29.90 .94 .23 .03 9 2n 3 5 4 6 — 5 3 4 1 76 53 55 34 54.5 November 29.75 2.20 .49 .073 16 14 2 2 4 3 3 — 1 3 1 66 39 52 I 27 47.18 December 29.64 6.23 1.38 .195 24 7 2 — — 4 5 11 4 n 3 57 36 36 29 43.35 24.43 156 209 17 50 18 45 29 1 85 51 59 11 Meteorology. 21 FREQUENCY CHART OF THE DIRECTION OF WIND. Daily Observations taken at 9 a.m., 1914. Each circle= 10 days. Sanitary Circumstances. 23 THE WEATHER IN 1914. The Rainfall was below the average for nine months, and above the average for the three months February, March, and December. The exceptionally heavy rainfall during December was phenomenal, rain falling on 24 days. In March rain fell on 26 days. The driest month was January, with a total of .42in. January was also remarkable for gloominess, only 23 2 hours of bright sunshine being recorded during the whole of the month. This was, however, eclipsed by December with only 20 hours' bright sunshine. The brightest months of the year were April, May, and June with 220.8 hours, 204.6 hours, and 260.2 hours of bright sunshine respectively. The prevailing w inds were chiefly of a westerly type. The wind blew from N.W. on 59 days, W. 51 days, S.W. 85 days. Calm was registered on 11 days. « The winter temperatures have been several degrees above the average. The shaded thermometer has fallen below 32° on seven times during November and December, 1914. SEWERAGE AND DRAINAGE. The water carriage system prevails throughout the district, with separate channels for storm water. For the following account of the Sewage Works I am indebted to W. Fairley, Esq., Engineer to the Richmond Main Sewerage Board, run conjointly by Barnes and Richmond. SEWAGE DISPOSAL WORKS. The main sewers discharge into a pump well at the Purification Works, which are on the riverside, at the extreme northern corner of Mortlake Parish. The area of the site is eleven acres, and a portion of the land is available for future extensions ; the surface was formerly below the level of high tides, and had to be 24 Sanitary Circumstances. raised some 3 or 4 feet; the material used was the surplus excavated materials taken from the sewer trenches while they were being constructed. The sewers enter the Purification Works 40 feet below the level of the ground, and pumping machinery is installed to lift the sewage from the bottom of the well, into which all the sewers discharge, sufficiently high to allow it to gravitate to the various tanks and filters. Various buildings of a substantial and decorative character are provided for carrying out pumping operations, treating the sewage by chemical precipitation, and operating on the sludge taken from the precipitation tanks. When operations were started, it was decided that the sewage should be treated on what was called the chemical precipitation process; that is, adding certain chemicals (generally lime and sulphate of alumina), and allowing the treated sewage to flow into tanks, and settle for one or two hours. The grosser matters are deposited, and a comparatively clear effluent can be drawn off and discharged. Further to purify the effluent, filters are provided which oxidise and aerate it, so that it may be discharged into the river without injurious effects. This method of working has now been in operation for above twenty-one years, and has satisfactorily fulfilled all requirements. In 1904, the Board installed the bacterial process, in an extension of the works. In this system the sewage is allowed to pass through large tanks, where, by natural means, a large amount of the solid matter is dissolved, and the effluent discharged is passed through filters, which aerate and oxidise out a considerable amount of the polluting matter. This process has also worked very well on the amount for which it was designed, which was about one-sixth of the daily flow. Sanitary Circumstances. 25 PUMPING MACHINERY. The most important operation at the works is the pumping of the sewage, so that the sewers from the different districts have at all times free discharge, and machinery is provided constantly to lift day and night the whole of the drainage flow ; this averages from three to four million gallons per day in dry weather, but is augmented considerably during times of rainfall by large volumes of storm water. If pumping operations ceased for any considerable length of time, sewage would collect in the system of sewers throughout the district until the lower parts of the district were flooded. To ensure that such an event should not occur, it has been the object of the Board to provide pumping machinery largely in excess of the capacity required for the average dry weather flow. At present the machinery installed is capable of lifting fifty million gallons, or 223,214 tons of water per day. Of course, it is not expected ever to have fifty millions to pump in twenty-four hours, but on occasions of sudden rain storms, the machinery has gradually to be set in motion, one engine after another, until within, say, thirty minutes, the pumps may be lifting 4,500 tons per hour, or twelve times the ordinary dry weather flow, and this rate of pumping may have to be continued for many hours. It might be suggested that, in a district where so much is done to provide that the rain water goes direct to the river by a special system of drains, there should not be much find access to the sewers; such would be the case, if the whole of the houses, as well as the streets, were provided with a double system of drains, one for rainfall and one for sewage. In Barnes and Richmond, however, a large proportion of the roofs are still drained to the sewers, and it is the roof water which causes the sudden fluctuations, and adds large volumes to be 26 Sanitary Circumstances. pumped during heavy rainfalls; one square yard of roof surface will discharge double the rainfall that would drain from an equal area of roadway. In 1910, the whole of the pumping was done by steam-driven machinery, and there were then seven pumping engines installed, varying in capacity from three to fifteen million gallons per day, but the Board considered that the time had arrived to increase the pumping power, in view of the rapid increase of population in the united districts. Further additions of steam engines would have entailed additional boilers and buildings; for, although the whole machinery is not in operation every day, still, all of it must be kept in a state of readiness for use, and a steam plant would have required boilers to be kept under steam, with their fires banked, ready for work on short notice. Various schemes were considered, but eventually it was decided that the new reserve plant, which was to be installed only to pump large volumes of rainfall and sewage, should be driven by gas; and a large installation of pumping machinery has been recently erected, capable of pumping twenty million gallons per day, operated by gas from the mains of the local Gas Company ; and the station is now equipped with pumping capacity to lift thirty million gallons by steam, and twenty million gallons by gas. The convenience of having two systems was demonstrated during the past coal strike. When the strike began, the Board's reserve stock of coal was not large ; so during the whole month of March the working of the station was altered so that all the sewage pumping was done by gas-driven machinery. SLUDGE DISPOSAL. I have already mentioned how the sewage is treated with chemicals, settled in tanks, filtered, and then discharged on the ebb tide into the river. The volume thus dealt with is from three Sanitaky Circumstances. 27 to four million gallons in the twenty-four hours, but in times of rainfall it is increased to seven or eight millions, and on some occasions fourteen millions. The disposal of the residue left in the tanks is an important and difficult part of sewage purification. A large amount of solid matter or sludge is deposited in the settling tanks; this deposit, containing about 90 per cent, of water, is cleared out once a week, into a special storage tank. If allowed to stand for any considerable time, a large accumulation of this liquid deposit might cause a nuisance; it cannot be transported in the form in which it comes from the tanks, so is operated on, in batteries of filter presses, being forced at a pressure of about 1001b. per square inch between iron plates, lined with jute cloth. The water passes through the cloth, which acts as a filter, and the solid matter is retained in between the plates of the press. This goes on until a press is filled with the solid matter, all the water that passes through the cloths draining back to the sewer to be treated with the incoming sewage. By this means the sludge is reduced to an easily transportable pressed cake, containing 50 to 60 per cent, of water, in a form in which it can be handled or stored, and of some value for agricultural purposes. The pressed sludge is in slabs about 2½ inches thick, and contains valuable manurial properties. In a residential district like Richmond, it cannot be readily disposed of, and while it may be useful for agricultural purposes, the expense of handling and transporting, renders it very difficult to find a market which will take a constant supply. At the present moment some 30,000 or 40,000 tons of wet sludge are produced per annum; this represents about 7,000 tons of pressed cake—produced day by day in a fairly constant quantity. 28 Sanitary Circumstances. When the works were first started, the Board decided that no accumulation should be allowed in the works, to in any way prejudice the neighbouring properties; a means had, therefore, to be devised of having a regular transport service to keep them clear. If the works had been situated nearer the mouth of the Thames, we might have followed an alternative on the lines adopted by the London County Council and Glasgow Corporation, viz., providing specially constructed boats to convey the wet sludge to sea and deposit in deep water. In our case, the difficulties in the way of such a means of disposal would be very great, as the works are situated at a considerable distance from the mouth of the river, with all the dangers of a difficult navigation, fogs, etc., so that a constant service could not in all probability be maintained. The next best to that system is to make an arrangement to take away the pressed sludge, by which means, the transport of an immense amount of water is saved, and you also can take advantage of its agricultural value. For many years past, the Board has arrangements by which a contractor supplies barges, and all the pressed sludge, as it is made in the pressing-house, is taken away direct, by means of a tramway, and deposited into the barges; the contractor being responsible for taking it away, and he disposes of it for agricultural purposes in Essex and Kent, round the Estuary of the Thames. BEVERLEY BROOK. The Beverley Brook still continues to be an annoyance to the district, and in times of flood a distinct menace to the health Of the inhabitants, whose houses it floods. Negotiations are going on between the Barnes Urban District Council and the London County Council. Sanitary Circumstances. 29 WATER SUPPLY. The Wnter Supply is that of the Metropolitan Water Board— the supply is constant and sufficient and of good quality. The best proof of the quality is the fact that Enteric Fever, which is largely a water-borne disease, is practically non-existent in the district. The raw Thames water has to be stored so as to allow of sedimentation and filtration. A system in which a river water of reasonably good and uniform quality is pumped into a nearly full storage reservoir of adequate capacity at the same rate as water is being abstracted for filtration purposes is in a state of what may be termed "quality equilibrium."Any falling off in the quantity or the quality of the river water upsets, in greater or less measure, this equilibrium. Reservoirs and filters possess, it is true, an immense "reserve of purifying ability," but it would be a most unwise policy to take too much advantage of this circumstance and abstract river water independently of its quality, or rush impure river water through depleted service reservoirs in the hope that the sand filters would sufficiently remove the impurities. Hence arises the desirability of considering the feasibility of adopting a new factor in the London water question, namely, the occasional employment of supplementary processes of purification. REFUSE DESTRUCTOR AND SLAB PRESSING PLANT. The Refuse Destructor is one of Heenan and Froude's Destructors, provided with three Trough Grates which are handfed from the back, and mechanically clinkered from the front. The heat is used to raise steam in the Boiler for the purpose of driving the fan for the forced draught, well pump, Electric Lighting set for lighting the works, and for the engine for the Slab Pressing Plant. 30 Sanitary Circumstances. 11,536 loads of refuse were collected and burnt. During the year a Slab Making Plant has been installed for making Paving' Slabs from the Clinker produced by the Destructor. Plant was in operation for about two months, and during that time 3,500 Slabs were made. COLLECTION OP HOUSE REFUSE. This is a vexed question, and reaches its height during the summer, when there are only gas fires used in many houses, and where there are no gardens for burying organic refuse. When the Council acquires electrically-propelled dust vehicles it is sincerely hoped that a twice weekly collection will be obtained instead of once weekly, especially during the summer months MATERNITY AND CHILD WELFARE. In August last a circular letter was received from the Local Government Board on these questions. The Board outline what they describe as a complete scheme as follows:— 1 Arrangements for the local supervision of Midwives. 2 (a) An antenatal clinic for expectant mothers. (b) The home visiting of expectant mothers. (c) A maternity hospital or beds at a hospital, in which complicated cases of pregnancy can receive treatment. 3 (a) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (b) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. 4 (a) The treatment in a hospital of complicatio>is arising after parturition, ivhether in the mother or in the infant, Sanitary Circumstances. 31 (b) The provisions of systematic advice and treatment for infants at a liaby Clinic or Infant Dispensary. (c) The continuance of these Clinics and Dispensaries so as to be available for children up to the age when thev arc entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Crfeche, Day Nursery school for mothers, or other school. (d) The systematic home visitation of infants and of children not on a school register as above defined. After going into this question the Special Committee appointed came to the following conclusions which were approved by the rest of the P H. Committee, and confirmed by this Council:— "We do not consider that for the Barnes Urban District a complete scheme should be undertaken, but that the work commenced since the Health visitor was appointed should be extended (1) for securing improved ante-natal conditions, and (2) for continuing the work in relation to children beyond the first year of age. Attendance at the centre would of course be quite voluntary, but if some attraction in the shape of tea was afforded, we think that its work would soon become known, and by degrees the benefit thus afforded would be appreciated. We think it reasonably probable that the result of proceeding on the lines recommended will be to reduce the infantile death rate, but, even if this should not be the case, we are confident that the result would be to save a considerable amount of unnecessary suffering, and to insure a greater proportion of children commencing their school lives in good health. We are advised by the Medical Officer of Health that nearly 50 per cent, of the children require some attention when they first go to school, and that one-third of their ailments would not have existed if they had received proper attention in the preceding four years. As a general rule the infantile death-rate increases with the aggregation of population, i.e., it seems to be necessarily higher as 32 Sanitary Circumstances. rural conditions disappear and a locality grows towards city conditions. There is nothing in the statistics which shows that the present state of affairs in Barnes and Mortlake compares otherwise than favourable with other more or less similar places. Indeed the statistics reflect the high state of sanitary efficiency. In this connection we advise that a scheme be prepared for the establishment of a Maternity Centre and an Infant Consultation, which would include advice to expectant mothers, the weighing and examining of infants so as to ensure that they are making progress, and where advice may be received; also that medical treatment be afforded as far as the necessary expenses in connection with it are provided by voluntary contributions. It would be necessary for the Health Visitor to give up her school work. The cost of the scheme would be £200 per annum, of which half would be recovered from the L.G.B. It is not considered necessary to establish a Milk Depot." With regard to Maternity cases our records are as follows:— Deaths from Accidents and Diseases of Parturition and Pregnancy— 1912 1 1913 2 1914 2 Cases of overlaying— 1912 0 1913 3 1914. 1 Puerperal Fever— 1912 1 1913 0 1914 0 The cases of Puerperal Fever reported are few, and are seldom likely to be a true record, owing to the predominance of the human factor in the case of the attendant in the lying-in-wards. INFANTILE MORTALITY. Figures have been got out over a period of ten years shewing that, with the exception of a rise in 1911, the infantile mortality has markedly diminished since the years 1904-5-6. Vital Statistics. 33 In 1904 it was above the average for England and Wales, in 1905 it was about the same as the rest of the country, and since then there has been a gradual improvement in comparison with the rest of the country. The general death rate was over 11 per 1,000 per annum in the three years 1904-5-6. Since then it has fluctuated between 8-6 and 10-9 compared with 13-3 and 15-1 for England and Wales. Year. Population. Deaths under 1 year Infant Death Rate per 1000 Births. Deaths 1 to 5 years. Rate per 1,000 of Population. District Death-rate. Infant Deathrate Eng. & Wales. General Death-rate Eng.& Wales. 1904 23,200 83 134.3 18 0.73 11.2 127 15. 1 1905 24,250 74 120.0 24 0.94 11.9 1906 25,500 75 112.0 37 1.04 11.2 1907 28,000 65 92.0 14 0.50 10.7 1908 28,500 67 93.0 11 0.38 8.6 Average Average * 1909 30,500) 29,000) 66 88.0 25 0.80 9.0 10.3 *1910 32,500) 49 69 13 0.4 7.9 30,0001 8.6 1911 30,786 70 95.0 34 1.1 10.9 95 14.6 1912 32,000 41 58.5 12 0.37 9.0 13.3 1913 33,386 62 84.2 28 0.8 10.5 109 13.4 Population overestimated, percentages are worked out on the lower estimates. Year. Deaths under 1 year from Marasmus, Prem. Births, Diarrhoea. Deaths 1 to 6 years from Infec. Diseases. 1904 42 6 1905 37 6 1906 39 20 1907 35 4 1908 33 1 1909 31 13 1910 15 2 1911 43 21 1912 18 2 1913 24 7 34 Vital Statistics. Deaths under one year from Marasmus, Premature Birth and Diarrhoea have dropped from 42 and 37 in 1904-5 to 18 and 24 in 1912-13. There has been a steady fall during the last ten years with the exception of 1911. Deaths from Infectious Diseases in children between 1 and 5 years are very low except for 3 rises in the years 1906, 1909 and 1911. The death-rate of residents registered in the district is equal to 7.9 per 1000 of the population. The amended death-rate, including residents who have died outside this district and deducting non-residents who have died in the district, is equal 9 6 per 1000 of the population. The deaths among resident infants under one year are given in the following table:— DISEASK. Number. Whooping Cough 3 Measles 0 Bronchitis 1 Pneumonia 6 Diarrhoea and Enteritis 6 Mai-Nutrition and Premature Birth 16 Violent Deaths 3 Syphilis 4 Other Defined Diseases 7 Suffocation—Overlying 2 Total 48 Vital Statistics. 35 The infantile death-rate for England and Wales for 1914 is 105 per 1000 births. The infantile death-rate for London for 1914 is 103 per 1000 births. The local infantile death-rate is only 63 6 per 1000. * EPIDEMIC DIARRHCEA—PREVENTION OF DISEASE. The attention of householders, occupiers of flats, tradesmen and others, is directed to the highly objectionable practice that prevails of depositing organic matter, viz. bones, scraps of meat, fat, portions of fish, cabbage leaves, etc., in dust-bins. All this waste matter soon undergoes putrefaction during hot weather, and is therefore an excellent breeding ground for flies. Flies are known to be carriers of deadly disease germs. At the same time very offensive smells arise from the dust receptacle, which although not annoying you may cause annoyance to others. During the summer months, when coal fires are not in use continually, chloride of lime (a cheap disinfectant powder) shouid be freely sprinkled over the contents of the dust-bin. The dust-bin should— 1. Always be covered to keep the contents as dry as possible. 2. Be kept away from the dwelling. The practice of thus consuming refuse is not only economica j and highly advisable for sanitary reasons, but by decreasing the amount that has to be collected by the scavengers, has a direct effect in relieving the charge upon the rates. * Circular distributed throughout the district. 36 Vital Statistics. EPIDEMIC DIARRHCEA. The number of deaths from this disease during 1914 was 9 which is low in spite of a warm and dry summer and autumn. SANITATION OF CLOSETS, YARDS AND STREETS. Unpaved streets and yards should, where necessary, be paved, and in particular all accumulations of refuse in the neighbourhood of dwellings should be promptly and efficiently removed. I would again call the Council's attention to the number of lanes and back passages left derelict. I notice that in very many cases where rows of houses have been built there remains at the rear a piece of waste land which is left derelict and in the rough, and which soon becomes a tipping ground for refuse of all sorts, which is allowed to remain there and rot, giving rise to smells and acting as a breeding ground for flies. There are three chief contributory factors to such refuse heaps: (a) shopkeepers and residents whose backyards abut on to the waste ground, (b) tradesmen's carts who use the track as a way to the backs of houses, (c) miscellaneous contributors, such as vagrants, hawkers, gardeners, etc. It is very plain that there is no equitable way of apportioning the responsibility, and the only remedy I can see is for the Council to make up or pave these places, and have them properly scavenged weekly. PREVENTION OF FLIES. This depends on personal cleanliness with efficient scavenging and watering of streets. For the benefit of the public, I think instructions might be published as to the destruction of flies : Mix one teaspoonful of Formalin with half a pint of sweetened water. Small quantities of this can be obtained from the local chemists at a small charge and ready diluted. Pour a little of this into a saucer and place same Vital Statistics. 37 on a ledge or mantelshelf. In the saucer place a little square of bread for the flies to alight upon and drink. I have asked the Surveyor to distribute posters dealing with Diarrhoea as widely as he can. There has been no outbreak so far, but August and September are the two worst months for this disease. The Sanitary Inspector has also been instructed to look out for and seize unsound fruit and vegetables. I have no doubt that there is another cause for Diarrhoea not dealt with in the circular, and one that is beyond the reach of Sanitary Authorities, viz., the conveyance of filth from the hands of children playing in the streets to their mouths, either directly or through the medium of sweets or food. With regard to domestic precautions as to food storage, milk, etc., the Health Visitor and Sanitary Inspectors have made this a part of their routine duties. POPULATION. The 1901 census showed a population of 17,900; the 1911 census showed a population of 30,377; the present figure as estimated for 1914, shows a population of 34,745. The number of inhabited houses in 1914 is 8,272, and this gives an inhabited house rate of 4.2. The natural increase of population or the excess of the number of nett births over nett deaths for 1914 is 418. The area of the district is 2,518 acres, exclusive of that area covered by water. BIRTHS. The nett number of births registered during the year is 754, being an increase of 18 compared with last year, and an increase»of 44 on the average for the last five years. 38 Vital Statistics. CYCLE DIAGRAM showing proportionate representation of causes of death during 1914. Vital Statistics. 39 The birth rate is 21.7 par 1,000 of the estimated population. Last year it was 22 07 per 1,000 of the population. Illegitimacy. Of the 754 births registered, 36 were illegitimate, or 4 7 per cent. The death rate amongst illegitimate children this year is about the same as that for legitimate children. DEATHS. The total number of deaths registered in the district is 276, but for comparative purposes, certain corrections have to be made, 28 deaths of non-residents have to be deducted, and 88 deaths of residents who have died in other districts have to be added. The nett deaths therefore are 336. This gives a death-rate of 9-6 per 1,000. There were 61 deaths in Public Institutions serving this district:— The Putney Hospital 4 The Royal Hospital, Richmond 4 The Richmond Infirmary 31 The West London Hospital 6 The Isolation Hospital Fever 0 Tuberculosis l6 MONTHLY CURVES OP BIRTHS AND DEATHS, 1914. The Births and Deaths curves show some similarity, which is probably only a coincidence, as a high birth-rate should not mean a high death-rate in a district like Barnes. Vital Statistics. 41 BIRTHS AND DEATHS LAST YEAR. The Lancet gives the following table showing the birth and death rates and the rates of infantile mortality in England and Wales and in certain parts of the country during the year 1914, the figures being provisional ;— Annual rate per 1,000 living Deaths under one year to 1.000 births. Birtbs. Deaths. Crude. Standardized* England and Wales 23-6 13-9 13.6 105 97 great towns including 24-9 14 6 14.9 113 145 smaller towns 23 6 128 12.9 104 England and Wales less the 242 towns 21-9 13 3 12.2 93 London 24 6 14. 4 14.4 103 * The standardized death-rates are the rates which would have been recorded had the sex ana age constitution of the populations of the several areas been identical with that of England and Wales as enumerated in 1901. In 1913 the birth-rate for the whole of the United Kingdom was 23*9 and the death-rate 14-2. LOCAL BIRTH RATES. 1904 26.6 1908 23.7 1912 21.8 1905 24.7 1909 24.2 1913 22.07 1906 24.7 1910 22.7 1914 21.7 1907 24.4 1911 23.7 These figures show that there is a gradual decline in the birth- rate going on. 42 Vital Statistics. BIRTH RATE VERSUS POPULATION. Total Births. Total Deaths. Natural Increases. Population. 1904 618 261 357 23,200 1905 600 289 311 24,250 1906 632 288 344 25,500 1907 684 300 384 28,000 1908 676 247 329 28,500 1909 703 321 382 29,000 1910 682 259 423 30,000 1911 731 336 395 30,786 1912 700 291 409 32,000 1913 736 350 386 33,386 1914 754 336 418 34,745 This table shows that in spite of a declining birth-rate the natural increase of population goes on. VACCINATION RETURNS. Mr. Raggett, the Vaccination Officer, has supplied me with the following figures for 1914. They are only approximately correct, as it is unlikely that all the children born in December, 1914, have yet been vaccinated. The true return is arrived at in June of each year. Table. Births. Vaccination. Exemption. NonSusceptible. January 60 37 16 February 57 45 14 March 63 47 8 April 67 45 19 May 51 38 27 June 60 43 13 1 July 77 44 14 1 August 61 50 14 September 72 52 28 October 53 51 19 November 57 47 15 December 56 27 18 734 526 205 2 School Work. 43 This table shows 205 exemptions as against 151 in 1913. There will be a very rude awakening in the near future when smallpox is introduced into the district, the result will be panic vaccination with the consequent marring of good results and a huge burden on the rates. Corrected return for 1913, obtained from Registrar-General:— No. of Births 709 „ Successful Vaccinations 470 „ Declarations 149 „ Insusceptible 5 „ Deaths before Vaccination 43 „ Removals and Postponements 42 MORTALITY TABLE, Comparative notes for different age groups. Deaths. Deaths. Deaths, Age Group. Rate per 1.800 of Population. 1914. 1913. 1912. 1912. 1913. 1914. 47 62 41 Under 1 year 1.2 I 1.9 1.3 18 28 12 1 to 5 years .3 .9 0.5 21 30 15 5 to 25 years .5 .9 0.6 139 129 134 25 to 65 years 4.2 3.8 4.0 111 101 89 65 years and upwards 2.8 3.0 3.2 336 350 291 All ages 9.0 10.5 9.6 This is a very useful and comprehensive little table and is deserving of careful perusal—when it becomes self-explanatory. SCHOOL INSPECTION NOTES. A table is appended showing number of children examined, and the number found defective in the different age groups taken during the year. 44 School Work. The parents turned up in good numbers in most of the schools and often gave useful information of the child's life. The teachers have shewn their willingness to assist in the work and in providing a quiet room for the medical examination, and to them thanks are due. The school for children found mentally defective is doing excellent work under t.he care of Miss Robinson; many of the children are doing good manual work. Heights and weights are not included in this report as they are valueless and not comparable with those taken at other places, and are a great waste of time, and moreover are not wanted by the Board of Education. Notes on the hygiene of the schools shew defects existing which ought to be remedied. 1 strongly deprecate the practice of using schools for any other purpose than teaching school children ; as long as these schools are open to the public we might as well not waste time in trying to control infectious disease amongst school children. SCHOOL NOTES. In addition to the Treatment Clinic, a modified Inspection Clinic is held for half an hour each morning when "attendance" cases are seen, and any other child on whom any teacher may want a medical opinion. I think teachers might avail themselves more of the Inspection Clinic, and send up all cases of doubt, and all cases which have been recommended for treatment but have obtained none. Chest cases detected at the School Inspection are referred to the Tuberculosis Dispensary for a more detailed examination. Teachers should impress upon parents the necessity of glasses or operation in the case of squint, as the squinting eye goes blind School Work. 45 in two years from want of use. Children with neglected squints should not be allowed to attend school. Teachers have also many opportunities of impressing upon parents the dangers of neglected Tonsils and Adenoids. Teachers should also keep an eye on children's heads and not throw all the burden on the School nurse. It is no trouble for the teachers to walk round the class, say during a writing lesson, and scrutinise the children's heads. On finding a dirty child she should be notified to the school nurse at once. The closure of Schools for non-notifiable diseases has the disadvantage of at once depriving the M.O.H. of his source of information ; for this reason alone measles and whooping cough should be made notifiable diseases. Certificates. Two hundred and twenty-five certificates were given by the M.O H. as the result of infectious diseases in School children or their "contacts." Fourteen certificates were given for verminous and contagious cases. One hundred and eighty-one certificates were given for School attendance purposes. The following non-notifiable infectious diseases have been reported among school children by the teachers during the year:- Measles 25 Whooping Cough 14 Chicken Pox 43 Mumps 30 Ringworm 4 Measles "Contacts" 18 Whooping Cough "Contacts" 7 Chicken Pox "Contacts" 10 46 School Work. TREATMENT OF CHILDREN FOUND DEFECTIVE AT SCHOOL MEDICAL INSPECTION. It has long been known that the inspection of thousands of children and compilation of tons of paper and statistics is waste of time and money, but it is only recently that the situation has been saved by establishing Treatment Clinics In this district a dental clinic was started in May. It was, however, a case of " veni vidi vici," and subsided after a short existence owing to the dentist leaving for the war. It is hoped, however, to revive it shortly. A medical clinic was opened in December on two days a week, and is going steadily on without, it is hoped, any break. The rooms are temporary, but a new Clinic will be built behind the new Council Schools in East Sheen. An Ophthalmic Clinic is very badly needed, and it is believed that very shortly one will be started, although the accommodation is not good. A fair number of the children are getting treatment at the hands of the private practitioner or at one of the hospitals serving the district. The Care Committee of ladies, under the direction of Mrs. Hills, the Secretary, is doing good and useful work in looking up cases for treatment and getting them to come to the Clinic unless they are getting treatment elsewhere. Mrs. Hills is very well versed in this kind of work, and is of great assistance to the School Medical Officer. SURREY EDUCATION COMMITTEE. Scale of Fees for Medical Treatment of School Children. (1) Operations for tonsils and adenoids including the necessary medical supervision after the operation 10s. per case. School Work. 47 (2) Prescription of spectacles, and quent examination to see that spectacles are satisfactory 2s. per case. Note—A separate charge will be made for spectacles. The charge will be the cost price, which will probably vary from Is. 9d. to 4s. a pair. (3) X-ray treatment of ringworm 8s, per case. (4) Ordinary treatment of ringworm 2s. „ „ (5) Treatment of running ears 2s. „ „ (6) Other minor ailments 1s. „ „ (7) Dental treatment:— Extractions 6d. for 1 tooth Is. for 2 teeth or more. Gas 1s. 6d. extra. Fillings 1s. 6d. per case. Note.—The above fees include any necessary drugs and dressings. TABULATED ROUTINE INSPECTIONS. School. Boys 66 Girls 56 Boys 8 Girls 8 Bovs 12 13 Girls 12 13 Lea Boys. vers Girls Totals, Church of England 53 46 - - 21 23 16 24 183 Catholic 10 9 - — 9 7 6 3 44 Westfields 54 51 — — 52 31 39 30 257 Barnes Green 19 17 — - — 19 — 16 71 Fanny Road 15 11 — - — 10 — 11 47 Mortlake Council 36 33 55 37 41 38 38 38 316 Lonsdale Road — — 38 — 38 52 128 East Sheen Council — — - 11 18 12 7 48 187 167 93 37 172 146 163 129 1094 48 School Work. 1914. Routine Inspections 1094 1st Re-examination 114 Non-routine Inspections 292 Grand Total 1941 The Medical inspection of school children is not intended to be carried on with the accuracy and detail of Life Insurance, but to discover, with a view to treatment, those defects which are likely to hinder a child from getting the best out of his period of elementary education. INFANTS BOYs. 354. GIRLS. TOTAL. No. Examined 187 ... 167 354 Parents Present 143 ... 127 270 Infectious Diseases Had— Diphtheria 4 ... 2 6 Scarlet Fever 4 ... 7 11 Measles 108 ... 99 207 Whooping Cough 86 ... 85 171 Clothing— Good 158 ... 145 3°3 Poor 29 ... 20 49 Bad — ... 2 2 Footgear— Good 160 ... 146 306 Poor 26 ... 16 42 Bad 1 ... 5 6 Nutrition— Good 148 ... 125 273 Poor 39 ... 42 81 Bad — ... — • 49 School Work. BOYS. GIRLS. TOTAL. Cleanliness— Good 163 140 303 Fair 24 27 51 Bad — — — Nits 1 11 12 Lice — 1 1 Mouth Breathers and Nasal Catarrh 14 7 21 Enlarged Tonsils 16 20 36 Adenoids 10 3 13 Blepharitis 4 3 7 Conjuntivitis 2 1 3 Eves: Squint 5 — 5 Teeth— Fairly Sound Sets 1-3 66 71 137 Kour or more decayed 35 37 72 Oral Sepsis 6 — 6 Ears— Obstructions 4 4 8 Otorrhœa 2 7 9 Hearing— Good 184 163 347 Poor 2 3 5 Bad 1 1 2 Heat and Circulation— Organic Disease — ... .. Anaemia 8 7 15 Other Defects 2 1 3 Lungs— Chronic Bron. Catarrh 4 5 9 Pre-Tuberculosis 2 4 6 Tuberculosis — .. — Other Diseases 17 11 28 5° 50 School Work. boys. girls. total. Mental— Dull or Backward 1 — 1 Nervous Diseases 4 5 9 Skin— Ringworm - 1 1 Impetigo 2 1 3 Scabies — — — Others 8 10 18 Rickets 5 1 6 Non-Pul. Tuberculosis 1 — 1 Deformities 3 1 4 Neck Glands 2 5 7 Rec. for Treatment— Medical 35 29 64 Ophthalmic 5 2 7 Dental 40 36 76 147 cases were recommended for treatment out of 354 examined. 207 had had measles „ „ 9 were badly clothed or shod „ „ 13 were verminous„ „ 70 had affections of the nose and throat „ „ 72 had bad teeth „ „ INTERMEDIATE GROUP. boys girls totai. No. Examined 265 183 • 448 Parents Present iis 87 • 202 Infectious Diseases Had— Diphtheria 17 14 31 Scarlet Fever 28 19 47 Measles 228 147 375 Whooping Cough .. 138 89 • 227 51 School Work. 51 boys. girls. total. Clothing— Good 213 149 362 Fair 45 30 75 Bad 7 4 11 Footgear— Good 235 149 384 Fair 25 3 56 Bad 5 3 8 Nutrition— Good 200 123 323 Fair 64 59 123 Bad 1 1 2 Cleanliness— Good 234 154 388 Fair 29 26 <5 Bad 2 3 5 Nits 2 18 20 Lice — 1 1 Mouth Breathers and Nasal Catarrh 17 2 19 Enlarged Tonsils 22 27 49 Adenoids 4 11 15 Blepharitis 8 6 14 conjuntivitis — 1 1 Eyes— Good 247 164 411 Fair 12 11 23 Bad 6 8 14 Squint 3 2 5 Teeth— 1-3 decayed 126 101 227 4 or more „ 54 20 74 Oral Sepsis 1 2 3 52 School Work. Boys. Girls. Total. Ears— Obstructions 5 4 9 Otorrhœa 6 3 9 Hearing— Good 259 178 437 Fair 3 3 6 Bad 3 2 5 Heart and Circulation— Organic Disease — 2 2 Anæmia 7 11 18 Other Defects 7 4 11 Lungs— Chron. Bron. Catarrh 8 4 12 Pre-Tuberculosis 10 8 18 Tuberculosis 1 1 2 Other Diseases 15 11 26 Mental— Dull or Backward 6 3 9 Nervous Diseases 9 7 16 Skin— Ringworm 1 — 1 Impetigo 1 — 1 Others 4 2 6 Rickets 4 2 6 Non-Pulm. Tuberculosis 3 3 6 Deformities 4 4 8 Neck Glands 4 2 6 Rec. For Treatment— Medical 54 4; 99 Ophthalmic 25 21 46 Dental 49 19 68 Recommended for Treatment 213 out of 448 examined Tubercular 2 ,, ,, 53 School Work. Pre-Tubercular 20 out of 448 examined. Heart Disease 2 „ „ Affections of Nose and Throat 83 „ „ Badly clothed or shod 19 „ „ Very dirty 5 „ „ Verminous 21 „ „ Bad Sight 19 „ „ Bad Teeth 74 „ „ LEAVERS. boys. GIRLS, TOTAL. Number Examined 163 129 292 Parents present at Examination 53 60 113 Infectious Diseases, Had— Diphtheria 14 17 31 Scarlet Fever 22 20 42 Measles 137 112 249 Whooping Cough 67 65 132 Vaccination— Marks visible 152 108 260 No mark 11 21 32 Clothing— Good 140 103 243 Fair 19 24 43 Bad 4 2 6 Footgear— Good 142 115 257 Fair 15 10 25 Bad 6 4 10 Nutrition— Good 111 94 205 Fair 50 35 85 Bad 2 — 2 54 School Work. boys. grils. total. Cleanlinkss — Good 134 108 242 Fair 30 17 47 Bad 1 2 3 Nits in Head 3 10 13 Verminous 1 1 1 Mouth Breathers and Nasal Catarrh 5 3 8 Large Tonsils 24 18 42 Adenoids 1 5 6 Blepharitis 2 8 10 Conjuntivitis 3 1 4 Eyes— Good 150 116 266 Fair 7 7 14 Bad 6 6 12 Squint 2 — 2 Teeth— 1-3 150 93 243 4 or more 22 17 39 Oral Sepsis 5 5 10 Ears— Obstruction 2 1 3 Otorrhoea 1 — 1 Normal Hearing 161 126 287 Fair 2 3 5 Heart and Circulation— Organic Disease 2 2 4 Functional Disease 4 2 6 Anasmia 6 5 11 Lungs— Chron. Bron. Catarrh 2 4 6 Pre-Tubercular 3 5 8 Other Diseases 14 6 20 55 School Work. boys. girls. total. Mental — Dull or backward 6 6 12 Nervous Diseases 2 7 9 Skin— Impetigo 3 - 3 Scabies 1 1 2 Others 8 6 14 Rickets (Slight) 1 1 2 Deformities 8 7 15 Neck Glands 4 — 4 Recom. for Treatment 54 70 124 124 children were recommended for treatment out of 292 eximined. 14 had bad sight ... „ „ 10 had bad teeth ... „ „ 56 had throat and nose affections ... „ „ 16 had bad clothing or boots ... „ „ 3 were very dirty ... „ „ 15 were verminous ... „ „ 4 had heart disease ... „ „ 8 had tendency to consumption ... „ „ NON-ROUTINE CASES. both sexes & ali. ages. No. of Children Examined 74 Bad Nutrition 3 Mouth Breathers and Nasal Catarrh 2 Enlarged Tonsils 3 Adenoids 1 Blepharitis 1 Conjuntivitis 1 56 School Work. roth sexes & all ages. Eyes— Normal - Poor 13 Bad 15 Squint 2 Teeth— Fair 1 Ears— Obstruction 2 Otorrhœa 4 Bad Hearing 2 Defective Speech 1 Heart and Circulation— Organic Disease 1 Functional Disease 2 Lungs— Chron. Bron. Catarrh 2 Pre-Tubercular 3 Mentally Subnormal 7 Nervous Diseases 4 Ringworm 1 Impetigo 1 Other Diseases 4 Deformities 3 Neck Glands 1 Of the special cases, 30 had bad vision, 7 were dull and backward. 2nd EXAMINATIONS. Totals No. Examined 441 No. Improved 199 No Change 242 Improvement shown is under 50 per cent. 57 School Work. 3rd EXAMINATIONS. totals No. Examined 114 No. Improved 52 No Change 62 Improvement shown is under 50 per cent. SCHOOL HYGIENE NOTES. Church of England: South class-room has no cross-ventilation, and is bounded by glass screens on two sides. One of the few schools where paper was found for sanitary toilet purposes. The urinals need attention. Roman Catholic : Walls damp in East class-room and cloak-room. Floors should be well sprinkled with a wet disinfectant before being swept. Castelnau, Fanny Road: The light is wrong in one class-room, and the ventilator is bad in the same room. Barnes Green: More play-ground space required. More class-room accommodation required. Better lighting. Caretaker should perform damp sweeping and dusting. Westfields Girls: A two-storeyed building. Cloak-rooms bad, especially downstairs, dark, and insufficient. Lavatory arrangements poor. Heating inadequate in two large corner rooms. Lighting poor downstairs. 58 School Work. Westfields Infants: Insufficient closet and urinal accommodation for boys. A shelter is needed in the play ground. The central hall wants better lighting both natural and artificial. Right of way through school playground used to be highly objectionable, but has now been stopped. Mortl ike Council Infants: The windows should be open at night. Hopper windows are better than the central swing windows. Provision might be made for an open-air class. Cloak-room accommodation is insufficient. SUMMARY Of WORK DONE BY THE HEALTH VISITOR. School Work. The Health Visitor was present at 45 Routine Inspections of School children by the School Medical Officer and assisted in the clerical work of sending notices of treatment to the parents, tabulating lists of defective children, scheduling the same and summarising for purposes of annual report. The Health Visitor also attends the "Inspection Clinic" for half-an-hour each morning at Railway Street, where records are kept of children seen by the School Medical Officer after being sent up by the teachers or by the School Attendance Officer. Certificates of exclusion or ability to return to school are given, and advice re treatment. The "School Clinic" was opened last December, and is distinct from the "Inspection Clinic." This Clinic is opened on Monday mornings and Wednesday afternoons for an hour when school children may be treated for minor ailments, after having been recommended by the School Medical Officer and visited by the 59 School Work. Care Committee. The Health Visitor is present and carries out the treatment under the supervision of the School Medical Officer. A "Dental Clinic" was opened last May for a short time, during which time the Health Visitor attended on 24 half-days, and the School Medical Officer attended and administered the gas. The Health Visitor visited the homes of 579 school children in cases of sickness and non notifiable infectious disease, and gave advice either that a medical man should be called in or that suitable home treatment should be carried out. Two hundred and seventy-four visits were paid to the various schools with the special object of detecting verminous conditions, and 10,002 children were examined with these results:— Filthy clothing 20 Nits 864 Verminous 167 Cleansing notices sent 603 Children excluded 1st time 329 „ ,, 2nd time 91 „ „ 3rd time 42 Parents prosecuted 56 Seventy visits were made to parents with regard to following up the treatment of defects found on Medical Inspection, but as this is becoming more the work of the Care Committee it has been dropped to prevent overlapping and over visiting. Tuberculosis Work. In her capacity as Tuberculosis nurse the Health Visitor attends at the Dispensary with the Tuberculosis Officer on Wednesday evenings and Saturday mornings for two hours on each occasion. Her duties there consist of copying the temperature 60 School Work. cards on to the clinic charts, the dispensing of malt and oil and the dressing and undressing of the women and children. Eighty-eight visits have been paid to the homes of tuberculous patients for the purpose of giving advice or obtaining information. Infant Work. The number of births visited by the Health Visitor is 345 and the number of visits paid is 826. About 80 per cent of the Infants are found to be breast fed, but it is difficult to persuade some mothers to keep only to the breast for eight or nine months, and for this reason the baby does not thrive as it should. A card is left with the parent at the first visit dealing with the " Feeding and Care of Infants," and this has been found of great utility. During the summer, seven "Talks to Mothers" were given in the Technical Institute at which about thirty-five mothers attended. Since October last, a "Talk" has been given on each Thursday afternoon at 54 Railway Street, at which about twenty mothers have attended, and where the babies are weighed. Although the individual attendance of mothers has not been so good, probably the inclement weather has been a cause, and pressure of school work has prevented the Health Visitor from looking up and reminding the mothers. Leaflets have been given to the mothers on "Infantile Diarrhoea" during the summer months, and on the feeding and care of older members of the family. Of the eleven deaths which occurred in infants from Marasmus, Enteritis and Diarrhoea, in two cases no information was obtained, and in the nine remaining cases, eight were bottlefed babies. 61 Sanitary Adminstration. The nine cases are set out as follows:— Botile-fed. Breast fed. Number of Rooms. Number Adults in family Children. 1. 1 - 4 2 3 2. l - 2 2 4 3. — 1 5 2 4 4. l - 4 2 3 5. l — 2 2 1 6. l - 4 2 1 7. l - 3 2 3 8. l - 5 2 6 9. l - 2 2 1 REPORT OF THE SANITARY INSPECTOR, 1914. The work of the Sanitary Staff comprises the general and systematic inspection of the district, under the housing of the working classes acts, house drainage, water supply, infectious diseases and disinfections; the factory and workshops acts, dairies and milkshops, slaughter houses, fish shops; the petroleum acts and general matters. The death-rate, as a rule, should reflect on the sanitary condition of a district, and there is no reason to show that the systematic inspections and carrying out of the public health statutes in this district have not met with success. The very small number of statutory notices served for the past year show that little trouble was experienced in persuading landlords to remedy sanitary defects. At the same time the inspector is confronted with a difficult problem in many cases. One would like to see some houses more up-to-date, but if too much is insisted on beyond that which can be done under the statutory powers up goes the rent, which is a serious consideration. Special attention has been paid to Hampton Square and West Road, Mortlake, as a number of the houses are occupied by members of 62 Sanitary Adminstration. more than one family, but it has been necessary to serve only one notice for overcrowding in these localities. The population of Hampton Square works out a little over six per house. Of these houses fifteen are 5-roomed ones. The owner of No. 40 to 54, Hampton Square is renovating the houses throughout, including kitchen ranges in place of the old open fireplaces—a great boon to the tenants. In West Road the number of inhabitants averaged 8.5 per flat of 4 rooms and scullery, but there is ample space for this number. A great improvement has been effected by the yards having been tar paved. Thirty-four notices were served during the year on the owners of St. Ann's Passage, Barnes. The street comprises twenty cottages, all occupied by persons of the poorer class. This is one of the streets the district could well do without, as it is in a cramped situation between Railway Side and Railway Street, and 1 hope that in the near future it may cease to exist. Stanton Road also needs careful attention, as there has always been a tendency to overcrowding and neglect. A general and systematic inspection is made of about fifty streets in the district. FACTORY AND WORKSHOPS. The inspection of factories is practically done by H.M. Inspectors, and it is their duty to give the local authority notice of any matter which is remediable, but it is also a rule of Sanitary Inspectors to inspect them under the Factory and Workshops Acts, and the Public Health Acts. No notices have been received this year from H.M. Inspector. There are about a dozen factories in the district. The Workshops, with the exception of a few outworkers and Hand Laundries are of an unimportant character. 63 Sanitary Administration. Laundry Factories and Sanitary Accommodation. w.c. accommodation.— One for every 25 females; One for every 25 males; up to 100 and one for 40 after. West End Hygienic Laundry, Glentham Road, Barnes. 93 Women and 7 men. 3 w.c.'s for women; one for men. The Proprietor has already given instructions for the rebuilding and extension of Women's w.c.'s and alterations to the men's w.c. Barnes and District Laundry, Station Road, Barnes. 32 Women, 2 men. 2 w.c.'s for women; none for men. Men's w.c. to be started, also yard paving. Mortlake Brewery. 350 men, not including drivers; 52 Women. Manager, 1 w.c.; Office, 1; 5 Brewers, 1; 15 Foremen, 2; 350 workers, 11; 52 women, 3 w.c.'s. Sufficient w.c.'s for 380. Field's Laundry, Lower Richmond Road. Women, 18; Men, 2. One w.c. each. Sheen Invicta Laundry, High Street, Mortlake. Women, 35, 2 w.c.s; Men, 2, 1 w.c. Anglo French Laundry, Upper Richmond Road. Women, 21, 1 w.c.; Men, 2, 1 w.c. Temple Sheen Laundry, Derby Road. Manager, 1 w.c.; Women, 55, 3 w.c.'s; Men, 7, 1 w.c. DAIRIES AND MILKSHOPS. These are visited quarterly and are generally fairly well kept. One or two new dairies in East Sheen have been constructed on modern and up-to-date lines. No. No. of Visits. Dairies and Milk Shops 36 Quarterly. 64 Sanitary Administration. PETROLEUM ACTS. Twenty-five applications were received last year for licences. With one or two exceptions, and where only a very small quantity is stored, the petrol is stored underground. WATER SUPPLY. The whole of the district is supplied by the Metropolitan Water Board, a great many houses being supplied by water direct from the mains. Unfortunately we have no power for compelling a direct supply in every case, the law for the requirement of cisterns being properly placed, constructed and kept, being not sufficient to meet the needs of populous districts. BAKEHOUSES. There are eleven bakehouses in this district, and these have been inspected quarterly. Of these bakehouses, 3 are underground, and are kept reasonably clean and ventilated. Two bakehouses (underground) have been closed in 1913. Sanitary Administration. 65 Table showing the work done by the Sanitary Inspectors during 1914, with regard to places under the Factory and Workshops Act, 1901. BARNES. MORTLAKK. TOTALS. No. Visits. No. Visits. No. Visits. A.—FACTORIES— Brewery .. ... 1 2 1 2 Electric Lighting Works .. ... 1 1 1 1 Printers 1 1 3 3 4 4 Coachbuilders 1 3 ... ... 1 3 Athletic Goods ... ... 1 2 1 2 Motor Works 3 6 2 6 5 12 Golf Club Maker ... ... 1 1 1 1 Rubber Works ... ... 1 2 1 2 Engineering Works 1 0 ... ... 1 2 Packing Case making 1 1 ... ... 1 1 ELECTRIC AND STEAM LAUNDRIES — Over 40 employees 1 2 1 2 2 4 Under 40 employees 2 6 4 9 6 15 B.—WORKSHOPS— Engineering Works 1 2 ... ... 1 2 Tailors 9 9 8 8 17 17 Dressmakers 7 12 7 10 14 22 Shoemakers 12 12 21 21 33 33 Cycle and Motor Works 3 3 4 4 7 7 Saddlers 1 1 1 1 2 2 Photographers 1 1 3 3 4 4 Smiths 3 3 3 3 6 6 Umbrella Makers ... ... 2 2 2 2 Glove Cleaning 1 1 ... ... 1 1 Upholsterer ... ... 1 1 1 1 Coachbuilder ... ... 1 1 1 1 Picture Frame Makers ... ... 2 2 2 2 Watch Makers 3 3 3 3 6 6 Metal Works 1 2 ... ... 1 2 Acetylene Works 1 3 ... ... 1 3 HAND LAUNDRIES — Under 40 employees 2 6 4 11 6 17 BAKEHOUSES— 2 6 9 27 11 33 C.—DOMESTIC WORKSHOPS Dressmakers 15 21 16 16 31 37 Family Laundries 9 18 10 30 19 48 D.—WORKPLACES — Stable Yards 5 12 5 10 10 22 Restaurants 5 12 12 20 17 32 Ice Cream Maker 1 5 ... ... 1 5 Totals 92 153 127 201 219 354 66 Sanitary Administration. Table showing the general work done by the Public Health Department during 1914, and in the preceding two years. Nature of Work Done. 1912 1913 1914 No. of Inspections under Housing Regulations 2138 1840 2250 ,, Various other visits 1736 1366 1164 ,, Defects Notified 641 593 624 ,, Houses cleansed 220 160 226 ,, „ ,, after Infectious Disease 89 45 70 „ Disinfections performed 235 348 340 ,, Drains unstopped 36 30 20 ,, ,, repaired IS 14 14 ,, ,, reconstructed 34 26 24 ,, Defective closet pans and traps 20 12 21 ,, ,, dust receptacles replaced 68 85 75 ,, Flushing tanks repaired 37 39 40 ,, Waste pipes trapped and repaired 10 16 10 „ Cisterns cleansed and covered 14 13 29 ,, Taps provided on rising main 75 51 35 ,, Offensive accumulations removed 4 6 7 ,, New sinks provided 34 29 20 ,, Roofs and eaves' gutterings repaired 46 14 45 „ Yards paved and paving repaired 06 39 37 ,, Dampness remedied 36 20 25 ,, Manholes made watertight 16 4 10 ,, Mica valves made good 8 5 6 ,, Receptacles for manure provided 2 3 2 ,, Cases of overcrowding abated 3 5 4 ,, Houses found unfit for habitation 16 12 15 ,, Bakehouse inspections 42 48 33 ,, Dairy inspections 121 142 144 ,, Licensed slaughter-house inspections 6 5 8 ,, Factory and Workshops inspections 392 336 323 ,, Visits to Infectious Diseases 405 281 286 „ Complaints received 96 115 85 ,, Statutory Notices served 15 6 8 ,, Summonses to abate Nuisances — — 1 ,, Premises licensed for storage of Petroleum 22 22 25 Re-inspections are not included in this table. At the request of the M.O.H. the Assistant S.I., Mr. Robinson has reported on subjects coming more particularly within his ken. FISHMONGERS. There are 14 shops of this class in the district. In 7 shops only wet and dried fish is retailed, and in the retriainder fish frying 67 Sanitary Administration. is carried on, in addition, in some cases, to the sale of wet and dried fish. A B Sale of Wet & Dried Fish only. Fish Frying & Sale of Wet & Dried Fish. Total No. No. of Inspections. 7 7 14 46 Twenty visits have been made to the shops in Column A, These are still found to be conducted in a satisfactory manner, no fish being detected unfit for food. Proper offal receptacles are provided, which, in some cases, are removed daily by a contractor, and in others three times a week, depending, naturally, on the amount of trade. Empty receptacles are left in place of the full receptacles removed. All these shops are constructed on hygienic principles, with impervious floors, slate or marble slabs, and, in some cases, tiled walls. Twenty-six visits have been made to shops in column B. In twoshops modern stoves for fish frying have been installed. These stoves are portable, that is, they are not made part of the building as in the case of the old pattern brick stove. They are of cast iron with tiling on the front and ends. The pans are covered with hinged covers. From the space above the pans and between the covers there is a duct leading to the fire and the flue, the direction of the vapours being governed by a valve. Covered receptacles on the top of the stove are provided for the storage of fish and potatoes. These stoves are much more economical, both in the quantity of frying medium used and in coal, and when properly managed are quite satisfactory. All parts of the stove are easily accessible for cleaning purposes, the tiling giving the whole a neater appearance than in the case of the old stoves. 68 Sanitary Administration. In the other shops the mediaeval form of stove is still in use. These stoves are built of brick with the cast iron pans set in the top, the fire opening being either at the ends or in front. The top of the stove is generally covered with zinc. About two or three feet above the pans there is a fantasticshaped canopy, with one or two gas jets inside, the purpose of the canopy is to carry off the steam and vapour through a hole opening into the chimney Hue. Contrary to theory, only a small percentage of steam is actually carried into the flue, as evidenced by the amount of steam which can be seen escaping into the shop. In the majority of cases side screens are not fixed, so that the function of the canopy is interfered with through draughts. Although that portion of the stove which is seen is kept fairly clean, it has been repeatedly found that the inside of the canopy is in a foul condition, it is also found that unsold fish and potatoes are left unprotected on the top of the stove, the result, in summer, being that the room swarms with flies. Ac two shops cotton-seed oil is used. It is considered by some of the trade to be more economical, as, when heated, it is more liquid, and consequently drains off the fish quicker. Nuisance will arise from the use of cotton-seed oil if the stale oil is not removed frequently. The practice obtains of adding fresh oil to the pan as occasion demands, so that the stale oil is never entirely removed. In the other shops dripping is the frying medium used, and is of varying qualities. This medium does not, however, give rise to such an effluvium nuisance as when cotton-seed oil is used. The trade of fish fryer is now governed by bye-laws, and under them the provision of modern stoves in lieu of the old pattern open stoves could be insisted upon. The principle adopted in carrying out the bye-laws is an educative one. It is one the results of which are not seen in twelve Sanitary Administration. 69 months. As the old stoves become defective, the tradesman is persuaded to instal a modern stove. One important point about these portable stoves is that they are tenant's property, as no building-in to the premises is necessary. The difficulty being, under the present conditions, a monetary one, the Inspector has to use every consideration, the immediate locality being an important factor, as has been stated by the Courts. RESTAURANTS AND COFFEE SHOPS. There are 17 shops of this character in the district, and 32 visits have been made to them. The majority are well conducted, the rooms used for the preparation of food being in a good hygienic state. In some cases, however, the premises are cramped, improperly lighted, and no extra provision made for ventilation These remarks refer in particular to the room used for preparing food. In only two cases are there separate receptacles for waste matter, other than the ordinary dust receptacle. In some cases the waste matter is burnt as far as possible. BUTCHERS. There are 26 butchers, and 68 visits have been made to them. Although two slaughter-houses exist, one in Barnes and one in Mortlake, only one of them is used. During the year 8 pigs have been killed at this establishment, and on each occasion the Assistant Inspector has been present and carefully inspected each carcase and organs, but no evidence of disease was found warranting condemnation. It is only the present prohibitive price of cattle which prevents this slaughter-house being more frequently used. Considering all circumstances the butchers' shops are well kept. 70 Sanitary Administration. The surrender of the following food was secured and destroyed at the Council's Destructor:— 4 Bovine Livers. 2 Plucks. 1 Rabbit. 1 Fowl. Most of the butchers obtain their supplies from the Central Market. It has, however, been found that a practice has started of occasionally obtaining carcases, particularly pigs, killed in an adjoining district, where they are not inspected after slaughter. At such shops it is obvious that extra care has to be taken in inspecting the stock. Sometimes the Assistant Inspector sees the carcases being delivered at the shop; he is then able to make an examination of the carcase and organs before they are cut up. During the summer months nuisance sometimes arises through the keeping of waste bones and fat. If these are kept in a receptacle with a close-fittino cover, offensive smells are given off. The better way, a practice now generally in vogue in this district, is to keep the bones and fat in a receptacle with a piece of canvas stretched over the top. This prevents the entrance of flies, but allows air to circulate in the receptacle. Although Bye-laws are in force in this district prohibiting the removal of offensive matter, &c., through the streets, except at certain specified times, the practice does, however, exist of Contractors removing trade refuse at other times than those stated in the Bye-laws. This is a difficult matter to deal with, because it is not an offence to remove such offensive matter at any other times provided the receptacle or vessel is properly constructed so as to prevent the escape of any offensive effluvia therefrom. While dealing with this matter of food supply, it would be appropriate to point out to the uninitiated that, beyond fried fish 71 Sanitary Administration. shops and bakers, a L.A. has no statutory power under the Public Health Acts to deal with premises as regards their suitability in all respects for the preparation of food for human consumption. Power only exists to deal with " nuisances " under Section 91 It is quite obvious that this Section is inadequate to deal with particular matters that are patent to restaurants, coffee-shops, and butchers. Some districts have useful power incorporated in a local Act. This, no doubt, is the best practicable way out of the difficulty, as the requirements vary according to the circumstances of each district. At the same time a Local Act should embody power enabling more than one Sanitary Inspector to be appointed to an Urban District, as in the Metropolitan Boroughs, thus increasing the efficiency of the administrative machinery. In both circumstances practically the same work is carried out. The disadvantages of the present system are many. For example, an Assistant Inspector may detect unsound or diseased food at premises. Having no direct power to make a seizure, he endeavours to persuade the tradesman to surrender the food. Failing surrender, the Inspector has to seek the M.O.H. or Inspector of Nuisances. Is it likely that the unsound food will be allowed to remain so that it can be seized ? The law, in its existing form, is, therefore, in favour of the wrongdoer, and fails to protect the public as they think they are protected. Certificates have been granted to tradesmen, submitting the following articles of food for inspection, to enable them to secure the return of the purchase-money from the wholesale dealers: 1 box of catfish, 8 boxes of tomatoes, 1 trunk of haddocks, 3 boxes of kippers. With regard to the Sale of Food and Drugs Acts, the procedure 72 Sanitary Administration. adopted in this district for the detection of fraudulent tradesmen seems to be somewhat farcical. Anyone who has had experience of "sampling" knows that it is a simple matter to take samples, but it is a different matter to procure adulterated samples. No good purpose would be served by going into the details of sampling, but this fact is apparent. A Sanitary Inspector, having some experience of the Sale of Food and Drugs Acts, should be instructed by the L.A. to take samples of food, as in other Urban Districts. They are the officers who have any knowledge of the varying circumstances or know the itinerant traders who frequent the district. Fish frying is the only offensive trade, and is now controlled by Bye-laws. There are 7 such shops in the district. The Public Health Authority have received a complaint, signed by twelve householders, certifying that the trade of a Fish Fryer, as carried on at White Hart Lane, causes effluvia and is a nuisance or injurious to the health of the inhabitants, the Public Health Committee have directed the Clerk to apply to the Justices for summons against the person by or on whose behalf the trade complained of is carried on with the view to enforcing penalties as provided by Section 114 of the Public Health Act, 1875. Alterations made to satisfaction of M.O.H. Summons dismissed, with costs against defendant. Premises controlled by Bye-laws. Trade. No. No. of Visits. No. of Notices serv»d. No. complied with. Fried Fish Shops 7 36 4 3 Slaughter Houses 1 8 - - Stable Yards 10 20 - - Houses let in Lodgings 43 129 28 28 73 Sanitary Administration. TABLE showing the number of certain places under the Council's supervision, and the visits made to them during 1914. BARNES. MORTLAKE. TOTALS. Places where petroleum is stored No. Visits. No. Visits. No Visits. 12 24 13 52 25 76 Servants' Registry Offices 4 4 8 8 12 12 Marine Stores 2 4 1 2 3 6 SALE OF FOOD AND DRUGS ACT. Barnes Urban District. Samples Analysed, 1914. Article. Number of Samples. Number Genuine. Adulterated, or deteriorated. Proceedings taken. Convictions Total Fines and Costs. £ S. d. Milk 89 79 10 3 3 26 4 0 Butter 18 14 4 1 1 7 15 6 Margarine 1 1 — — — 0 0 0 Flour — — — — — — Spirits — — — — — - Cream — — — — — Totals 108 94 14 4 4 £33 19 6 FOOD CONTAMI NATIONIt is very important that the large group of persons who supply food for human consumption should develope a "clean food" conscience. 74 Sanitary Administration. They should all know by this time that dust and dnrt convey the germs of disease, and it should require no great effort of the magination to picture the wily microbe having a "joy ride" on the back of a particle of dust as it is chivvied about from place to place. Milk should be supplied to every householder on the sterilised bottle system, after severe tests at the farm before it leaves for the dairy. Two acts of thoughtless kindness impressed me recently in this district; in one case, on a Sunday morning, a gill of milk was sold to a customer on the pavement and was consumed there and then out of the milk measure; in the other case a small milk can, such as is left on doorsteps, was put in the road—upside down— and a little milk allowed to drain into the inverted and open lid, and this was offered to a cat which promptly lapped it up. Bread.—There is far too much handling of bread after it leaves the oven, and the final handling outside the house is often by a dirty boy who ought to be at school. Bread should invatiably be wrapped in paper before it leaves the shop for the van, the basket and the dirty hand. Meat.—Meat as a rule gets quite a " rind" of dirt on it before it reaches the householder; the handling at the slaughter house, the hanging at the abattoir, the handling of inspectors and buyers, the carting of it in dirty carts through the dirty streets, where it is sat upon by dirty men, all add their quota. The householder should sponge all meat well with clean cloth and salt water or vinegar before roasting or boilng it. Fruit and Vegetables are essentially dirty food products from the manner of packing and storage. All fruit should be washed or held under the tap before being eaten, especially grapes and succulent fruits. Dates are about the worst offenders in this respect. Sweets.— Sweets should not be exposed for sale uncovered, and Sanitary Administration. 75 put in the window for show. It is just as easy to cover sweets with glass. No doubt many young children become ill by eating infected and dirty sweets. TABLE SHOWING WORK DONE DURING 1914 IN RELATION TO INFECTIOUS DISEASES, INCLUDING PULMONARY TUBERCULOSIS. 1 Visits and inspections in consequence of notifiable disease 286 2 Disinfections performed 340 3 Lots disinfected by steam at the Isolation Hospital 251 4 No. of Notices served by the Medical Officer of Health 115 5 Premises inspected 286 6 *No. of secondary visits to Pulmonary Tuberculosis 36 7 No. of visits supervising works 432 * In addition to the visits under No. 1. There were 6 deaths among residents from the following zymotic diseases:— Scarlet Fever 0 Diphtheria 0 Measles 1 Whooping Cough 0 Epidemic Diarrhoea 5 Typhoid Fever 0 6 This gives a Zymotic Death Rate of .17 per 1,000. 76 Sanitary Administration. Pulmonary Tuberculosis gives 31 deaths registered in the district, but after adding 7 deaths of residents who died outside the district and deducting 12 deaths of non-residents who died in the Hospital, we get a net resident number of 26, giving a Tuberculosis death rate of 1*9 per 1,000 per annum. HOUSING AND TOWN PLANNING ACT. The following work has been done under this Act during the year, and 2,250 houses have been inspected. As a result of this inspection 624 notices have been served, 15 closing orders have been made, and 3 demolition orders have been carried out. Report of the Inspectors appointed under the Housing and Town Planning Act, 1909. barnes. MORTLAKE. TOTALS. 1. No of dwelling houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 14 1 15 2. No. of representations made to the Local Authority with a view to the making of closing orders 3. No. of closing orders made 14 1 15 4. No. of dwelling-houses, the defects in which were remedied without the making of closing orders 5. No. of dwelling houses which, after the making of closing orders, were put into a fit state for human habitation 6. No. of houses demolished after closing orders — 3 3 77 Sanitary Administration. In the majority of cases the defects remedied were of a structural kind. 226 houses were cleansed, 37 yards were paved or repaired, 45 roofs and eaves gutters were repaired, 25 cases of dampness were remedied, and 4 cases of overcrowding abated. The work of reparation has been for the most part supervised by the Assistant Inspector, whose practical knowledge of building and plumbing has been of much service in this branch of the work of the Health Department. It appears strange that the Sanitary Inspectors, who, by virtue of their duties have a more intimate knowledge of the requirements of the working classes than any other officials, are not asked for any information when plans are drawn up, by the L.A., for workmen's dwellings. NEW ROADS IN 1914. Bracken Gardens Ferry Road Extension Suffolk Road Limes Avenue NEW SEWERS IN 1914. Fife Road. WORKING CLASS HOUSES. No. demolished in 1914 16 in Malthouse Area. No. built and occupied 14 „ „ No. now building 8 „ ,, No. of prospective new houses for workpeople 32 The rents of the houses (which are well appointed) varies from 7s. 6d. to 8s. 6d. per week. 78 Hospital Administration. HOUSE BUILDING GENERALLY IN 1914. No. of plans approved 84 No. of houses erected during the year 184 No. building 152 OTHER DISTRICT IMPROVEMENTS. Street vvidenings have been carried out during the year in:— 1. The Upper Richmond Road near the Schools. 2. Near Christ Church Road on the Temple Grove Estate. 3. In Upper Sheen Lane along the frontage of Sheen House Estate. 4. In the Malthouse Area. 5. In the High Street, Barnes. In the Malthouse Area 16 of the old cottages have been pulled down, a new street called "Limes Avenue'' has been laid out, and 14 cottages have been built and occupied in the street. The work of pulling down the remaining cottages in this area, and erecting new cottages in their place is still being carried out. HOSPITAL. The Hospital is situated upon four acres of land, adjoining South Worple Way, Mortlake. The buildings consist of an administrative block, three ward blocks, discharge block, mortuary > laundry and disinfecting station, porter's lodge and several shelters for open air treatment. There is also a small building of galvanized iron for the sleeping accommodation of nurses on night duty. The Hospital contains 50 beds for cases of Scarlet Fever, Diphtheria, Enteric Fever and Pulmonary Tuberculosis. Hospital Administration. 79 The Resident Staff consists of The Matron, 2 Sisters, 7 Probationers, 3 Ward Maids, 1 Laundress, 1 Laundry Maid, 1 Cook, 1 Kitchen Maid 1 House Maid, 1 Lodge Keeper (Porter and Wife), The Porter is also Mortuary Keeper. Outdoor Staff: 1 Gardener. Lectures are given to the Probationers by the Matron and Medical Superintendent. Certificates of proficiency art given at the end of two years' training, providing the theoretical and practical work have been satisfactory. These certificates are stamped with the Council's seal and are good testimonials for further posts. During 1914 the number of infectious cases admitted into Hospital was 160. There have been no deaths. No deaths in 160 cases of infectious disease, some of which were very severe, speaks well for the care and attention the patients get at the hospital. The hospital is excellently managed by the Matron, who is able to get the best results with the maximum of economy consistent with efficiency, and the district is well served in having such a competent and experienced Matron in charge of its hospital. Probably 1914 is a record in that we have lost no cases of infectious disease, excluding, of course, the Tuberculosis side. 80 Hospital Administration. SCARLET FEVER. One hundred and twenty cases of Scarlet Fever were admitted during 1914, a large proportion of which occurred during the last quarter, when there was a smart outbreak—part of a general metropolitan outbreak. At times we were pressed for room, and a few cases had to be kept out for a few days until room could be found. This was, in some cases, disadvantageous to the district, but at the same time the public should know that, even if a local authority builds and controls an Isolation Hospital, that authority is not legally bound to give way to the demands of any ratepayer for admission. In connection with this outbreak 1 reported as follows:— "The Scarlet Fever Block is for acute cases of Scarlet Fever, and where they are kept in bed for the first three weeks of the illness. This block contains two wards capable of accommodating eight patients in each This block is deficient in not being provided with two small single wards for observation and isolation purposes in cases of doubtful and mixed infections, and I would urge that these additions be made This would greatly diminish the arduous and responsible task of nursing cases of mixed infection with those of simple infection. "Scarlet Fever cases not infrequently develop or come in with whooping cough, measles, and chicken pox and diphtheria. These cases should be isolated from the others, but our ward does not admit of this." Without going into a dissertation on the uses of an Isolation Hospital one can summarise as follows:— 1. An Isolation Hospital is of use to a district, when judiciously used, for those cases who cannot be satisfactorily isolated at home. 81 Hospital Administration. 2. Isolation Hospitals will never accomplish the eradication of scarlet fever, owing to missed cases, delay in notification, &c. 3. Isolation Hospitals have doubtless contributed largely in bringing about the mild type of disease one sees at present, because it has taken away from slummy surroundings cases which would otherwise go septic. 4. In times of rush, epidemic and overcrowding, an Isolation Hospital is probably worse than keeping the cases at home. Overcrowding in hospital comes to the same thing as the slummy house, and septic complications may arise. In connection with septic cases, should they occur in hospital, 1 have drawn up the following rules for the nurses:— RULES FOR SCARLET FEVER NURSING. 1. All newly admitted cases to be isolated as far as possible, or in some way kept aparc from the others for a fortnight. 2. Septic or dirty cases are not to mingle with clean cases, either in the wards or in the grounds. 3. Each case to have its own spray and all other accessories, the spray to be dipped into Izal solution before and after use. 4. The nurse attending to the nose and throat of every case, and more particularly septic cases, must wear rubber gloves. 5. The gloved hands are to be well rinsed in the Izal bowl at the foot of each bed before proceeding to the next case. 6. Cases of ear discharge, nose discharge, neck glands, and kidney disease may be a direct reflection on the way the nurse does her duty. 7. Ward windows to be kept open in all weather. 8. All dressings and used wool to be burned at once. 82 Sanitary Administration. SCARLET FEVER. The following cases of Scarlet Fever were complicated or modified in some way:— Peeling on admission 8 Dental Caries 2 Abscess of Neck 1 Impetigo or other Skin disease 4 Nasal discharge 10 Albuminuria 5 Vaginitis 1 Ear discharge 9 Heart disease 1 Adenoids 9 Chorea 1 Enlarged Tonsils 18 *Mumps 1 „ Neck Glands 19 Conjunctivitis 1 Bronchial Catarrh 4 Rheumatism 2 Deafness 2 Ringworm 2 *Whooping Cough 2 Verminous 1 *Chicken Pox 2 * Shewing the need for Isolation Cubicles. There was one "return" case of Scarlet Fever during the year. Nasal discharge, neck glands, ear discharge, adenoids and tonsils are all a reflection on the neglect of the parents in not having their children's throats and noses seen to. Probably no child with tonsils and adenoids will escape Scarlet Fever, and when he gets it he will have it badly with complications which may handicap him for life. The nursing of these cases is arduous and responsible, the convalescence prolonged and the result often unsatisfactory. This state of things will go on so long as this parental neglect of the nose and throat goes on. DIPHTHERIA. The district has been fairly free of Diphtheria this year, except for a slight prevalence in the spring. Thirty-nine cases were admitted to the hospital, two or three were desperately ill, but no 83 SCARLET FEVER. Diagram showing 153 Scarlet Fever Notifications received during 1914. It will be noticed that only on 8 weeks out of the 52 were there no notifications received. The outbreak in the autumn is graphically shown. No deaths occurred from this disease during the year. 84 Hospital Administration. deaths occurred. Tracheotomy was required in one case, while another just escaped it by vomiting the membrane up. The complications were:— Tracheotomy 1 Mentally Defective 1 Serum Rash 2 Nasal Diphtheria 1 Paralysis 2 "Carrier" Cases 2 Scarlet Fever 1 Adenoids 1 Impetigo and other Skin disease 2 Enlarged Neck Glands 1 Nasal Discharge 1 Rheumatism 1 Conjunctivitis 1 Bronchitis 1 Verminous 1 Enlarged Tonsils 1 ENTERIC FEVER. One case was admitted, but no history of infection was obtained. He was a furniture remover and moved about in different parts of the county and was therefore difficult to locate. This patient died about two months after returning home from malignant disease. BACTERIOLOGY. The following Table shows the results of Bacteriological Examinations carried out by the Medical Officer of Health at the hospital during 1914:— Result. Diphtheria. Typhoid Fever. Pulmonary Tuberculosis. Other Diseases. Totals. Positive 59 — 65 14 138 Negative 84 3 56 8 151 Totals 143 3 121 22 289 It is proposed to give the Medical Superintendent a more 85 DIPHTHERIA, 1914. Fifty-six notifications. There has been no prevalence of Diphtheria beyond a few cases in the Spring. On 23 weeks there were no notifications received. No deaths occurred from this disease during the year. 86 Hospital Administration. commodious laboratory for his bacteriological work so soon as the new Tuberculosis ward block and dispensary are erected. TUBERCULOSIS SUMMARY FOR 1914. SHEWING CHIEFLY WORK DONE AT THE HOSPITAL. Sixty-six cases of Pulmonary Tuberculosis were notified in 1914, against 74 in 1913 and 107 in 1912, This shews a diminution in the number of cases over a period of three years, and should do much to assuage the fears in some minds that the district runs a danger in admitting cases from outside to its hospital. TUBERCULOSIS DISPENSARY PATIENTS. Number of new cases seen in 1914 107 Total number of cases seen since Dispensary opened 327 Of the 107 cases, 57 passed a course of treatment, plus 20 cases carried on from 1913 77 Residents attending Dispensary for course of treatment in 1914 58 Non-residents attending Dispensary for course of 77 treatment in 1914 19 Insured workers (resident and non-resident) attending Dispensary for course of treatment in 1914 42 Non-insured workers (resident only) attending Dis- 77 pensary for course of treatment in 1914 35 Patients improved in health 60 „ worse „ 10 77 „ died 7 Dispensary patients sent to a Sanatorium 16 Dispensary patients warded in Barnes hospital or Shelters during some part of their treatment 37 8; PULMONARY TUBERCULOSIS, 1914. Sixty-six notifications. This diagram shows that on 17 weeks of the year no notifications of Consumption were received, and there appears to be no marked seasonal variations. Thirty-one deaths from this disease occurred during the year among residents. In addition to this, 7 cases have been transferred to us from other districts, and 12 deaths among non-residents have to be deducted, leaving a net number of 26 deaths for the year. 88 Hospital Administration. Those patients labelled improved, are nearly all cases able to go about their daily work, and in a good proportion of these the disease has been wholly or partially arrested. "Cure" is too optimistic a term to use in connection with this disease, and practically only occurs after lesions so slight as to warrant no obligation on the part of the patient to seek medical advice and treatment. A form of Tuberculin called Bacillary Emulsion has been consistently used in suitable cases, and in many cases has proved a useful adjunct to the general treatment. Given cautiously no untoward results occur, and in the thousands of injections given at this Dispensary, there has never been a skin abscess. Malt and Oil is given to most of the cases, and palliative, expectorant and tonic medicines—and other treatment where found necessary. In Patients: Eighty-nine patients were admitted to our ward in 1914, or 12 more than the previous year. Of these 89 cases, 79 were insured workers; some 15 improved sufficiently to be sent on to a Sanatorium; 16 died in the hospital, and 11 died after returning home; the wish being expressed in several cases that they might die at home, and no objection was raised seeing that the patients had been trained in the use of sputum cups and the destruction of their sputum. An analysis of the 89 cases shows: No change in 14 cases Improvement in 40 cases. Worse in 8 cases. Death in 27 cases. Hospital Administration. 89 These figures are explained by the fact that practically all the cases admitted have the disease in an advanced stage. On looking over the 77 patients admitted during 1913, we find that 36 are still alive, 36 are dead, and 5 are untraced. TUBERCULOSIS ADMINISTRATION. Judged from the standpoint of the present medical knowledge of Tuberculosis, the campaign against the spread of the disease must be in the main preventive rather than curative, and must continue so until some specific means are found of destroying the Tubercle Bacillus. All the Dispensary can do at present is to advise, educate, and prescribe such remedies as will alleviate distress or stimulate the patients' powers of resistance. The Hospital treatment is purely preventive by reducing the risks of spreading infection. The Sanatorium treatment is purely educational. Domiciliary treatment is next to useless among the working classes. SANATORIUM TREATMENT. Sanatorium treatment is quite distinct from Hospital treatment, and as much so as Hospital treatment is distinct from Dispensary treatment. What can be done in Barnes ? 1. We can treat Hospital cases, i.e., advanced and brokendown cases in our wards. 2. We can treat early cases, and chronic resistant cases at our Dispensary. 3. Can we treat the intermediate case as well as some other Institutions ? By the intermediate case, I mean a case with a pronounced but not an advanced lesion, and one whose resistance is lowered, i.e., 90 Hospital Administration. the disease has a tendency to get the upper hand. It is found in these cases that Dispensary treatment alone is not sufficient, but that on the other hand the case is not one for the Hospital. In other words he is a Sanatorium case. Can we as at present placed treat this case satisfactorily ? Up to a certain point, yes, i.e., we can give him a month's open air treatment in a shelter in order to watch his progress. If the progress is satisfactory then he should be transferred to a Sanatorium proper, and there put through such physical outdoor culture as we cannot give him here. The air and surroundings moreover in other Sanatoria might be preferable to those found locally. 4. With regard to the keeping on of our shelters I would suggest that they might be somewhat reduced, and that if we kept accommodation for five patients that would be sufficient. I say this because the new ward block will have cubicles and verandahs, so that any individual case can be treated practically in the open air should his condition justify it. I might then summarise as follows:— 1. Keep on the Dispensary. 2. Maintain a cubicle ward to hold twelve, more or less advanced cases. 3. Retain some shelters for observation purposes, and particularly for those patients whom we intend to draft shortly into a properly established Sanatorium where advanced cases are not treated. AGREEMENT BETWEEN THE SURREY C.C AND THE BARNES U.D.C. The County Council will during the continuance of this agreement establish Institutional treatment of Tuberculosis in the said Urban District by means of a Dispensary, a Hospital and Shelters. 91 Hospital Administration. The District Council will erect in the grounds of the Isolation Hospital, South Worple Way, Mortlake, the said Dispensary and Hospital, and will reserve for the purposes of out-door treatment under this Agreement a three-bed shelter and two single shelters already provided by the said District Council in the said grounds. The said Dispensary and Hospital shall be erected in positions and in accordance with plans and estimates of cost to be previously approved by the County Council, the said Hospital to contain at least a twelve bed ward block. The District Council shall also provide for the Dispensary, Hospital and Shelters, all proper necessary and adequate furniture and equipment, drugs and appliances. The District Council will, at their own cost, maintain and keep during the continuance of this Agreement the said Dispensary, Hospital and Shelters with the necessary and efficient medical and nursing staff and servants, and in particular will appoint and pay the salary of the Medical Officer of Health for the said District or other Medical Officer approved by the County Council to be the Tuberculosis Officer of the said District, and will appoint, subject to the approval of the County Council, and pay the salary of a Health Visitor to act as Tuberculosis Nurse and Visitor in the said district. The Medical service of the Institutional treatment of Tuberculosis provided for under this Agreement shall be under the general supervision and directions of the County Medical Officer of Health or other the Medical Officer appointed by the County Council to act as Tuberculosis Officer of the County. The County Council will pay to the District Council for or towards the maintenance and upkeep of institutional treatment by the District Council in the said dispensary hospital and shelters, the following sums:— (a) for dispensary treatment £100 per annum. 92 Hospital Administration. (b) for the services of a Health Visitor, twenty-five pounds per annum. (c) for the treatment in hospital or shelter of each approved patient being an insured person or the dependent of an insured person under the National Insurance Act, 1911, the sum of thirty shillings per week to include all patients' cost of maintenance treatment, nursing and food. (d) for the like treatment of patients resident in the said district who are neither insured nor dependent the sum of fifteen shillings per week inclusive of all charges the balance of the cost of treatment to be found by the District Council and the patients in such proportions as they may respectively agree. (e) for the like treatment of non-insured persons resident in other parts of the Administrative County the sum of thirty shillings per week inclusive of all charges. The result of the Agreement will be that at the end of 20 years the Ward Block and Dispensary becomes the property of this District Council, and that in case of need this Council can acquire them at any time on terms which under the circumstances seem reasonable. The Tuberculosis Ward block and Dispensary are in course of erection, and so soon as they are completed the little mortuary adjacent will be converted into a bacteriological laboratory. A small mortuary for infectious cases has recently been added to the present public mortuary. The furnishing and equipment of the new buildings will cost about £200, after allowing £50 for stock in hand. TUBERCULOSIS. The deaths from Tuberculosis of the lungs for the last two years are in excess of the average for the last ten years, but this is probably due to the compulsory notification of the disease Hospital Administration. 93 and more correct certification. With regard to deaths from other forms of Tuberculosis there is no marked change during the ten years. The death rate from all forms of Tuberculosis is, however, only half that for England. Year Population. Tuberculosis of lungs. Other Tuberc. Total Deaths. District Death rate per 1,000 of population. Rate for Engl'nd. 1914 34,745 26 8 34 0-98 1913 33,386 33 8 41 1-2 3-5 1912 32,000 28 5 33 1*3 1911 30,786 21 11 32 1-03 *1910 32,500 22 9 31 103 30,000 •■=1909 30,500 23 1 24 0-83 29,000 1908 28,500 19 5 24 0-84 1907 28,000 18 6 24 0-85 1906 25,500 13 7 20 0-78 1905 24,250 30 9 39 1-60 1904 23,200 17 8 25 1-64 *Population over-estimated. In 1914 the notifications have been less than in the previous two years, and the resident deaths much less. Towards this improvement the Dispensary has, 1 venture to think, played its small part. 94 Hospital Administration. PULMONARY TUBERCULOSIS CASES, 1914. TABLE shewing treatment of cases. Ages. Attending other hospitals includ'g Richm'd Infiriy. Dispensary Treatment. Private. Mortlake Hospital Sanatorium Left District. All ages. 16 27 16 14 9 3 1 and under 15 6 9 — 3 1 - 15 and under 25. 1 5 1 4 3 1 25 and under 45. 4 8 4 4 5 2 45 and under 65. 3 4 3 3 - - 65 and upwards. 2 1 4 - - - Note.—Totals do not correspond with No. notified. Total No. notified 67* Hygienic condition of premises Bad 10 Fair 22 Good 35 *Three of these are doubtful cases and one ease passing through Barnes only. NON PULMONARY TUBERCULOSIS, 1914. Ages. Barnes. Mortlake. 1—15 8 9 15-25 — 1 25—45 2 3 46—65 — 1 95 PULMONARY TUBERCULOSIS, 1914. TABLE shewing occupations and Ages:— INDOOR. OUTDOOR. Ages. Servant. Warehouseman. Clerk. Shop Assistant. Caretaker. Tailors Presser. Packer. Barman Bus Conductor. Labourer. Brewery Worker, Errand Boy. Club Grou'dm n Plumber. Unclassified occupations. No occupations. Married Women. 1 and under 15 - - - - - - - - - - - 1 - - - 14 — 15 and under 25 3 - 2 — — — — — — — 1 1 — - — 7 1 25 and under 45 3 1 4 1 1 — — 1 — 2 1 — 1 — - 1 5 45 and under 65 — — 3 — — 1 1 — 1 1 1 — — 1 — 1 5 65 and over - - 1 - - - - - - - - - - - - - — 22 11 23 11 Note.—This table shews the preponderance of the disease among indoor workers in the ratio of 2 to 1. Total cases notified 67—1914. Deaths 26 „ „ 74—1913. „ 33 „ „ 106-1912. „ 28 Statistical Cables. 98 TABLE 1. Vital Statistics of whole District during 1914 and previous Years. Name of District—Barnes Urban. Year Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Of nonresidents registered in the District. Of residents not registered in the District. Uncorrected Number. Nett. Under 1 year of age. At all ages. Number. Rate. Number. Rate per 1,000 nett births Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1909. 28181 703 — 24.9 277 7.8 — 44 62 88 321 11.00 1910. 29437 682 — 23.1 215 7.3 — 44 47 69 259 9.1 1911. 30786 721 731 23.7 272 8.8 9 73 70 95 336 10.9 1912. 32000 679 700 21.8 220 69 11 82 41 58.5 291 9.0 1913. 33386 718 736 22.07 294 8.8 29 85 62 84.2 350 10.5 1914. 34,745 734 754 21 7 276 7.9 28 88 48 63.6 336 9.6 Area of District in acres Total population at all ages 30,377 (land and inland 2,518 Number of inhabited houses 7,157 At Census of 1911 water). Average number of persons per house 4.2 TABLE II. Cases of Infectious Disease notified during the year 1914. Notifiable Disease. Number of Cases Notified. Total Cases notified in each locality. Total Cases removed to Hospital. At all ages. At ages—Years. 1 . 2 Under 1. 1 to 5. 5 to 15. 15 to 25 25 to 45. 45 to 65 65 and upw'ds. Barnes M'rti'ke. Small pox — — — — — — — — — - — Cholera or Plague - - - - - - - - - - - Diphtheria (including Membranous Croup) 56 — 7 24 13 7 5 - 17 39 40 Erysipelas 11 — — - 2 4 5 — 7 4 — Scarlet Fever 153 1 35 95 15 6 1 — 54 99 119 Typhus Fever — — — — — — — - — — — Enteric Fever 2 - - - - 1 1 - 1 1 2 Relapsing Fever - — — — — — — — — — — Continued Fever Puerperal Fever — — — — — — — — — — — Cerebro-spinal Meningitis - - - - - - - - - - - Poliomyelitis — — — — — — — — — - — Ophthalmia Neonatorum 2 2 - - - - - - - 2 - Pulmonary Tuberculosis 66 — 2 13 14 22 14 1 22 44 13 Barnes 14 Other Hosp. 27 Other forms of Tuberculosis 22 1 7 7 1 6 — — 9 13 - Totals 312 4 51 139 45 46 26 1 110 202 188 Isolation Hospital—South Worple Way, Mortlake. S.W. Tuberculosis Dispensary, Hospital Block and Shelters—South Worple Way, Mortlake. 100 TABLE III. Causes of, and Ages at, Death during the year 1914. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of Residents or Nonresidents in Institutions in the District. All Ages Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25 25 and under 45. 45 and under 65. 65 and upwards. All Causes (certified) 364 48 7 11 6 19 59 100 114 — Enteric Fever — - — — — — — — - — Small-pox — — - — — — - - - — Measles 1 — — — 1 — - — — - Scarlet Fever - — — — — — — — — — Whooping Cough 4 3 1 — — — — — - — Diphtheria and Croup — — - — — — - — — — Influenza 2 — — — — — — - - — Erysipelas — — — - - — — — — Phthisis (Pulmonary Tuberculosis) 38 — — — 1 7 14 15 16 (Res. 4 Non-Res. 12) Tuberculous Meningitis 4 2 2 — — — — — — - Other tuberculous diseases 4 — 1 1 1 1 — — - — Cancer, malignant disease 34 — — — — — 5 9 20 — Rheumatic Fever 1 — — — — 1 — — — — Meningitis 1 — — 1 — — — — — — Organic Heart Disease 39 — - - 1 1 7 16 1 1 101 meningitis - — * 1 Organic Heart Disease 39 — — 1 1 7 16 1 — Bronchitis 22 — — — — — 7 14 - Pneumonia (all forms) 20 6 — 3 1 1 3 3 3 - Other diseases of Respiratory organs 5 — - — 1 - - 1 3 - Diarrhœa and Enteritis 9 6 2 1 — - — — - - Appendicitis and Typhlitis 3 — — 1 — - 1 1 — - Cirrhosis of Liver 10 — — — — — 3 7 - - Alcoholism - - - - - - - - - - Nephritis and Bright s Disease 10 - — - - - - 5 5 - Puerperal fever — - — — — — - — — - Other accidents and diseases of Pregnancy and Parturition 3 - 1 - - - 2 - - - Congenital Debility and Malformation, including Premature Birth 16 16 - - - - - - - - Violent Deaths, excluding Suicide 21 1 - - - 4 4 9 3 - Suicide 4 — — - - - 1 2 1 - Other defined diseases 113 13 - 3 — 4 19 23 51 - Diseases ill-defined or unknown - - — — - — — — — - Totals 364 48 7 11 6 19 59 100 114 - Inquests—Residents, 27 ; Non-Residents, 17; Total, 44. 102 TABLE IV. Infant Mortality during the Year 1914. Nett Deaths from stated causes at various ages under 1 Year of Age. CAUSE OF DEATH. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under I year. All Causes (certified) . 9 1 2 6 18 12 10 6 2 48 Small-pox - - - - - - - - - - Chicken-pox — — — - — — - — - — Measles — - — - - - — — — — Scarlet Fever - - - - - - - - - - Whooping Cough — — - - — 1 1 1 — 3 Diphtheria and Croup — — — — — - — - — — Erysipelas — — — — - - — — — — Tuberculous Meningitis — — — - — — 1 1 — 2 Abdominal Tuberculosis — — — — — - — — — — Other Tuberculous Diseases — — - - — — — — — — Meningitis (not Tuberculous) — — — — — - — — — — Convulsions - - - - - - - - - - Laryngitis — — - - — — — — — - Bronchitis — — — - - — - 1 — 1 Pneumonia (all forms) — — - - — - 3 3 - 6 103 Diarrhœa — — — — — 3 2 — — 5 Enteritis — — — — — 1 — — - 1 Gastritis — - 1 1 2 1 — — — 3 Syphilis — 1 — 1 2 2 — — — 4 Rickets — — — — — — — — — — Suffocation, overlying — — — 1 1 — 1 — — 2 Injury at birth — — — — — — — — — - Atelectasis — — - — — — — — — - Congenital Malformations 3 — 1 — 4 — — — — 4 Premature Birth 5 — — 1 6 — — — — 6 Atrophy, Debility, and Marasmus — — — 2 2 3 1 — 1 7 Other Causes 1 - - - 1 1 1 - 1 4 Totals 9 1 2 6 18 12 10 6 2 48 Nett Births in the year Legitimate, 718 Illegitimate, 36. Nett Deaths in the year of Legitimate Infants, 45. Illegitimate Infants, 3