AC 4413(2) BARNES BARN 3 (Later Hun. B.) Urban district Council of Barnes. Annual Report on the Health, Sanitary Conditions, Etc., OF THE URBAN DISTRICT OF BARNES, for the Year 1917, 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, 1918. Urban District Council of Barnes. Annual Report ON THE Health, Sanitary Conditions, Etc., OF THE URBAN DISTRICT OF BARNES, for the Year 1917. 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, 1918. THE Urban District Council ok Barnes. public health Department. Staff. Medical Officer of Health, Medical Superintendent of Isolation Hospital, Tuberculosis Officer, etc. Bbrtram Crossfield Stevens, F.R.C.S. (Edin.), D P.H. (Oxon ), M.D.. M.S. (Dunelm), L.R.C P. (Lond.) Assistant School Medical Officer Surrey Education Committee. Medical Officer, Child Welfare Centre and Day Nursery. Sanitary Inspector and Inspector of Housing, T. Grylls, Senior Assistant Sanitary Inspector and Assistant Inspector of Housing, Junior Assistant Sanitary Inspector, *C. W. Slade, a.r.s.i. Matron of the Hospital, Miss Wb«b. Health Visitor, Miss Williams. * Absent on Military Service. Summary—1917. Area (Barnes and Mortlake) 2,650 acres, including 133 of water Census Population, April, 1911 30,377 Estimated Population, June 30th, 1917—Por Birth-Rate 36,223 ,, ,, ,, ,, For Death-Rate 32,495 Rateable Value £285,119 Assessable Value, 1917 £263,263 General District Rate 3s. 9d. in the pound Poor Rate Barnes, 3s. 2d. Mortlake, 3s. 5d. " " " A Penny Rate Produces £1,058 VITAL STATISTICS. Birth-rate per 1,000 living 13.2 Resident death rate per 1,000 living 8.2 Nett death-rate per 1,000 living 10.9 Infantile Mortality per 1,000 births registered 68.6 Zymotic death-rate per 1,000 living 0.4 HOSPITAL ACCOMMODATION. Por infectious cases Barnes U.D.C. Isolation Hospital For smallpox Guildford, Godalming, and Woking Joint Hospital at Whitmoor. Electricity Barnes U.D.C. Electric Works Water Supply Metropolitan Water Board Gas Supply Brentford and Richmond Gas Co's Sewerage Separate System Sewage Disposal Chemical Precipitation and Bacterial Filtration, Richmond and Barnes Joint Sewerage Board ANNUAL REPORT. WAR EMERGENCY COMMITTEES. Many Committees have been formed for the purpose of dealing with conditions arising out of the War. These have meant much extra time given up by the Councillors and the Executive Officers of the Council. The chief Committees are :— The Barnes and Mortlake Tribunal. The Naval and Military War Pensions Committee. The War Savings Committee. The War Allotments Committee. The Food Control Committee. The Food Economy Committee (Communal Kitchens, etc). MUNITIONS WORKS. There are four such works in the district, employing a large number of people. SOLDIERS. Men continue to be billetted in the district, and a militaiy camp exists in Barnes. VITAL STATISTICS FOR THE YEAR ENDING 31ST DECEMBER, 1917. Barnes. Mortlake. Totals. Births, Male 92 150 242 1481 „ Female 98 141 239 Total Births— Legitimate 178 277 455 1481 Illegitimate 12 14 26 Deaths at all ages—Resident 121 143 264 297 Non-Resident 18 15 33 Deaths under 1 year 11 17 28 297 1 to 5 years 3 7 10 5 to 15 years 2 10 12 15 to 25 years 5 16 21 25 to 65 years 47 53 100 Over 65 years 74 52 126 "Deaths registered locally. Vital Statistics. Deaths from: Barnes. Mortlake. Totals. Cerebro Spinal Fever — 1 1 Diphtheria — 1 1 Pulmonary Tuberculosis 9 30 39 Other Tuberculosis 2 2 4 Cancer 19 19 38 Measles I 2 3 Whooping Cough 2 2 4 Diarrhoea I 2 3 Total deaths from preventable disease 34 39 93 Cases Notified or ascertained. Cerebro Spinal 3 l 4 Scarlet Fever 7 30 37 Diphtheria 12 16 28 Typhoid 5 1 6 Erysipelas 4 4 8 Puerperal Fever — — — Ophthalmia Neonatorum 2 1 3 Pulmonary Tuberculosis 19 35 54 Other Tuberculosis 4 10 14 55 98 153 VITAL STATISTICS. The Registrar General's figures are 36,223 population for estimating the Birth Rate and 32,495 for estimating the Death Rate. This means that for purposes of Birth Statistics the male population is counted as being in the district, while for Death Statistics they are counted as being absent on Military Service. After all said and done, the population is constantly and quickly changing, and estimates can only be approximate. Very few houses remain empty, there being about 7,800 inhabited houses in the district. 5 6 Vital Statistics. The Births notified in the district number 481, compared with 570 for 1916. The births will probably continue to fall for a few years owing to the present social and economic conditions. For 1917 the rate is 13.2 per 1,000 of the population, compared with 16.4 in 1916. The Deaths of residents in the district number 264, compared with 256 in 1916. This gives a residential death rate of 8.2 per 1,000, compared with 7.3 in 1916. This is a strictly residential death rate, and does not include people who have died elsewhere and given a Barnes or Mortlake address. This rate is 10.9, compared with 10.5 in 1916. Deaths from the principal Zymotic Diseases number 13 in 1917, compared with 11 in 1916. The district Infantile Mortality or deaths under 1 year number 33, compared with 37 in 1916. This gives a death rate of 68.6, compared with 62.4 in 1916. The deaths from Tuberculosis of the Lungs in 1917 number 27, compared with 36 in 1916. Deaths from Cancer number 38, compared with 29 in 1916. The number of illegitimate births number 26, with 10 deaths, compared with 24 in 1916, with 11 deaths. BIRTH RATE. 1916 18.8 1916 17 1917 13.2 DEATH RATE. 1915 10.9 1916 10.5 1917 10.9 INFANTILE MORTALITY RATE. 1915 83.8 1916 62.4 1917 68.6 birth rate. death rate. infantile mortality. England and Wales . 17.7 14.4 97 London 17.4 15.0 103 Barnes 13.2 10.9 68.6 Sanitary Administration of the District. 7 EPIDEMIC DISEASES. Deaths from the seven principal epidemic diseases, viz: Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Fever (Typhus, Enteric and Continued), and Diarrhoea, number 13, which is equal to a rate of 0.4 per 1,000 of the population *VACCINATION AND SMALL-POX. Fifteen per cent, of the school children are unvaccinated, and exemption certificates are obtained for 25 per cent, of all children born in the district. In order to prevent the spread of Small-pox, every individual should be twice successfully vaccinated. The present half-and-half measures are a common danger, as a person, say, vaccinated once in infancy may contract the disease in a mild form, be undetected and spread the disease far and wide, whereas if he had not been vaccinated at all he would get the disease badly, be very ill, would be recognised at once, and promptly isolated, while all contacts would be immediately vaccinated. "Figures kindly supplied by Mr. Raggett, Vaccination Officer. MORTALITY TABLE. Deaths, Deaths. Deaths, Age Group. Rate per 1,030 of Population. 1915. 1916. 1917. 1915. 1916. 1917. 55 38 33 Under 1 year 1.5 1.2 1.0 34 20 12 1 to 5 years 0.9 0.6 .3 35 30 32 5 to 25 years 1.0 0.9 1.0 130 120 127 25 to 65 years 3.8 3.7 4.0 126 129 152 65 years and upwards 3.7 4.1 4.6 380* 337 356 All ages 10.9 10.5 10.9 *Total nett deaths relegated to the district by the Registrar General and including residents who have died outside the district. 8 Sanitary Administration of the District. INFANTILE MORTALITY (compared with two previous years). DISEASE. No. Year 1916. No. Year 1916. No. Year 1917. Whooping Cough 2 2 4 Measles 4 — 3 Tuberculosis 1 1 — Heart Disease 1 — 2 Other Respiratory Diseases 7 3 3 Meningitis 2 1 — Diarrhoea (up to 2 years) 1 6 3 Mai-Nutrition and Premature Birth 21 10 8 Violent Deaths 2 5 6 Syphilis 1 — 1 Other Defined Diseases 11 6 5 Ill-defined Diseases 2 4 — Totals 55 38 *35 Including 2 over 1 year of age. Infantile Mortality Rate, 1915 83 8 „ 1916 624 „ „ „ 1917 686 1916 1917 (provisional) Births 570 484 Vaccinations 391 325 Exemptions 111 122 Sanitary Administration of the District. 9 INFECTIOUS DISEASES. MEASLES AND RUBELLA. These diseases were very prevalent during 1917: 743 (451 Measles, 292 Rubella cases were notified; 603 by doctors, 140 by parents and others. The number of visits paid to these cases was 454. The deaths numbered 3. No school closure was deemed necessary. Two district nurses have been appointed by the Council to nurse cases of measles at their homes on the advice of the Medical Officer of Health. In exceptional circumstances also, cases of measles are admitted to the Isolation Hospital. Five cases were admitted in 1917. The diminishing proportion of fatal cases shows that compulsory notification and home visiting have done good. Year. Cases Notified. Deaths. 1915 — 15 1916 434 2 1917 743 3 SCARLET FEVER. There has been no outbreak of this disease worth noting during 1917. 37 cases have been notified. Of these, 35 cases were removed to the Isolation Hospital. There were no deaths. Two of the cases were doubtful. Two cases were complicated by chicken-pox before admission. There were no return cases after discharge. Year. Cases Notified. Deaths. 1914 154 nil 1915 137 3 1916 94 nil 1917 37 nil PUERPERAL FEVER. No cases were notified in 1917, Under the Maternity and Child Welfare Scheme evolved by the District Council but now 10 Sanitary Administration of the District. taken over by the County Council, provision has been made for nursing such cases in the District Council's Isolation Hospital. Year. Cases Notified. 1915 6 1916 1 1917 0 OPHTHALMIA NEONATORUM. This disease is usually caused by the child's eyes becoming infected during birth by venereal disease of the mother, and is a serious and frequent cause of blindness. It needs both urgent and energetic treatment to be of any success. Three cases were notified in 1917 and one in 1916. Two of these were imported. POLIO-MYELITIS. No cases notified. We were warned, however, of an outbreak in the Esher and Epsom districts. Of the NON-NOTIFIABLE INFECTIOUS DISEASES, Chicken-pox, Mumps, Whooping-cough, have been prevalent among children, and in one infant school the attendance was so reduced by the two former diseases and the heating arrangements were unsatisfactory, so that the department was closed ten days prior to the end of the term. DIPHTHERIA. This disease has shown no prevalence during 1917; 28 cases were notified, and of these 27 were removed to the Isolation Hospital. The only death was a child brought in dying, who only survived a few hours. One case was imported. Antitoxin is always given at the earliest opportunity, and was frequently given by the medical attendant before admission. There was one case of mixed Scarlet Fever and Diphtheria, who though very ill at first made a good recovery. There were no return cases after discharge. Year. Cases Notified. Deaths. 1914 57 0 1915 41 0 1916 34 1 1917 28 1 Sanitary Administration of the District. ii CEREBRO-SPINAL MENINGITIS. Four cases have been notified; three were associated with military contacts; one case was admitted to the Hospital and died after 11 weeks, being unconscious practically the whole time. One military case died in a military hospital. No secondary cases arose in the families affected. Year. Cases Notified. 191 5 0 191 6 3 191 7 4 ENTERIC (typhoid fever). Six cases were notified: two at least of these were imported; one case (R.N. A S.) was removed to Hospital. There were 2 deaths among the privately nursed cases. No secondary cases arose in the families affected. Year. Cases Notified. 1915 3 191 6 2 191 7 6* * Two Imported Cases. LIST OF INFECTIOUS DISEASES NOTIFIED 1917. Measles, 451 Rubella, 292 3 deathsScarlet Fever, 37. No deaths. Diphtheria, 28 (including 1 imported case). 1 death. Enteric Fever, 6 (including 2 imported). 2 deaths. Puerperal Fever, nil. Cerebro-Spinal Fever, 4 (including 2 soldiers, Ranelagh Camp). 2 deaths. Polio-Myelitis, nil. Pulmonary Tuberculosis, 54. 15 deaths. Other Tuberculosis, 14. No deaths. Erysipelas, 8. No deaths. Ophthalmia Neonatorum, 3 (including 2 imported cases). No deaths. 12 Sanitary Administration of the District. BACTERIOLOGICAL EXAMINATIONS FOR 1917. Result. Diphtheria. Typhoid Fever. Pulmonary Tuberculosis. Other Diseases. Totals Positive 35 — 27 7 69 Negative 106 2 71 2 181 Totals 141 2 98 9 250 CONTAGIOUS DISEASES. Ringworm, Scabies, Impetigo, and Verminous Heads and Bodies, have been rather in evidence this year, due partly to depletion of school nurses, mothers being away at work all day, and contact with men home on leave. VENEREAL DISEASES. Efforts are being made throughout the country to educate people as to the prevention and treatment of these scourges. Facilities for early treatment have been placed at the disposal of all affected if they will only enquire of the county or local medical officer of health or report at once to any medical man. In order to stimulate interest in thejrjatter in this district, a conference was held in the Council, when Sir Thomas Barlow, K.C.V.O., gave an address, under the auspices of the National Society for the Prevention of Venereal Disease. After this the Society sent down two lecturers to address men and three to address women. The attendance was only fair, but a good deal of literature was disposed of, and many influential people were present, so that it is hoped that some good was done in educating the people here. The Health Department is steadily continuing the propaganda by means of its staff. The Medical Officer of Health would welcome confidential notification from any desiring treatment and would see *In this connection (under the Cleansing of Persons Act, 1897) the establishment of a cleansing station is being seriously considered by the Public Health Committee. Child Welfare. 13 that they got it. Treatment does not mean incapacity for work. The scheme for Surrey is, however, controlled by the Surrey County Council, from Kingston. The following letter was widely circulated in the district last October:— Venereal Diseases. the barnes urban district council. A conference will be held on Wednesday, the 31st October, 1917, at 8 p.m., at the Council House, High Street, Mortlake. Sir Thomas Barlow, Bart., and Miss W. Cullis, D.Sc., from the National Council for Combating Venereal Diseases, will explain the working of the Regulations of the Local Government Board for the Prevention and Treatment of these Diseases, and indicate generally how all interested in the welfare of our race can actively assist in this desirable object. Your presence at the conference will be appreciated, and you will be helping in a great National Effort to combat diseases which affect so seriously the national life, and are well-known causes of in-efficiency in the home and industrial life and in the services. A card of admission is enclosed which is hoped you will use yourself or pass on to a friend ready to assist in so worthy an undertaking. As space will be restricted an early intimation of attendance to the Medical Officer of Health would assist the organisers. The Public Health Department, Council Offices, Mortlake, S.W. 14. CHILD WELFARE. Under the Notification of Births Extension Act, 1915, all births must be notified to the Medical Officer of Health, and are visited by the Health Visitors after the doctor or midwife in attendance have ceased their visits. The Mother and Child Welfare Centre receives mothers and their children up to five years of age, and is attended by the doctor 14 Child Welfare. and Nurse, Expectant mothers are also invited to come for advice. Three age groups of school children are inspected annually, numbering well over 1,000. Those found defective are treated at medical, dental, and eye clinics regularly; those requiring surgical treatment are given hospital tickets. It is hoped that the age up to which children will be medically supervised will shortly be increased from 14 to 18 years. Fuller information on school work can be obtained by reference to the Annual Report of the Medical Officer of the Surrey Education Committee, Kingston, being the controlling body for education in this district. The Day Nursery (Voluntary Committee) takes care of children, up to the age of five, whose mothers find it necessary to go out to work. Details of their work are published in their first Annual Report recently published. The Education Authority and Mother and Child Welfare Authority rent rooms from the Day Nursery Committee, and so district, county, and voluntary work in connection with Child Welfare are all conducted in one building. The local Medical Officer of Health has medical supervision over all three. Now that the Surrey County Council has taken over the control of the mother and child welfare work already well established in the district, the duty of providing medical and other assistance for necessitous and complicated cases of pregnancy and parturition devolves upon them. There are no hospitals for women and children in the district. The only way the District Council can help (and this has been done) is to provide beds for Puerperal Fever, and to admit certain cases of Infective Diarrhoea in children. Owing to the present congested state of our large Metropolitan and County Hospitals and to the depletion of their staffs, it is impossible to get beds for children needing medical care as opposed to surgical operations. Child Welfare 15 Health Visitors' Report for 1917. There were 481 births, 291 in Mortiake and 190 in Barnes. Of these 469 were notified by doctors or midwives; 243 births were visited, and advice given verbally and by means of leaflets, and the mothers urged to attend the centre at Afon House. The following visits were paid during the year:— Infants and children up to five years 1722 Measles 454 Tuberculosis 163 Expectant mothers 45 Other visits 15 2399 Only 22 expectant mothers were found and visited. No information was forthcoming from the district midwives, who have been provided with the necessary forms. More babies are bottle-fed owing to the mothers going out to work; 250 enquiries on this matter showed 116 breast-fed, 98 bottlefed, 9 part breast anil part bottle, 27 left the district. The scarcity and high price of cow's milk has shown itself, but has to some extent been overcome by a supply of condensed or prepared milk. 33 infants died under one year of age; 10 of these were illegitimate; five were found dead (abandoned); 12 died before they were a fortnight old, and so escaped visiting. Of the 11 visited, nineijrgre bottle-fed and only two breast-fed. There only 3 deaths from Diarrhoea, probably due to the very wet summer. There were a few cases of Diarrhœa, and the only infant death occurred in an illegitimate bottle-fed baby of one month. Child Welfare Centre. During 1917, 106 new babies attended, bringing the register up to 285. The centre was opened on 46 Thursdays and the attendance was good, viz.: Babies, 1,018; mothers, 1,429; other children, 527. Of the 106 new babies, 64 belonged to Mortiake and 40 to 16 Child Welfare. Barnes; 49 were breast-fed and 59 bottle-fed. It is chiefly on account of the latter that the mothers seek advice. Dried milk, special foods, Virol, etc., are sold to the mothers; also a few simple medicaments and apparatus; literature and patterns are also displayed. Of babies attending the Centre, three died; two of pneumonia and one of malnutrition (illegitimate) in Hospital. 49 older children attended for medical advice, and all children are regularly weighed. Tuberculosis. 163 visits were paid to the homes to see that preventive measures were carried out. 89 attendances were made by the Health Visitors at the Dispensary. Measles. 454 visits were made to see that proper isolation and treatment were carried out. The two District Nurses visit cases at home at the discretion of the Medical Officer of Health. The notification of measles has done much good in reducing the mortality from this disease. Maternity and Child Welfare Scheme. urban district council of barnes. 1. The Ante-Natal Clinic now established should be looked upon as a treatment centre to which Midwives can bring or send patients who in their opinion need medical advice, either for general ill-health or for the ailments of pregnancy. 2. Midwives who send patients are asked to send with them a sealed note stating any facts which the Doctor should know. She will in turn receive a sealed report from the Doctor. 3 In no case will a Midwife's case be referred to a Hospital or Doctor direct from the Clinic, but the need for such a step will be reported to the Midwife, who can refer her own patient. Hospital Administration. 17 4. Only minor ailments will be treated at the Clinic, but advice will be given in all cases. 5. Any Midwife suspecting venereal disease can send her patient to the Clinic Doctor with a note, and blood will be taken for testing and treatment given or recommended in accordance with the pathologist's report. 6. Urine will be tested as a matter of routine. 7. An internal examination will not be made as a matter of routine, but only when there is reason to believe that such is desirable. 8. In the case of a woman attending the Clinic who has not booked an attendant, no particular Doctor, Hospital, or Midwife will be recommended, but a list of those available will be shown to her, and she will be advised to choose her own as soon as possible 9. Medical etiquette will always be observed in dealing with both Midwives' and Doctors' cases. 10. All correspondence between the Doctor and Midwife must be strictly confidential. Patients seen at Afon House, High Street, Mortlake, S.W., Thursdays, 3 to 4.30. HOUSING OP THE WORKING CLASSES. Government Scheme. It is estimated that at least 100 houses are required for the accommodation of the artisan class. These should not be flats, but self-contained houses, averaging ten to the acre. H. AND T. P. ACT, ETC. Certain areas have been visited by the Inspector. Two houses have been closed and one demolished. One closing order was made; the other closure and demolition were voluntary. HOSPITAL ADMINISTRATION. The Hospital is situated in South Worple Way, and contains blocks for Scarlet Pever, Diphtheria, Typhoid Fever, and Tuberculosis. It also contains a Tuberculosis Dispensary, 18 Hospital Administration. Bacteriological Laboratory, Coroner's Court and Mortuary, and a Disinfecting Apparatus. The Staff consists of the Matron,* 2 Sisters, 1 assistant nurse, 4 probationers, Domestic and Laundry Staff, Ward Maids, Porter and Portress, Assistant Porter, and a Gardener. There is accommodation for fifty patients in all. Scarlet Fever.—Ten cases were carried over from 1916. 35 cases were admitted in 1917 with no deaths. There were two doubtful cases. Diphtheria.—Only 27 cases were admitted, some of whom were "carriers" only. There was only one death during the year. This case was dying on admission. Enteric Pever (Typhoid).—Only one case was admitted, which recovered. Cerebro-Spinal Fever.—One case admitted, death ensued in 11 weeks. Two cases of Scarlet Fever had Chicken Pox as well on admission. One case of Diphtheria had Scarlet Fever as well on admission. Five cases of Measles were admitted: one complicated by Whooping Cough on admission. One case of Whooping Cough was admitted from the West London Hospital. TUBERCULOSIS WARD A new ward to accommodate 6 male and 6 female patients was opened at the same time as the dispensary. In addition to the ward cubicles, 5 patients can be accommodated in shelters. The patients for the most part were in an advanced state of the disease when admitted, but some improved sufficiently to recommend them for further treatment in a sanatorium. The results for the year are as follows:— Patients admitted toward or shelter 64 „ sent on to a sanatorium 13 „ died in hospital 12 „ known to have died since discharge 6 *Miss Webb was appointed Matron in April, 1917, vice Miss Woods, resigned. Hospital Administration. 19 The balance consists of patients sent home after a course of treatment, for the most part improved, and those who have been discharged at their own request. In several cases those discharged are following on with the dispensary treatment. Of the 64 in-patients, 55 were insured workers and 12 were residents in the district. To public authorities who propose building blocks for advanced cases of pulmonary tuberculosis I would suggest that the ward system is preferable to the cubicle system. The drawbacks to the latter are increased work for the nursing staff, heating difficulties, awkward lavatory arrangements, and more or less solitude for the patient. In the long ward there is the open fire, proper lavatory accommodation at the end of the ward, more company, and a side ward available for an extreme case. TUBERCULOSIS DISPENSARY (ESTABLISHED 1911). The new dispensary was opened in the summer of 1915. It is now opened twice weekly for sessions of two hours for the treatment of ambulatory cases of pulmonary tuberculosis. The register shows 818 names of persons who have attended since the old dispensary first opened in 1911. During this year 263 new cases have presented themselves for diagnosis, or an opinion, but many of these were found not to be tuberculous. 50 recruits were sent by the R.A.M.C. Of the 263 cases 113 received dispensary treatment with the results shewn below. The present patients may be roughly sub-divided as follows:— Adults Only. jPit for ordinary work 27 Fit for light work 237 Unfit for light work 11 Died during the year 6 Pretubercular Children attended during the year, mostly school children 52 20 Hospital Administration. At the dispensary medicines are dispensed, malt and oil distributed and tuberculin given according to the needs of the patient. For 1917 :— The number of attendances of Insured persons 456 ,, „ „ „ Non-Insured „ 171 852 „ ,, ,, Dependants 225 Visits to the homes of all classes 163 Experience over 5 years of uninterrupted work goes to show that cases with Tubercle Bacilli in the sputum who have had considerable dosage of Tuberculin live longer than those who have not been so treated. Also that the Dispensary and the Hospital are the two most useful means of dealing with early and late cases respectively, but that the home conditions of the majority of the working classes are adverse to recovery, as shown by the frequent relapses; and that many Sanatorium cases find their way eventually into Hospitals for advanced cases. I am convinced that for every able bodied consumptive, state controlled, state founded and state aid farm-colonies should be established, and that home life and freedom on the colonies should be so arranged as to be agreeable to all patients concerned and their earning capacity developed to the full. Pulmonary Tuberculosis in the District. Cases notified for the first time during 1917 54 Of these:— Treated at the Dispensary 10 Treated at the Hospital 10 Treated at Home 14 Treated in Hospitals or Sanatoria outside the district 20 Died 15 (including 3 cases notified after death) Year. First Notification. Residents' Deaths, Old& New Cases. Mortality Rate 1,000 of Population. 1915 60 29 .8 1916 55 35 1.09 1917 54 27 .8 Hospital Administration. 21 Where there are dispensaries established, there is more correct certification of deaths from Tuberculosis. During the years of the war deaths from Pulmonary Tuberculosis have increased. England and Wales, deaths from Pulmonary Tuberculosis:— 1911 39,232 1912 38,085 1913 37,055 1914 38,637 1915 41,676 1916 41,545 The Tuberculosis (Domiciliary Treatment in England) Order of 1916 states that from January, 1917, with regard to cases of consumption treated at home:— Article 11.—The treatment shall be carried out under the care and direction of a Medical Practitioner, subject to the following conditions, and to such other conditions as we may in any case from time to time approve ; that is to say :— (1) That the Medical Practitioner attend each patient at such intervals as may be necessary in the interest of the patient. (2) That the Medical Practitioner give the patient such instructions as are required as to his mode of living, diet, rest, and work, and as to precautions necessary to protect the patient against re-infection. (3) That the Medical Practitioner prepare and transmit to the Consulting Officer at such reasonable intervals, not being less often than once in every three months, as may be arranged between them, a report in regard to each patient in the Form set forth in the Schedule to these Regulations. (4) That the Medical Practitioner make arrangements with the Consulting Officer for each patient to be examined by the Consulting Officer not less often than once in every twelve months. (5) That the Medical Officer confer with the Consulting Officer at such times and in such circumstances as may be arranged between them in regard to patients under the care of the Medical Practitioner. 22 Hospital Administration. (6) That the Medical Practitioner from time to time inform the Medical Officer of Health of the Sanitary District in which the patient resides, of any circumstances known to the Medical Practitioner which may effect adversely the sanitary conditions under which the patient is living, and in respect to which action by the Medical Officer of Health or of the Sanitary Authority would, in the opinion of the Medical Practitioner, be necessary or desirable. Note.—There is no evidence to hand that the private Practitioners in this district are carrying out these regulations, unless they have reported directly to the County Insurance Committee at Kingston. I would also earnestly press for the earliest notification of Tuberculosis. Postmortem notification is of little use. LOCAL DISTRIBUTION OF TUBERCULOSIS CASES. Barnes. East Ward 1 West Ward 7 South Ward 3 11 Mortlake. South Ward 4 North Ward 4 Middle Ward 8 16 27 LOCAL DISTRIBUTION OF CANCER CASES. Barnes. East Ward 4 West Ward 11 South Ward 4 19 Mortlake. South Ward 10 North Ward 2 Middle Ward 7 19 38 Sanitary Administration. 23 RECENT LEGISLATION. The Public Health (Small-Pox Prevention) Registrations, 1917, gives power to Local Authorities to appoint their Medical Officer of Health to vaccinate or re-vaccinate persons during an outbreak of Small-Pox at the expense of the Local Authority. TABLE SHOWING WORK DONE DURING 1917 IN RELATION TO INFECTIOUS DISEASES, INCLUDING PULMONARY TUBERCULOSIS. 1 Visits and inspections in consequence of notifiable disease 148 2 Disinfections performed 241 3 Lots disinfected by steam at the Isolation Hospital 56 4 No. of Notices served by the Medical Officer of Health 32 5 ,, ,, Inspectors 68 6 Premises inspected 148 7 *No. of secondary visits to Pulmonary Tuberculosis 22 8 No. of visits supervising works 117 9 Military Kit and bedding disinfected (lots) 9 10 Statutory notices served 9 * In addition to the visits under No. 1. MORTUARY AND CORONER'S COURT. Inquests during 1917. Residents 24 Non-Residents 18 Unknown 5 47 Cause of Death. Natural 25 Violence 17 Suicide 5 47 24 Sanitary Administation. REPORT OF SANITARY INSPECTOR FOR 1917. 1 302 House-to-house Inspections have been made as compared with 2,565 in 1916, and 2,007 various other visits as compared with 1,140. 68 Preliminary Notices dealing with 174 Nuisances were served during the year 1917 and three Statutory Notices. Special attention has been paid to Hampton Square and West Road and other localities of the poorer class. It is a singular fact that not one case of Scarlet Fever or Diphtheria has occurred in Hampton Square, West Road, or Lodge Avenue, and only two cases of Pulmonary Tuberculosis. It has been a difficult matter to get the landlords to do sufficient cleansing work, but the shortage of labour has made it a difficult task. Two houses in Mortlake have been voluntarily closed on notice being served as to their unfitness for human habitation. There are 12 Bake-houses in the district, and they have been inspected quarterly and found generally to be well kept. Dairies and places where Milk is sold number 36, and have also been inspected quarterly. There are 24 Butchers' Shops and 12 Fishmongers in the district, and 72 visits have been made to the former and 28 to the latter. Two boxes of fish were condemned. The number of Factories is 18, and 40 visits made. The number of Workshops is 144, and 183 visits paid to same. There are four Munition Works in the district. The Beverley Works comprise five firms, employing in the aggregate 380 men and 245 women. The Anglo-Belgian Manufacturing Co. employing 17 men and 33 women. The Miralite, Ltd., Aluminium Works employ 36 men and 28 women, and the Mortlake Aircraft Co. which employ 53 men and 30 women. The outdoor inspections, drain testing, and disinfections, have since July, 1917, been carried out by one Inspector. The Secretary Society Medical Officers of Health 1 Upper Montague Street Russel Square W. C.