Urban District Council of Barnes. Annual Report OF THE Medical Officer of Health ON THE Sanitary Conditions of the District during the Year 1920. Barnes, S.W.: R. W. SIMPSON & CO., LTD., PRINTERS, 15 HIGH STREET. 1921 Urban District Council of Barnes. Annual Report of the Medical Officer of Health on the Sanitary Conditions of the District during the Year 1920. Barnes, S.W.: R. W. SIMPSON & CO., LTD, PRINTERS, 15 HIGH STREET. I 92 I. CONTENTS. PAGE Rateable Value, etc. 4 Staffs 5-16 Vital Statistics 6 General Features of the District 6 Analysis of Infantile Mortality 7 Hospitals 8 Drainage, Water 8 Schools 9 Contagious Diseases, Verminous Children 10 Pood and Drug 11 Infectious Diseases 12 Tuberculosis 13 Venereal Disease 14 Child Welfare Centre 15 Health Visitors' Work 16 Isolation Hospital 17 Bacteriology 18 Housing 19 Tables 22-25 Inspector's Report 27 Statistical Memoranda for 1920 Rateable Value— £ s. d. Agricultural Land 1,696 0 0 Other Hereditaments 289,630 0 0 Total £291,326 0 0 Assessable Value £269,471 15 0 Barnes. Mortlake. Rates, year to March, 1921— s. d. s. d. Poor 6 6 6 8 General 7 1 7 1 13 7 13 9 Id. in the £ General District Rate produces £1,100. Population for Birth and Death Rates 37,127 Birth Rate 20. per 1,000 of population Death Rate 0. „„ „ Infant Mortality 66. per 1,000 births Total Deaths 384 Total Births 777 annual report, 1920. To the Chairman and Members of the Urban District Council of Barnes. Gentlemen, The solution of continuity occasioned by my relinquishing charge of the Public Health Department last September makes it difficult to pick up the thread of one's work again. Any shortcomings, however, will 1 feel sure be ably compensated by your Chief Sanitary Inspector, who has by now got a good grip of the work and the needs of the District. Owing to the economy fever now seizing hold of all public bodies, it is incumbent on all public health authorities to see that the health of the people is not neglected—to allow this for one moment is the direst form of false economy. 1 feel, however, that in your hands the public health will be jealously guarded consistent with economic finance. With regard to the staff, I have to record the retirement of Mr. Grylls, your Chief Sanitary Inspector, after many years' faithful service. The consequent changes and promotions are, in my opinion, satisfactory, and you may expect to be well served. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. The Urban District of Barnes extends from Hammersmith Bridge to the Richmond Boundary at Manor Grove, and Upper Richmond Road, East Sheen. It covers 1,583 acres, and is 3 ½ miles long by 1½ miles broad. The Urban District includes the Ranelagh Club, reservoirs of the Metropolitan Water Board at Barnes Elms and Lonsdale Road, 600 acres of Richmond Park, 126 acres of Barnes Common, 52 acres of 6 General. East Sheen Common, and 15 acres of Palewell Common. There are some 50 acres in use as Allotments, including 6 acres of Barnes Common. The District is situated in the N.W. corner of Surrey, and is within the Metropolitan Police and the London Postal area. Contiguous to the District are parts of Putney, Roehampton, Richmond, and the River Thames. The District lies on gravel over London clay, and rises gradually towards the Park to 64 feet above sea level. The Atmosphere is humid, especially along the river valley and in the more wooded parts of the District, severe cold is seldom experienced, the effects of heavy rains quickly disappear, except in the waterlogged area drained (sic) by the Beverley Brook. The Industries of the District are (a) Brewing; (b) Driving, Conducting and Repairing Omnibuses. (London General); (c) Motor Engineering; (d) Chocolate Manufacturing; (e) Market Gardening; (/) Building. The Census population of 1901 was 17,900, that of 1911 was 30,377. The pre.war population was 34,745, and the estimated present population 37,127; the number of dwelling houses is 7,812, but the separate tenements are computed to be 8,075. Table 7. at the end of the Report, sets out the estimated population over the past five years. STATISTICS FOR 1920. Infantile Mortality Birth Rate Death Rate per 1,000 Births England and Wales 25.4 12.4 80 96 great towns 26.2 12.5 85 148 smaller towns 24.9 11.3 80 London 26.5 12.4 75 Barnes 20.9 10.3 67 Although, these figures might be improved with advantage, we compare favourably with the rest of the country. The Birth Rate for 1920 is 20.9, and has greatly increased compared with 13.7 in 1919, and 12 in 1918. Death Rate. The nett deaths belonging to the District give a rate of 10.3, compared1 with 9.5 in 1919, and 12.4 in 1918. The Natural Increase (births minus deaths) is 393, compared with 162 in 1919, and 34 in 1918. Vital Statistics. 7 Cancer.—There were 39 deaths from this disease, including 17 males, and 22 females,, giving a mortality of 1.05 per 1,000, compared with 1.09 in 1919- With regard to Cancer, deaths among males include 1 over 8 years, 6 over 50 years, 4 over 60 years, and 6 over 70 years. Among females, 3 were over 30 years, 3 over 40 years, 5 over 50 years, 4 over 60 years, 6 over 70 years, and 1 over 80 years. Tuberculosis.—There were 20 deaths from tuberculosis, 17 being from Pulmonary Tuberculosis, and 3 from other forms. The Infantile Mortality Rate works out at 66.9 for every 1,000 births, compared with 89.6 in 1919. While the mortality of legitimate infants is 56.4 for every 1,000 births, that for illegitimate infants reaches the appalling rate of 312.5 per 1,000 births. Nothing can show more plainly the fate of the "Not Wanted" child. The Bastardy Bill of 1920 has the approval of the Council, and is a step towards helping the unmarried mother, penalising the father, and giving the illegitimate child a better chance of living and getting subsequently legitimised. ANALYSIS OF INFANTILE DEATHS. Pertussis 4 deaths. Bronchitis 6 „ Brancho-pneumonia 3 „ Pneumonia 1 „ Enteritis 6 „ Congenital Syphilis 2 „ „ Heart Disease 2 „ Suffocation (overlaid) 1 „ Convulsions (ill-defined) 1 „ Premature Birth 14 „ Atrophy, Debility and Marasmus 2 „ Congenital Malformations 4 „ Syncope (ill-defined) 3 „ Body found in river 1 „ Body found 2 „ 52 „ 8 Sanitary Circumstarces of the District. Four deaths were due to Accident or Violence. Congenital Malformations account for 4 deaths. Syphilis accounts for 2 deaths. Twenty-two- deaths were accounted for by Ante-natal conditions. Four of the deaths, viz., Convulsions and Syncope, are so illdefined as to be impossible to classify. POOR LAW RELIEF DURING 1920. One hundred and twenty-nine orders were issued for Medical Attendance. One hundred and one orders were issued for admission to Workhouse and Infirmary. Thirty deaths occurred among Barnes and Mortlake cases in the Workhouse Infirmary. Hospitals serving in this District include:— The Royal Hospital, Richmond. The Putney Hospital, Putney Common. The West London Hospital, Hammersmith. The Isolation Hospital in Mortlake provides for the Isolation of Infectious Diseases for the Urban District, and contains 50 Beds for Scarlet Fever, Diphtheria, Enteric Fever, and Tuberculosis, the County ma,king use of some of the beds for the latter disease. WATER. The Water Supply is that of the Metropolitan Water Board. It is constant, sufficient, and of good quality. Its plumbo-solvemt action is negligible. The raw Thames water is stored to allow of sedimentation, and then filtered. It is quite likely that Chlorine will play an important part in the purification of future water supplies. The system- of storing drinking water in cisterns in houses is not to be encouraged, and, wherever possible, we get Taps off the rising Main supplied to houses. SEWERAGE AND DRAINAGE. The Water-carriage System prevails throughout the District, with separate channels for storm water. The Sewage is treated at the Richmond and Barnes Joint Sewage Works—effluent discharge into the Thames and the sludge barged away. The Pumping Machinery at the Works can dea.1 with 50 million gallons of water daily; a good Sanitary Circumstances of the District. 9 deal of the rain waiter goes direct to the river by a special system of drains (but most of the roof water enters the sewers). The sewage is treated with chemicals, sedimented, filtered and then discharged after aeration, three to four million gallons being thus treated in the 24 hours. The residue or sludge is filtered under pressure, and pressed into slabs 2½in. thick, and amounting to 7,000 tons of pressed cake annually, which is barged away and sold for agricultural purposeis. I only know of three cesspools and one pail closet in the District, and these are only allowed because of the difference in level between drains and sewers. SCAVENGING. For collection of house refuse the prevailing system is one of movable sanitary bins, which are emptied once a week, and the contents cremated in the Council's Destructor. The resulting clinker i;s used for making pavement slabs in normal times. There are several fixed receptacles for refuse still in use, which tend to become untidy and leaky unless properly rendered inside and out with cement. These fixed receptacles are being gradually replaced by movable ones as opportunities arise. SCHOOLS. The Public Elementary Schools, with the exception of Mortlake Council Schools, East Sheen Council Schools, Lonsdale Road Council Schools, and Westfield's Boys' School, are old buildings, and do not conform architecturally to modern ideas. The Sanitary arrangements are satisfactory. The Caretakers would have more control of the dust, if Dust Allayers were used on the floors and Vacuum Cleaners run over the walls, cupboards, and hangings. There is an urgent need for a good Secondary School in this District, and this scheme is maturing. N0 Schools were closed for infectious disease during the year. Contagious skin diseases have been prevalent. The Private Schools in the District have been systematically visited, and various sanitary defects remedied. Medical Inspection of the children should, in my opinion, be undertaken with regard to these private school children, on the same lines as that obtaining in the Public Elementary School ; and powers granted in that direction would, I think, be of great benefit to the welfare of the children, whether day scholars or boarders. 10 Sanitary Circumstances of the District. VERMINOUS AND OTHER CONTAGIOUS AFFECTIONS. It is generally agreed that during the War, home life has been altered and children neglected as far as cleanliness is concerned. The mothers are often out all day, and the children get out of hand in more ways than one. The bulk of the subjects of these dirty conditions, including itch, scab and ringworm, are children of school age, and are treated by the School Authorities; it is also to some extent a Public Health question, in view of recent research work. The School nurses follow out the routine laid down by the Surrey Education Committee, but cannot be expected to do the actual cleansing where the mother fails. Itch, scab, and ringworm, are largely treated at the School Clinic. Itch is treated specially (when the case will go) at the Council's Disinfecting Station with good results. The Surrey Education Committee have now recognised the necessity for a Cleansing Station for verminous children, so that Section 122 of the Children's Act will shortly be applicable in this respect. If the station were used, dirty heads and bodies could be cleansed there after a trial had been given at the child's home by his parents. Overcrowding, infected bedding, dirty hair brushes, etc., are the chief causes of failure at home. The County Council are responsible for the work of Medical Inspection of the children attending the public elementary schools within the district, and the statistics regarding this work are reported to the School Medical Officer for Surrey for inclusion in his Annual Report. SCHOOL CLINICS. The County Scheme for the dental treatment of school children, by which local deotists were employed on rota began distinctly well, and will, I hope, continue and be extended to mothers, and to children under 5 years. The need for a more commodious School Clinic is apparent, as both the Day Nursery and the Clinic work have grown too- large folr mutual accommodation. MENTALLY DEFECTIVE. A pressing problem is the care of the mentally defective child and the proper enforcement of the Mental Deficiency Bill of 1913. The idiot, the imbecile, the mentally deficient, and the moral imbecileall need protection and care; and the sane public need protection Sanitary Circumstances of the District. 11 from them. They are all incurable and when they cannot be sent to private institutions, should be cared for by the Guardians of the Poor. A certain proportion of these children are educable, and, failing institution, life, should be trained in manual and other exercises. Half the offences committed against the law are made by moral imbeciles of both sexes. FOOD INSPECTION. Details of the work in connection with the inspection of, and action taken with regard to, unsound food will be found in the report of the Sanitary Inspector. SALE OF FOOD AND DRUGS ACT. Barnes Urban District. —Samples Analysed, 1920. Article. Number of Samples. Number Genuine. Adulterated. Proceedings Taken. Convictions Fines & Costs. £ S. d. Milk 114 112 2 - - - Butter 1 1 - - - - Cake Flour 2 - 2 2 - - Golden Syrup 1 1 - - - - Raisin Wine 2 1 1 1 1 - Fish Paste 1 1 - - - - Brawn 1 1 - - - - Lemon Cheese 1 1 - - - - Totals 123 118 5 3 1 - K. A. Houghton, County Inspector. The question of sampling Sunday milk in the District is an urgent one, and it is hoped that some permanent arrangement will be made for this to be done. 12 Infectious Diseases. INFECTIOUS DISEASE. Influenza, which may now, unfortunately, be considered as an endemic plague, did not repeat its ravages so heavily this year. The District was flooded with bills urging precautionary measures, by the request of the Ministry of Health, with possibly good results. Influenza is a disease which the public must be taught to treat with fear, since it can manifest itself in many subtle ways. Thirty five cases of post-influenzal pneumonia were notified, with 21 deaths. In 1919, there were 24 deaths from influenza. Measles and Rubella.— Measles has not been severe during the year, but I advised the Public Health Committee to keep the notification of the disease in force in the District, as it has proved a helpful measure in the past. There was a mild epidemic in 1920, 474 cases of measles resulting with 3 deaths; and 96 cases of rubella, were notified. Scarlet Fever was prevalent; part of a Metropolitan epidemic; 69 notifications were received with 1 death resulting, compared with 88 cases in 1919 with no deaths, and 32 in 1918 with 110 deaths. Diphtheria.—103 cases were notified as such with 7 deaths, including 6 in hospital. This disease was unduly prevalent. Whooping Cough accounted for 8 deaths. Infantile Diarrhœa.—There were 6 deaths only from infantile diarrhoea, and the disease was not prevalent during last summer. Enteric Fever.—Three cases were notified during the year. Typhus.—Nil. Small Fox.— Nil. Folio-myelitis. —Nil. Cerebrospinal Fever.—Nil. Malaria. —Twelve cases were notified, all amongst returned soldiers. There were no deaths. Malarial Sites have been pointed out to Council, and treatment of same advised. Trench Fever.—One case has been notified, but no lice were found on or about the patient. Dysentery.—Nil. Infectious Diseases. 13 Encephalitis Lethargica.—One case has been notified. This disease has often been called "Sleeping Sickness" in the press, but is quite different from the disease. Puerperal Fever.—Four cases were notified with 4 deaths. Ophthalmia Neonatordum.— Three cases were notified and treated until well, with no resulting damage to the eyes. (See Table 11. for the list of Infectious Diseases notified during the year.) Tuberculosis.—Thirty-five cases were notified in 1920, against 44 in 1919, and 58 in 1918. PULMONARY TUBERCULOSIS. YEAR. NOTIFICATIONS. DEATHS. DEATH RATH PER 1,000. 1915 60 29 .8 I916. 55 35 1.09 1917 54 27 .8 1918 58 26 .8 1919 44 26 .7 1920 35 17 .4 It will be seen, that the death rate from. Pulmonary Tuberculosis is decreasing in this district. There were 20 deaths from Tuberculosis; 17 being from Pulmonary Tuberculosis and 3 from other forms. The Surrey County Council is the authority responsible for the treatment (institutional, dispensary, and domiciliary, within the Urban District, of all tuberculosis cases), and statistical returns as to the work carried out are furnished to the County Medical Officer, and will be published in his Annual Report. By arrangement with the Surrey County Council a Tuberculosis Dispensary is provided in the Isolation, Hospital grounds, and advanced cases, from, the County area as well as from, the Urban District, are admitted to a special Tuberculosis Block at the Hospital. Forty-four cases were so admitted to the Hospital during the year, and 12 of these cases died in the Hospital; all being advanced cases of the disease. One hundred and sixty-five visits were made to, patients at their homes by the Tuberculosis Nurses. 14 Infectious Diseases. So far as tuberculosis is concerned, the policy should be, I think, the care of delicate and pre-tuberculous children by open air schools, convalescent homes and better housing, the acquisition of beds for the treatment of surgical tuberculosis in children, and prolvision for the segregation of hopeless and advanced cases—so as to prevent further family infection. Sanatorium benefit is making heavy claims on the National Health Insurance purse, and the strictly Sanatorium part of it will possibly have to be curtailed. The Dispensary is the most important part of the whole scheme and should be maintained at a, high standard of efficiency. Tuberculosis is declining throughout the County and will continue to do so as better housing and fewer slums appear. Much propaganda work in the way of educating the public can be done through the press, which, in my experience, is always willing to help. VACCINATION RETURN. The Vaccination Officer's Returns are as follows:— Remarks:— No. of Births. No. of Certificates of Successful Vaccination No of Certificates of Exemption (Statutory Declaration). No. of Certificates of Insusceptibility. 777 509 198 5 Removals out of District 30 Postponements owing to ill health 17 Certificate of Insusceptibility from. Public Vaccinator — Certificate through infectious disease or condition of house — VENEREAL DISEASES. Clinics for the treatment of Venereal Diseases are available at Hammersmith and Richmond for residents in the District. With regard to Venereal Diseases, the campaign for preventing infection after exposure is superseding that for combating the disease, and offering early treatment. The Council would do> well to consider the advisability of having warning bills posted in public places, Child Welfare. 15 ing out the dangers of infection and giving directions for immediate self-disinfection after promiscuous sexual intercourse; at the 'same time advising continence and sexual morality. MOTHER AND CHILD WELFARE CENTRE. A small number only of Ante-natal cases attended during the year; it is still found very difficult to get into' touch with the expectant mother. Babies under one year of age made 1,955 attendances, while children over one year of age made 685 attendances. The Centre was opened on 104 occasions, and the average attendance at each session was 25. A great deal of food (infant) has been sold at the Centre and, with the increasing numbers on the register, voluntary help has been accepted, so as to release the Health Visitors for their more professional work. The Child Welfare Centre has made strides and the work increased, largely due to the provision of foods and dried milk at cost price. I think that the time is approaching when the sale of foods, etc., might be dispensed with, and the shop-keeping aspect of the work eliminated. "Health Week" was observed in the district with distinct success. It included Lantern Lectures, School Essays, Addresses, Displays, and Pound Days, and, with the exception of the lecture to mothers, was well attended. I think that "Health Week" should continue and should absorb " Baby Week" and be made a really good show. The present accommodation can only be considered temporary, for, in several ways, it is very unsatisfactory. Since the Milk (Mothers and Children) Orders of 1918 and 1919 have been in force, 145 families have been assisted in the purchase of cows' milk, where the case has, after inquiry, been found to be a necessitous one. INSTITUTIONAL ARRANGEMENTS FOR MOTHERS AND CHILDREN. It is desirable that a. Maternity Home should be provided nearer ■home than in London, for the reception of women whose home circumstances are unfavourable to the confinement taking place there. 16 Child Welfare. A Hostel for Deserted or Unmarried Mothers with their babies has been opened at Epsom, and provides 10 beds for Surrey women. The Surrey County Council have also made arrangements for the admission of mothers with children under 5 years into convalescent homes at Bexhill and St. Leonards, upon the recommendation of Medical Officers of Child Welfare Centres. With regard to Dental Treatment for Expectant Mothers, I have drawn up a scheme, after conference with the local dentists, which might extend to the children of school age. The scheme, however, still awaits confirmation by the County. The Barnes and Mortlake Day Nursery receives, by the day, the children of mothers who have to go out to work. HEALTH VISITORS. There are two Health Visitors, one for Barnes and one for Mortlake. An account of their work for the year is summarised below:— BARNES. MORTLAKE. School visits for inspection for cleanliness 141 249 No. of children inspected 9248 12378 „ „ children excluded for uncleanliness 141 144 „ „ attendances at the various Clinics 49 128 „ „ attendances at Child Welfare Centre 45 59 „ „ Infant visits at their homes 724 1021 „ „ Visits re Infectious Diseases 125 163 „ „ Visits re Tuberculosis 146 19 „ Attendances at Tuberculosis Dispensary 74 10 „ „ Other Visits 115 152 „ „ Babies' attendances at C. W. Centre 727 1228 „ „ Mothers' attendances at C. W. Centre 916 1708 „ „ Older children's attendances at C. W Centre 327 358 PUBLIC HEALTH AND HOSPITAL STAFFS. The Public Health Department has an Inspector of Nuisances, and one qualified Assistant Sanitary Inspector and a Junior Clerk. Food Sampling is done by the County Authorities. The Shop Act is administered by the Inspector of Nuisances. Work done under the Housing Act of 1919 is reported to the Child Welfare. 17 Housing Committee; the work under the other Public Health Acts is reported to the Public Health Committee. The two Health Visitors work the Notification of Births Act, do Tuberculosis visitation, and work under the County as regards Maternity and Child Welfare work, and School work. The Maternity and Child Welfare Centre was initiated by the Urban District Council in 1914, and taken; over by the County in 1917. Tuberculosis Dispensary and Ward Treatment were also initiated by the Urban District Council, the first in 1911, and the second in 1913, and taken over by the County in 1914. The Midwives Act is administrated by the County. The Hospital Staff consists of a Matron, a sister, 7 nurses, 7 domestics, and porter and portress, with gardener, boiler attendant, handy man and assistant gardener. ISOLATION HOSPITAL. There were carried over from 1919 one case of Diphtheria, 18 cases of Scarlet Fever, and 12 cases of Tuberculosis. The admissions were:— Diphtheria, 75. Septic Tonsillitis, 2. Septicaemia, 1. Scarlet Fever, 57. Enteric Fever, 1. Cellulitis, 1. Measles, 5. Otitis Media, 1. Tuberculosis of the Lungs, 44. Total Admissions, 187. Deaths, 12 of Tuberculosis—(resident, 1; non-resident, n); 6 of Diphtheria; Scarlet Fever, 1; Septicaemia of brain, 1. The large number of deaths from tuberculosis is solely due to the advanced stage of the disease oil admission. The nursing and domestic arrangements and duties have been satisfactorily carried out under the direction of the Matron (Miss Pearson). 18 Sanitary Administration. Those responsible for the Garden, Laundry, Disinfector, Ambulance, Mortuary, and Coroner's Court have carried out their duties satisfactorily. If the accommodation at the Hospital allows of it, I would urge the reservation of at least six beds for the treatment of Measles and Whooping Cough- and also that cases of Encephalitis Lethargica and Cerebror spinal Meningitis be admitted when, occasion arises. The Coroner's Court and Public Mortuary are situated in the grounds of the Isolation Hospital, and are the property of the District Council. The Hospital Porter acts as Mortuary attendant. The number of Inquests held during 1920 was 50, including 26 residents, 13 non-residents, and 11 unknown. The verdicts returned were:— Natural causes 21 Accidental 3 Suicide 11 Found drowned 9 Murder 1 Unascertainable 2 Want of attention at birth 2 Manslaughter 1 50 BACTERIOLOGICAL WORK FOR 1920. Specimens examined at the Council's Laboratory at the Isolation Hospital by the M.O.H. Bacteriological Examinations. Result. Diphtheria Typhoid Fever. .pulmonary Tuberculosis. Other Diseases. Totals. Positive 99 - 44 13 156 Negative 255 1 100 4 360 Totals 354 1 144 17 516 19 Sanitary Administration. HOUSING. The pre-war population of the District was 34,745, and the present population is estimated at 37,127. Some houses have been built, but there is still overcrowding and sub-letting. With regard to the Housing Problem:, the Council's policy is now formed, and the work is proceeding, so there is no need to dilate upon it beyond reminding them of the necessity for clearing slum areas as soon as new houses are ready. During the year 75 new houses were erected, 32 being part of the Council's Housing Scheme. Further buildings are in course of erection, including schemes being carried out by the Council with direct labour. The Housing Committee are making use of the new powers conferred by the 1919 Housing Act, and a, large amount of repairing work is in hand. Bye-laws are in course of preparation to assist the Council in the proper conversion of houses, originally for one family, into flats for two of more families. There are no Common Lodging-houses in the District, but some of the houses in Stanton Road are such in fact, if not in name, and will have to be dealt with under the new Bye-laws. West Road was dealt with more on account of general untidiness, due to litter and want of proper ash bins. Stanton Road and Bee'chcroft Road were reported upon as examples of houses turned into flats without proper sanitary equipment, such as a self-contained flat should contain. It must be borne in mind that unless the regeneration of slum areas goes hand in hand with Town Planning and new Building Schemes, there is no hope whatever of getting a result even approximately approaching Garden City Schemes. Many of the Council's Schemes are maturing, or about to' mature, and it is hoped that the gross cases of overcrowding occasionally coming to our nolice will soon cease to exist. In my opinion, the rules laid down for cubic space in living and sleeping apartments and schools are antiquated, and I hold that a growing child requires as much fresh air as an adult, and that every 20 Sanitary Administration. one should breathe 3,000 cubic feet of pure air per hour, or 1,000 cubic feet thoroughly changed three times in the hour. Accessory means of Ventilation (simple and inexpensive) should obtain in every habitation by day and night. Thanks are due to the Council for building more commodious offices for the Medical Officer of Health and the Health Visitors. I am, Gentlemen, Yours faithfully, B. C. STEVENS. (Medical Officer of Health.) March, 1921. FACTORY AND WORKSHOPS ACT. 1.— Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices Factories (Including Factory Laundries) 4 2 Workshops (Including Workshop Laundries) 51 12 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 55 1 Total 110 15 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Found. Remedied. Nuisances under Public Health Acts : — Want of cleanliness 2 2 Other nuisances 2 2 Sanitary accommodation insufficient 1 1 unsuitable or defective 6 6 not separate for sexes 2 2 Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 5 5 Total 18 18 21 Sanitary Administration. 3. -Registered Workshops Motor and Cycle Works 8 Blind Maker 1 Boot Repairer 5 Metal Workers 1 Furriers 1 Upholsterers 1 Dressmakers 6 Tailors 5 Workshop Laundries 3 Workshop Bakehouses 10 Others 10 51 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5. 1901). Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Underground Bakehouses (s. 101) in use at the end of the year, 4. 22 TABLE I. Vital Statistics of whole District during 1920 and previous Years. Name of Distkict—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. Uncorrected Number. Nett. Of nonresidents registered in the District. Of residents not registered in the District. Under 1 year of age. At all ages. Number, Rate. Number. Rate per 1,000 nett births Number. Rate Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1914. 34,745 734 754 21.7 276 7.9 28 88 48 63.1 336 9.6 1915. 33,516 636 656 19.5 287 8 .2 38 93 55 83.8 380 11.3 *1916. 34,773 31,960 570 570 17.0 256 7.3 37 118 38 62.4 337 10.5 *1917. 36,223 32,495 481 481 13. 2 264 8.2 31 123 33 68.6 356 10.9 *1918. 36,223 32,495 438 438 12.0 368 11.3 41 108 40 91.0 404 12.4 * 1919 37,193 35,704 475 513 13.7 299 8.4 36 88 46 89.6 351 9.5 1920. 37,127 762 777 20. 9 309 8.3 31 103 52 66.9 384 10.3 *Higher Figure. —Birth Rate population. Lower Figure.— Death Rate population (civilian only). 23 TABLE II. Cases of Infectious Disease notified during the year 1920. Notified Disease. No. Barnes. Mortlake. No. Removed to Hospital. Deaths. Deaths in Hospital. Scarlet Fever 69 30 39 57 1 1 Diphtheria 103 56 47 75 7 6 Cerebro-spinal Fever — — — — — — Erysipelas 13 4 9 — — — Puerperal Fever 4 3 1 — 4 — Enteric Fever 3 3 — 1 — — Encephalitis Leth 1 — 1 — 1 — Pulmonary Tuberculosis 35 18 17 44* 28† 1‡ 11‡ Other Tuberculosis 6 2 4 — 1 — Dysentery 1 — 1 — — — Malaria 12 3 9 — — — Trench Fever 1 — 1 — — — Ophthalmia Neonatorum 3 1 2 — — _ Influ. Pneumonia 35 36 29 — 21 — Measles 474 166 308 5 3 — Rubella 96 33 63 — — — *'Pulmonary Tuberculosis.—Admissions to Hospital include 10 local and 34 Surrey County Council patients. † Deaths from Pulmonary Tuberculosis 28, Residents 17, County Patients 11. ‡Deaths in Hospital 12, Residents 1, County Patients 11. Isolation Hospital—South Worple Way, Mortlake. S.W. Tuberculosis Dispensary, Hospital Block and Shelters—South Worple Way, Mortlake 24 TABLE III. Causes of, and Ages at, Death during the year 1920. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of Residents or 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 upward Certified Cases 384 Enteric Fever — — — — — — — — — — Small-pox — — — — — — — — — — Measles 3 — 3 — — — — — — — Scarlet Fever 1 — — — 1 — — — — 1 Whooping Cough 8 4 3 1 — — — — — — Diphtheria and Croup 7 — — 1 6 — — — — 6 Influenza 7 — — — 2 — 1 2 2 — Meningitis — — — — — — — Phthisis (Pulmonary Tuberculosis) 17 — — — 1 5 1 7 3 12 Tuberculous Meningitis 2 — — — 2 — — — — — Othertuberculousdise'ses 1 — — — — — 1 — — — Cancer, malignant disease 39 — — — 1 — 7 17 14 — Rheumatic Fever 3 — — — 1 2 — — — — Septicaemia of Brain — — — — — — — — — 1 25 Organic Heart Disease 31 — — — 3 2 6 10 10 — Bronchitis 28 3 1 — — — 2 6 16 — Pneumonia (all forms) 21 4 1 1 1 — 3 4 7 — Other diseases of Respiratory organs 1 — — — — — — — 1 — Diarrhoea and Enteritis 6 3 1 — — — — 1 1 — Appendicitis and Typhlitis 2 — — — — 1 — — 1 — Cirrhosis of Liver 5 — — — — — 1 2 2 — Alcoholism — — — — — — — — — — Nephritis and Bright's Disease 12 — — — — — — 9 3 — Puerperal fever 4 — — — — 1 3 — — — Other accidents and diseases of Pregnancy and Parturition 3 — — — 3 — — Congenital Debility and Malformation, including Premature Birth 18 18 — — — — Violent Deaths,excluding Suicide 14 3 — 1 — 1 6 3 — — Suicide 9 — — — 1 5 2 1 — Other defined diseases 140 7 1 2 — 1 14 33 82 — Diseases ill-defined or unknown 2 1 1 — — — — — — — Totals 384 43 11 6 18 14 53 96 143 20 Special Causes (included above)—Encephalitis Lethargica, 1. Report of Inspector of Nuisances for the Year 1920. To the Chairman and Members, Barnes Urban District Council. GENTLEMEN, I beg to submit my first Annual Report on the Sanitary Inspection of the District during the past year. A tabulated slatement is given shewing the number of inspections made, also the number of defects found and remedied under the Public Health Acts. INCRKASK OF RENT AND MORTGAGE INTEREST (RESTRICTION) ACT. Three applications for Certificates under the above Act were received, nnd a Certificate was granted in each case. It is anticipated that this Act will add considerably to the work of this department during the conning year. RATS AND MICK (DESTRUCTION) ORDER, 1919. Good work is being done by the. Council's rat-catcher throughout the District. 7,765 rat tails were brought to the office during the year; these being from rats caught with the aid of ferrets and clogs. In addition, a large number must have been accounted for by the use of poison that was laid. It was found that the rodents were breeding light throughout the year, 110 doubt due to the mild weather we have experienced this winter. The principal breeding grounds appear to be the variolas allotments, also the river bank and in the vicinity of the reservoirs. INSPECTION OF SCHOOLS. The Public and Private Schools in the district have been inspected. In one instance, the premises in use as a private school were found 27 28 Inspector of Nuisances. to be most unsuited for such, purpose. Representation was made to the principal, Miss Newman, with the result that the premises were given up. PUBLIC CONVENIENCES. These places have been kept under supervision, and as a result of a report made to the Council, it is now proposed to take over the Urinal attached to the White Hart Hotel. This will be a great improvement, but there is urgent need for the provision of Public Conveniences for both sexes in different parts of the district. PREMISES CONTROLLED BY BYE-LAWS AND REGULATION. Houses Let in Lodgings. Hampton Square.— Number of Houses on Register, 50. This property has been periodically inspected. A certain amount of overcrowding exists, which, no doubt, will be relieved as the present house shortage becomes less acute. West Road.— Number of houses on Register, 38. This property is now being put in a thorough state of repair. The ashpits have been reconstructed; the roofs, guttering and chimney stacks repaired; and cleansing work is now in progress. During the coming summer it is hoped to get the yards properly paved. Stanton Road.— Number of houses on the Register, 8. These houses are in a very bad condition, and nothing short of remodelling will be of use. It was. hoped that the proposed Bye-laws, now under consideration, would by this time have been in operation. The shop portion, with two exceptions, are now in use as bedrooms. The fronts should be taken out, and replaced with brickwork ; double sash windows being fitted in order to provide proper ventilation. There should be separate w.c. accommodation for each family, likewise separate sinks with a tap from the rising main over same; also adequate accommodation for the storage and cooking of food. The yards should be paved throughout, and either thrown into one common yard or means of communication provided from one yard to another, in order to obviate the necessity of carrying the dust bins through the houses, as is the practice at present. SERVANTS' REGISTRIES. There are five of these establishments on the register. They have been inspected, and the books examined It was found that in three 29 Inspector of Nuisances. instances the requirements of the Bye-laws were not being complied with, and the proprietors have been requested to provide the necessary forms. OFFENSIVE TRADES. Fish Frying. There are five fried-fish shops in the district. In the early part of the year complaint having been received from ten inhabitants of the district to the effect that the fried-fish shop at 69, White Hart Lane, Barnes, was a nuisance. Under Section 114, Public Health Act, 1875, complaint was made by this Council before a Justice, and a Summons taken out against the owner, who appeared before a Court on the 21st January, at Mortlake, where the case was heard and dismissed. In October two tradesmen in Barnes were cautioned for carrying on the business of fish-frying without a Licence. SANITARY CONDITION OF PLACES OF PUBLIC AMUSEMENT. A Circular letter, No. 120, was received from the Ministry of Health on the 25th August, requesting that periodical inspection should be made of the above premises. There are only three. Cinemas in the district, and these have been inspected. In two instances the attention of the management was called to certain matters not in order, which were afterwards put right. FACTORY AND WORKSHOPS ACT, 1901. No. of Workshops in the district 51 No. of Workplaces in the district 55 No. of Workshop Laundries in the district 3 No. of Bakehouses in the district 10 There are four underground bakehouses in the district. These places were all visited during the year. Notices in respect of 18 defects found were sent out, which have since been complied with. 30 Inspector of Nuisances. FOOD INSPECTION. Unsound Food. Beef 3571b Surrendered voluntarily Mutton 1331b „ „ Veal 551b „ „ Bacon 223½Ib „ „ Butter 81b „ „ Fish 2471b. and 1 bushel of Shrimps „ „ Eggs 192 (imported) „ „ On March 17th, when visiting the Piggeries, on the Lonsdale Road, I noticed a bullock standing in the yard, evidently diseased. At my request the animal was slaughtered at the Slaughter House, Mortlake; when a post mortem examination revealed it to be extensively affected with Actinomycosis. The carcase was destroyed. Butcher Shops in the district 26 Fishmongers' Shops in- the district 9 Milk Shops in the district 26 Cooked-provision Shops in the district 4 Dining Rooms in the district 12 Greengrocers in the district 24 SLAUGHTER HOUSES IN THE DISTRICT. Jan. 1914. Jan. 1920. Dec. 1920. Registered 1 Not in use at present. Licenced 1 1 1 All these premises are subject to periodical inspection, the slaughter house being inspected several times during the week. Butchers', fishmongers', Greengrocers' and Cooked-provision Shops are visited at least once a week at irregular times, particular attention being given to the backs of these premises during the summer months, with a view to preventing accumulations. Dining Roms are visited once a month ; Milk Shops, twice a year. BAKEHOUSES. Number in the district, 14. Including underground, 4. There is also one large chocolate factory. Twelve Notices were served requiring cleansing, and remedying of various sanitary defects. I take this opportunity of thanking my predecessor, Mr. Grylls, for the assistance he has given me since taking over the district. I remain, Gentlemen, Your obedient servant, CHAS. S. PERCHARD. 31 Inspector of Nuisances. SANITARY INSPECTION OF THE DISTRICT. Total number of inspections made, (not under Housing Regulations) 6699 Number of complaints received and investigated 180 Number of defects notified (not including work under Housing Regulations) 745 Number of preliminary Notices issued (excluding Notices under Housing Regulations) 511 Number of such notices complied with 424 Number of Statutory Notices issued 19 Number of such notices complied with 12 HOUSING REGULATIONS, 1910. Number of houses inspected under Sec. 28, Housing and T.P. Act, 1919 204 Number of re-inspections in connection with same 1220 Number of houses found not to be in a reasonable state of repair 204 Number of informal letters issued with schedules of works required to be carried out attached 204 Number of such informal letters complied with 47 Number of Statutory Notices issued under Section 28, H. and T.P. Act, 1919 124 Number of such Statutory Notices complied with 89 Number of representations made by Medical Officer of Health Section 17, H. and T.P. Act, 1909 3 Number of Closing Orders made by Local Authority, Section 17, H. and T.P. Act, 1909. 3 Number of demolition orders made, Section 18, H. and T.P. Act, 1909. 1 INFECTIOUS DISEASE. Number of rooms disinfected 238 Number of lots of bedding disinfected 97 Number of rooms stripped and cleansed after Infectious Disease 32 32 Inspector of Nuisances. DEFECTS REMEDIED AND NUISANCES ABATED. Animals improperly kept S Water closets repaired, cleared or improved 52 New pans supplied 13 Waste water preventers repaired or new supplied 29 Drains inspected on complaint 33 Drains tested 42 Drains cleared or repaired 63 Drains reconstructed 21 Fresh-air inlets repaired or new provided 67 Inspection chambers repaired or new provided 31 Caps to interceptors provided 9 Soil-pipes repaired or new provided 23 Cess-pools cleared (Kew Club) 2 Waste pipes repaired and R.W. Pipes disconnected from, drains 14 Sink stones provided 6 Dampness remedied other than by damp-proof course 64 Damp-proof courses inserted 36 Water supply cisterns repaired 14 Taps on main supplied 12 Yards paved or paving repaired 74 Offensive accumulations removed 21 Dangerous structures remedied 8 Rooms cleansed 165 Ashpits repaired 10 Ashpits abolished 1 Dust bins supplied 241 Kitcheners and grates repaired 61 Roofs, gutters and stack-pipes repaired 89 Floors repaired 63 Ventilation provided below floors 24 Sites concreted 2 Food larders ventilated or new provided 69 Washing coppers repaired 35 Walls and ceilings—plaster repaired 106 Windows repaired 90 Smoky chimneys remedied 6 Verminous premises fumigated and treated with blow-lamp 3