BARN042 Urban Distrtct Council of Barnes. ANNUAL REPORT ON THE. Health, Sanitary Conditions, etc., OF THE URBAN DISTRICT OF BARNES, for the Year 1911. BY Thos. Strain, avd., d.f.h., Medical Officer of Health. Barnes, s.w. R. W. Simpson & Co., Ltd., Printers, 15 High Street, 1912. Public Health Department, The Council House, Mortlake, S.W. January, 1912. Gentlemen, In presenting my Annual Report for 19J1, on the health and sanitary circumstances of the Urban District of Barnes, I tender to the Chairman, Mr. Moonan, and the members of the Public Health Committee, my thanks for the support given to various schemes l have placed before you during the year. l also express my gratitude to my official colleagues for their help, and to the staffs of the Public Health Department and Hospital for their valuable services. 1 am, Gentlemen, Your obedient Servant, THOS. STRAIN The Chairman and Members of the Urban District Council of Barnes. THE Urban District Council of Barnes. The Public Health Committee, 1911=12. Chairman : Councillor Moonan. the Chairman of the Council: Councillor S. W. LAMBERT, J.P. The vice=Chairman of tbe Council: Councillor J. D. FIRMSTON. Councillors BATES, CUTBUSH, DAVENPORT, HAMPTON, JONES, KITLEY, LANGDON, MAGGS, MAYNARD, MEDUS, MERRICK, PALMER, RAGGETT, RANDALL, SHEARMAN, SPENCER, TIMSON, WATERMAN, WEST, and WESTON. The hospital Subcommittee, 1911=12 Councillor MEDUS (Chairman). Councillors BATES, MAGGS, MAYNARD, MOONAN, and RAGGETT. Medical Officer of Health and Medical Superintendent of the Isolation Hospital: THOS. STRAIN, M.D., D.P.H. (Camb.) Inspector of Buisances: T. GRYLLS. assistant inspector of IRuisances : C. H. ROBINSON, Cert. San. Insp. Exam. Board, A.R.S.I. R.P.C. Hons. Building Constr., Hons. Practical Plumbing. Matron of tbe Hospital: Miss CAROTHERS. index. Page Bakehouses 26 Bacteriological Examinations 37 Barnes Green Pond 16 Beverley Brook 17 Birth Rate 10, 45 Butchers 25 Bye-Laws 22 Chemical Examinations 37 Closet Accommodation 19 Cellar Dwellings 21 Common Lodging Houses 21 Deaths during 1911. Table III. 50,51 Death Rate 10, 46 Drainage 20, 31 Factory and Workshop Act, 1901 32,54,55,56,57,58 Hospital Administration 34 Housing 28 Houses Let in Lodgings etc. 22 Infectious Diseases, Control over 34 Table 49 ,, Work done in Relation to 36 ,37 Inspections of District 20,21 Infantile Death Rate 10, 46 Infantile Mortality 42,43,52,53 Medical Relief, Poor Law 12,13 ,, Gratuitous 14 Manure, Removal of 17 Milk Supply 24, 25 Malthouse Area 30 ,, ,, Map of See Frontispiece Offensive Trades 21 Offensive Matter, Removal of, through streets 22 Premises where foods are prepared, stored, etc 26 ,27 Physical Features 11 Poor Law Relief 12,13,14 Public Hospitals, Deaths in 15 Passages Rear of Buildings 18 Population 10, 44 Persons per House 45 Restaurants 26 Refuse, Removal and disposal of 19 Sale of Food and Drugs Acts 27 Sanitary Administration 33 Social Conditions 11 Sewerage and Drainage 18 Schools 22,23 Summary 10 Scavenging 17 Tuberculosis, Control and Prevalence of 38,39,40 Vaccination 59 Vital Statistics 44, 48 Water Supply 15 summary. Area—exclusive of water 2,400 acres Population—Census, 1911 30,319 „ Midsummer, 1911 30,786 Inhabited Houses - Census, 1911 7,157 Rateable Value—Agricultural Land, Oct., 1911 £2,011 Other Hereditaments, Oct., 1911 £262,250 General District Rate 3/8 Assessable Value—Oct., 1910 £239,937 15s. Poor Rate—Barnes 3/1 „ Mortlake 3/6 Birth Rate—Per 1,000 population, 1901 23.5 . „ „ 1911 23.7 Death Rate „ „ 1901 12.5 1911 8.8 Corrected Death Rate—Per 1,000 population, 1901 13.2 1911 10 9 Infantile Death Rate—Per 1,000 births, 1901 133 „ „ „ „ 1911 95 ANNUAL REPORT. PHYSICAL FEATURES. The Urban District of Barnes is situated in the northwestern 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 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 till at Vicarage Road the highest level is reached. The soil is mainly a layer of permeable gravel overlying at varying depths the subjacent London clay, which forms a more or less impermeable stratum with a fall towards adjoining waterways. In certain parts of the district the London clay reaches very near the surface and even outcrops on the Palewell Common. The effect of such a gravel soil on health is certainly a favourable one, it does not form so cold a site for dwelling-houses as does clayey soil, it allows also the rapid removal of water from the surface of the ground because of its greater permeability. 12 Social Conditions. There is an abundance of vegetation in the neighbourhood; large tracts of common lands, Barnes Common, Palewell Common, Sheen Common, and Richmond Park, and the smaller but equally important areas, Barnes Green, Mortlake Green, the several Club grounds, Reservoirs, Pond, and Waterways form "lungs," the importance of which on the physical well-being of the community cannot be over-estimated. SOCIAL CONDITIONS. The census returns of occupations are not yet available for statistical purposes, but it will probably bear out the general statement that the majority of the inhabitants of this district are employed in the metropolis, following pursuits of a more or less sedentary nature. A certain proportion of the inhabitants are railway and Mortlake Brewery employees. There is no doubt that a greater proportion of the residents are between the ages of 25 and 45; the population at these ages is of recent growth, coincident with the growth of the district. POOR LAW RELIEF. The amount expended for the out-door relief in Barnes and Mortlake during the year ended the 30th September last was £745 8s. 5d., the number of paupers in receipt of relief in the district on the 1st January, 1912, was in-door 150, out-door 163. POOR LAW MEDICAL RELIEF. The following is a summary of the fortnightly returns supplied by the Board of Guardians of the Richmond Union from the District Medical Officer's Relief Book. The total number of new cases of sickness seen by the District Medical Officers during the year was 417. Of these, 116 and 301 are the proportions respectively in Barnes and Mortlake. Social Conditions. 13 Appended is a classified list of those diseases. BARNES. Mortlake. Total. Heart Diseases, etc. 7 3 10 Acute Rheumatism 1 5 6 Chronic Rheumatism 5 10 15 Rheumatoid Arthritis 2 1 3 Gout 1 3 4 Debility 2 17 19 Marasmus - 7 7 Senile Debility 7 18 25 Influenza 10 2 12 Epilepsy and Convulsions 1 9 10 Mental Diseases 4 14 18 Whooping Cough - 3 3 Measles 3 18 21 Tonsilitis 1 13 14 Erysipelas - 1 1 Diphtheria - 1 1 Diarrhoea 4 19 23 Cancer 1 - 1 Parasitic Diseases - 2 2 Skin Diseases and Injuries 12 21 33 Bone Diseases and Injuries 1 6 7 Joint Diseases and Injuries 2 2 4 Child bearing 5 9 14 Bronchitis 17 51 68 Phthisis 5 7 12 Other Respiratory Diseases 5 13 18 Gastric Intestinal Diseases 6 19 25 Cerebral Hemorrhage, Paralysis, etc. 8 5 13 Cirrhosis and Alcoholism 1 4 5 Eye Diseases 2 - 2 Glandular Diseases 1 2 3 Neuralgia - 2 2 Meningitis 1 1 2 No Diagnosis 1 13 14 116 301 417 The above list, together with information in the hands of the Education Authority, forms the only available information at present with reference to the existence of sickness other than infectious disease in the district. Information of this nature forms a most valuable index to the social and physical condition of the residents, and together with the extended information which will be 14 Social Conditions. available to the Medical Officer of Health when the Scheme fof National Health Insurance is in operation, will be extremely useful in directing attention to any excessive sickness and lead to local investigations as to how far the sickness is capable of removal or mitigation. In a riverside district, it is important to consider the amount of sickness due directly or indirectly to local conditions, such as dampness. The diseases commonly attributed to dampness are the Rheumatic Group, to which may be added a large proportion of the Heart Diseases, as the latter are closely related in causation to the former, so that if we take the total number of cases of acute and chronic rheumatism and two thirds of the cases of heart disease it will be seen that the proportion of sickness of this variety is 6.6 per cent. of the total sickness from all diseases, amongst those receiving Poor Law Medical Relief. OTHER FORMS OF GRATUITOUS MEDICAL RELIEF. Situated as this district is, so near to London, it follows that much advantage is taken of the charitable hospitals, both special hospitals and general hospitals, and as both in-patients and as out-patients, some employers of labour in the district contributing to these institutions and becoming entitled to send their employees for treatment. There are also several charitable societies or agencies in the district who make use of these hospitals in this way. The number of people belonging to this district, dying in these institutions, is but a small fraction of the number who attend, but if it is said that 52 have died during last year in institutions, it will be evident that hospitals are being well utilised for the treatment of the sick. Sanitary Circumstances of the District. 15 Table shewing the number of deaths of residents of this district ccurring in Public Hospitals in the Metropolitan area during 1911. TABLE A. Institution. No. Institution. No. Richmond Infirmary 26 St. Thomas's 1 West London Hospital 12 Queen Charlotte 2 Royal Hospital, Richmond 8 Westminster 1 Guys Hospital 1 Charing Cross Hospital 1 47 5 Total 52. In this connection, it may be stated that the District Council maintain an ambulance for conveyance of cases of illness from one place to another. Sanitary Circumstances of the District. WATER SUPPLY. The Water Supply is that of the Metropolitan Water Board; it is a constant supply, is of good quality, and is stored and filtered before it reaches the consumer. The only contamination to which the water is liable is on the premises of the consumer, where it is stored in tanks, which are in some cases uncovered and under bedroom floors, in others in most inaccessible places for cleansing purposes. It is imperative that all water used for domestic purposes, and all water used on premises where food is prepared or sold for human consumption, should be drawn direct from the main, thus reducing any possibility of contamination in storage tanks. This is being done in many cases throughout the district in a gradual way. The River Thames, forming one of the boundaries of the district, is here subject to tidal variations, sometimes to an extreme 16 Sanitary Circumstances of the District. and disagreeable degree, the roadway on the Terrace being often submerged, causing cessation of all traffic, and the occupiers of houses on the Terrace to adopt hasty measures to prevent the ingress of water to their premises. Recognising that some measure or measures should be adopted to mitigate this evil, a sub-committee has been appointed to consider a scheme prepared by the Surveyor, for the erection of a suitable wall, as will obviate any risk of flooding in the future. During the long spell of dry weather experienced last Summer, complaints were made respecting smells alleged to arise from the putrefaction of mud and dead fish on the foreshore of the river. BARNES GREEN POND. The following report was made to the Highways Committee on the 4th December, 1911:- "In accordance with the instruction of the Council given on the 14th December, 1911, I beg to report on the effect or likely effect on the public health of the mud in Barnes Pond. "My attention was directed to this question during the month of August, owing to complaints being received respecting smells emanating from this source, and in one instance, a case of Infectious Disease was attributed to this cause, another complaint alleging that the smell was a nuisance under the Public Health Acts, and an action was threatened against the Council. I gave it as my opinion that there was no nuisance existing, and based that opinion on the result of an analysis of the contents of the pond, which I deemed it advisable to have undertaken. The interpretation of this analysis is that the contents of the pond was quite unsuitable for any domestic purpose, as there was evidence of vegetable and animal contamination. But it is inconceivable that anyone could use the water for any such purpose, and that the elements composing the contamination could exist in the air. It is possible, however, that if these contaminating elements are exposed to the sun's rays there Sanitary Circumstances of the District. 17 would ensue a certain amount of putrefaction, giving rise to smells. On receipt of this analysis, the Surveyor and I determined to deal with the matter, viz: (1) the existence of a vegetable algoid growth on the surface and in suspension in the pond, (2) the existence of the mud at the edges of the pond, caused by the recession of the water edge due to the prolonged spell of dry weather. "The former of these matters presented some difficulties, as the employment of any disinfectants or strong poisons would have been dangerous to the lives of the swans. We overcame these difficulties and clarified the water by the use of dilute solutions of sulphate of copper. "The second of these matters was dealt with by removal of the mud, and making secure that there would be no recession of the water edge. "Summed up, my opinion, as will be observed from the above, is that, so long as it is certain that the mud is suitably and sufficiently under water, there can be no decomposition, no putrefaction, no smells, and therefore no deleterious effect on the public health, provided always that means be taken to prevent children having access to the mud. Thos. Strain, Medical Officer of Health" THE BEVERLEY BROOK. The Beverley Brook overflowed its banks on several occasions during the year. At the present time, the Council are in communication with the London County Council on the matter, with a view to the mitigation or removal of this recurring nuisance, and it is to be hoped that some satisfactory action will be agreed upon at an early date. Scavenging. REMOVAL OF MANURE FROM STABLES, The Byelaws in force in this district provide for the removal, once a week, of manure from stables. That removal once a week 18 Sanitary Circumstances of the District. is quite insufficient for this district is quite apparent, and it is to be hoped that the Council will take steps to alter the Byelaws, so that removal of accumulations of manure should be carried out twice a week. PASSAGES AT REAR OF BUILDINGS. Many complaints were received during the past year with regard to the condition of back passages. It was found that occupiers of houses abutting on the passages make it a practice to deposit their garden refuse in these passages. In the summer the putrefaction of this organic matter gives rise to offensive emanations. The method of dealing with this problem is certainly laborious. It is necessary to serve a notice on each occupier having entrance to the passage, even then, in numbers of cases, the person " by whose act, default or sufferance "the nuisance arises or continues, is not included. In some cases the Council have decided to scavenge the passages and recover the cost from the occupiers, but the cost of recovering this money is twice that of the actual work. This is a problem in which it is difficult to suggest an effectual remedy. SEWERAGE AND DRAINAGE. I am indebted to the courtesy of the Surveyor for the following information. The drainage and sewerage of the district is carried out on the separate system, the sewerage being conducted to the Works of the Richmond Main Sewerage Board at the extreme western end of Mortlake, where it is treated, chemically and bacteriologically, the effluent being discharged into the Thames. The surface water from the roads and roofs of houses is conducted into a surface water sewer, and thence discharges into the river at various points. Two public conveniences, long urgently needed, are being erected in the district, one at Milestone Green, Upper Richmond Sanitary Circumstances the District. 19 Road, the other at Mortlake Green. It will probably be found necessary, in the near future, to erect a public convenience at the other end of the district, where it is to be hoped provision will be made for both sexes. REMOVAL AND DISPOSAL OP REFUSE. The removal of house refuse is carried out by the Council's own staff. The refuse from all ordinary houses is cleared once a week, and from certain blocks of flats and a few large houses it is cleared twice or three times weekly, as is found necessary. The refuse collected amounts to about seven cwt. per head of population per annum, and it is collected into covered carts, shot into covered barges, taken out and deposited at sea; the Council, however, have now in course of erection a refuse destructor, a much more hygienic method of refuse disposal. This destructor will be at the extreme west end of this district, near the Sewerage Works, and is about 500 yards away from the nearest house. It consists of three cells of Messrs. Heenan and Froude's through grates, these will be hand fired from the front, the clinker being withdrawn from the rear into clinkering wagons. CLOSET ACCOMMODATION. The closets in the district are all water closets, but in many cases the lack of knowledge of the simple rules of hygiene are clearly apparent in the foul and thickly-encrusted condition of the pans and the dirty condition of the floor round the W.C. These conditions are largely conduced to by the fact that in a large number of the old houses the W.C.s are not lighted and ventilated. It should be here mentioned that in several cases during 1911 in which complaints of smells in houses were made, that the smells emanated from the dirty conditions of the W.C.s inside the house. 20 Sanitary Circumstances of the District. TABLE B. Showing the general work done in the Public Health Department during 1911, and in the preceding four years. Nature of Work Done. 1907 1908 1909 1910 1911 Inspections under the Housing Regulations ... ... ... ... 1598 Various other Inspections ... ... ... ... 1855 Notices served for abatement of defects 715 486 400 406 715 Houses and Premises cleansed and repaired 96 129 159 149 172 Houses disinfected 92 74 135 113 112 Defective drains (amended) 42 69 67 40 26 Defective drains (reconstructed) 19 31 18 23 37 Defective soil pipe ventilators (made good) 3 6 5 Defective closet pans and traps (replaced) 49 38 23 18 12 Dustbins (replaced) 103 91 115 77 77 Defective flushing cisterns (repaired) 85 123 94 83 32 Defective Waste Pipes 2 19 19 10 15 Cisterns cleansed and covered 41 39 21 191 50 Taps provided on rising main ... 17 7 147 36 Premises on which animals causing nuisance 2 3 3 ... 2 Foul accumulations (removed) 7 17 6 21 2 New Sinks provided 18 7 8 11 16 Defective roofs and eaves' gutterings 30 37 38 33 30 Insanitary Yards paved 94 76 37 75 174 Floors ventilated, dampness remedied 24 13 34 7 55 Defective Mica Valves (made good) 42 31 12 23 6 No proper receptacle for manure or offal ... 2 ... ... ... Overcrowding (abated) 3 1 3 6 9 Houses found unfit for habitation 1 0 8 2 12 Bakehouse inspections 14 13 13 58 39 Dairy inspections 25 26 26 115 115 Licensed slaughter-house inspections 3 3 2 56 10 Factory and Workshops inspections 194 206 206 419 403 Number of visits to notifiable diseases 106 81 289 192 332 *Premises licensed for storage of Petroleum 12 14 13 15 18 Complaints received 42 46 52 72 128 Statutory Notices served 97 61 36 56 47 Summonses for abatement of Nuisances 2 8 ... 1 ... * Under Petroleum Acts. Sanitary Circumstances of the District. 21 SANITARY INSPECTIONS OP DISTRICT. During the year under review the amount of work done by the Inspectors of the Public Health Department, comprising inspections, under the Housing Regulations, Public Health Acts, 1875 to 1907, Infectious Disease Acts, etc., will be seen in the preceding Table. The various nuisances discovered during the year were removed or abated without recourse to a single summons, 47 Statutory Notices being served. The fact that no proceedings have been taken to secure compliance with notices, is due in a great measure to the diplomacy and tact of the Sanitary Inspectors when dealing with owners of property. Premises and Occupations controlled by Byelaws. OFFENSIVE TRADES. The only offensive trade existing in this district is that of fish frying. This was scheduled as such in March, 1911. No Byelaws have yet been drawn up regulating the conduct of such businesses. It is hoped, therefore, that the Council will take steps to formulate suitable Byelaws. CELLAR DWELLINGS. No rooms exist in this district coming within the provisions of the Public Health Acts. COMMON LODGING HOUSES. As a result of a case of Infectious Disease occurring at a Public House in Mortlake, the Inspector found that lodgers of the working class were received for short periods, paying 6d. a night. These facts were reported to the Council who ruled that the premises did not constitute a Common Lodging House within the meaning of the Statute. 22 Sanitary Circumstances of the District Consequently no action has been taken in the matter. It is, however, a very questionable point whether such premises constitute a Common Lodging House, and it will certainly be and is imperative that local authorities should be furnished with a statutory definition as to what does and what does not constitute a Common Lodging House. HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. Byelaws for houses coming within the above definition are now before the Local Government Board. REMOVAL OF OFFENSIVE MATTER THROUGH THE STREETS. As a result of complaints from inhabitants as to the offensive emanations from carts used for conveying " offal," etc., the Council considered the matter and decided to draft Byelaws. This has been done and thev are now awaiting confirmation. TABLE C. Premises controlled by Byelaws. Trade. No. No. of Visits. No. of Notices served. No. complied with. Fried Fish Shops 8 33 11 11 Slaughter Houses 1 10 2 1 Stable Yards 11 17 - - Houses let in Lodgings Byelaws only in fo rce in 1912 SCHOOLS. The local Education Authority for the Urban District of Barnes is the "Surrey Education Committee," Barnes not being an autonomous area for the purposes of the Education Act, 1902. Sanitary Circumstances of the District. 23 The supervision of the health of the school-children therefore devolves upon the local Education Authority under the Education Act (Administrative Provisions), 1907. Notwithstanding this, each school in which any case or cases of infectious disease occurred among the scholars was immediately notified of the fact by the Public Health Department, who also gave all facilities and assistance for the effectual disinfection of the classroom. The contacts in the School were examined by the Medical Officer of Health. During the earlier part of the year Measles was very prevalent, and it was found necessary to close Barnes Green School for 11 days in order to prevent the spread of the disease. In the same school several cases of Scarlet Fever occurred; it was deemed advisable to close the infected class-room for one week. Chicken-pox also prevailed in the Railway Side School during the latter half of the year. Cases of Diphtheria occurred also amongst scholars attending Mortlake National Schools, necessitating immediate visitation and swabing of the contacts, disinfection, etc. In accordance with the request of the Local Government Board that the Medical Officer of Health should state in his report what arrangements are in force for the discharge of the duties of School Medical Officer, and for the medical inspection of children in the Public Elementary Schools in the district, it may be stated that the County Medical Officer is the School Medical Officer, and for this district, in conjunction with other districts, there is an assistant School Medical Officer, who visits the schools at stated intervals to inspect the children. The Council, appreciating the value of unification, and with a desire to give effect to the recommendations contained in circulars, etc., of the Local Government Board that the Medical Officer of Health should, where possible, give his whole time to work of a public health character, passed a resolution asking the Surrey Education Committee to make such arrangements as would allow the work of medical inspection of children being carried out by their Medical Officer of Health. 24 Sanitary Circumstances of the District. MILK SUPPLY. In this district there are no cow-sheds, all of the milk supplied is imported, mainly from large wholesale firms. Most of the purveyors of milk have lock-up premises, and receive only sufficient quantity of milk from the wholesale firms as will, as nearly as possible, serve for one day's supply. It is supplied by delivery vans to these retailers twice daily as a rule, so that extensive storage accommodation does not exist in any of those premises. These retailers, together with others from without this district, supply milk from hand-carts. It is certainly a fact that the measures and cans carried about on these carts, especially the " stirrers " carried on the wholesalers' vehicles, are liable to a great deal of pollution through dust, etc. The risk of pollution in this respect would be diminished to an extent if means were taken to protect these utensils from dust. There are several premises registered as milk-shops in which the trade of milk-purveyor is a subsidary branch, such associated businesses as those of grocer, oilman, coal vendor being carried on with that of purveyor of milk. The supply of milk is kept in a counter pan of varying capacity, and in such premises as these there is no proper storage accommodation, the purveyor alleging that there is only sufficient milk left over from each delivery to supply casual customers. This statement is open to question, as it is difficult to understand how the demand can be so accurately foretold that no milk would be left exposed over-night, and in any case the exposure of the small quantity for casual requirements during the day in such premises is liable to contamination from a multitude of sources, Sanitary Circumstances of the District. 25 All dairies and milk-shops were systematically visited during the year, and no cases of infectious disease occurring during the year could be attributed to the milk supply. In this connection it should be noted that part of the cordon drawn round any case of infectious disease treated at home is that the milk supplied to the premises is supplied in a can or bottle which is left at the premises for the occupier's sole use. At the cessation of the illness this can or bottle is destroyed, the principle borne in mind being to adopt all such measures as will prevent the spread of infection. TABLE D. Shewing the number of registered premises visited during 1911. No. f Visits. Dairies and Milk Shops 32 115 BUTCHERS. There is one licensed slaughter-house in this district and this is only used occasionally, otherwise all meat is imported mostly from the Central Meat Market, where it is already inspected. The butchers' premises are regularly and periodically visited by the Assistant Inspector. Most of the butchers have ice chests in which the meat is kept, and as a rule their premises are kept in a cleanly condition. During the year no meat has been detected as tuberculous in the district. With regard to the statement that no tuberculous meat has been found, the point cannot too strongly be emphasized that the meat is thoroughly inspected at the Central Meat Market, or at Deptford before reaching this district. The Assistant Inspector, has, on many occasions, found small portions of meat, which, although not actually unsound enough as 26 Sanitary Circumstances of the District. to warrant seizure, have been destroyed by the salesman, the Inspector waiting and viewing the method of destruction. While on the matter of meat inspection, it is necessary that a serious flaw in the administrative provisions of the Public Health Act, 1875, should be pointed out. An Assistant Inspector, having no statutory power to seize unsound food, is compelled, when such food is found, to leave it and seek the Medical Officer of Health or Sanitary Inspector, hoping of course that the tradesman will not remove or conceal the food ; so that the law favours the wrongdoer, and fails to protect the public, as they think it does. This is a matter which my predecessor referred to in no measured terms, and I strongly endorse his comments. RESTAURANTS. The work of the Sanitary Inspectors with regard to Restaurants is shewn in the Factory and Workshops table page. No serious nuisances were detected, the premises being in a fair condition. BAKEHOUSES. There are thirteen bakehouses in this district, and these have been inspected thirty-nine times during the year. Of these bakehouses five are underground, the majority are kept in a well ventilated, and clean condition. SANITARY CONDITION OF PREMISES WHERE FOODS ARE PREPARED, STORED, AND EXPOSED FOR SALE. The premises coming under this heading, are Restaurants, Fried Fish Shops, Wet Fish Shops, Butchers, Bakers. These are regularly and carefully inspected, and any matters found which come within the provisions of Sect. 91, Public Health Act, 1875, are dealt with, Sanitary Circumstances of the District. 27 It would perhaps at this stage be appropriate for comment on the absence, in any Public Health Statute, of power to deal with the suitability of premises for the purpose of preparing food for human consumption, with the exception of bakehouses. Without any doubt whatever, no premises should be used for the preparation of human food intended for sale unless the Sanitary Authority is first satisfied of their suitability for the purpose, such suitability or otherwise would be determined by the spaciousness, lighting, ventilation, condition of the drainage, etc., cooking room the proper storage of offal pending removal, and the provisions for storage or protection of food unsold. If a Local Authority possessed powers, or some of them outlined above, a great deal of the Inspector's time, taken up in endeavouring to secure a mitigation of the evils, could be better spent in other work. SALE OF FOOD AND DRUGS ACTS. The administration of this Act is carried out by the Surrey County Council. The report of the Inspector who deals with this district, among others, appears on following page. One is compelled, when making comparisons with the work of the adjoining Metropolitan Districts, to make observations on the results of working the same Act. As this district is, although Urban in name, essentially Metropolitan in character, it seems desirable, in order to effectually protect the public against adulteration, that the same methods should obtain here, viz., the officers of the Local Authority should be able to procure samples for analysis by the public analyst. Knowing the district as they do and the itinerant dealers who frequent it, the officers are in a more favourable position to obtain adulterated samples. 28 Sanitary Circumstances of the District. TABLE E. Shewing the work done during 1911, under the Foods and Drugs Act, by the County Inspector, Mr. R. A. Houghton. Articles Purchased. Samples taken. Found Genuine. Slightly Adulterated, etc. Cases in which proceedings have been taken. Convictions obtained. Fines Inflicted. Milk 69 57 10 2 Butter 26 26 — — — — Spirits 5 5 — — — — Lard 2 2 — — — — Demerara Sugar 2 1 1 - — — Ice Cream 2 2 — — — White Pepper 1 1 — — — — French Capers 1 1 — — — — Ground Ginger 1 1 - — — — Totals 109 96 11 a — — HOUSING CONDITIONS. During the year, as a result of visits made under the Housing Acts, 13 houses were condemned as unfit for human habitation, and closing orders were made. In the case of 3 houses a demolition order was made. The houses condemned under Section 17 of the Housing and Town Planning Act, 1909, as being in "a state so dangerous or injurious to health as to be unfit for human habitation,"were:— 3 and 4 Lifford's Place, High Street, Barnes; 20 High Street, Mortlake; Hope Cottage, Vineyard Path, Mortlake; Sanitary Circumstances of the District. 29 1 and 2 Ivy Cottages, Lower Richmond Road, Mortlake; Waldeck House, Lower Richmond Road, Mortlake; Waldeck Cottage, Lower Richmond Road, Mortlake; 56 High Street, Mortlake; 48 High Street, Mortlake; 16 and 18 High Street, Mortlake; Benham's Place, High Street, Mortlake. The nature of the defects found in some or all of these premises is as follows:— Excessive dampness of walls, due either to decayed brickwork or the absence of any damp-proof course or both of them. Defective flooring. Absence of an impervious material on site. Want of through ventilation under floors. Roofs in a dilapidated condition. Absence of means for effectually disposing of rain water. Air space about the buildings being insufficient. The drainage in a bad condition. In respect of the above, 3 houses were dealt with by demolition orders:—20 High Street, Mortlake; 2 and 4 Lifford's Place, Barnes. Under Section 15 of the same Act, as will be seen in the Inspector's Report, 55 houses were dealt with in such a manner as to put them in good order. Among other work executed was the following:— insertion of a suitable damp-proof course, provision of cement concrete on the site of premises, and means for securing proper ventilation under the floors. Inspector's Report appears on following page. 30 Sanitary Circumstances of the District. TABLE F. Report of the Inspector 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 2 11 13 2. No. of representations made to the Local Authority with a view to the making of closing orders 2 11 13 3. No. of closing orders made 2 11 13 4. No. of dwelling-houses, the defects in which were remedied without the making of closing orders 21 34 55 5. No. of dwelling-houses which, after the making of closing orders, were put into a fit state for human habitation MALTHOUSE AREA. An order was made by the Local Government Board, 2nd June, 1911, calling on the District Council to make a scheme forthwith under Part 1 of the Housing of the Working Classes Act, 1890, for the improvement of the area in which the buildings known as Waring Buildings, Malthouse Cottages, Vine Cottages, Quicks Cottages, Morwenha Cottages, and Wentworth Row, Parkers Row, Thornes Cottages, and St. John's Row exist. During the year the Council considered several schemes, and in November approved one of them. On the 23rd December, 1911, the first notice of publication was issued in the local newspaper. It is the intention of the Council to seal the petition at the February meeting. Sanitary Circumstances of the District. 31 The acreage of the area affected is 2 acres, 0 roods, 22 poles, 20 yards; the number of persons of the working classes who will be displaced is 141; the approximate rents at present paid by such are 5s. to lis. per week. Provision will be made by the erection of 16 cottages in the area proposed to be improved, for the accommodation of 80 persons. The Council considered that the provision of this accommodation will be sufficient in view of the number of tenement houses now to be let within a radius of half mile of the area. GENERAL. All property in the district is in private ownership, with the exception of Alexandra Road, Mortlake, which is owned by the District Council. There are about fifteen houses occupied as Almshouses in the district. There are many houses for the working classes in Mortlake which are occupied by members of more than one family, the rents and the houses being too large for one family. In some cases even, more especially in Hampton Square and to a lesser degree in West Road, single rooms are let out to separate families. In these roads there have been some cases of overcrowding during the year, the tenants being of the poorest class of the community. In Mortlake North there is much old property which will require to be dealt with under the Housing Acts. The erection of all new houses is under the supervision of the Surveyor's Department. A continuous record is kept of each house erected from the time the foundation is put in until completion. Particular attention is paid to the drainage and sanitary fittings. The drains are water tested during construction, and before the certificate of fitness for habitation is granted, the drains are finally tested with water, the soil pipes being smoke tested. 32 Sanitary Circumstances of the District. TOWN PLANNING. The Council have appointed a special Committee to deal with the future development of the district, in accordance with principles embodied in the Housing and Town Planning Act, 1909. With regard to the western part of the district, a joint conference will take place with the Corporation of Richmond to ascertain whether a uniform scheme can be modelled for that part of the district. FACTORY AND WORKSHOPS ACT, 1901. The inspections carried out under this Act are set out in the tables in the appendix, the defects discovered being minor ones, and all were remedied without the necessity of prosecutions. There is a certain amount of Home-Work done by Outworkers in this district, the lists received from employers with one exception coming through the Public Health Departments of other Local Authorities. The variety of Home-Work done in this district is mainly the making, altering, etc., of wearing apparel for large West End firms, and is carried on under satisfactory conditions. During the year no case of infectious disease has occurred on any of these premises. All the laundries on the register, as well as the laundries without the district, are immediately informed by the Public Health Department of the occurrence of any case of infectious disease among their customers. With regard to other premises, not specifically dealt with in the report, but coming within the jurisdiction of the Council, these are shown in the table on following page. Sanitary Administration of the District. 33 TABLE G. Showing the number of certain places under the Council's supervision, and the visits made to them during 1911. BARNES. MORTLAKE. TOTALS. No. Visits. No. Visits. No. Visits. Places where petroleum is stored 9 25 9 42 18 67 Servants' Registry Offices 4 5 3 3 7 8 Marine Stores 2 4 1 2 3 6 SANITARY ADMINISTRATION. The staff of the Public Health Department consists of:— An Inspector of Nuisances, whose duties are inspections under the Housings Regulations, the Factory and Workshops Act, the Dairies, Cowsheds, and Milkshops Orders, etc. The inspections under the Housing Acts are carried out in a most thorough and tactful manner. On visiting, with Mr. Grylls, many of the houses in the poorer localities, it is refreshing to observe the welcome afforded to an inspector who has for so many years been doing such good work for the improvement of their homes and surroundings. He also deals with Marine Stores, Servants' Registry Offices and premises licensed for the Storage of Petroleum. An Assistant Inspector, whose duties comprise visits to premises where cases of notifiable disease have occurred, disinfecting, inspecting the premises and supervising the execution of works done in consequence of notices served. Visits to the houses of consumptives, where he carries out his duties in an unostentatious manner. Other duties performed by this officer are the supervision of the partial or entire reconstruction of drainage systems, as a result of notices from this department. The thorough practical knowledge possessed by this inspector in drainage and building 34 Sanitary Administration of the District. construction and kindred matters, ensures this work being efficiently done. His practical knowledge of building construction, etc., is of considerable use when premises under the Housing and Town Planning Act and other Acts are being dealt with. An Office Clerk, who carries out all the clerical and statistical work of the department, including the control of the comprehensive card filing system in use, in a thorough manner. It would be appropriate to mention that the clerical work of the Public Health Department is continually increasing year by year. HOSPITAL ADMINISTRATION AND CONTROL OVER INFECTIOUS DISEASES. For the isolation of cases of Small-pox, the Council is one of the constituent authorities forming the Surrey Joint Small-pox Hospital Committee, and arrangements are in operation which will allow of an expeditious removal of cases of this, should they occur, in the Council's own special ambulance, which is always ready for this purpose. For the other Infectious Diseases in the district, the Isolation Hospital in South Worple Way has ample accommodation in three pavilions, forty beds are available in eight wards and two side or small wards. The Nursing Staff consists of a Matron, Miss Carothers, a Sister, two staff nurses (fever trained), and two probationers ; the Domestic Staff consists of a Cook, Laundrymaid, and four other maids; the Outdoor Staff consists of a Porter and Portress (residing at the Gate Lodge), a Gardener, and the occasional services of a boy. All laundry work of the Hospital is carried out in the laundry of the Hospital, all disinfection of the bedding, etc., from the wards, as well as the disinfection for the Public Health Department, is Sanitary Administration of the District. 35 done in the Washington-Lyon disinfector, and all the refuse, etc., of the Hospital is consumed in the Incinerator there. In addition to the Small-pox ambulance, another ambulance is provided for the removal of the other infectious diseases, and two bedding carts are provided, one for the removal of infected articles, the other for the delivery of the disinfected articles. The procedure for the removal of cases to hospital is such as will minimise delay and make smooth working On receipt of the notification, information is supplied by telephone to the hospital and to the Council's depot that a horse is required. A nurse and the porter always accompanying the ambulance, the porter seals the infected room till the arrival of the Inspector. After office hours and on Sundays, the doctors notify by telephone all cases needing removal, so that there is no possible chance of delay or misunderstanding, Immediately on admission to hospital, all cases are seen by the Medical Superintendent, and are treated on the case-isolation system, so successfully carried on by Dr. Crookshank, the objects of this method being to minimise the risks of complications, crossinfection, and return cases. Scarlet fever patients are only discharged when free from desquamation, and when no sores or discharges are present. All diphtheria cases are submitted to bacteriological tests before being discharged. Enteric fever cases are treated by careful nursing and dieting, there being no disease in which efficient nursing is so important. During the year no deaths occurred from scarlet fever, the cases being of a mild type. One death occurred from diphtheria, and that was in a laryngeal case which had been ill for about ten days before admission. The experience gained in infectious diseases work leads one to believe that "every sore throat, especially in children, should be treated as infectious until the contrary is proved." 36 Sanitary Administration of the District. The only case of erysipelas admitted during the year proved fatal, being in a female of 83 years. The health of the staff remained good during the year. In April Miss Bellinger received a holiday, but was unable to again take up her duties, and the Council accepted, with regret, the resignation of so valuable a servant, but granted her a testimonial under the Common Seal of the Council. The vacancy thus created was filled by the promotion of Miss Carothers from the position of Sister. She has amply justified the Council's selection, and proved herself thoroughly capable of holding the position. The work of the Public Health Department with regard to infectious disease is as follows : Each case of infectious disease is visited by the Assistant Inspector, and a full report is made, including the following particulars : Day and Sunday School attended, occupation, milk, and other food supply, accommodation at the home. A record of these reports is made in a register kept for this purpose, and on one of the cards in the very complete card index filing system which is in operation. On the termination or removal of any case to hospital, the premises are thoroughly cleansed and disinfected, the bedding and other articles being removed for disinfection by steam at the Council's disinfecting station at the Isolation Hospital. The premises are thoroughly inspected, and nuisances detected are dealt with in such a manner that their recurrence is prevented, as far as possible, all notices served being followed up till the work is completed. Sanitary Administration of the District. 37 TABLE H. Work done during 1911 with relation to infectious diseases. BARNES. MORTLAKE. TOTALS. Visits and inspections in consequence of notifiable disease 171 205 376 Disinfections performed 51 59 110 Lots disinfected by steam at the Isolation Hospital 60 63 123 No. of Notices served 19 25 44 No. of Notices complied with 18 22 40 CHEMICAL EXAMINATION. One sample of water from the pond on Barnes Green was submitted to a chemical analysis during the year. The result of this analysis shewed that the water was subjected to a considerable amount of contamination, mainly vegetable in character. BACTERIOLOGICAL EXAMINATIONS. The Council decided in May that the Medical Officer of Health should make the examination of specimens submitted from medical practitioners for diagnosis. In June this facility was extended to include the examination of sputum from cases or suspected cases of Pulmonary Tuberculosis. These examinations are made at the Council's laboratory at the Isolation Hospital, and the results are immediately communicated to the doctors, in the case of a positive finding, by telephone. The importance of a bacteriological examination as an aid to diagnosis, in doubtful cases, cannot be over-estimated. In each of the diseases in following table it is sometimes necessary to delay for a day or two before a clinical examination reveals the disease, whereas 38 Sanitary Administration of the District. much valuable time may be saved by a bacteriological examination. An early diagnosis in all three diseases is vitally important, both to the patient and to the public health of the district. TABLE J. Shewing results of bacteriological examinations made during 1911. Diphtheria. Enteric Fever. Phthisis. Totals. Positive 36 1 4 41 Negative 66 2 10 78 102 3 14 119 CONTROL AND PREVALENCE OF TUBERCULOSIS. The following is a summary of the steps which the Council have authorised to be carried out for dealing with this disease:— 1. Facilities are given to local doctors to have an early diagnosis made of the disease, in having the sputum tested by means of a bacteriological examination free of charge. 2. The house of each case is visited and any conditions inimical to health are remedied. 3. Sputum bottles are supplied free of charge. 4. A Dispensary has been provided by the Council on the premises of the Isolation Hospital, where those residents suffering from Consumption and not already under medical care are urged to come for advice and guidance, and where certain cases are treated by the Medical Officer of Health with Tuberculin. All contacts are examined if possible. 5. The distribution of literature giving the early symptoms of the disease and suggestions for sufferers to follow in order to minimise the spread of the disease. Sanitary Administration of the District. 39 6. Shelters are loaned for open air treatment where necessary. 7. The disinfection of the house is carried out on the termination or removal of any case of Consumption, and at anytime during illness, upon request. 8. The Council have approved of the principle of utilising the Joint Small-Pox Hospital for the educative treatment of certain cases, and conferences are to be held with the various constituent authorities, as to the best means of giving effect to the principle. The Richmond Board of Guardians have set aside in their Infirmary special wards for the treatment of certain cases of Consumption, but great difficulty is experienced in persuading sufferers to take advantage of this accommodation. Other than this, there is no Hospital accommodation for the treatment of advanced cases. During the year there were thirty deaths from all forms of Tuberculosis. Of these twenty were caused by Pulmonary Tuberculosis and the number dying in Public Institutions from all forms of tuberculosis was six, of these four being from Pulmonary Phthisis. All Institutional deaths from Consumption taking place in the Workhouse Infirmary. The cases of Consumption notified during the year numbered thirty-eight, twelve of these being notified under the Tuberculosis Regulations, 1908, that is, the cases coming within the purview of the Poor Law Medical Officers, shewing the intimate relation between pauperism and Consumption. Of the cases notified, twenty received or are receiving treatment : seven in the Poor Law Infirmary seven attending the Council's Dispensary, the remainder in various voluntary Hospitals. DISPENSARY FOR TREATMENT OF CONSUMPTION. Record of Persons visiting during October, November and December, 1911. No Age. Sex. Occupation. Reason of Visit. Result of Chest Examination. Wh'th'r any Sputum Result of Sputum .Ex'm'nti'n Result of Tuberculin Test. Treatment. History of Infection. Remarks. 1 35 yrs. M Insurance Agent Cough and Spit Apices of both lungs affected Yes Positive No test By Tuberculin Contact with a patient 20 years ago. 2 34 „ F — Notified case Apex of one lung affected None — Positive „ Not known Married. 3 8 „ F „ „ „ — „ „ 4 52 „ M P. H. Manager Retired Cough and Spit Long standing chronic lesions in both apices Yes Positive No test „ Contact with a patient 20 years ago. 5 36 ,, M Clerk Notified case . Advanced lesions in both lungs „ „ „ Private medical case 6 20 ,, F Servant „ Early lesion in one apex None Positive Hshleft district — 7 14 „ F — „ Lesion in one apex Yes Positive No test Attending special hospital Parent. All members of one family 8 8 „ F — Contact No physical signs None No reaction - - 9 6 „ M — Contact „ „ — „ — - 10 6 ,, F Contact „ „ ,, — - 11 2 ,, M Weak chest „ „ — „ — - 12 5 ,, M „ „ „ — „ — - 13 6 ,, F — „ „ — „ — - 14 7 „ M — Enlarged glands „ „ — Positive (due to glands) — - 15 5 „ F — „ „ „ — „ — - 16 „ F Cough „ „ — No reaction — - 17 3 „ F — Predisposition „ „ — „ — - 18 4 „ M — Breathlessness Severe Heart Disease „ — „ — - 19 3 ,, F — Contact No physical signs .. „ — „ — - 20 8 „ F — Notified case Early lesion in one apex „ — Positive By Tuberculin - 21 42 ,, M Railway Worker „ Apex of one lung affected „ Positive No test „ - 22 46 „ M Tailor „ Old standing lesions in both apices Yes „ „ „ Contact with a patient some years ago. LOCAL GOVERNMENT BOARD TABLE. Phthisis : Sanatorium and Hospital Accommodation. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds. Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Small-pox Hospital, for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium: If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable open-air Shelters or Tents ? a) Early cases None — — — — — (1) No No Yes (Shelters) (6) Intermediate cases None — — — — -- — — — (c) Advanced cases * None — — — — — (2) Under consideration — — Have the Council, or any Private Body provided a Dispensary ? ) The Council have provideDispensary. If so, give particulars. * See Context. Other Diseases. 41 There was a large outbreak of measles in the early part of the year, all the schools being affected, the disease finding its greater number of victims in the infant departments. Numerous returns were received from each school giving large numbers of absentees from this cause. Disinfection of schoolrooms and the distribution of leaflets setting forth the early signs and urging parents to secure medical advice is the only action that can be taken. Measles is essentially a disease of young children, the greater fatality is among the younger children, so that even if the age at which a child catches measles is postponed the smaller is the risk of a fatal termination. It is important that the havoc wrought by measles should be fully appreciated, in many cases this disease is treated too lightly. It should be always borne in mind that, apart from the immediate complications, it is a cause of much ill health in later years, such chronic complaints as running ears, certain eye diseases, and bronchitis often dating from an attack of measles. The following table shows cases of non-notifiable diseases, based on information received from the Head Teachers of the Schools. TABLE K. DISEASE. Number. Chicken Pox 47 Mumps 42 Measles 216 Whooping Cough 15 Ringworm 7 42 Infant Mortality. The summer of last year exacted a heavier toll among infants than has been experienced since 1906 ; seventy deaths occurred in children under one year of age, making an infantile mortality rate of 95.7 per thousand births. It will be seen from Table IV. that this excess of infantile deaths was largely due to summer or epidemic diarrhoea, which was responsible for 24 victims, or a rate of 33-2 per 1,000 births. The greatest mortality from diarrhoeal diseases was attained, as will be seen in the accompanying chart, during the last week in August, when six deaths occurred. Chart shewing infantile mortality from Diarrhceal Diseases, during 13 weeks commencing 23rd July, The distribution of deaths was general throughout the district Barnes and Mortlake parishes having an equal number. The only common point was that the deaths occurred almost exclusively in Infant Mortality. 43 houses with smaller rentals. In this connection it must be emphasized that adequate accommodation should be provided for food storage in every house. Much effort is expended in supervising the storage and preparation of food before it reaches the consumer, yet, in very many cases, no facilities exist for its proper storage in the home of the consumer. The Inspectors spent much time during the summer in securing the prompt removal of collections of material which would act as a breeding-ground for flies, which are so important in the causation of epidemic diarrhoea. With the same object in view, much could be done by securing a more frequent removal of house refuse ; in many of the smaller houses with a back yard of small size, the dustbin is a potential danger to child life during the summer months. It is to be hoped that, with a refuse destructor erected, the Council will see that a more frequent removal of house refuse is undertaken before next summer. Much benefit would also accrue if the Byelaws were so amended as to secure the removal twice weekly of all stable-manure, especially during the summer months. Another important factor in the causation of infant mortality is in that class including premature birth, congenital causes, etc. These deaths are for the most part due to ante-natal causes, which are in some cases capable of removal, and something could be done if the older girls received some instruction in the hygiene of Sex. The Supervision of Midwives under the Midwives' Act rests with the Surrey County Council, who employ a female Inspector to carry out the inspections. It is certain that the work under this Act could be more appropriately dealt with by a local officer, who would be able, if the Notification of Births Act were in force, to divide her time between the allied duties, and could do much to reduce infant mortality by visiting and guiding the mothers in rearing their children. 44 Vital Statistics for 1911 POPULATION. The population enumerated at the decennial census this year March, was 30,379. The mean population for the year estimated by the Registrar-General's method was 30,786. This estimate is probably less than would have been the case had the rate of increase been the same as in the previous decennium (1891-1901). This district is one of those in the immediate outer ring of suburbs, which have grown very rapidly as a result of the " spilling over" and depopulation of central London. The sex distribution of the population in the census returns shows that for the whole district females are in excess in the proportion of 16,752 to 13,627. The proportion of males to 100 females in Barnes is 75, in Mortlake the proportion of males to 100 females is 86. So that in Barnes, all other conditions being the same, there should be a lower death-rate, as the death-rate amongst females at all ages is lower than among males. The sex distribution in the different wards show, in places of greater social prosperity, a greater predominance of females over males. Table showing Proportion of Males to 100 Females in different Wards. Barnes E. 58 N 71 S 94 W 74 Mortlake Middle 88 N 97 S 68 From the above table it will be seen that in Barnes East and in Mortlake South, the proportion of males to females is much smaller than in Mortlake North, which is essentially a working-class Vital Statistics. 45 district, compared with the residential nature of both Barnes East and Mortlake South. The excess of females in these residential neighbourhoods is probably due to a large proportion of female domestic servants, the further excess of females over males in Barnes East is probably due to the large number of female householders living in the residential flats abutting on Castelnau. NUMBER OP PERSONS PER HOUSE. The average number of persons per house as calculated on the census return is 4.244, a considerable decrease since the last census. The averages for the two parishes are for Barnes and Mortlake 4.28 and 4.21 persons per house respectively. The averages for the various wards are very similar to the sex distribution sequence. Table showing Average Number of Persons per House in different Wards. Barnes E 4.00 N 4.20 S 4.47 W 4.32 Mortlake Middle 4.10 N 4.35 S 4.23 BIRTHS. The total number of births properly belonging to this district was 731, as will be seen in Table I, including 10 births occurring outside the district, yet properly belonging to it. Under new arrangements, these births, like outside deaths, are transferred from one district to another by the Registrar General. The nett birthrate therefore was 23 7 per 1000 of the population, an increase oq 46 Vital Statistics. that of last year, but lower than that of England and Wales as a whole, 24'4 per 1000, and still lower than that of London 25 per 1000. Of the births, 29 were illegitimate, forming 4 per cent, of the total births. DEATHS. The uncorrected number of deaths at all ages in the district was 272, making a crude death-rate of 8.8 per 1000 of the population. When appropriate corrections are made for excluding and including certain deaths, the corrected number is 336, i.e., a death-rate of 10.9 per 1000, an increase on that of last year, but still lower than that of England and Wales, 14.6 per 1000, and still lower than that of London, 15 per 1000. The low death-rate in a suburban and rapidlygrowing district like this is probably due in a large measure to the age and sex constitution of the population. When the completed census returns are to hand, it will be possible to make corrections for this, and see how far the low death-rate is due to these factors. INFANTILE MORTALITY (Table IV.) The deaths of infants under one year were 70, which gives an infantile mortality of 95 per 1000 births; of these 70 deaths under one year, 9 were of illegitimate babies. This means that the infantile mortality rate among illegitimate babies is 310, as compared with 86 per 1000 among babies born in wedlock. CHIEF CAUSES OF DEATH. The chief causes of death, and the number of deaths from each disease or groups of diseases are tabulated in Table III. This table gives the relative incidence of different diseases, and the incidence of each disease at the different ages, Statistical Tables. 48 TABLE I. Vital Statistics of whole District during 1911 and previous Years. Name of District—Barnes Urban. Year. Population estimated to middle of each year. Uncorrected Number. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. 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 1906. 24414 632 — 25.8 256 10.4 — 32 71 112 288 11.7 1907. 25669 884 — 26. 6 267 10.4 — 33 63 92 300 11.2 1908. 26925 676 — 25.1 213 7.9 — 34 63 93 247 9.1 1909. 28181 703 — 24.9 277 9.5 — 44 62 88 321 11.03 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 Kates in columns 5, 7, and 13 calculated per 1,000 of estimated population. Area of District in acres\ Total population at all ages 30,379 (exclusive of area 2,408 Number of inhabited houses 7,167 At Census of 1911. covered by water) Average number of persons per house 4 244 Isolation Hospital, Mortlake. Total available beds, 40. Number of Diseases that can be concurrently treated, 4. * Removed to Poor Law Infirmary at Richmond. t Three cases removed to Mount Vernon Hospital, one to Richmond Hospital, one to Brompton and Royal National Hospital for Consumption, Ventnor. 49 Cases of Infectious Disease notified during the year 1911. Notifiable Disease. Number of Cases Notified. Total Cases notified in each locality. Total Cases removed to Hospital. At all ages. At ages—Years. 1 Barnes. 2 M'rtl'ke Under 1. 1 to 5. 5 to 15. 15 to 25 25 to 45. '5 to 65 65 and upw'ds. Small pox - - - - - - - - - - - Cholera - - - - - - - - - - - Diphtheria (including Membranous Croup) 42 - 9 28 3 1 1 - 14 28 40 Erysipelas 14 - - - 1 2 4 7 5 9 1 Scarlet Fever 46 - 5 31 9 1 - - 23 23 37 Typhus Fever — - - - - - - - - - - Enteric Fever 4 - - 2 1 1 - - 3 1 3 Relapsing Fever — - - - - - - - - - - Continued Fever — - - - - - - - - - - Puerperal Fever 1 - - - - - - - 1 - - Phthisis Under Tuberculosis 12 - - - 5 6 1 - 4 8 7* Regulations, 1908 Ditto 1911 12 - - 2 2 8 - - 7 6+ Others 14 - - 3 1 6 4 - 5 9 - Totals 145 - 14 66 22 26 10 7 60 85 94 TABLE III. Causes of, and Ages at, Death during the year 1911. 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, Enteric Fever — - — — — — — — — — Small-pox — — — — — — — — — — Measles 17 4 7 4 2 — — - — — Scarlet Fever — — — — — — — — — — Whooping-Cough 7 4 3 - — — — — — — Diphtheria and Croup 1 — - 1 — — — — — 1 Influenza 3 — — — — — — 1 2 — Erysipelas 2 — — — — — — — 2 1 Cerebro-Spinal Fever - — — - — — — — — — Meningitis 2 - 1 1 — — — — — — Phthisis (Pulmonary Tuberculosis) 21 — — 1 1 1 14 3 1 — Tuberculous Meningitis 5 3 2 — — — — — — — Other tubercular diseases 6 2 1 — — — 1 2 — — Rheumatic Fever 2 — — — 1 — 1 — — — Cancer, malignant disease 33 — — — - — 6 13 14 — Bronchitis 23 2 — 1 - — — 6 14 — 50 51 Broncho-Pneumonia 3 1 — — — — — 2 — — Pneumonia (all other forms) 15 3 1 1 — — 3 4 3 — Other diseases of Respiratory organs 6 — 1 1 — — — 2 2 — Diarrhoea and Enteritis 36 25 6 — 1 1 1 2 — — Appendicitis and Typhlitis 1 — — — 1 ' — — — — — Alcoholism 1 — — — — — 1 — — — Cirrhosis of Liver 3 — — — — — 1 2 — — Nephritis and Bright's Disease 9 — 2 6 1 — Puerperal fever — — — — — — — — — — Other accidents and diseases of Pregnancy and Parturition 9 2 - - - - 6 1 Congenital Debility and Malformation, including Premature Birth 20 19 1 - - - - Violent Deaths,excluding Suicide 6 1 — — 2 — — 2 1 — Suicides 1 — — — — 1 — — — — Other defined diseases 104 4 — 1 3 5 7 19 65 — Diseases ill-defined or unknown — — — — — — — — — Totals 336 70 23 11 11 8 43 65 105 2 52 TABLE IV. Infant Mortality during the Year 1911. 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 1 year. All Causes (certified) 12 7 — — 19 IS 10 10 13 70 Small-pox - - - - - - - - - -Chicken-pox - - - - - - - - - - - Measles — — — — - 1 — — 3 4 Scarlet Fever - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough — — — — — 1 — 3 — 4 Diarrhoea - - - - - 6 5 2 4 17 Enteritis — 1 — — 1 3 1 1 2 8 Tuberculous Meningitis - - - - - - 1 1 1 3 Abdominal Tuberculosis - - - - - - - 1 — 1 Other Tuberculous Diseases — — — — — — 1 — — 1 Congenital Malformations — — — — — — 1 — — 1 Premature Birth 5 2 — — 7 1 — — — 8 Atrophy, Debility, and Marasmus 5 1 6 2 1 1 10 53 Atelectasis - - - - - - - - - - -Injury at birth 1 1 — — 2 — — — — 2 Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - — — Convulsions — 2 — — 2 — — — — 2 Gastritis - - - - - - - - — — Laryngitis - - - - - - - - — — Bronchitis — — — — - 1 — — 1 2 Pneumonia (all forms) — — — — — 2 1 1 — 4 Suffocation, overlying - - - - - 1 — — — 1 Other Causes 1 - - - 1 - - - 1 2 12 7 — — 19 18 10 10 13 70 Nett Births in the year Legitimate,702 Illegitimate,29 Nett Deaths in the year of Legitimate Infants,61 Illegimate Infants,9 54 TABLE Showing the work done by the Sanitary Inspectors during 1911 with regard to places under the Factory and Workshops Act, 1901. BARNES. MORTLAKE. TOTALS. No. Visits. No. Visits. No. Visits. A.—FACTORIES— Brewery - - 1 1 1 1 Electric Lighting Works .. - - 1 1 1 1 Printers 1 1 2 4 3 5 Coachbuilders - - 1 4 1 4 Athletic Goods - - 1 2 1 2 Motor Works - - 1 4 1 4 Golf Club Maker - - 1 2 1 2 Motor Body Works 1 1 - - 1 1 STEAM LAUNDRIES — Over 40 employees 1 4 1 3 2 7 Under 40 employees 2 6 4 8 6 14 B.—WORKSHOPS— Engineering Works 2 4 - - 2 4 Tailors 8 10 4 6 12 16 Dressmakers 13 20 11 16 24 36 Shoemakers 12 19 20 22 32 41 Cycle and Motor 4 8 2 4 6 12 Saddlers 1 1 1 1 2 2 Photographers 1 1 3 3 4 4 Smiths 2 2 3 4 5 6 Umbrella Maker - - 1 2 1 2 Upholsterer - - 1 1 1 1 Coachbuilder - - 2 6 2 6 Cabinet Maker 1 2 - - 1 2 Picture Frame Makers - - 2 2 2 2 Watch Makers 2 2 3 3 5 5 Brush Maker - - 1 2 1 2 Rubber Works - - 1 1 1 1 HAND LAUNDRIES — Under 40 employees 3 6 8 16 11 22 BAKEHOUSES— 3 9 10 30 13 39 C.—DOMESTIC WORKSHOPS Dressmakers 17 34 14 28 31 62 Family Laundries 6 14 12 24 18 38 D.—WORKPLACES— Stable Yards 6 12 5 5 11 17 Restaurants 5 10 13 28 18 38 Ice Cream Makers 2 4 - - 2 4 Totals 93 170 130 233 223 403 55 Annual Report of the Medical Officer of Health for the year 1911 for the Urban District of Barnes on the administration of the Factory & Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES, and HOMEWORK. 1.- INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Prosecutions. Factories (Including Factory Laundries) 41 4 — Workshops 303 10 - (Including Workshop Laundries) Workplaces 59 - - (Other than Outworkers' premises included in Part 3 of this Report) - - - Total 403 14 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Found. Remedied. Referred to H.M. Inspector Prosecutions Nuisances under the Public Health Acts :— Want of cleanliness 11 11 - - Want of ventilation 2 2 - - Overcrowding - - - - Want of drainage of floors - - - - Other nuisances - - - - Sanitary ac- commodation insufficient - - - - unsuitable or defective - - - - not separate for sexes - - - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences - - - (Excluding offences relating to outwork which are included in Part 3 of this Report). - 1 - - Total 13 13 - - 56 57 3.—HOME WORK. NATURE OF WORK OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES (SEC. 108). OUTWORK IN INFECTED PREMISES (SECS. 109, 110). * Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen Contractors. Workmen. Wearing Apparel— (1) making, &c. — — — 12 — 34 - - (2) cleaning & washing Household Linen - - - - - - - - Lace, lace curtains & nets Curtains and Furniture Hangings - - - Furniture and Upholstery Electro Plate - - - File making - - - - Brass and Brass Articles Fur pulling - - - - Cables and Chains - - - - Anchors and Grapnels - - - - Cart Gear - - - - Locks, Latches and Keys Umbrellas, &c - - - - Artificial Flowers - - - Nets,Other thanWire Nets Tents - - - Sacks - - - Racquet and Tennis Balls Paper Bags and Boxes - - - Brush making — — — 1 1 Pea picking Feather sorting Carding, .&c., of Buttons, &c. Stuffed Toys Basket making Total — — 13 35 * One list only from employers, remainder From other Councils. 58 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Laundries 26 Dressmakers 55 Shoemakers 32 Bakehouses 13 Total number of workshops on Register 174 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5) Notified by H.M. Inspector - Reports (of action taken) sent to H.M. Inspector - Other — Underground bakehouses (S. 101)— 5 Certificates granted during the year — In use at the end of the year 5 TABLE Showing the administration of the Vaccination Acts in the Mortlake Registration Sub-District (which includes the parishes of Barnes and Mortlake) according to the return made by Mr. Umney, Clerk to the Richmond Guardians. Return for the period January ls£ to December 31st, 1910. Registration Sub-District Comprised in the Vaccination Officer's District. No. of Births returned in the Birth List Sheets as registered. Number of these Births duly entered by 31st January, 1911, in Cols. 1. 2, 4, & 5 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which on 31st Jan., 1912 remained unentered in the Vaccination Register on account (as shown by Report book) of Number of these Births remaining on 31st Jan., 1912, neither duly entered in the Vaccination Register (Cols. 3 4, 5, 6. & 7 of this return) nor temporarily accounted for in the Report Book (Cols. 8, 9, & 10 of this Return). Number of Statutory Declarationsof Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of Birth of the Children to which they relate during the year 1911. Total number of Certificates of successful Primary Vaccination at all ages received during the calendar year 1911. Col. 1. Column 2. COL. 4. COL. 5. Postpone ment by Medical Certificate. moval to Districts the Vaccination Officer of which has been duly apprised. Removal to place unknown or which cannot be reached and cases not having been found. Successfully Vaccin ated. Insusceptible of Vaccination. Had Small Pox. Number in respect ofwhom Statut'y Declarations of Conscientious Objection have been received. Dead un vaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 MORTLAKE 683 531 4 - 88 31 10 4 14 l — 539 Return for the Period January-June, 1911. (Supplementary). MORTLAKE 379 259 4 — 61 25 17 4 9 - 114 — 59