BAT 6 B-I The vestry of the Parish of St. Mary, Battersea. R E PORT upon the PUBLIC HEALTH & SANITARY CONDITION of The parish of St. Mary, Battersea, Including the work of the Public Health Department, DURING THE YEAR 1898, by W. H. KEMPSTER, M.D., MEDICAL OFFICER OF HEALTH. Treasurer of the Incorporated Society of Medical Officers of Health and Vice-President of the Metropolitan Branch. Fellow and Member of Council of the Royal Institute of Public Health. Fellow of the Obstetrical Society. 1899. CONTENTS Page. Population 5 Birth and Death Rates 7 Mortality Tables 11 Comparative Statistics from 1856 21 Zymotic Diseases 27 Non-zymotic Diseases 49 Inquests 52 Water Supply 55 Public Health (London) Act 64 Customs and Inland Revenue Act 69 Sickness and Mortality of Parish Poor 72 Vaccination 73 Houses let in Lodgings, &c. 82 Infant Life Protection Act 83 Food 83 Sanitary Operations 86 Proceedings 89 Public Sanitary Conveniences 91 Bakehouses 93 Reports of Chief Sanitary Inspector 94 Report of Female Sanitary Inspector 122 General Conclusions 123 Appendix 125 The vestry of the parish of St. Mary, Battersea. Chart indicating number of Births and Deaths registered weekly as occurring within the Parish during the year 1898. To the Vestry of the Parish of St. Mary, Battersea. Gentlemen, A recapitulation of the main facts of the Census enumeration of 1896 is again necessary in order that the following statistics may be seen to be correctly based. The Census taken on March 29th, 1896, shewed that the increase of population in the preceding five years had not quite kept pace with that which prevailed during the last few intercensal periods; in fact, since 1871-81 the rate of increase has uniformly decreased, the probable reason of which is that nearly all the available building land in the parish has been covered. The following are the particulars of the last three census enumerations, the number of inhabited houses, of persons, and of inhabitants per house being given for the several wards into which the parish is at present divided. Census 1881. Census 1891. Census 1896. Inhabited Houses. Population. No. of Inhabitants per House. Inhabited Houses. Population. No. of Inhabitants per House. Inhabited Houses. Population No. of Inhabitants per House. Ward 1 2,665 23,667 8.9 3,327 27,899 8.3 3,442 29,178 8.4 „ 2 5,120 37,011 7.2 6,748 50,087 7.4 6,846 52,653 7.7 „ 3 4,536 31,652 6.9 5,457 40,217 7.3 5,705 43,119 7.5 „ 4 2,284 14,932 6.5 5,247 32,255 6.1 6,428 40,165 6.2 Totals 14,605 107,262 7.3 20,779 150,458 7.2 22,421 165,115 7.4 6 Table shewing the population in relation to houses in each ward as indicated by the Census of 1896. Wards. Houses. Population. Inhabited. Empty. Occupied by day only Building. Male. Female. Total. No. 1 3,442 48 39 14 14,967 14,211 29,178 „ 2 6,846 101 84 5 26,279 26,374 52,653 ,, 3 5,705 74 79 — 21,637 21,482 43,119 ,, 4 6,428 272 61 153 17,939 22,226 40,165 Whole Parish 22,421 495 263 172 80,822 84,293 165,115 7 This table shews that there were, at the date of the 1896 census, 22,421 inhabited houses in the parish, four hundred and ninetyfive empty, two hundred and sixty-three used for business purposes only and not inhabited at night, and one hundred and seventy-two building. It may be safely assumed that most of the empty houses have since been occupied, as well as the houses which were then building, with the exception of some of the flats recently erected, there being a demand for houses in Battersea at present exceeding that of any previous period. The persons were eighty thousand eight hundred and twentytwo males; eighty-four thousand two hundred and ninety-three females, and a total population of one hundred and sixty-five thousand one hundred and fifteen. As the census of eighteen hundred and ninety-one shewed a population of one hundred and fifty thousand, four hundred and fifty eight, it follows that the increase was fourteen thousand, six hundred and fifty seven, or an average increase of two thousand, nine hundred and thirty-one per annum. It will be necessary, in order to calculate the birth, death and other rates to arrive at the mean or average population of the year 1898, which is obtained by adding the above number, two thousand nine hundred and thirty-one yearly, so as to shew the population estimated to exist on the middle day of the year. The estimated mean population of the parish for 1898 was 171,709, and it is upon this number that the birth and death rates which follow are calculated. Details as to the Metropolis are added for the purpose of comparison. The estimated mean population of London for 1898 was 4,504,766, the number of births registered during the year was 132,432 and the consequent birth rate 29.4 per thousand. The number of births registered in Battersea in 1898 was 5,157 giving a birth rate of 30.0 per thousand or 0.5 per thousand above that for the Metropolis. 8 The deaths in London numbered 83,936, with a consequent Metropolitan death rate of 18.6 per thousand. The deaths registered in Battersea numbered 2,762, the mortality (uncorrected) being equal to 16.0 per thousand or 2.6 per thousand below that for London. It will be observed that the birth and other rates approximate very closely to those of the Metropolis at large, of which indeed Battersea is now becoming an integral part, losing much of its suburban character and acquiring that of a town district. That the death rate has not increased is evidence of care in sanitary administration which has always distinguished this parish and the tendency to equalization and constant lowering of the mortality over the whole Metropolis is probably in great part due to the fact that the methods adopted for many years past in this parish have now met with almost universal adoption over the rest of the Metropolis. The death rate for the year under report, 16.0 per thousand per annum, is, with the exception of 1888, 1889, 1894 and last year, the lowest in the past forty-three years, when these statistics commenced, as shewn in Table V. An epidemic wave of zymotic disease has been experienced in the Metropolis during the last few years, causing an increase of notifications over preceding years. The number of notifications received by me for the last six years is given below:— Year. 1898 1,975 1897 2,569 1896 1,929 1895 1,657 1894 1,845 1893 2,798 Of the 1,975 notifications received in 1898, seventy-nine were duplicates, and notifications were withdrawn in nine instances, leaving a net total of 1,887 cases of infectious disease. 9 It has been shewn that the total number of deaths in Battersea during 1898 was two thousand seven hundred and sixty-two, giving an uncorrected death rate of 16.0 per thousand. If this be corrected by deleting the deaths of two hundred and fifty-eight non-parishioners which took place in the parish, viz.:—Wandsworth and Clapham Union Infirmary, two hundred and thirty, the Bolingbroke Hospital, thirteen, and elsewhere fifteen, and adding three hundred and eighty-eight deaths of Battersea parishioners which took place in the various public institutions, outside the Parish, a total mortality of Battersea parishioners of two thousand eight hundred and ninety-two will result, giving a corrected death-rate of 16.8 per thousand per annum. Table A. This table is compiled in all sanitary districts under the express direction of the Local Government Board, for the purpose of securing uniformity of tabulation in all parts of the country, of the important particulars contained therein. It is at the same time expressly stated that the Medical Officer of Health of any district is at liberty, in addition, to continue to use any other form of tabulation which, in his opinion, illustrates more fully the sanitary condition of the district for which he acts. For purposes of comparison with the vital statistics of the past forty-two years, since the year 1856, other tables which have been employed in this parish are also given herewith, and will be found denoted by numbers, those of the Local Government Board being denoted by the letters A. and B. In Table A. will be found particulars of mortality in the various Registrar's districts and public institutions which are also treated as separate districts. They comprise the Registrar's districts of East and West Battersea, and the following public institutions, situated within the parish, viz.:—Wandsworth and Clapham Union Infirmary, Bolingbroke Hospital, &c. The broad grouping of ages is under and above five years of age, so as to clearly define the mortality of each of these periods 10 of life, more especially the infantile ages under five, as the greatest waste of life has occurred in the past at the early years, and although great improvement has taken place in this respect during the last few years, still much remains to be done in this direction. For instance, three hundred and eighty-six out of a total of one thousand two hundred and forty-six deaths under five years were from Zymotic diseases, a proportion which ought to be largely diminished. This, however, shews a great ment compared with former years. Particulars of the other ages at death are also given in this table. The two thousand seven hundred and sixty-two persons, including non-parishioners, who died in the parish during 1898, would give a gross death rate of 16.0 per thousand living during the year, and were distributed as follows:— East Battersea— (a) Parishioners 1,054 1,062 (b)Non-parishioners 8 West Battersea— (excluding public institutions) (a) Parishioners 1,198 1,205 (b) Non-Parishioners 7 Wandsworth and Clapham Union Infirmary— (a) Parishioners 240 470 (b) Non-parishioners 230 Bolingbroke Hospital— (a) Parishioners 12 25 (b) Non-parishioners 13 Whole Parish 2,762 Table of Deaths during the Year 1898 in the Metropolitan Sanitary District of Battersea, classified according to Diseases, Ages and Localities. Names of Localities adopted for the pose of these Statistics; Public Institutions being shewn as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under 5 Years. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 At all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and wards fevers. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, &c Heart Disease Influenza. Injuries. All Other Diseases. Total. Typhus. Enteric Fever. Continued. Relapsing. Puerperal. East Battersea 1062 414 184 35 40 281 108 Under 5 ... 3 11 4 ... ... ... ... ... ... 2 59 33 86 ... 19 105 3 4 24 245 598 5 upwards ... 1 4 1 ... 1 ... ... 2 ... 2 1 ... 2 6 84 72 5i 19 22 196 464 West Battersea (excludingPublic Insts.) 1205 390 174 37 41 350 213 Under 5 ... 1 10 3 ... ... 1 ... ... ... 4 46 35 70 ... 29 73 ... 9 22 261 564 5 upwards ... 1 12 ... ... 5 ... ... 2 ... 4 1 ... 4 4 88 77 57 40 23 323 641 Wandsworth and Clapham Infirmary. 470 36 21 ... 15 253 145 Under 5 ... ... ... ... ... ... ... ... ... ... 1 12 3 2 ... 1 15 ... ... ... 23 57 5 upwards ... ... ... ... ... 1 ... ... 2 ... 7 ... ... 1 1 100 41 52 4 15 189 413 Bolingbroke Hospital 25 ... 3 3 1 15 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 13 7 22 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2762 840 382 75 97 899 469 Under 5 ... 4 21 7 ... ... 1 ... ... ... 7 117 71 158 ... 49 193 3 13 49 529 1222 5 upwards ... 2 16 1 ... 7 ... ... 6 ... 13 2 ... 7 11 273 190 161 63 73 7i5 1540 The subjoined numbers have also to be taken into account in judging of the above Records of Mortality. Deaths occurring outside the District of Persons belonging thereto. 388 39 97 5i 25 146 30 Under 5 ... 16 48 ... ... ... ... ... ... ... ... 5 ... 6 ... 9 13 1 ... 5 33 136 5 upwards ... 6 27 ... ... 8 ... ... ... ... 2 ... ... 1 7 32 7 27 ... 12 123 252 Deaths occurring within the District of Persons not belonging thereto. 258 23 18 3 11 123 80 Under 5 ... ... ... ... ... ... ... ... ... ... ... 10 2 1 ... 1 11 ... ... 1 15 41 5 upwards ... ... ... ... ... 1 ... ... ... ... 4 ... ... ... 1 41 13 29 ... 23 105 217 12 Deaths occurring within the parish, of persons not belonging thereto: In the Union Infirmary 230 In the Bolingbroke Hospital 13 Elsewhere 15 Total 258 Deaths occurring outside the parish, of persons belonging thereto: Union Workhouses & Infirmaries 13 General and Special Hospitals 199 Metropolitan Asylums Board Hospitals 107 County and other Lunatic Asylums 51 Elsewhere (including River Thames) 18 Total 388 Table I. This table contains details of the deaths of Battersea parishioners in Metropolitan public institutions outside the parish. The disease from which death ensued, the sex, age, and particular class of institution are herein indicated, as well as the localities in which other parishioners lost their lives or were found dead, which latter require no comment, the causes of death being set out in the table. Table I. shews that three hundred and eighty-eight Battersea parishioners died in outlying public institutions, in addition to the two hundred and forty dying in the Union Infirmary, (vide Table VIII) and thirteen in the Bolingbroke Hospital, making a total number of six hundred and forty-one deaths in public institutions. During the year 1897 five hundred and ninety-five deaths similarly occurred. 13 TABLE I. Deaths of Battersea Parishioners occurring outside the Districts in Public Institutions and Elsewhere within the Metropolis. Deaths of Parishioners in outlying Public Institutions. DISEASE. Totals. Sex. Age. Institutions. Males. Females. Under 1 year. 1 to 5 years. All under 5. 5 to 15 years. 15 to 25 years. 25 to 65 years. 65 and upwards. Union Workhouses General and Special Hospitals. Asylums Board Hospitals. County and other Lunatic Asylums. | Elsewhere. i.—ZYMOTICS. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 22 ii 11 1 15 16 5 i ... ... ... ... 22 ... ... Diphtheria 75 35 40 4 44 48 26 ... 1 ... ... 2 73 ... ... Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric „ 8 5 3 ... ... ... ... 1 7 ... ... 1 7 ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing „ ... ... ... ... ... ... ... .... ... ... ... ... ... ... Puerperal ,, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 2 1 1 ... ... ... . ... 2 ... ... 1 ... 1 ... Measles 5 4 1 1 4 5 ... ... ... ... 1 3 1 ... ... Whooping Cough ... ... ... . ... ... ... ... ... ... ... ... ... ... . Diarrhoea 7 5 2 5 1 6 1 ... ... ... ... 7 ... . . ... Other Zymotics 1 1 ... ... ... ... ... ... i ... ... 1 ... ... ... Total Zymotics 120 62 58 11 64 75 32 2 ii 15 103 1 Rheumatic Fever 6 4 2 ... ... ... 2 i 3 ... ... 6 ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis and other Tubercular Diseases 41 17 24 5 4 9 2 2 27 1 ... 30 ... 10 i Respiratory 20 14 6 2 11 13 ... i 6 ... i 17 2 ... ... Circulatory 28 18 10 ... 1 1 5 3 18 1 2 17 3 6 Nervous 46 28 18 2 6 8 1 8 26 3 2 18 ... 25 1 Cancer 28 13 15 ... 1 1 ... ... 23 4 i 24 ... 3 ... Violence 17 13 4 1 4 5 2 2 6 2 ... 8 ... ... 9 All Other Diseases 82 37 45 18 6 24 7 6 26 19 6 64 2 9 1 Totals 388 206 182 39 97 136 51 25 146 30 13 199 107 51 18 14 The eighteen deaths recorded as having occurred "elsewhere" are here located: Male Trinity Road, Wandsworth. ,, On way to St. George's Hospital. ,, Victoria Street, Westminster. ,, Army & Navy Stores, Pimlico. Female Albert Embankment. Male On way to St. Thomas' Hospital. ,, Queen's Road, Chelsea. ,, On way to Westminster Hospital. ,, Grosvenor Canal, Belgravia. ,, L.B. & S.C. Railway, Balham ,, York Road, Wandsworth. ,, On way to St. Thomas' Hospital. ,, River Thames at Hammersmith. ,, River Thames at Fulham. ,, ,, ,, ,, ,, ,, ,, W.L.E. Railway, near West Brompton. ,, H.M. Prison, Wormwood Scrubbs. The particulars of deaths of non-parishioners dying within the parish will be found in Table IX. and following tables. Tables II. and III., give in tabular form the weekly returns of the District Registrars of Births and Deaths for East and West Battersea respectively, and include the deaths of all persons within the parish and in public institutions, whether parishioners or not. They shew the incidence of births and deaths at the various periods of the year, being grouped in quarters for that purpose, with additional particulars as to causes of death to be found in Table IV. 15 TABLE II. BIRTHS AND DEATHS IN EAST BATTERSEA, 1898. Week ending:— BIRTHS. DEATHS. Males. Females. Total. Males Females. Total. 8th January 1898. 26 32 58 20 11 31 15th „ „ 27 21 48 10 17 27 22nd „ „ 32 23 55 17 13 30 29th „ „ 28 18 46 10 12 22 5th February „ 27 31 58 9 17 26 12th „ „ 24 22 46 11 13 24 19th „ „ 23 18 41 12 • 11 23 26th ,, „ 25 28 53 19 13 32 5th March „ 29 21 50 14 14 28 12th „ „ 30 25 55 16 11 27 19th „ „ 26 26 52 11 15 26 26th „ „ 19 19 38 7 16 23 2nd April „ 35 30 65 6 8 14 1st Quarter 351 314 665 162 171 333 9th April „ 35 23 58 15 8 23 16th „ „ 19 25 44 9 12 21 23rd „ „ 31 20 51 9 7 16 30th „ „ 24 23 47 7 10 17 7th May „ 20 26 46 9 7 16 14th „ „ 17 18 35 4 8 12 21st „ „ 22 28 5° 5 8 13 28th „ „ 16 23 39 7 5 12 4th June ,, 24 14 38 14 6 20 11th „ „ 24 23 47 10 9 19 18th „ „ 25 28 53 7 4 11 25th „ „ 16 19 35 9 4 13 2nd July „ 35 21 56 9 5 14 2nd Quarter 308 291 599 114 93 207 16 Births and Deaths, East Battersea, 1898—continued. Week ending:— births. deaths. Males. Females Total. Males. Females. Total. 9th July, 1898 26 25 51 4 13 17 16th ,, ,, 26 22 48 5 11 16 23rd ,, ,, 13 35 48 8 7 15 30th ,, ,, 27 15 42 9 12 21 6th August ,, 20 17 37 10 17 27 13th ,, ,, 24 22 46 10 16 26 20th ,, ,, 23 19 42 18 17 35 27th ,, ,, 20 22 42 17 18 35 3rd September ,, 16 22 38 9 12 21 10th ,, ,, 22 22 44 16 10 26 17th ,, ,, 24 24 48 9 9 18 24th ,, ,, 16 21 37 12 5 17 1st October ,, 22 18 40 15 6 21 3rd Quarter 279 284 563 142 153 295 8th October ,, 20 25 45 7 9 16 15th ,, ,, 21 17 38 11 14 25 22nd ,, ,, 26 21 47 7 16 23 29th ,, ,, 24 32 56 8 11 19 5th November ,, 25 25 5o 9 8 17 12th ,, ,, 25 20 45 7 3 10 19th ,, 24 21 45 5 8 13 26th ,, ,, 16 26 42 4 9 13 3rd December ,, 23 31 54 10 11 21 10th ,, ,, 20 25 45 14 4 18 17th ,, ,, 30 19 49 8 11 19 24th ,, ,, 25 19 44 6 8 14 31st ,, ,, 19 18 37 12 7 19 4th Quarter 298 299 597 108 119 227 Whole Year 1,236 1,188 2,424 526 536 1,062 17 TABLE III. BIRTHS AND DEATHS IN WEST BATTERSEA, 1898. Week ending:- births. deaths. Males. Females. Total. Males. Females. Total. 8th January, 1898 27 42 69 23 16 39 15th „ „ 36 28 64 21 16 37 22nd „ „ 24 29 53 29 22 51 29th „ „ 30 29 59 14 19 33 5th February „ 22 24 46 14 25 39 12th „ „ 29 23 52 25 19 44 19th „ „ 31 26 57 18 14 32 26th „ „ 26 26 52 20 22 42 5th March „ 32 37 69 15 13 28 12th „ „ 29 21 50 19 16 35 19th „ „ 23 19 42 26 20 46 26th „ „ 23 24 47 27 16 43 2nd April „ 42 45 87 21 15 36 1st Quarter 374 373 747 272 233 505 9th April 24 25 49 13 21 34 16th ,, „ 27 23 50 22 18 40 23rd ,, ,, 32 27 59 8 14 22 30th ,, ,, 24 23 47 11 16 27 7th May ,, 34 21 55 16 15 31 14th ,, ,, 31 26 57 14 12 26 21st ,, ,, 22 20 42 14 12 26 28th „ „ 31 23 54 19 11 30 4th June ,, 24 31 55 14 14 28 11th „ ,, 21 21 42 13 17 30 18th „ „ 30 29 59 14 12 26 25th ,, ,, 28 19 47 13 11 24 2nd July „ 29 22 51 11 9 20 2nd Quarter 357 310 667 182 182 364 B 18 Births and Deaths in West Battersea, 1898—continued. Week ending:— BIRTHS DEATHS. Males. Females. Total. Males. Females Total. 9th July, 1898 26 29 55 15 8 23 16th ,, ,, 27 24 51 22 12 34 23rd ,, ,, 25 27 52 17 14 31 30th ,, ,, 28 23 51 12 13 25 6th August ,, 17 21 38 14 23 37 13th ,, ,, 30 30 60 18 23 41 20th ,, ,, 32 24 56 23 21 44 27th ,, ,, 22 29 51 21 15 36 3rd September ,, 32 26 58 19 22 41 10th ,, ,, 22 24 46 19 17 36 17th ,, ,, 29 27 56 22 13 35 24th ,, ,, 24 34 58 20 16 36 1st October ,, 19 25 44 20 14 34 3rd Quarter 333 343 676 242 211 453 8th October ,, 24 26 50 12 17 29 i5th ,, ,, 27 30 57 16 17 33 22nd ,, ,, 28 19 47 16 14 30 29th ,, ,, 30 35 65 14 15 29 5th November ,, 17 21 38 17 9 26 12th ,, „ 28 28 56 15 13 28 19th ,, ,, 24 23 47 9 16 25 26th ,, ,, 24 32 56 14 14 28 3rd December ,, 22 22 44 18 12 30 10th ,, ,, 19 24 43 10 15 25 17th ,, ,, 21 22 43 19 8 27 24th ,, ,, 26 24 50 20 8 28 31st ,, ,, 21 26 47 23 17 40 4th Quarter 311 332 643 203 175 378 Whole Year 1,375 1,358 2,733 899 801 1,700 19 TABLE IV. Quarterly and Annual Summaries of Births and Deaths. battersea. 1898. Births Deaths Deaths Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Fever Diarrhoea Cholera Violence Inquests Public Institutions (including NonParishioners.) Under 1 Year Above 60 Years 1st Quarter E 665 333 107 53 ... 44 4 6 9 ... 2 ... 13 45 ... 2nd Quarter W 747 505 94 159 ... 40 2 8 16 ... 2 ... 16 35 153 E 599 207 77 28 ... 15 ... 2 8 ... 3 ... 13 28 ... 3rd Quarter W 667 364 79 98 ... 18 ... 2 9 ... 2 ... 13 28 110 E 563 295 154 29 ... 1 ... 3 9 ... 69 8 13 24 ... 4th Quarter W 676 453 174 103 ... ... ... 4 11 ... 64 3 20 36 111 E 597 227 76 40 ... ... ... 9 7 1 6 ... 7 27 ... Whole Year W 643 378 79 101 ... 1 ... 11 2 3 6 ... 27 44 121 E 2424 1062 414 150 ... 60 4 20 33 1 80 8 46 124 ... w 2733 1700 426 461 ... 59 2 25 38 7 74 3 76 143 495 Totals 5157 2762 840 611 ... 119 6 45 71 8 154 11 122 267 495 The Births and Deaths during the various quarters in the whole parish are here set out:— Births. Deaths. 1st quarter 1,412 838 2nd ,, 1,266 571 3rd ,, 1,239 748 4th ,, 1,240 605 Totals 5,157 2,762 Table V. contains a valuable and reliable sanitary history of Battersea since 1856, the year in which modern sanitation first came into existence under the provisions of the Metropolis Local Management Act of 1855, and by which sanitary authorities, in the form of Vestries and District Boards, the latter consisting of small parishes grouped together, were first constituted for London as a whole. This parish at that time consisted of a congeries of small villages, between which extended market gardens; the inhabitants 20 and dependents of some few dozens of large houses, the residences chiefly of merchants, with the workers at the market gardens, constituting the principal population. It will be observed that the population was then but 15,069, and at the census of 1861, had but reached the number of 19,582. The birth rate was then a little higher than now. The death rate, however, although the population was very sparse, was much higher than at present. It has been laid down as an axiom that mortality increases in direct proportion to the density of population, and it is the aim of modern sanitation to limit or prevent such increase. That the same parish, of course with the same superficial area, should, with a ten-fold population have a reduced instead of an augmented death rate, shews that the authority having charge of the sanitation, which includes the health condition and duration of lives of the inhabitants, has performed its public duties in an exemplary manner. It will be observed that the year 1898 comes out very favourably by contrast, having the lowest mortality, with four exceptions, of the forty-three years included in Table V. Tables VI., VII., VIII., and IX., with addendum, contain particulars of the mortality respectively of East Battersea, West Battersea, and in the Union Infirmary, giving separately parishioners and non-parishioners, and in the addendum of the other public institutions situated within the parish. These tables have been used from 1856, and are continued for purposes of comparison with former years as well as being the basis upon which all the other mortality tables are founded. 21 table v. comparative statistics of births, mortality, &c. Year. Mean Population for Year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1856 15,069 536 36.2 320 21.2 45 216 1857 15,970 582 36.0 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 292 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.7 669 22.1 129 471 1865 33,688 1,357 40.2 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.8 1,121 23.4 247 975 1870 51,32o 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92, 464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,190 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 151,190 5,237 34.6 2,619 17.3 398 2,618 1892 154,121 4,990 32.3 2,692 17.4 473 2,298 1893 157,052 5,225 33.2 2,801 17.8 564 2,424 1894 159,984 5,024 31.4 2,404 15.4 468 2,620 1895 162,915 5,264 32.3 2,901 17.8 491 2,363 1896 165,847 5,358 32.3 2.941 17.7 608 2,419 1897 168,778 5,266 31.2 2,620 15.5 391 2,646 1898 171,709 5,157 30.0 2,762 16.0 517 2,395 The years marked thus were census years. 22 TABLE VI. STATISTICS OF MORTALITY. EAST BATTERSEA. Population (Census) 1896, 71,730. Estimated mean population tor middle of 1898, 73,792. Total Deaths from each Class of Disease, &c. Sex. Age. Social Position Males. Females. Under 1 year. 1 to 5 years. All under 5. From 5 to 15 years. From 15 to 25 years. From 25 to 65 years. 65 years and upwards. Nobility, Gentry, &c. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Class. I. Zymotic. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 60 27 33 12 47 59 1 ... ... ... ... ... 2 58 Scarlet Fever 4 2 2 ... 3 3 1 ... ... ... ... ... ... 4 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... ... 1 1 Diphtheria 15 7 8 ... 11 11 3 ... ... 1 ... ... 2 13 Membranous Croup 5 3 2 ... 4 4 1 ... ... ... ... ... 1 4 Whooping Cough 33 18 15 17 16 33 ... ... ... ... ... ... 3 30 Erysipelas 4 1 3 1 1 2 ... ... 2 ... ... 1 1 2 Diarrhœa, Dysentery & Cholera 88 44 44 70 16 86 1 ... 1 ... ... ... 8 80 Influenza 23 6 17 4 ... 4 1 2 9 7 ... ... 1 22 Other Zymotic Diseases 1 ... 1 ... 1 1 ... ... ... ... ... ... ... 1 Total of Zymotic Diseases 236 109 127 104 99 203 8 2 15 8 ... 1 20 215 II. Constitutional. Gout and Rheumatism 6 2 4 ... ... ... 2 4 ... ... ... ... 6 Cancer & other Tumours 30 10 20 ... ... ... ... 2 23 5 ... 1 2 27 Other Constitutional Diseases 8 6 2 6 1 7 ... ... 1 ... ... ... ... 8 Tubercular. Phthisis and other Tubercular Diseases 131 77 54 32 12 44 4 2 60 1 ... 1 6 124 III Local. Nervous 62 24 38 18 15 33 2 ... 22 5 ... ... 5 57 Circulatory 54 26 28 1 2 3 5 4 35 7 ... ... 5 49 Respiratory 177 82 95 58 47 105 9 1 53 9 ... ... 10 167 Digestive 55 30 25 31 2 33 1 3 17 1 ... ... 4 51 Urinary 22 17 5 ... 1 1 ... 1 19 1 ... 1 3 18 Generative 7 ... 7 ... ... ... ... ... 7 ... ... ... ... 7 Locomotory 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 Integumentary ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.Developmental. Premature Birth, &c. 144 86 58 143 ... 143 1 ... ... ... ... ... 8 136 Old Age 81 29 52 ... ... ... ... ... 12 69 ... 2 10 69 V. Violence 46 26 20 19 5 24 3 ... 17 2 ... ... 2 44 VI. All other Diseases 2 2 ... 2 2 ... ... ... ... ... ... 2 Totals 1062 526 536 414 184 598 35 40 281 108 ... 6 75 981 23 TABLE VII. STATISTICS OF MORTALITY. WEST BATTERSEA. Population (Census) 1896, 93,385 Estimated mean population including institutions, for middle of 1898, 97,917. Total Deaths from each class of Disease. Sex. Age. Social Position Males. Females. Under 1 year. From 1 to 5 years. Total under 5 years. From 5 to 15 years. From 15 to 25 years. From 25 to 65 years. 65 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes, &c. I. Zymotic. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 47 22 25 7 39 46 1 ... ... ... ... ... 3 44 Scarlet Fever 2 ... ... ... 1 1 1 ... ... ... ... ... ... 2 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 5 3 2 ... ... ... ... ... 3 ... ... ... ... 5 Continued Fever 1 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... ... ... 2 Diphtheria and 25 14 11 ... 13 13 11 1 ... ... ... 2 4 19 Membranous Croup Whooping Cough 35 17 18 15 20 35 ... ... ... ... ... ... 4 31 Erysipelas 8 3 5 3 1 4 ... ... 3 1 ... ... 1 7 Diarrhœa, Dysentery & Cholera 74 42 32 62 8 70 ... 1 1 2 ... ... 7 67 Influenza 49 29 20 3 6 9 ... 3 22 15 ... 1 6 40 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Total of Zymotic Diseases 248 131 117 91 88 179 13 7 31 18 2 3 25 218 I. Constitutional Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism 4 1 3 ... ... ... 1 2 1 ... ... ... ... 4 Cancer & other Tumours 49 14 35 ... ... ... ... ... 37 12 ... 1 10 38 Other Constitutional Diseases 7 3 4 2 ... 2 ... 1 4 ... ... ... ... 7 Tubercular. Phthisis and other Tubercular Diseases 140 83 57 34 17 51 5 17 66 1 ... 2 28 110 III. Local. I Nervous 79 40 39 14 14 28 6 1 37 7 2 1 12 64 Circulatory 57 23 34 ... ... ... 4 3 45 5 ... 1 8 48 Respiratory 150 ... 68 38 35 73 3 2 56 16 1 ... 14 135 Digestive 96 43 53 57 15 72 1 3 16 4 1 1 4 90 Urinary 35 15 20 ... 2 2 1 2 22 8 ... 1 3 31 Generative 8 ... 8 1 ... 1 ... 1 6 ... ... 1 3 4 Locomotory ... ... ... ... ... ... ... ... ... ... ... ... ... ... Integumentary ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.Developmental. Premature Birth, Low Vitality, and Congenital Defects 134 94 40 134 ... 134 ... ... ... ... ... 2 11 121 Old Age 147 57 90 ... ... ... ... ... 13 134 9 4 16 118 V. Violence 45 22 23 19 3 22 1 2 13 7 ... 2 1 42 VI. All other Diseases 6 1 5 ... ... ... 2 ... 3 1 ... ... 1 5 Totals 1205 609 596 390 174 564 37 41 35o 213 15 19 136 1035 24 TABLE VIII. STATISTICS OF MORTALITY. Wandsworth and Clapham Union Infirmary. [Parishioners,] 1898. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position Males. Females. Under 1 year. From 1 to 5 years. All under 5 years. From 5 to 15 years. From 15 to 25 years. From 25 to 65 years. 65 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and T rading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. I. Zymotic. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 1 ... 2 2 ... ... ... ... ... ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... 2 ... ... ... ... ... 2 ... ... ... ... 2 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 1 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Erysipelas 4 1 3 1 ... 1 ... 1 2 ... ... ... ... 4 Diarrhœa, Dysentery & Cholera 2 ... 2 1 ... 1 ... ... ... 1 ... ... ... 2 Influenza 4 2 2 ... ... ... ... ... 2 2 ... ... ... 4 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total of Zymotic Diseases 15 5 10 3 2 5 ... 1 6 3 ... ... ... 15 II. Constitutional. Gout 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer & other Tumours 15 6 9 ... ... ... ... ... 7 8 ... ... ... 15 Other Constitutional Diseases 2 1 1 1 ... 1 ... 1 ... ... ... ... ... 2 T ubercular. Phthisis and other Tubercular Diseases 62 45 17 2 ... 2 ... 3 56 1 ... ... ... 62 III. Local. a _ Nervous 16 10 6 ... ... ... ... ... 16 ... ... ... ... 16 Circulatory 24 14 10 ... ... ... ... 2 17 5 ... ... ... 24 Respiratory 32 24 8 2 2 4 ... 1 21 6 ... ... ... 32 Digestive 8 6 2 6 ... 6 ... 1 1 ... ... ... ... 8 Urinary 10 6 4 ... ... ... ... ... 10 ... ... ... ... 10 Generative 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 Locomotory 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 Integumentary ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.Developmental. Premature Birth, Low Vitality and Congenital Defects 1 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Old Age 43 23 20 ... ... ... ... ... 1 42 ... ... ... 43 V. Violence 7 3 4 ... ... ... ... ... 5 2 ... ... ... 7 VI. All other Diseases 2 2 ... ... ... ... ... ... 1 1 ... ... ... 2 Totals 240 147 93 15 4 19 ... 9 143 69 ... ... ... 240 25 TABLE IX. STATISTICS OF MORTALITY. Wandsworth and Clapham Union Infirmary. [Non-Parishioners,] 1898. Total Deaths from each Class ot Disease, &c., in the Sub-District. Sex. Age. Social Position Males. Females. Under 1 year. From 1 to 5 years. Total under 5 years. From 5 to 15 years. From 15 to 25 years. From 25 to 65 years. 65 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Class. I. Zymotic. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 10 7 3 2 8 10 ... ... ... ... ... ... ... 10 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 2 2 ... 1 1 2 ... ... ... ... ... ... ... 2 Erysipelas 4 1 3 ... ... ... ... ... 2 2 ... ... ... 4 Diarrhœa, Dysentery & Cholera 1 ... 1 1 ... 1 ... ... ... ... ... ... ... 1 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total of Zymotic Diseases 18 10 8 4 9 13 ... ... 3 2 ... ... ... 18 II. Constitutional. Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Cancer & other Tumours 16 8 8 ... ... ... ... ... 10 6 ... ... ... 16 Other Constitutional Diseases 5 3 2 4 ... 4 ...... 1 ... ... ... ... ... 5 Tubercular. Phthisis and Other Tubercular Diseases 42 29 13 1 1 2 ... 2 35 3 ... ... ... 42 III. Local. Nervous 24 14 10 ... ... ... ... 2 17 5 ... ... ... 24 Circulatory 28 12 16 ... ... ... ... 1 17 10 ... ... ... 28 Respiratory 24 12 12 5 6 11 ... ... 9 4 ... ... ... 24 Digestive 7 4 3 4 1 5 ... ... 2 ... ... ... ... 7 Urinary 8 8 ... ... ... ... ... ... 8 ... ... ... ... 8 Generative ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locomotory ... ... ... ... ... ... ... ... ... ... ... ... ... ... Integumentary ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.Developmental. Premature Birth, Low Vitality, Congenital Defects 3 ... 3 3 ... 3 ... ... ... ... ... ... ... 3 Old Age 46 18 28 ... ... ... ... ... 2 44 ... ... ... 46 V. Violence 8 7 1 ... ... ... ... ... 6 2 ... ... ... 8 VI. All other Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 230 126 104 21 17 38 ... 6 110 76 ... ... 230 26 Particulars of deaths in Public Institutions within the Parish other than the Wandsworth and Clapham Union Infirmary. Parishioners. Bolingbroke Hospital Female 8 7/12 years Accident—burns. ,, ,, Female 66 years Accident—burns ,, „ Male 55 years Heart disease ,, ,, Male 59 years Accident— fracture of skull ,, ,, Male 45 years Accident—burns ,, „ Male 64 years Accident—run over ,, ,, Male 55 years Psoas abscess ,, ,, Male 1 3/12 years Accident—scalds „ „ Male 45 years Suicide—cutthroat ,, „ Male 2 years Accident—burns ,, ,, Male 52 years Digestive „ ,, Male 6½ years Accident—burns Non-Parishioners Bolingbroke Hospital Female 7 8/12 years Accident—burns ,, ,, Male 36 years Accident—run over ,, „ Male 42 years Cancer ,, Male 17 years Congenital Hernia Peritonitis ,, ,, Male 50 years Open verdict— poisoned „ ,, Female 43 years Digestive ,, ,, Male 3 years Accident—run over ,, ,, Male 30 years Tuberculosis ,, ,, Female 45 years Suicide— fracture of skull „ „ Female 59 years Cancer „ ,, Male 30 years Accident—fall ,, ,, Female 72 years Cancer ,, „ Female 92 years Accident—burns 27 Of the deaths under one year, two hundred and eighty-two were from premature birth, malformation, or low vitality at birth, a little more than one-third of the total number of deaths recorded at that age. All deaths under five years, the infantile period of life, were equal to forty-four per cent. of the total deaths. This is an improvement even upon that which has been maintained during recent years; formerly sixty per cent. of the total deaths were under five years of age, showing an immense saving of infantile life, which can only be ascribed to the improved sanitation which has prevailed in this parish for many years. At the other extreme of life, three hundred and ninety-three persons died above sixty-five years of age, including the deaths of aged parishioners in the Union Infirmary, where the deaths of seventy-six aged non-parishioners also took place. In public institutions, &c., outside the parish thirty Battersea people died above sixty-five years, making a total of four hundred and twenty-three parishioners dying at this advanced age. Table B. This, the second table prescribed by the Local Government Board, contains particulars of the population, births, notifications of infectious disease in the several localities and various public institutions (themselves treated as separate localities), situated within the parish, and the cases of infectious disease removed from their homes in these several localities for treatment in the Metropolitan Asylums Board isolation hospitals. The cases of erysipelas are mostly removed to the Infirmary of the Wandsworth and Clapham Union, situated on St. John's Hill, within the parish, as also cases of puerperal fever, other hospitals not providing accommodation for these two diseases. It will be observed that the several localities and institutions have populations assigned to them. The out-door districts of East and West Battersea have populations based upon the ascertained increase of population during the last inter-censal period, while the institutions have the census populations of 1896 given. Table B of Population, Births, and of New Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health, during the Year 1898 in the Metropolitan Sanitary District of Battersea, Classified according to Diseases, Ages and Localities. Names of localities adopted for the purpose of these statistics. Public Institutions being shown as separate localities. Population at all ages. Registered Births. Aged under 5 or over 5. New cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their homes in the several localities for treatment in Isolation Hospital. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Small Pox. Scarlatina. Diphtheria. Membranous Croup. FEVERS. Cholera. Erysipelas. Small Pox. Scarlatina. Diphtheria. Membranous Croup. FEVERS. Cholera. Erysipelas. Last Census. 1896. Estimated to middle of 1898. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. East Battersea 71,730 73,792 2,424 Under 5 ... 86 133 8 ... 3 ... ... ... ... 10 ... 65 92 4 ... 2 ... ... ... ... 2 5 upwards 2 206 308 5 1 39 ... ... 4 ... 103 1 156 215 3 ... 30 ... ... 1 ... 13 West Battersea 91,928 96,460 2,733 Under 5 ... 139 108 4 ... ... ... ... ... ... 10 ... 108 71 ... ... ... ... ... ... ... ... 5 upwards 2 370 223 ... ... 51 ... ... 6 ... 51 ... 285 94 ... ... 26 ... ... 2 ... 7 Wandsworth and Clapham Union Infirmary 708 708 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... Bolingbroke Hospital 39 39 ... Under 5 5 upwards Westminster Union Schools 183 183 ... Under 5 5 upwards 3 2 3 2 Masonic School, Battersea Rise 316 316 ... Under 5 5 upwards 2 1 2 1 Emanuel School, Wandsworth Common 211 211 ... Under 5 5 upwards 3 3 Totals 165,115 171,709 5,157 Under 5 225 241 12 3 20 173 163 4 2 2 5 upwards 4 584 533 5 1 91 10 ... 158 1 449 311 3 57 3 20 29 TABLE X. Infectious Sickness and Mortality, 1898. No. of Cases notified. No. ot cases removed to Hospital. Deaths at home. Deaths at Hospital. Total Deaths. Small Pox 4 1 ... ... ... Scarlatina 809 622 6 22 28 Diphtheria and Membranous Croup 791 481 45 75 120 Typhus Fever 1 ... ... ... ... Enteric and Continued Fevers 94 59 7 8 15 Relapsing Fever ... ... ... ... ... Puerperal Fever 10 3 4 2 6 Cholera ... ... ... ... ... Erysipelas 178 22 12 6 18 totals. 1887 1188 74 113 187 This Table takes the place of Tables X and XI in former reports, and shows plainly any difference in results between home and hospital treatment. It must not be forgotten that the more severe and necessitous cases find their way to the hospitals, which are principally those of the Metropolitan Asylums Board, with the exception of Puerperal Fever and Erysipelas, for which diseases no provision is made by that Authority, and cases of those diseases have to be sent to the Union Infirmary. 30 TABLE XI. Below will be found a synopsis of the notifications received during the year, with removals to hospital:— Notified. Removed to Hospital. Small Pox 4 1 Scarlatina 809 622 Diphtheria and Membranous Croup 791 481 Typhus Fever 1 ... Enteric and Continued Fever 94 59 Relapsing Fever ... ... Puerperal Fever 10 3 Cholera ... ... Erysipelas 178 22 1887 1188 Ages:— Under 5 years 501 344 5 years and upwards 1386 844 1887 1188 Where occurring:— East Battersea 908 584 West Battersea 964 593 Union Infirmary 4 ... Westminster Schools 5 5 Masonic School 3 3 Emanuel School 3 3 1887 1188 31 TABLE XII. Particulars of the Prevalence of Notifiable Infectious Disease in the several Sanitary Districts. Sanitary Districts. Cases NotifiedContinued Fever Relapsing Fever . Cases Removed to Hospital. Small Pox Scarlatina Diphtheria and Membranous Croup Typhus Fever Enteric Fever Puerperal Fever Cholera Erysipelas Totals Small Pox Scarlatina Diphtheria and Membranous Croup Typhus Fever Enteric Fever Continued Fever Relapsing Fever Puerperal Fever Cholera Erysipelas Totals No. 1 1 69 131 ... 14 ... ... 1 ... 34 250 1 61 73 ... 13 ... ... 1 ... 2 151 „ 2 1 123 234 1 16 ... ... 1 ... 39 415 ... 82 156 ... 10 ... ... ... ... 4 252 „ 3 ... 132 141 ... 12 ... ... 2 ... 29 316 ... 94 79 ... 7 ... ... 2 ... 5 187 „ 4 1 130 55 ... 12 ... ... 1 ... 21 220 ... 111 40 ... 9 ... ... ... ... 3 163 „ 5 ... 74 55 ... 11 ... ... 2 ... 24 166 ... 57 42 ... 9 ... ... ... ... 4 112 „ 6 1 175 82 ... 10 ... ... 1 ... 15 284 ... 127 54 ... 6 ... ... ... ... 4 191 „ 7 ... 55 42 ... 14 ... ... ... ... 8 119 ... 32 21 ... 5 ... ... ... ... ... 58 „ 8 ... 51 51 ... 5 ... ... 2 ... 8 117 ... 58 16 ... ... ... ... ... ... ... 74 Whole Parish 4 809 791 1 94 ... ... 10 ... 178 1887 1 622 481 ... 59 ... ... 3 ... 22 1188 32 Table XII. is a table shewing the incidence of notifiable disease in the different sanitary districts, and, taking into consideration the numerical differences of population, the numbers are more equal than may appear at first sight. Small-Pox. Four notifications of this disease were received during 1898. Three of these were not true cases of Small-Pox. The only true case of Small-Pox which occurred in the parish, was in the person of a man who had been working at the erection of a temporary Small-Pox hospital at Middlesboro', where an epidemic of the disease had broken out. The patient was at once removed to hospital, and the necessary disinfection performed, with the result of no second case occuring. In June notices were received from the Port Medical Officer of Southampton that two persons were proceeding to this parish from Cape Town, passengers by s.s. Briton, on which cases of Small-Pox had occurred. They were kept under close observation and did not contract the disease. As there have been complaints that persons suffering from infectious diseases have been conveyed in public conveyances, the following notice has been issued to those concerned, such as cabmen and conductors of tram cars and omnibuses. The Vestry of the Parish of St. Mary, Battersea.—Notice to owners of public conveyances, drivers, &c.—The Vestry of the Parish of St. Mary, Battersea, desire to draw the attention of the public to sec. 70, of the Public Health (London) Act, 1891, which enacts that it shall not be lawful for any owner or driver of a public conveyance knowingly to convey, or for any other person knowingly to place in any public conveyance a person suffering from any dangerous infectious disease, or for a person suffering from any such disease to enter any public conveyance, and if he does 33 so he shall be liable to a fine not exceeding £10; and if any person so suffering is conveyed in any public conveyance, the owner or driver thereof as soon as it comes to his knowledge shall give notice to the Sanitary Authority, and shall cause such conveyance to be disinfected, and if he fails to do so he shall be liable to a fine not exceeding £5, and the owner or driver of such conveyance shall be entitled to recover in a summary manner from the person so conveyed by him or from the person causing that person to be so conveyed a sum sufficient to cover any loss and expense incurred by him in connection with such disinfection. A chamber has been provided at the Vestry's Depot, Culvert Road, where conveyances can be disinfected free of charge. The Metropolitan Asylums Board will remove in one of their ambulances any person suffering from infectious disease to places other than the Board's hospitals upon application and payment of the sum of five shillings. In the case of inability to pay such sum application should be made to the Public Health Department of the Vestry, by whom such removal will be effected. Chicken-Pox. Judging from the number of notices received from Head Teachers of Schools, this disease appeared to be very prevalent during the month of June. In every case enquiries were made at the houses as to whether the patients were under medical attendance, lest the cases should be those of unrecognised Small-Pox. The largest number of notices received was from No. 1 District, and suggests that the outbreak was more prevalent in that locality. Scarlet Fever. Eight hundred and nine notifications of this disease were received, and six hundred and twenty-two of the less effectively isolated cases removed c 34 to hospitals of the Metropolitan Asylum Board, and to the London Fever Hospital, &c., leaving one hundred and eighty-seven which were treated at home. The deaths in hospital, to which the worst type of cases is generally removed, were twenty-two or just 3.5 per cent. of cases, while of the cases treated at home, the majority of which were of a very slight nature, involving perhaps only scarlatinal sore throat, 3.2 per cent. died. One thing is certain, that the generally improved sanitary conditions, including early removal of cases which could not be effectively isolated, have reduced the mortality of this disease to a remarkable extent. Diphtheria and Membranous Croup. Seven hundred and ninety-one cases of this disease were notified during the year, four hundred and eighty-one were removed to hospital, the remainder, three hundred and ten remained at home. Of the cases removed to hospital, seventy-five died, giving a hospital mortality of 15 per cent., the worst and most urgent cases being removed thereto. Of the cases remaining at home, forty-five died, being at the rate of 14 per cent. Some of these cases were of a doubtful nature, being probably cases of ordinary sore throat. A glance at Table XIII will show the number of fatal cases of Diphtheria at home during the last eleven years. They were in 1888, twenty-two; 1889, twenty-one; 1890, twenty-seven; 1891, thirty-five; 1892, twenty-eight; 1893 ninety; 1894, sixty-seven; 1895, sixty; 1896, fifty; 1897, fifty-two; and in 1898, forty-five or just half the mortality from this disease in 1893. In the report for 1897 I observed "This disease appears to have become endemic in London. It has a tendency to shift from locality to locality," and in consequence of the incidence of a number of cases in No. 2 Sanitary district, I was directed to report thereon, and subsequently upon the undue incidence of this disease in districts No. 4 and 6. 35 In order that the prevalence of Diphtheria in Battersea may he seen, I have here added a table of the notifications of this disease yearly from 1890, the first complete year when notification became obligatory. These numbers include Membranous croup from which Diphtheria is undistinguishable clinically. Year. No. cases notified. 1890 349 1891 260 1892 366 1893 682 1894 504 1895 411 1896 426 1897 614 1898 791 As the sanitary districts have been altered in number and area several times during these years, I am unable to locate the disease for these years in districts. The summer and autumn of 1898 were very hot and dry, there being practically no rainfall for many weeks. During this period an excessive incidence of diphtheria in No. 2 sanitary district occurred. In my report I stated that diphtheria could be spread in many ways, by direct personal infection at school or elsewhere, by sewer gas, by water, milk or other food. There were at this time, numerous complaints of offensive effluvia from the sewers, by the gullies, surface ventilators, &c. The Schools were closed for most of the period, and the milk supply was so varied that it was clearly not the cause of the outbreak. A very detailed examination of the sewers convinced me that to their condition must the outbreak be in great measure ascribed. The Surveyor reported fully on the subjects, showing numerous defects in the sewers, gullies, ventilators, &c., and the Chief Sanitary Inspector made a detailed report to the same effect. 36 The Health Committee and the Vestry adopted this view, and works to amend the defects were ordered, many of which have been carried out at the time of writing. Subsequently an outbreak was found to exist in No. 4 and 6 sanitary districts, the latter especially. It was found that most of the cases were attending the infant's department of the Plough Road School, and further investigations showed that a child suffering from diphtheritic sore throat had been attending school, without the true nature of her illness being suspected, and it was not until other cases occurred in her family and in the same house that she was medically examined, and found to have just recovered from diphtheria. I examined the school, and found that the whole of the children from the different class rooms assembled together in the main hall, and therefore recommended the Vestry to close the whole of the infants' department for three weeks; an order was made to that effect, and the schools closed and disinfected, with the result that there has been no recurrence of the disease. Another cause of diphtheria infection is the return of children from hospital still in an infectious condition, generally in my opinion, from the nasal cavities still containing the bacillus causing the disease. A case occurred in Henley Street, where a child was prematurely returned, subsequently six persons were attacked and sent to hospital from the same house, together with the original patient, for treatment. On June 14th the Committee had under consideration a report to the effect that a child whilst suffering from diphtheria had been taken to St. George's Hospital in a perambulator, thereby contravening Section 68 of the Public Health (London) Act, 1891. It was alleged that the parents had acted under the advice of one of the Medical Staff at the Hospital. A letter was directed to be sent requesting that the hospital authorities would exercise care in seeing that a proper ambulance was in future provided. 37 On one occasion only during the year has any difficulty been experienced in obtaining hospital accommodation for cases of this disease. This was on the 20th October, and was quite temporary. To meet such contingencies the Metropolitan Asylums Board have now made arrangement that when hospitals are full and cases unable to obtain admission and require treatment with Anti-toxic Serum, a supply of the Serum may be obtained at the Health Department of the Local Authorities, the Authorities' supply being obtained upon presentation of the necessary warrants at the Examination Hall of the Royal College of Physicians and Surgeons, Victoria Embankment. The forms for obtaining a supply of Anti-toxin by the Vestry's Medical Officer, and from him by the Medical Practitioner are appended. It has not been necessary to obtain a supply, as all cases have been speedily removed to hospital. METROPOLITAN ASYLUMS BOARD. To the Director of Laboratories, Royal College of Physicians and Surgeons, Examination Hall (near Waterloo Bridge), Victoria Embankment, S. W. 189 Dear Sir, Please let me have by bearer doses of Anti-Toxin -—of 4,000 units each—for distribution amongst those Medical Practitioners in my district who may have diphtheria patients awaiting admission into the Hospitals of the Metropolitan Asylums Board. Please also let me have warrant forms for such Medical Practitioners to sign. Yours faithfully, Medical Officer of Health, Parish or District Board. 38 METROPOLITAN ASYLUMS BOARD. Warrant for Anti-Toxic Serum. In Exchange for this Warrant and the subjoined Certificate, the Bearer is entitled to receive one bottle of Anti-toxic Serum, for use in the treatment of the Patient named in the said Certificate, who cannot be immediately received into one of the Board's Hospitals. (By Order) T. Duncombe Mann, Clerk to the Board. Certificate of Medical Practitioner. To the Medical Officer of Health for (on behalf of the Metropolitan Asylums Board.) I hereby certify that I require one bottle of Anti-toxic Serum for use in the treatment of a Patient under my care residing at , who is suffering from Diphtheria, and who cannot immediately be received into one of the Hospitals of the Board. I undertake to use the Serum so supplied to me exclusively for the treatment of the above-mentioned case, and for none other and I further undertake to return forthwith the Serum should the Patient (or responsible relations) object to its use. (Signed) Name and Address of Medical Practitioner. Dated 189 39 Enteric and other Fevers. Ninety-four cases of Enteric Fever were notified during the year in addition to one of Typhus and and ten of Puerperal Fever. Of the Enteric cases fifty-nine were removed to hospital with a mortality of eight equal to thirteen per cent. Of the thirty-five cases treated at home, seven died equal to a mortality of twenty per cent. The difference in favour of hospital treatment lies in the fact that the diet is strictly regulated there, many deaths arising at home from injudicious feeding with solids before the bowels are fitted for their reception, ulceration of the bowels being usual in this disease. Last year in consequence of the prevalence of Enteric or Typhoid Fever in the Metropolis and in this parish I prepared a special report shewing the action taken upon the notification of Typhoid Fever. Upon the receipt of such notification a disinfector is immediately despatched to the infected premises with a supply of disinfectants and apparatus tor flushing of house drains. The District Sanitary Inspector visits the premises and ascertains whether sufficient means of isolation are provided, and if n-ecessary adopts measures for the removal of the patient to hospital, makes investigations as to whether patient has in any way subjected himself to infection, examines and tests drains and sanitary appliances, inspects the cistern and water fittings, and makes enquiries as to the source of milk supply, and as to schools attended by children in the house or places and nature of employment of adults. Notices of the case are immediately forwarded to the headmasters of the schools attended. Disinfection of the bedding and premises is carried out after the removal of the patient or at the termination of the case. 40 During the last five years there has been a steady decrease in the number of cases of Enteric fever in the parish, as the following will shew:— 1898 94 1897 95 1896 110 1895 135 1894 153 Typhus. There was but one case of this disease during the year, the patient, a nurse, had been in attendance upon several cases of sickness at Wellingborough. The case recovered. Erysipelas. For some reason this disease has increased during the last few years in the Metropolis. During 1898 one hundred and seventy-eight cases were notified, of these twentytwo were removed to hospital, of whom six died. Of the one hundred and fifty-six remaining at home twelve died. Those removed were admitted into the Wandsworth and Clapham Union Infirmary in the majority of instances. The term Erysipelas covers so many degrees and forms of inflammatory affections, that no further discussion of the subject would be profitable. Diarrhœa. One hundred and sixty-five fatal cases were registered from this cause alone, the majority being hand-fed infants. To reduce this mortality the Health Committee has for some years issued the following handbill during the hotter months, when disorders of the digestive tract are most prevalent. It is hoped that much good has been done and many lives saved by this means, as a notable diminution in the number of fatal cases has always been manifest after its issue. No case was notified as Asiatic Cholera. 41 PRECAUTIONS AS TO DIARRHŒA. In consequence of the prevalence of Diarrhoea amongst young children, more especially those brought up by hand, the Vestry as the Sanitary Authority acting under the advice of their Medical Officer of Health, beg to direct the attention of Parents and others having care of young children to the great advisability of boiling all water and milk used for feeding such children. Care should be taken as to the sound condition of every article of food for children, anything not fresh being withheld. Fruit especially should not be given if in the slightest degree decomposed. Cleanliness of person and dwellings with frequent flushing of house drains is of the greatest value. Disinfectants in case of illness are supplied free of charge on application to the Public Health Department, Town Hall Road, between the hours of 9 a.m. and 5 p.m., and on Saturdays, between 9 a.m. and 1 p.m. Measles and Whooping Cough. The number of cases which occurred during 1898 cannot be ascertained, as these, the most fatal of all zymotic diseases, still remain non-notifiable. I reported relative to the prevalence of Measles, and the number of fatal cases becoming grave I was directed to re-issue a bill giving the public instructions asto the necessary precautionsto beobserved during an epidemic of this disease, and they are here appended. One hundred and nineteen fatal cases of Measles were recorded during the year, the number during 1894 having been one hundred and fifty-one, during 1895 ninety-nine, in 1896 one hundred and eighty-five, and in 1897, seventy-six. At a Meeting of the Health Committee in April, a letter was considered from the London County Council, enclosing copy of a communication from the London School Board, asking the Council 42 to include Measles in the term "dangerous and infectious diseases" and enquiring whether the Vestry would be in favour of the extension to Measles of the provisions contained in section 68 of the Public Health (London) Act 1891, which was agreed to by the Committee and reported to the Vestry. PRECAUTIONS TO BE OBSERVED DURING THE EPIDEMIC OF MEASLES. The Vestry, as the Sanitary Authority for the Parish, and as advised by the Medical Officer of Health, desire to direct the attention of parents and others to the importance of checking the spread of Measles, which is now prevalent in an epidemic form and is causing much mortality by complications, such as Bronchitis and Pneumonia. All children suffering from Measles, even in the earliest stage, before the eruption appears, should be isolated from others. The first symptoms of Measles are running at the eyes and nose, with repeated sneezing and a puffy appearance of the face and eyelids and, a few days after, the appearance of the rash which is raised and red or purplish in colour. The child should be kept in bed from the first appearance of the symptoms until the rash has finally disappeared, in order to avoid the danger of lung complications, which are the real causes of death, uncomplicated measles not being usually fatal. Medical aid should be sought in every case where difficulty of breathing is observed. Disinfectants in a dilute form should be freely used in every case of measles in a warm bath at the onset and termination of the disease, and to sponge the face and other parts during the illness. 43 In case of inability to obtain suitable disinfectants the same will be supplied, free of charge, on application to the Public Health Department, Town Hall Road, Lavender Hill. The epidemic of measles was accompanied and followed as usual by deaths from various respiratory disorders. From Whooping Cough seventy-one deaths were registered, a large majority complicated by Measles. Thus from the two diseases combined one hundred and ninety deaths occurred, comparing unfavourably with a total of one hundred and eighty-seven deaths from all the notifiable zymotic diseases an unanswerable argument in favour of the compulsory notification of all infectious diseases, they, in the prenotification period, being said to be equally intractable to supervision and modification, an idea which the present greatly diminished case mortality demonstrates to be incorrect. Influenza. This disease assumed grave proportions during the earlier months of 1898, an immense number of people being prostrated by it. Seventy-six persons were certified as having died directly from influenza, but there can be no doubt that the enormous number of deaths from diseases of the respiratory organs was largely due to influenza, as also affections of the brain, nerves, digestive organs &c., there being no organ or part of the body exempt from its influence and probably many cases of suicide without any adequate motive, have been committed under temporary brain stress, brought about by this disease. When the disease has been unusually prevalent, the Health Committee has issued the following PRECAUTIONS AGAINST INFLUENZA. / The Vestry of the Parish of St. Mary, Battersea, as the Sanitary Authority and as advised by the Medical Officer of Health, in consequence of the renewed prevalence of Influenza, 44 desire to direct the attention of the public to the extremely infectious character of the disease, and to point out that to the exposure of those in an infective condition from Influenza, by neglect to isolate themselves during the period of such infective condition, the spread and maintenance of the disease is chiefly due. It is probable that the breath of those so affected is the principal medium by which infection is conveyed. The early symptoms of Influenza are chiefly chills and shivering, accompanied by great muscular weakness and prostration, often amounting to inability to stand or move, with pains in the spine or other parts of the body. It is desirable that persons thus affected should at once go to bed and there remain until convalescence is established in order to avoid the dangers of Pneumonia or Bronchitis, which are the chief complications to be feared, as likely to lead to fatal results. Early recourse to medical assistance is desirable in every case, both for the determination of the real nature of the disease and for the prevention of the more serious complications. A most important memorandum was issued in 1895 by the Medical Officer of the Local Government Board, and was produced as the result of questions in Parliament, addressed to Ministers, on the subject of a very fatal outbreak at the end of 1894 and beginning of 1895, and is here set out. Influenza became epidemic in England in the winter of 1889-90; it recurred in epidemic form in the spring of 1891, and was maintained up to June of that year; a third epidemic took place in the winter of 1891-92, and after a minor recrudescence in the spring of 1893, a fifth prevalence on a wide scale took place in the winter of 1893-94. England is now passing through a sixth epidemic period. Two detailed reports have been issued by the Board on the subject. The first was Dr. Parsons, "On the Influenza Epidemic of 1889-90," with an introduction by Sir 45 George Buchanan, M.D., F.R.S., the Board's Medical Officer at that date. The second was a "Further Report on Epidemic Influenza, 1889-92," by Dr. Parsons, with papers on the Clinical and Pathological aspects of the Disease, by Dr. Klein, F.R.S., and an introduction by Sir R. Thorne Thorne. A "Provisional Memorandum upon Precautions advisable at times when Epidemic Influenza threatens, or is prevalent," was also drawn up in January, 1892, and was issued by the Board to local sanitary authorities. The further study made by the Medical Department as to the natural history of Influenza, and as to its clinical and bacteriological characteristics, goes to show that it is a disease against which it is most difficult to apply measures of prevention with any substantial prospect of success. Influenza is highly infective from person to person; its infectious quality is often manifested before the disease is fully recognised ; its incubation period is one of the shortest of all infectious diseases; it varies so much in intensity that many cases are never diagnosed at all; one attack confers no marked immunity against another; and the infection is largely eliminated by means of the lungs, the sputa of the sick being invariably charged, during the acute stage of the disease, with its pathognomonic micro-organism. The disease calls primarily for measures of isolation and of disinfection, but there are difficulties in making any such measures universally applicable. Wherever they can be carried out, the following precautions should, however, be adopted:— 1st. The sick should be separated from the healthy. This is especially important in the case of first attacks in a locality or a household. 46 2nd. The sputa of the sick should, especially in the acute stage of the disease, be received into vessels containing disinfectants. Infected articles and rooms should be cleansed and disinfected. 3rd. When Influenza threatens, unnecessary assemblage of persons should be avoided. 4th. Buildings and rooms in which many people necessarily congregate should be efficiently aerated and cleansed during the intervals of occupation. It should be borne in mind that the liability to contract Influenza, and also the danger of an attack, if contracted, are increased by depressing conditions, such as exposure to cold, and to fatigue whether mental or physical. Attention should hence be paid at epidemic periods to all measures tending to the maintenance of health, such as the use of clothing of suitable warmth, and a sufficiency of wholesome food. Persons who are attacked by Influenza should at once seek rest, warmth, and medical treatment, and they should bear in mind that the risk of relapse, with dangerous complications, constitutes a chief danger of the disease. It will be perceived that the contents of the above memorandum are in accord with the precautions issued by this parish early in 1894, and now re-issued for the guidance of the public. Infectious Disease at Cowsheds, Dairies, &c. In the event of an outbreak of infectious disease occurring at the premises of a milk-purveyor or dairyman, the London County Council who undertake the registration of such premises are at once communicated with: all milk upon the premises is destroyed, and business is suspended 47 until disinfection of the premises and all trade utensils has been carried out, and a certificate thereof granted by the Medical Officer of Health, after the termination of the case or the removal of the patient to hospital. With a view to uniformity throughout the Metropolis, the London County Council has adopted a form of certificate authorising the resumption of the sale of milk, a copy of which is appended and is now in general use for that purpose. In the Administrative County of London. In the matter of the Dairies, Cowsheds and Milkshops Orders ot 1885 and 1886, and in the matter of The Regulations thereunder of the London County Council, being the Local Authority for the Administrative County of London. I, the undersigned, being the Medical Officer of Health of the undermentioned District, in pursuance of No. 29 of the aforesaid Regulations, do hereby declare that the building or premises known as in the said District, in which building or premises an outbreak of infectious or contagious disease to wit occurred on or about the day of 189 , and in which building or premises milk is purveyed or sold by one have been disinfected, and that the said building or premises are in my opinion free from infection. As witness my hand this day of 189 . Medical Officer of Health of the District of Battersea, in the Administrative County of London. 48 Closing of Public Elementary Schools. A memorandum, prepared in the Medical Department of the Local Government Board on the circumstances under which the closing of Public Elementary Schools or the exclusion therefrom of particular children may be required in order to prevent the spread of disease was issued in July, 1897. This gives information derived from the reports of the Board's own Medical Inspectors, and of local Medical Officers of Health, respecting school closure and exclusion from schools as precautions against infection, with a view to indicating the best means of preventing the spread of disease by school children, while avoiding any unnecessary interruption of the work of education. The regulations of the Education Department (Art. 88) prescribe, as one of the general conditions required to be fulfilled by a Public Elementary School in order to obtain the grant, that the managers must at once comply with any notice of the Sanitary Authority, acting on the advice of the Medical Officer of Health, requiring them for a specified time, with a view to preventing the spread of disease, or any danger to health likely to arise from the condition of the school, either to close the school, or to exclude any scholars from attendance, but provides for their appeal to the Department, after complying, if they consider the notice unreasonable. It has subsequently been found necessary to make use of this provision for the closing of the Infants' department of the Plough Road school. It has generally been found so far sufficient to exclude scholars from infected houses from attendance for that purpose, daily returns being forwarded to the Head Masters of Schools notifying the existence of infectious disease at the residences of scholars attending such schools. Table XIII. illustrates the epidemic or zymotic mortality for the past eleven years with the resulting death rates. The 49 number of deaths from each class of disease is shewn. The zymotic death rate for 1898 was 3.0 per thousand persons. TABLE XIII. Comparative Table of Zymoiic Mortality during the past II years. 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Small Pox ... ... ... ... ... ... ... ... ... ... ... Measles 87 104 159 37 90 90 151 99 185 76 119 Scarlet Fever 25 12 10 10 15 17 5 10 5 7 6 Diphtheria 22 21 27 35 28 90 67 60 5° 52 45 Enteric, &c., Fevers 13 15 21 19 8 14 13 15 11 8 8 Whooping Cough 119 81 146 104 100 115 77 52 137 82 71 Epidemic Diarrhœa 75 112 121 104 99 120 93 151 169 141 154 Other Zymotic Diseases 22 21 59 89 133 118 62 104 45 25 114 Total Deaths from Zymotic Diseases 363 366 543 398 473 564 468 491 602 391 517 Zymotic Death Rate 2.6 2.5 3.6 2.6 3.0 3.5 2.8 2.9 3.6 2.3 3.0 Death-rates from all Diseases 15.7 15.6 19.3 17.3 17.4 17.8 15.4 17.8 17.7 15.5 16.0 TABLE XIV. Comparative Table of all non-zymotic causes of Deaths during the past 11 years. 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Tubercular, including Phthisis 342 334 320 285 237 355 304 353 374 355 376 Of Brain, Nerves, &c. 223 212 261 195 259 213 211 334 211 241 181 Of the Heart, &c. Of the Respiratory 113 108 148 141 183 159 173 213 182 189 164 gans,excluding Phthisis 474 391 618 572 635 653 471 623 531 439 383 Of Digestive Organs 113 100 118 122 112 127 197 114 154 202 168 Of Urinary Organs 24 39 34 49 72 60 57 56 88 69 75 Of Organs of Generation 6 14 15 16 15 14 12 7 22 14 16 Of Joints, Bones, &c. 9 3 4 7 2 3 6 — 5 6 2 Premature Birth, Low Vitality, Malformation, &c. 175 205 206 238 256 295 273 332 298 286 288 Of Uncertain Seat Cancer, Syphilis, Dropsy, &c. 79 96 70 89 233 130 114 108 122 141 131 Age 57 52 71 74 122 103 118 128 207 150 317 Violence 56 60 77 60 81 102 70 102 117 118 122 Constitutional ... ... ... 2 12 23 20 40 28 19 22 Total 1671 1614 1942 1850 2219 2237 2026 2410 2339 2229 2245 D 50 Non-Zymotic Diseases. It will be seen by Table XIV that, considering the great increase of population during the eleven years included in the table, the Non-Zymotic deaths have not increased in proportion to the number of residents, but have diminished, in almost the same proportion as the Zymotic deaths. On former reports this has been attributed to the fact that improved sanitation reduces the death rate of both classes of disease, and consequently suggesting that many of the so called non-zymotic diseases will in time be transferred to the zymotic class. A notable example of this tendency is to be found in the case of Tuberculosis, also known as consumption of the lungs, water on the brain, tabes or consumption of the bowels, scrofula, &c. This disease is without doubt communicable under certain circumstances, probably to persons predisposed constitutionally to contract the disease. Public attention has been much directed to this aspect of the question of late and large meetings have been held on the subject, by which the attention of those having control of the public health has been aroused, and in many of the districts of the Metropolis and elsewhere the local authority has issued handbills, giving the public information as to the precautions to be observed against this disease. Such handbill has been drawn up by me, and adopted by the Health Committee and the Vestry, and is here appended. PRECAUTIONS TO BE OBSERVED against TUBERCULOSIS OR CONSUMPTION. The Vestry, as the Sanitary Authority for the Parish, and as advised by the Medical Officer of Health, desire to direct attention to the importance of adopting measures to prevent the spread of Tuberculosis, which is also known as consumption of the lungs or bowels and also as water on the brain, scrofula, &c. 51 The disease is caused by a special germ or microbe which may be taken into the system in several ways. Amongst others it is generally contracted in otherwise healthy persons by inhalation of the dust containing the germ or microbe of the disease derived from the dried expectoration or phlegm of persons suffering from consumption. All persons suffering from consumption should expectorate either into the fire or a vessel containing disinfectants such as carbolic acid or into rags or paper which should be afterwards burned. They should especially abstain from expectorating phlegm or spitting on the floors of houses or vehicles or in public places. The disease may also be contracted by partaking of meat or milk of tubercular animals especially of the cow, therefore all meat should be properly cooked and all milk, including condensed milk, boiled before being given to children in every instance. Milk so treated is as nourishing and palatable as new milk, and it need only be brought to the boiling point for a minute, prolonged boiling being unnecessary. A further mode of contracting the disease is by sleeping in a room which is or has been inhabited by a person suffering from consumption. Therefore if possible all persons suffering from this disease should have a separate bedroom, the windows of which should be kept open as long as possible daily. After the death or removal of a person suffering from consumption the room should be disinfected, the wall paper stripped and the ceilings whitewashed. Disinfection will be performed in such cases by the Vestry's staff, free of charge, upon application at the Public Health Department, Municipal Buildings, Town Hall Road, where disinfectants will also be supplied to the poor, without charge, in cases where the same cannot otherwise be obtained. 52 Social Position of Persons Dying During 1898. N umber. Per Cent. Nobility and Gentry 15 0.5 Professional Class 25 0.9 Middle and Trading Class 211 7.6 Industrial and Labouring Class 2,486 91.0 2.737 100.0 Steam Disinfection. On several occasions during the last few years the Health Committee has considered as to the advisability of carrying out steam disinfection without the intervention of a contractor. In November, 1895, a letter was received from the Metropolitan Asylums Board, recommending that Sanitary Authorities provide their own steam disinfectors, and have the work carried out by their own officials. The subject was at that time adjourned for three months, when the Committee recommended the renewal of the contract. In July, 1897, the Committee again considered the matter and a Sub-Committee was appointed, who visited several of the Metropolitan Disinfecting stations, but decided to again adjourn the matter until it could be ascertained what steam would be permanently available for the purpose of a steam disinfector, either in connection with the Electric Lighting Works at the rear of the Town Hall or elsewhere. During the year the Vestry has again renewed the contract with Mr. W. G. Lacy to carry out this work. Inquests. During the year 1898, 333 deaths were referred to the Coroner. In sixty-six instances he decided that no further inquiry was necessary, and they are therefore marked in the Registrar's Returns as "submitted to Coroner," which is sufficient to authorise registration. 53 In the other 267 cases inquests were held with the following verdicts:— From Natural Causes 145 From Accidental Causes:— Poisoning 1 Burns 12 Falls 32 Run over 3 Suffocated 7 Suffocated in bed with parents 18 Scalds 3 On Railway 3 Drowned 1 Want of attention at birth 1 Fractured Skull 1 Strangulation 1 Hæmmorhage 1 — 84 From Suicidal Causes:— Cut throat 5 Drowning 3 Poisoning 4 Hanging 1 Railway 1 — 14 From Homicidal Causes:— Suffocation 2 Neglect 1 — 3 Open Verdicts:— Drowned 8 Injuries 7 Poisoned 2 54 Suffocated 2 Alcoholism 1 Hæmmorhage 1 — 21 Total 267 Eighteen deaths were due to suffocation whilst in bed with parents, the dates and days of the week being as follows: 18th January Tuesday 19th June Sunday. 3rd February Thursday 2nd August Tuesday. 20th ,, Sunday 17th „ Wednesday. 11th March Friday 12th September Monday. 31st ,, Thursday 5th October Wednesday. 8th April Friday 2nd November Wednesday. 29th Friday 4th Friday. 15th May Sunday 21st December Wednesday. 13th June Monday. 26th ,, Monday. Classified according to days of week:— Sunday 3 Monday 3 Tuesday 2 Wednesday 4 Thursday 2 Friday 4 Saturday 0 18 55 Water Supply for London. This most important subject, more especially with reference to the health and sanitary condition of the inhabitants of this vast metropolis, among whom of course are included the many thousands of persons who are inhabitants of Battersea, is now engaging general attention. In my report for 1895 the subject was very fully discussed, and as the matter is one involving as it does the expenditure of many millions of the public money as well as the health and lives of the community, and in which every public man should take a strong personal interest, a condensed account of the present position of the question is again given. The water supply for London has been under consideration by a Royal Commission which sat during 1892 and 1893. The Chairman was Lord Balfour of Burleigh; Sir Archibald Geikie, Professor Dewar, Dr. Ogle, Mr. Mansergh, Mr. Hill, and Sir George Bruce constituted the Committee, all men of eminence and selected for their intimate knowledge of the subject. No Commissioner was in any way connected with either of the London Water Companies, and Mr. Mansergh is the Engineer who is now bringing water to Birmingham from Wales, while Mr. Hill is supplying Manchester from Thirlmere. The witnesses examined include nearly one hundred of the leading sanitarians and engineers, together with representatives' of the great public bodies of the Metropolis and elsewhere, the Local Government Board, the London County Council, the Corporation of London, and the various Water Companies and others having interests in the Water Supply of the Metropolis. Briefly reviewing the inquiry, the main question referred to and considered by the Commission was whether the water of the Thames and Lea Valleys was good, and whether enough of it could be obtained for the London of the future without injury to the interests of other districts in those watersheds. They find, as the Companies always maintained, that " the water as supplied 56 to the consumer in London is of a very high standard of excellence and of purity, and that it is suitable in quality for all household purposes," and also that the Thames and Lea Valleys may, without prejudice to the claims or material injury to the interests of districts outside the area of Greater London, be made to supply more than double the present population of the Metropolis with 35 gallons per head daily. The Commissioners recommend that the inspection of the River Thames should be more thoroughly done than it is at present, and that increased provision should be made, in the form of reservoirs for avoiding the taking in of water while the river is in a state of flood. Of all the sites that have been suggested to them as suitable for reservoirs they consider none in the Thames Valley so reliable as can be found upon the London clay, only a short distance above the Hampton intakes. From the Thames, when required, may be taken 300,000,000 gallons a day; from the Lea, 52,500,000 gallons; from wells in the Lea Valley, 40,000,000 gallons; and from wells in the Kent Company's district, 27,500,000 gallons, besides a further considerable quantity, should it ever be wanted, from the Valley of the Medway and the country to the east of it. The Commission, as might be expected, deal with the question broadly, without committing themselves to details. It would be going beyond the duty of useful criticism to discuss some of the interesting scientific, though minor, points upon which the Commissioners adopted views adverse to those of some of the distinguished witnesses who appeared before them. There are, however, in the enquiry two points which rather hang upon one another, and about which we wish the Commission had told us a little more. These are:— (1) The effect which might be expected upon the Thames of taking double the present quantity of the water from the river during periods of drought. 57 (2) The amount of storage space to be provided above the intakes in order to make the taking of any more of this water unnecessary. The conclusion of the Commission is most distinct that there is ample supply of water derivable from the River Thames and Lea, from wells in the chalk in the Lea Valley, and also in the district of the Kent Water Works Company, which will be sufficient to meet the requirements of London for fifty years to come. As to the purity of these supplies, the chemical and bacteriological evidence of Dr. Frankland, Dr. Odling, Professor Crookes, Professor Ray Lankester, Dr. P. F. Frankland and others, is most satisfactory; and no evidence submitted as to impurity could stand the test of the investigations and inquiries of the Commissioners. In their report, however, they very properly advise that further efforts shall be made to keep pollution of all kinds out of the Rivers, and maintain their purity in every possible way. The Commissioners then state that— "We are strongly of opinion that the water as supplied to the consumer in London is of a very high standard of excellence and of purity, and that it is suitable in quality for all household purposes. We are well aware that a certain prejudice exists against the use of drinking water derived from the Thames and the Lea, because these rivers are liable to pollution, however perfect the subsequent purification, either by natural or artificial means, may be. But, having regard to the experience of London during the last thirty years, and to the evidence given to us on the subject, we do not believe that any danger exists of the spread of disease by the use of this water, provided that there is adequate storage, and the same is efficiently filtered before delivery to the consumers. "With respect to the quantity of water which can be obtained within the watersheds of the Thames and the Lea, we are of opinion that, if the proposals we have recommended are 58 adopted, a sufficient supply to meet the wants of the Metropolis for a long time to come may be found without any prejudice to the claims, or material injury to the interests of any district outside the area of Greater London. We are of opinion that an average daily supply of 40,000,000 gallons can be obtained from wells and springs in the chalk of the Lea Valley without affecting any material interests, but that, if this quantity be exceeded, it is probable that the springs and wells in the parts of the Valley immediately adjacent to the wells and all the districts farther down the Valley may be injuriously affected. "From wells in the chalk area on the south side of the Thames, in the district of the Kent Company, we are of opinion that a daily average supply of 27,500,000 gallons may be obtained. We think it of very great importance that distinct obligations should be laid upon any company or Local Authority which is allowed to pump water from the chalk for purposes of public supply to keep accurate observation of the effect of their operations on the level of the water in the wells from which they pump, and return the results to the Water Examiner under such regulations as may be framed. "The great difficulty which we have had to encounter has been in getting accurate and reliable information as to the actual effect of the operations now carried on. The importance of procuring this will increase each year as the limit of what can be taken from any district with safety is gradually being reached. From the River Lea we are of opinion what with adequate additions to the present system of storage 52,500,000 gallons may be taken daily. We are of opinion that, by the construction of storage reservoirs in the Thames Valley, at no great distance above the intakes of the Companies, it will be possible to obtain an average daily supply of 300,000,000 gallons without taking in any objectionable part of the flood water. The average daily flow of the Thames at Teddington Weir, adding the water taken 59 by the Companies, is about 1,350,000,000 gallons per day. It will thus be seen that, when 300,000,000 gallons are taken, there will be left to flow down into the tidal portion of the river an average daily quantity of not less than 1,000,000,000; and we think that regulations could be framed under which the quantity we suggest could be taken, not only without reducing the flow of the river on the rare occasions of exceptional drought to the present minimum, but in such a way as to secure that the volume of water left in the river at these times should be substantially greater than it is under existing conditions. "To our minds, one great advantage of such a scheme of storage reservoirs is that it can be carried out progressively to meet the increasing demands for water; and should the population not grow so rapidly as we have thought it right to contemplate, the extensions may be from time to time deferred as successive decennial enumerations reveal that the ratio of increase is remaining stationary or even falling. From the sources and by the methods we have mentioned, a daily supply of 424,000,000 gallons can, in our opinion, be obtained. This is a sufficient quantity to supply 35 gallons per head to a population of 12,000,000 persons, which is about three-quarters of a million in excess of what the total population of Greater London, together with the outlying parts of Water London, will have become in 1931 even if the ratio of increase in the last decennial period from 1881 to 1931 is fully maintained. We are further of opinion that a large supply of water might be obtained from the chalk area east of the Kent Companies' district in the basis of the Medway, and in the district further east, without any risk whatever of damage to that area." The London County Council and its Views upon the Water Supply. Of these witnesses examined whose evidence was directly adverse to the reservoir and storage schemes put forward by the 60 Companies, that of Sir A. R. Binnie, M. Inst., C.E., Chief Engineer to the London County Council, was the most important. Sir A. R. Binnie's evidence was to the effect that the supply that could be drawn from the Thames and the Lea was wholly insufficient to meet the future wants of Greater London; and he stated that, in his opinion, deeper storage reservoirs in the Thames Valley were impracticable, and, further, that any large increase in quantity pumped from the chalk formations would only ultimately diminish the amount of surface water in the various contributory streams, and therefore could not be reckoned on for increasing the supply. The Water Committee of the London County Council issued a memorandum by its Chairman and a series of reports by the principal officers of the Council on the report of the Royal Commission on the Metropolitan Water supply by which it will be seen that the conclusions of the Royal Commission are controverted to a certain extent. An admirable synopsis of the views of the London County Council and its chief officials appeared in the British Medical Journal, which is here closelv followed. Mr. Basset Hopkins, the Chairman of Committtee, in his memorandum, insists strongly on the narrowness of the scope of the inquiry by the Royal Commission, and points out that mischievous consequences may follow, and the Council may be grievously hampered in its action if people accept the idea that the report was the result of an all-embracing investigation of the general subject. The real question which is of most interest to Londoners is—what is the best course for London to pursue under the circumstances? But this never entered into the reference to the Commission, and in considering their report it has constantly to be borne in mind that whatever they say in support of the prospective sufficiency (for forty years only) of the watersheds on the Thames and Lea has no bearing on the real question whether new gathering grounds ought not to be sought for outside that area altogether. 61 Considerable stress is laid on the shortness of the term of forty years to which the Commission have limited their forecast. The capacity of the Thames and Lea watersheds as sources of supply may be expected to have reached, or nearly reached, their limit about the year 1931, and then it will be impossible any further to delay turning to some outside source. By that time, however, the best gathering grounds in the country, which "are already being rapidly taken possession of by other municipalities," may be lost to us. In regard to this, one has to bear in mind the long time which is required for the execution of the vast works necessary in large water schemes, and the Council's chief engineer says plainly that the people of London, "will at some not very distant date (probably twenty years hence) have to contemplate the exhaustion of the supplies which can be obtained in the Thames Valley," and the necessity of looking elsewhere for an increased supply. "One of the greatest blots upon the finding of the Royal Commission" is that "it can in no way be considered a final settlement of the case." This limitation of forecast to forty years is all the more curious in view of the fact that two members of the Royal Commission. giving evidence before the House of Lords on the Birmingham water scheme, gave much longer periods as the time for which estimates should be made, Mr. G. H. Hill stating that provision for a large town should be for a period of not less than 50 years, and Mr. James Mansergh, the engineer to the scheme, indicating that he calculated his supply for some sixty-four years, and on that basis laid out the works which the Corporation of Birmingham are now carrying out. Sir A. R. Binnie shows in a striking way the difference between averages and actualities in regard to the flowofwater down a river bed. The Royal Commissioners contemplating taking 300 million gallons from the Thames daily, trusting to the fact that the average daily flow at Teddington weir is about 1,350 million gallons; but he shows that during certain dry months the 62 total average flow would often only slightly exceed the amount of water required by the Companies, and in such a case as that of September, 1893, the total flow would not come up to the requirements. If the extreme minimum flow per twenty-four hours is taken, the difficulty of providing a supply both for the River and the Metropolis is still more apparent. There is a good deal of common sense in some of the remarks in the reports about the safety, or otherwise, of polluted waters. Sir A. R. Binnie draws attention to the fact that " the Royal Commissioners received, although they do not quote it, some very strong evidence from one of the highest authorities, namely, Sir G. Buchanan, M.D., F.R.S., late Chief Medical Officer to the Local Government Board." This evidence was to the effect that neither chemical nor bacteriological tests were to be relied on as to the purity of water, that we did not know how small an amount of morbific material, if it gained access to the water, might set up disease, and that the way to gain information as to purity and safety was to search out the conditions surrounding water courses and water services. Asked what would be his treatment of the water if it were found to be polluted, he could only answer that " there was nothing for it but either to boil the polluted water, or else to leave it alone." In face of such evidence from such an authority we turn with interest to the paragraphs in Sir A. R. Binnie's report summarising the pollutions of the Thames water, which the Commission thinks good enough for London. It seems that at the census of 1891 there was a population of 1,056,415 persons draining into the river above the intakes, and that in the last thirty years this population had increased from 816,814 to its present number. That, however, gives but a poor idea of the increase which is going on in the urban population living on the banks of the Thames and its Tributaries, many of these towns having more than doubled their size in thirty years. "Besides this human population there are probably 1,600,000 animals inhabiting the 63 above area." Consequently it is cleat that if the Thames is to be retained as a source of water supply, the people of London must drink the more or less clarified excreta of this vast population. Mr. Shirley Murphy, Medical Officer of the London County Council, confines his observations to that portion of the report of the Royal Commission which relates to the quality of the present sources of supply. The Royal Commission had before it evidence, he says, which showed that the rivers from which the Water Companies draw their supplies, receive from the towns situated on their banks at varying distances above the intakes, sewage effluents, which, after treatment of the sewage, either by filtration through land or by chemical processes, enter smaller rivers. In addition to these, numerous pollutions from smaller populations discharging into cesspools and ditches reach, untreated, the streams at times of heavy rainfall. Such sewage must not infrequently contain the excremental matter of persons suffering from typhoid fever and may not improbably in the future, contain from time to time the excreta of persons suffering from cholera. The virus of both these diseases has been found by past experience to have been disseminated by water and to have produced fatal results in persons drinking such water. Not only are these diseases known to be waterborne, but experience has shewn that a very small amount of the excremental matter of persons suffering from them is capable under favourable circumstances of infecting vast volumes of water. In the present state of knowledge on such matters we are driven back to much the same opinion as that held by the late Sir George Buchanan, who said that he did not think that it was possible, either by chemical, microscopical, or bacteriological processes, to say when a water was or was not injurious, and that there was no way of arriving at a solution of this question except by inspecting the sources of supply, and seeing if they 64 were or were not pollutted. According to this criterion London river water stands absolutely and hopelessly condemned. Although very little is definitely said on the subject, the impression which the perusal of the report leaves upon the mind is that the whole control of the water supply, from the sources to the final delivery to the consumer, should be in the hands of one authority, and that the time has arrived when competing companies, the result of private enterprise, should no longer be left in possession of a monopoly of the primary necessity of existence. At the time of writing the London County Council have introduced a Bill into Parliament, empowering it to bring a supply of water from South Wales. The Bill failed to pass the second reading. It is certain that some further source of supply other than the Thames and Lea must before many years be found. The Vestry has ordered that monthly samples of water for the purposes of analyses be taken from the supplies of the water companies in the Parish. Public Health (London) Act, 1891. The procedure of the Public Health Department is almost entirely based upon the provisions of the Public Health (London) Act, 1891, which consolidated and amended the various Acts under which the Sanitation of London has been previously carried out. It contained also many valuable provisions which had hitherto only been extra Metropolitan and contained in the Public Health Act, 1875, under which provincial Sanitary Authorities had effected great improvement in the Sanitation of their districts. A condensed synopsis of its provisions here will be useful for reference. Sec. 1 provides for house to house inspection by the Sanitary Authority, for which additional Inspectors with separate and smaller districts have been appointed within the last few years. Sec. 2.—A nuisance must be abated that is dangerous or likely to be dangerous to health. Under the Metropolis Management and other Acts it was necessary to prove actual injury tohealth. 65 Sec. 3 provides that information of a nuisance may be made to the Sanitary Authority, who shall serve intimation to parties responsible. Sec. 4—The most essential difference between the procedure under the Public Health (London) Act, 1891, and the various other preceding Acts, is that formerly if a notice to abate a nuisance from the Sanitary Authority was not complied with, proceedings had to be commenced before a justice and evidence produced to satisfy him that a nuisance injurious to health existed, when, if satisfied that such nuisance existed and was injurious to health an order would be made for the abatement of the same. If this order was disregarded and the necessary works not executed it was necessary to commence fresh proceedings to recover penalties. The Sanitary Authority under this section itself considers the matter and makes orders, if necessary suing for penalties for non-compliance therewith. Absence of proper water-fittings is constituted a nuisance under section 4, and by section 5 a house may be closed for this reason. The authority can specify works and insist upon the carrying out of the same under the latter section, and now does so in a large proportion of cases. Secs. 5, 6 and 8 contain provisions for orders, penalties and appeals, and enables the Sanitary Authority itself to carry out necessary works in default of responsible owners, &c. Sec. n provides for recovery of expenses and costs consequent thereon, and Sec. 13 enables the Authority to take action in the first instance in the higher Courts should it think fit. Under Sec. 14 an important proviso is introduced, as a Sanitary Authority has power to take proceedings for the abatement of nuisances arising in the district of another authority should the nuisance injuriously affect the inhabitants of their own district. E 66 Sec. 15 renders liable to a penalty of £5 any person wilfully injuring or destroying any closet or sanitary apparatus, and will probably be useful in restraining persons from wantonly damaging fittings. Bye-laws are to be made by the authority for the prevention of nuisances or keeping of animals so as to be a nuisance or injurious to health, and as to paving yards. The London County Council has made Bye-laws nnder the following sections which are now operative:— Sec. 16-1.—Removal of fcecal matter. ,, Removal and disposal of refuse. ,, Cleansing and filling up of cesspools and privies. Sec. 39-1.—Water closets and soil pipes. „ Ashpits. ,, Receptacles for dung, cesspools, &c. The Vestry has made Bye-laws under the undermentioned Sections of the Act:— Sec. 16.—Prevention of nuisances. ,, 39.—Keeping of water closets. ,, 50.—Cleansing of cisterns. ,, 94.—Houses let in lodgings. These are in active operation, and can be obtained at the office of the Public Health Department by any ratepayer desiring a copy. There are other bye-laws which may be made by the Sanitary Authority. They are:— Sec. 66. Removal to hospital of infected persons. This is now effected under the provisions of the various acts and regulations of the Metropolitan Asylums Board. 67 Sec. 88. Bye-laws for the Mortuary. Regulations are in existence for the control of the Mortuary-keeper under which the Mortuary has hitherto been regulated. Sec. 95. Tents and vans. Bye-laws were made by the District Board some years since, under the Housing of the Working Classes Act, 1885, which have been acted on until the present time. By Secs. 23 and 24 the control of smoke nuisances other than in private dwellings is placed under the Sanitary Authority instead of the Police, and has considerably increased the work of the Public Health Department, it being necessary in many cases to keep observation throughout the night. Work-shops, Work-places and Factories are also placed under the supervision of the Sanitary Authority with certain duties as to giving notice to the Factory Inspector when children, young persons, or women are employed. It is also the duty of the Authority to see that proper and separate accommodation is provided for each sex. Sec. 47 provides that a medical officer of health or sanitary inspector shall examine all articles intended for the food of man if unsound, and shall seize the same and obtain an order from a Justice for its destruction. The fine is raised to a maximum of £50 for every animal or parcel of food condemned, and should a person be so convicted twice in twelve months the Court may order a notice of the facts to be affixed to his premises for a period not exceeding twenty-one days. Should a person find himself in the possession of unsound food he himself may give notice to the Vestry, who must remove the same as trade refuse and this procedure would seem to relieve him of the penalties mentioned. Sec. 48 contains the important provision that a newly-erected dwelling-house must not be occupied until a certificate has been obtained of the Sanitary Authority to the effect that a proper and 68 sufficient supply of water exists. This section seems to be now more generally understood and imposes much work on the Public Health Department. The following sections 49, 50, 51, 52, 53 and 54, apply inter alia to water supply generally. Secs. 55,56 and 57 re-enact, as elsewhere stated, the provisions of the Infectious Disease (Notification) Act. Secs. 59, 60 and 61 require the authority to make provisions for the disinfection of clothing, &c., which provision has been duly made by the Vestry. The subsequent sections provide that Infectious refuse shall not be treated so as to be dangerous to the public health, and prescribe penalties on persons letting houses or apartments in which infectious disease has occurred without having the same properly disinfected and obtaining a certificate thereof, which certificate is given to applicants free of charge on application to the Public Health Department. Other important provisions for the prevention of the spread of infectious disease follow in subsequent sections; but they have long been in operation in this parish. In fact, it may be said generally that the methods of Sanitary procedure which may have gradually evolved in this parish during the last twenty years, were adopted by the framers of the Act as its basis. Provision is made for Mortuaries and post-mortem examinations; such have existed in Battersea for many years. The Mortuary accommodation is, however, becoming somewhat inadequate for the needs of this ever increasing parish, and it is proposed to provide a new Mortuary with Coroner's Court. The present Mortuary, originally said to be the best arranged in London, in a commendable spirit of emulation, other parishes have improved upon, until we are at the present time somewhat short of the standard of excellence. The plans of the Surveyor, when carried out, will provide a building far in advance of the majority of Metropolitan Mortuaries. There was a difficulty in deciding as to the most suitable site, but one adjacent to the Public Baths in the Latchmere Road has been finally determined upon. 69 The following Table shews the number of bodies admitted into the Mortuary during the past eleven years, together with the number of post-mortem examinations and inquests held. Table shewing number of Bodies removed to the Parish Mortuary during the past ii Years. *No. of bodies received. No. of post-mortem examinations. No. of inquests. 1888 134 106 134 1889 140 118 140 1890 199 148 194 1891 176 139 169 1892 193 163 187 1893 243 200 237 1894 224 197 208 1895 259 210 232 1896 293 242 278 1897 289 246 273 1898 294 238 267 * Includes bodies of infectious dead and cases removed for sanitary reasons. Customs This Act, which is simply an extension of the Revenue provisions of the Customs and Inland Revenue Act, Act, 1891. 1890, exempting houses structurally fitted in the opinion of the Medical Officer of Health for occupation as 70 separate tenements at an annual rental not exceeding £10 from the liability to house duty. The 1891 Act raised the amount to £4.0 annual rental. These Acts have added much to the duties of the Medical Officer, as personal inspection; is imperative and certain forms of certificate have to be sent by him to the Surveyor of Taxes. Many hundreds of tenements have been inspected and certified since the Act came into force in January, 1891, and many flats are now being built and converted in the parish in order to obtain exemption or abatement of the house duty. The numbers inspected yearly from 1890, in which two hundred and forty-three were inspected, and after the execution of necessary works re-inspected and certified were for 1891, one hundred and nineteen; for 1892, one hundred and sixty-five; for 1893, two hundred and one; for 1894 and 1895, each ninety-one; during 1896, one hundred and twenty. During 1897 forty-three applications were made and certificates given in twenty-seven cases. In 1898, eighty-two certificates were granted after personal inspection of the premises. The Act requires that in order that a certificate may be granted by the Medical Officer of Health, the house be so constructed as to afford suitable and separate accommodation for each tenement. In connection with the granting of these certificates, the following recommendations have been adopted by the Metropolitan Branch of the Incorporated Society of Medical Officers of Health. I. That in no case should a Medical Officer of Health examine a house with a view to giving a Certificate under these Acts, until he is absolutely satisfied— as advised in the letter from the Local Government Board, dated the 15th August, 1892—that the house in question comes within the sections of the Acts. 71 2. That a Certificate under these Acts should state that the following requirements are complied with : (a) A definite minimum height and superficial area for living and sleeping rooms, as defined by the London Building Act, 1894. (b) That there is a sufficient and available supply of water on each floor. (c) That there is at least one water-closet, properly supplied with water for every twelve occupants (or less) on each floor. (1d) That the drainage of the premises is in accordance with the regulations recognized by the Authority in whose jurisdiction the house is situated. (e) That accommodation for clothes washing is provided, sufficient for the number of persons inhabiting the house. At the end of 1897 certificates were outstanding in regard to applications for 10 premises, and have during 1898 been granted, the works required to be carried out to satisfy the requirements of the Medical Officer of Health having been attended to. During 1898 seventy-two fresh applications were received, and in all cases certificates were granted. Applications 72 Certificates granted 82 Deaths Cases Battersea OTHER DISEASES. Deaths Cases Battersea ZYMOTIC OR EPIDEMIC DISEASES. TABLE XV. Sickness and Mortality amongst the Parish Poor dining the year 1898. 8 109 Diseases of the Tubercular Class. ... ... Small-Pox. 4 211 Of Brain, Nerves, &c. 2 57 Measles. 2 124 Of Heart. ... 14 Scarlatina. 21 861 Of Respiratory Organs. ... 7 Diphtheria. 1 201 Of Digestive Organs. 1 17 Whooping Cough. ... 10 Of Kidneys. ... 3 Enteric & other Fevers. 1 3 Premature Birth, Low Vitality, Malformation, &c. ... 16 Erysipelas. 4 139 Age. ... 4 Puerperal Fever or Metria. 1 123 Violence. ... 147 Diarrhoea, Dysentery, or Cholera. 7 2231 All other Diseases. 6 156 Influenza. 49 4012 Total. ... 3 Other Zymotic Diseases 9 424 Total. 58 4436 Grand Totals of Cases and Deaths from all Diseases. ZL 73 TABLE XVI. Batternea Vaccination Returns, January to December, 1898. Registration Sub-District. Number of Births returned in the Birth List Sheets—1898. Nos. of those births duly entered by the 31st j anuary, 1899, in Cols. 10, 11, and 13, of the Vaccination Register, (Birth List Sheets), viz.:— No. of Births which on, the 31st March, 1899,remained unentered in the Vaccination Register on account. Number of those Births remaining on 31st January neither duly entered in Vaccination Register (Col. 3, 4, 5. and 6 of this Return) nor accounted in the Report Book. Col. 10, successfully vaccinated. Col. 11, Insusceptible of vaccination. Had Smallpox. Col. 13, Dead unvaccinated. Conscientious Objection Certificates received. Postponement by Medical Certificate. Removed to Districts the vaccination officers of which have been apprised. Removed to places unknown. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) east battersea 2433 912 11 ... 268 49 189 18 292 694 west battersea 2755 1088 6 ... 248 57 164 17 294 881 totals 5188 2000 j7 ... 516 106 353 35 586 1575 Vaccination In the Annual Report for 1896 a very copious resume of the report of the Royal Commission on Vaccination was given. It will not be necessary to reproduce the body of the report, but the conclusions of the majority report as well as that of the min6rity are epitomised and here given as well as the new Vaccination Act. After setting out at great length the advantages and disadvantages of arm to arm vaccination the report goes on to say that it is obvious that the employment of calf-lymph only would wholly exclude the risks as regards both Syphilis and Leprosy. Respecting the latter disease, however, there appears to be reason to doubt whether any risk exists, and at any rate it 74 does not concern the British population. Even in Leprosy districts the employment of English human lymph would be, so far as Leprosy is concerned, as safe as that from the calf. The risk of Syphilis, although real, is an exceedingly small one, even when humanized lymph is employed, and may probably be wholly avoided by care in the selection of the vaccinifer. As regards all the other dangers, whether of severe illness or temporary inconvenience, the two forms of lymph appear to stand on the same level. The instances of inflamed arms, of Erysipelas, of Vaccinia Maligna, and Eczematous eruptions are not more common after the use of human lymph than after that from the calf. Some of the best qualified witnesses who have afforded us their assistance have expressed a deliberate preference for armto-arm vaccination, believing that the advantages of calf-lymph are more imaginary than real. A careful examination of the facts which have been brought under our notice has enabled us to arrive at the conclusion that, although some of the dangers said to attend vaccination are undoubtedly real and not inconsiderable in gross amount, yet when considered in relation to the extent of vaccination work done they are insignificant. There is reason further to believe that they are diminishing under the better precautions of the present day, and with the addition of the further precautions which experience suggests will do so still more in the future. We put the use of calf-lymph in the forefront because, as we have said, this would afford an absolute security against the communication of Syphilis. Though we believe the risk of such communication to be extremely small where humanized lymph is employed, we cannot but recognize the fact that however slight the risk, the idea of encountering even such a risk is naturally regarded by a parent with abhorrence. We think, therefore, that parents should not be required to submit their children to vaccination by means of any but calf-lympth, but this should not preclude the use of humanized lymph in case they so desire. 75 So long as the state, with a view to the public interest, compels the vaccination of children, so long even as it errlploys public money in promoting and encouraging the practice, we think it is under an obligation to provide that the means of obtaining calf-lymph for the purpose of vaccination should be within reach of all. We have no hesitation, therefore, in recommending that steps should be taken to secure this result. Whether the duty of providing calf-lymph should be undertaken by the Local Government Boards in the several parts of the United Kingdom, or whether some other method would be more advantageous, can be better determined by those who have had practical acquaintance with the wqrking of the vaccination laws. In connection with this subject, our attention has heen drawn to the experiments recently made by Dr. Copeman as to the effect of the storage of vaccine lymph in glycerine. The conclusions at which he arrives are that the addition of glycerine, whilst it leaves the efficacy of the lymph undiminished or even increases it, tends to destroy other organisms. If it be the fact that the efficacy of the lymph remains unimpaired, its storage in glycerine would largely diminish the difficulties connected with the use of calflymph, which are inseparable from calf to arm vaccination. If lymph is to be preserved in glycerine, due care would be requisite to ensure its purity and the absence of contamination in its introduction. We think that, whether mixed with glycerine or not, each tube should contain only sufficient lymph for the vaccination of one person. We have no difficulty in answering the question, what means other than vaccination can be used for diminishing the prevalence of Small-Pox ? We think that a complete system of notification of the disease, accompanied by an immediate hospital isolation of the persons attacked, together with a careful supervision, or, if possible, isolation for sixteen days of those who had been in immediate contact with them, could not but be of very high value 76 in diminishing the prevalence of Small-Pox. It would be necessary, however, to bear constantly in mind as two conditions of success, first, that no considerable number of Small-Pox patients should ever be kept together in a hospital situate in a populous neighbourhood, and secondly, that the ambulance arrangements should be organised with scrupulous care. If these conditions were not fulfilled, the effect might be to neutralise or even do more than counteract the benefits otherwise flowing from a scheme of isolation. The question we are now discussing, must, of course, be argued on the hypothesis that vaccination affords protection against Small-Pox. Who can possibly say that if the disease once entered a town, the population of which was entirely or almost entirely unprotected, it would not spread with a rapidity of which we have in recent times had no experience, or who can foretell what call might then be made on hospital accommodation if all those attacked by the disease were to be isolated ? A priori reasoning on such a question is of little or no value. We can see nothing, then, to warrant the conclusion that in this country vaccination might safely be abandoned, and replaced by a system of isolation. If such a change were made in our method of dealing with Small-Pox, and that which had been substituted for vaccination proved ineffectual to prevent the spread of the disease (it is not suggested that it could diminish its severity in those attacked), it is impossible to contemplate the consequences without dismay. To avoid misunderstanding, it may be well to repeat that we are very far from underrating the value of a system of isolation. We have already dwelt upon its importance. But what it can accomplish as an auxiliary to vaccination is one thing, whether it can be relied on in its stead is quite another thing. Our attention has been drawn to the circumstances that outbreaks of Small-Pox have not unfrequently had their origin in the 77 introduction of the disease to common lodging-houses by tramps wandering from place to place. In view of this we make the following recommendations : — (i) That common shelters which are not now subject to the law relating to common lodging-houses should be made subject to such law. (ii) That there shall be power to the local authority to require medical examination of all persons entering common lodging-houses and casual wards to see if they are suffering from Small-Pox, and to offer a reward for prompt information of the presence of the disease. (iii) That the local authority shall have power to order the keeper of a common lodging-house in which there has been Small-Pox to refuse fresh admissions for such time as may be required by the authority. (iv) That the local authority should be empowered to require the temporary closing of any common lodginghouse in which Small-Pox has occurred. (v) That the local authority shall have power to offer free lodgings to any inmate of a common lodging-house or casual ward who may reasonably be suspected of being liable to convey Small-Pox. (vi) That the Sanitary Authority should give notice to all adjoining Sanitary Authorities of the occurrence of Small-Pox in common lodging-houses or casual wards. (vii) That where the disease occurs the Public Vaccinator or Medical Officer of Health should attend and vaccinate the inmates of such lodging houses or wards, except such as should be unwilling to submit themselves to the operation. 78 In connection with the subject with which we have been dealing we may advert to the suggestion that the vaccination and the Sanitary Authority should in all cases be identical. It has been pointed out that whilst the isolation of patients in hospitals and otherwise is provided for by the Sanitary Authority the extent of the provision requisite to deal with an outbreak of an epidemic of Small-Pox may depend upon the degree in which the vaccination laws have been enforced. More hospital accommodation may be required where vaccination has been neglected than where the vaccination laws have been complied with. It is contended than sanitation and vaccination, concerning as they both do the health of the people, should be under the jurisdiction of a single authority, and that the Sanitary Authority is the appropriate one for that purpose. Indeed, the advantage of placing in the same hands the supervision of vaccination and of the other measures designed to prevent the spread of disease are so great and obvious that the proposal to do so deserves most serious consideration At the same time, we fully recognise the importance of achieving it as far as possible, and we should regard with favour such changes as would render the amalgamation of the vaccination and sanitary authorities feasible, or indeed any steps taken in that direction, even although they should only partially effect the object in view. The report then goes on to discuss as to whether any alterations should be made in the arrangements and proceedings for securing the performance of vaccinations, and, in particular, in those provisions of the Vaccination Acts with respect to prosecutions for non-compliance with the Law. This will be found at length in my report for 1896. The Commissioners signing the majority report conclude as follows :— " It is to be hoped that our Report will stimulate belief in the efficacy of vaccination, that it will remove some 79 sions and reassure some who take an exaggerated view of the risks connected with the operation, as well as lead to a more ready enforcement of the law by local authorities. We desire to call attention again to the recommendation, which we made in our fifth interim report, that persons committed to prison by reason of the non-payment of penalties imposed under the vaccination laws, should no longer be treated as criminals. We stated in that report our reasons for this recommendation, to which we still adhere. If, however, the changes in the compulsory provisions of the vaccination laws which we have suggested were adopted, the matter would lose much of its importance." Two Commissioners, Mr. W. Guyer Hunter and Dr. Jonathan Hutchinson, both medical men of great experience did not recommend any alteration of the then existing law, but advocated re-vaccination at the age of twelve years. Messrs. Samuel Whitbread, John Bright, J. Allanson Picton and Dr. Collins objected to the proposal to retain, in any form compulsory vaccination. They alsoadvocated that a conscientious objection to vaccination on the part of the parents should be respected, and that the proposal that the Public Vaccinator should attend at the home of the child and offer to vaccinate it did not meet with their approval. As is well known both these proposals were carried in the Government Bill passed last session, as well as the provision of glycerinated calf-lymph recommended by the majority report. The Section i extends the period within which the Vaccination Act, 1898. parents or guardian of a child shall cause the child to be vaccinated to six months from the birth of the child, instead of three months as prescribed in Section 16 of the Vaccination Act of 1867, and repeals so much of that Section as requires the child to be taken to a Public Vaccinator to be vaccinated. 80 It becomes the duty of the Public Vaccinator of the district, if the parents or guardian of the child so requires, to visit the home of the child for the purpose of vaccinating it. If the child is not vaccinated within four months after its birth, the Public Vaccinator of the district, after at least twentyfour hours notice to the parent, shall visit the home of the child, and shall offer to vaccinate the child with glycerinated calflymph, or such other lymph as may be issued by the Local Government Board. The Public Vaccinator shall not vaccinate a child if, in his opinion, the condition of the house is such, or there is or has been such a recent prevalence of infectious disease in the district, that it cannot be safely vaccinated, and in that case shall give a certificate under Section 18 of the Act of 1867 of postponement of vaccination, and shall forthwith give notice of any such certificate to the Medical Officer of Health for the district. Nothwithstanding any regulation of any lying-in hospital or infirmary, or other similar institution, the parent of any child born in any institution shall not be compelled under such regulation or otherwise to cause or permit the child to be vaccinated at any time earlier than the expiration of six months from its birth Under Section 2 no parent or other person shall be liable to any penalty under Section 29 or 31 of the Act of 1867, if within 4 months from the birth of the child he satisfies two justices, or a stipendiary or metropolitan police magistrate, in petty sessions, that he conscientiously believes that vaccination would be prejudicial to the health of the child, and within seven days thereafter delivers to the Vaccination Officer for the district a certificate by such justices or magistrate of such conscientious objection. This Section came into operation on the passing of the Act, viz., on August 12, 1898, but in its application to a child born 81 before that date the period of 4 months from the passing of this Act is substituted for the period of 4 months from the birth of the child. Section 3. An order under Section 31 of the Act of 1867 directing that a child be vaccinated, shall not be made on any person who has previously been convicted of non-compliance with a similar order relating to the same child. Section 4. - No proceedings under Section 31 of the Act of 1867 shall be taken against any parent or person who has been convicted under Section 29 of the said Act on account of the same child, until it has reached the age of four years. Section 5 provides that persons committed to prison on account of non-compliance with any order or non-payment of fines or costs under the Vaccination Acts shall be treated as first-class misdemeanants. Section 6 empowers the Local Government Board to make rules and regulations with respect to the duties and remuneration of Public Vaccinators. Section 7 enables that Board when there is risk of outbreak of small-pox or under other exceptional circumstances, to require the Guardians of any Poor law Union to provide vaccination stations for the vaccination of children with glycerinated calflymph or other lymph, and to modify the provisions of this Act requiring the Public Vaccinator to visit the home of the child otherwise than on request of the parent. Section 8 makes it the duty of the clerk of any sanitary authority maintaining a hospital for cases of small-pox to keep a list of the names, addresses, ages, and conditions as to vaccination of all small-pox patients treated in the hospital, such entries to be made on admission, and at all reasonable times to allow searches to be made therein, and upon demand to give a copy under his hand or under that of his deputy of every entry in the same on payment of a fee of sixpence for each search, and threepence for each copy. F 82 Section 9 repeals certain earlier enactments during the continuance of this Act. Section 10 states that the Act shall not apply to Scotland or Ireland, that it shall, except where specially provided, came into operation on January 1st, 1899, and that it shall remain in force until January 1st, 1904. Common No application has been made by the keeper of any Lodging- Houses Common Lodging House to free the bedding of such Acts, 1851-3. house from vermin by means of disinfection. Houses Let in Lodgings or Occupied by Members of more than one family. Since the passing of the Public Health (London) Act, 1891, this Vestry has made bye-laws to deal with this class of property, which are made to apply to a house or part of a house which is let in lodgings or occupied by members of more than one family, except where the rent or charge payable by each lodger, and exclusive of any charge for the use by such lodger of any furniture, is at a rate of seven shillings and sixpence per week or upwards or where the rent or charge payable by each lodger, and inclusive of any charge for the use by such lodger of any furniture, is at the rate of ten shillings per week or upwards. Obviously this definition would include most of the houses in the parish, and having regard to the fact that the bye-laws require, inter alia, the lime-whiting and cleansing every April of all walls and ceilings, it follows that nearly the whole of the parish would require to be inspected during that month, which would be absolutely impracticable. There are however, houses in this parish to which the byelaws advisedly apply, viz., Orville Road, Wayland Road and Green Lane, from which forty-four houses have been placed upon the register. 83 These houses were kept under close and constant observation more particularly during the latter part of the year, by the Female Sanitary Inspector, who advised the tenants upon the questions of domestic hygiene and cleanliness of the rooms occupied by them with good results in many cases. Infant Life The Infant Life Protection Act provides for the ' Protection Act, 1897. registration by the London County Council of any premises where more than one infant is kept for hire or reward. The Council's Inspector under the Act sees that the infants are properly provided for, but as regards sanitary conditions inspection is made by the Vestry's officers. Such visits have been made on many occasions during the year,and reportsfurnished to the Chief Officer of the Council who has requested that the special objects of the visits should not be disclosed, as cases have occurred where landlords have ejected persons notified under this Act on ascertaining that their tenancy may involve the sanitary inspection of the premises. Food unfit The question of what steps are taken in this parish for human , . . consumption, to prevent food unfit for human consumption, either from decomposition or disease having been taken into consideration by the Vestry I was directed to report thereon, and the report is here given :— Having been instructed to report upon the steps taken by the Health Department with a view to safeguarding the public by the seizure and destruction of food unfit for human consumption, I beg to report that constant observations are made by the Sanitary Inspectors, more especially on Saturday evenings and Sunday mornings, of the various premises in the Parish where food is sold, and upon several occasions seizures have been made and prosecutions followed, and it may be assumed that it is owing to 84 the constant supervision that takes place over the food stuffs sold that there has appeared to be, for some time past, a decided improvement in the quality of the articles offered for human consumption. The exceedingly hot weather of late has been very trying for those engaged in the sale of meat and fish, especially as in such temperatures meat may have been slaughtered in the morning and in an advanced state of decomposition in the evening. Although inspections have been made of butchers premises, &c., as before-mentioned, with six exceptions, nothing during the last month has been discovered which the Department would have felt justified in seizing as unfit for human consumption. Frequent inspections are made of premises at which food is prepared for sale, especially in two instances, one a manufacturer of sausages, and another in which pork pies are made. On every occasion the meat has been found to be in a good and wholesome condition. It has been the practice for years past to condemn and destroy and give a certificate to proprietors of businesses who purchase food, whether animal or vegetable, from the wholesale markets, if it is brought to the office within a few hours after the purchase, and this is generally known amongst the tradesmen, especially fishmongers, who constantly avail themselves of this privilege, and are thereby enabled to recover from the wholesale vendors the amounts paid by them for the articles which have been destroyed. It will be seen that this arrangement considerably mimimises the tendency to retail unsound food, which would result if the retailer had to bear the entire loss. In cases of diseased meat, it is submitted to my inspection, and I am further empowered to call in skilled veterinary assistance, of which I have several times availed myself, with the result of obtaining convictions and the imposition of heavy fines. 85 Where meat is sold on Saturday nights for a few pence per pound, it does not [follow that it is at the time of sale unfit for human food, but is in such condition that decomposition will speedily follow if kept longer without being cooked, most of it being foreign meat which has been kept in refrigerators. Under the provisions of the Food and Drugs Act, three hundred samples have been taken annually and submitted to the Analyst. The Vestry has decided that, in future, five hundred samples shall be taken each year. Skimmed or The public attention has been directed to the Separated Milk. importance of milk being used in its entirety, more especially in the case of infants brought up wholly or in part, whether the milk was given as derived from the cow or as condensed milk, the abstraction of the most important element, the fat, being most prejudicial as tending to practically starve the child. A warning to the public of these dangers of using such impoverished milk is here given : — CONDENSED, SKIMMED OR SEPARATED MILK. The Vestry of the parish of St. Mary, Battersea, as advised by the Medical Officer of Health, desire to call the attention of parents or persons having charge of young children to the fact that Milk consists, broadly speaking, of three constituents: firstly, Fat, as in cream or butter; secondly, Cheese, as casein or curds; thirdly, Whey, chiefly water, salts, etc. The abstraction of the major part of the fat in separated or skimmed milk takes away the most important constituents as far as nourishment is concerned, and a young child fed wholly or principally on such impoverished milk is under-nourished to the extent to which the abstraction of fat has gone. On the other 86 hand if such milk is to give a sufficient proportion of fatty constituents, the child must, if fed on this separated milk, consume a much larger quantity of the impoverished milk, far beyond its power of digestion. The fat in good new milk should be from 3 to 4 per cent. in weight, but many of the condensed separated milks contain less than 1 per cent of fat. Those having charge of young children are therefore recommended to avoid the separated condensed milks, and to give the children good new milk, both from a health point of view and as a matter of real economy. If condensed milks are given, those which contain the whole of the constituents of the milk, as the best do, should be used. All condensed milk should be made ready for use as food by boiling water, in order to destroy any disease germs present. The conclusion is, to beware when feeding young children, of the numerous condensed skimmed or separated milks which give little or no nourishment, but on the contrary more or less starve the infant. Table xvii shews the sanitary work of the Public Health Department for the last seven years. The total number of sanitary operations during 1898 was 72,782. These were more numerous than in 1897, owing to the inspectorial staff being increased. The total number of house inspections during the year 1897 was forty-seven thousand six hundred and thirty. It must not be imagined that this is identical with the number of separate houses inspected, as many in a bad and insanitary condition required re-inspection on many occasions. The number of intimations served under sec. 3 of the Public Health (London) 87 table xvii. summary of sanitary operations during 1898. 1892 1893 1894 1895 1896 1897 1898 Total Sanitary operations 38,779 54,577 53,791 55,806 69,432 67,200 72,782 Number of House Inspections 23,587 25,091 24,747 30,051 38,781 42,486 47.630 Bakehouses Inspections 215 296 313 460 532 545 539 Bakehouses Nuisances abated ... 18 19 49 57 29 33 Urinals — Inspections 251 260 318 483 468 367 450 Do. altered, repaired, or water laid on ... 120 119 31 40 58 78 Intimations served, 541 & 55 Vic. cap. 76(3) 3.691 4,420 4,289 4.256 3,461 3,030 3,807 Notices Served under Sec. 4 921 1,211 1,076 1,198 909 611 1,138 Notices Served under Sec. 62 and 65 1,588 2.572 1,605 1,709 1.952 2,246 1.779 Complaints Received and attended to ... 4.089 3.253 3.877 3.302 3.254 3.847 Number of Houses Disinfected 1,227 2,069 1.449 M54 1,698 2,009 1,608 Houses Supplied with Disinfectants 3,026 5,275 3 175 3,616 6,748 7.846 6.739 House drains flushed with disinfectants after infectious disease ... ... ... ... ... ... 923 Overcrowding Abated 34 38 56 33 60 65 107 Premises Cleansed and Repaired 189 280 328 138 235 319 934 Drains Tested ... By Smoke 700 1,491 1,272 1.33I 1.188 914 1.550 Water 178 491 794 997 2,829 3,080 6.959 Drains Cleansed and Repaired 1,107 1.564 1,106 1,205 941 799 725 Drains Relaid 220 917 742 742 762 636 1.070 Soil Pipes ventilated ... ... 135 796 846 764 1,283 Sink and Rain Water Pipes disconnected or repaired 1,360 562 1,012 634 565 318 584 Water Closets Cleansed and Repaired 237 314 426 236 282 327 683 Cesspools Abolished 1 4 6 8 5 4 Mews and Stables Drained and Paved 86 30 11 8 17 10 36 Yards Drained and I'aved 161 253 938 555 735 765 929 Accumulations of Manure and other obnoxious matter removed or proper receptacles provided 41 70 56 61 56 93 180 Dust Receptacles Provided 738 772 1,221 688 587 714 690 Dust Complaints forwarded to the Surveyor ... 271 214 377 200 205 150 Leaky House-roofs and Gutters repaired 185 84 240 134 l80 182 409 Houses Supplied with Water 151 130 93 252 121 122 141 Water Closets Supplied with Water, or supply disconnected from drinking water cistern 860 73i 1.113 1.054 911 1,029 925 Cisterns Covered, Cleansed & Repaired 409 469 624 816 687 637 541 Keeping of Animals in unfit state discontinued 5 l6 11 16 25 26 21 Smoke Nuisances dealt with 10 26 21 11 12 36 46 Certificates of Disinfection Granted 1,044 1,659 1.551 1.538 1,740 2,176 1.740 Water Supply Certificates Granted (Sec. 48) 16 118 i4i 282 288 236 327 Proceedings Ordered by Vestry and Health Committee 444 1,211 1,100 1.243 959 1.536 1,213 Summonses Issued 14 73 52 63 65 48 72 Magisterial Orders Obtained and Enforced 14 70 42 59 55 40 62 Sanitary Conveniences provided or improvements affected to Factories and Workshops, Sec. 38 4 8 19 14 38 40 l80 Underground sleeping rooms disused ... ... ... 12 19 42 28 Gipsy vans inspected ... ... ... 64 56 30 no Drains laid to New Houses ... ... ... ... 266 244 287 Samples taken under the Sale of Food and Drugs Act 101 1 103 101 227 300* 300* 400* *This is for the Analytical year ending March. 88 Act was three thousand eight hundred and seven, under sec. 4, eleven hundred and thirty-eight, and the notices served under sees. 62 ancl 65 were one thousand seven hundred and seventynine. Complaints to the number of three thousand eight hundred and forty-seven were received and attended to. The number of houses disinfected was one thousand six hundred and eight, while disinfectants were distributed in six thousand seven hundred and thirty-nine instances, and of certificates of disinfection, one thousand seven hundred and forty were issued, and nine hundred and thirty-four premises were cleansed and repaired, overciowding abated in one hundred and seven cases, and nine hundred and twenty-three drains flushed with disinfectants after infectious disease. Drains were tested by water in six thousand nine hundred and fifty-nine instances, and by smoke in fifteen hundred and fifty. There were seven hundred and twenty-five drains cleansed and repaired, while one thousand and seventy were relaid. There were two hundred and eighty-seven drains laid to new houses under the supervision of sanitary inspectors; each sanitary inspector now takes charge of all the drains, both old and new in his district. Soil pipes were ventilated in one thousand two hundred and eighty-three cases, sink and rain water pipes disconnected or repaired in five hundred and eighty-four instances. Six hundred and eighty-three water closets were cleansed and repaired, and four cesspools discovered and abolished, nine hundred and twenty-five closets were supplied with water or 89 the supply disconnected from the drinking-water cistern. Five hundred and forty-one cistern's were covered, cleansed or repaired. One hundred and forty-one houses were supplied with'water, and three hundred and twenty-seven certificates of proper and sufficient supply of water and fittings issued. The Health Committee and the Vestry ordered proceedings in one thousand two hundred and thirteen instances. Summonses were issued in seventy-two instances to enforce the same, and in sixty-two magisterial orders were obtained. Mews and stables were drained and paved in thirty-six instances, and one hundred and eighty accumulations of manure &c. removed or proper receptacles provided. Animals were found to be kept in an unfit state in twenty-one cases. Sanitary conveniences were provided or improvements effected to Factories or Workshops in one hundred and eighty instances. Dust receptacles were provided in six hundred and ninety instances, and one hundred and fifty complaints forwarded to Surveyor. Leaky house roofs and gutters were repaired in four hundred and nine cases. Underground sleeping rooms were disused in twenty-eight cases and gipsy vans inspected in one hundred and ten cases. Details of During the year 1898, 72 summonses were issued proceedings on behalf of the Public Health Department, particulars at Police Court of which are here set out:— 90 Summonses issued. Withdrawn. Dismissed. Orders obtained. Under the Sale of Food and Drugs Act 45 3t 7* 35 Uuder the Public Health (London 189!) Act:— Non-compliance with Sanitary notices, &c. 17 17 Contravention of byelaws 2 — — 2 Nuisances from emission of black smoke 6 — — 6 Exposure for sale of unsound food 1 — — 1 Permitting the occupation of new houses without obtaining water certificates 1 — —• 1 Totals ... 72 3 7 62 + The three summonses withdrawn under the Sale of Food and Drugs Act were upon production of warranties by the Vendors. * The circumstances of the dismissal of these summonses is here set out: — Difference in opinion (as result of analyses) between Public Analyst and Somerset House Officials 1 case. "Butter" held to be a perishable article —Summonses not served within 28 days of purchase 5 cases Articles held not to have been exposed for sale 1 case 7 The following articles of food have been condemned during the year, and certificates granted for same :— i box of herrings 1 bag of oysters 2 boxes of haddocks i bushel of winkles i trunk of mackerel i trunk of hake i barrel of skate 70 pomegranates 6 boxes of haddocks 1 trunk of plaice 1 bag of mussels 1 bag of walnuts 91 1 barrel of herrings 1 barrel of apples 39 lbs. of sprats 3/4 barrel of herrings 3/4 barrel of sprats 4 boxes of kippers 1 box of plaice A practice has been adopted that when retail vendors become aware that articles of food purchased of wholesale dealers are unsound and unfit for human consumption, they attend with the same at the Public Health Offices, and if satisfied that no attempt has been made to sell the articles, they are condemned by the Vestry's Officers, and cremated at the Dust Destructor, and a certificate is given in support of any claim upon the wholesale firm who originally sold the same. This no doubt prevents a large amount of unsound food being offered for sale. The whole of the butchers, fishmongers, fruiterers, and other tradesmen's premises have been kept under close and frequent supervision both on week days and Sundays, and in two cases it was found necessary to effect seizures. In one case proceedings were taken and the defendant fined, and in the other the defendant was cautioned and called upon to pay the costs incurred by the Vestry. Public List of Public Chalets, Sanitary Conveniences Lavender Hill, at junction of Falcon Road. Battersea Park Road, at corner of Cabul Road. Victoria Road, in the shrubberies in Battersea Park, by the Victoria Suspension Bridge. Victoria Circus, in the shrubberies in Battersea Park. In course of erection during the year under report. Opened March, 1899. During the year the Committee had under consideration the desirability of providing a public chalet, at the corner of 92 Bridge Road and Battersea Park Road. The consideration of the subject was eventually adjourned. Public-house The Health Committee in accordance with a Urinals. . . . practice adopted in several previous years, appointed a Sub-Committee in January, to inspect the urinals attached to Public Houses throughout the Parish. The Sub-Committee met on the 29th January and the 7th February, 1898, and consisted of the following members. No. 1 Ward. No. 2 Ward. Mr. C. Joiner. Mr. J. F. Lane. No. 3 Ward. No. 4 Ward. Mr. H. Giles. Mr. H. Chandler. The Sub-Committee having inspected the urinals, gave directions for notices to be served in 73 instances. They found that insufficient accommodation was provided for customers, or that their condition was so dilapidated or insanitary at nine premises, that the Health Committee directed that communications be addressed to the proprietors, requiring them to provide suitable accommodation, or that in default the renewal of the licenses would be opposed at the March meeting of the Licensing Justices. It was subsequently found necessary to oppose, and in several cases the licenses were renewed subject only to the Vestry's requirements being complied with. Disinfection During the year, 83 books were returned to the destruction Public Libraries from premises at which infectious UbraryBooks disease existed, and were forwarded to the Public Health Department. Of these it was considere'd necessary to destroy 67, the original value of the books being refunded to the Library Department, the remaining 16 being books difficult, and in many instances impossible of replacement, were subjected to disinfection and returned. 93 A daily list of premises at which infectious disease exists is supplied to the Librarian, who takes the necessary action for the collection of books which may be out and for the time prevents any further ones being issued. Bakehouses. The half-yearly inspection of bakehouses was carried out in May and September. At the May inspection there were 108 in active use, and with fifteen exceptions the cleansing and lime-washing had been carried out, in which cases intimations were served, followed in two instances by statutory notices by order of the Health Committee, which were subsequently complied with. At the September inspection it was found necessary to serve several notices, which were duly complied with. At that time the bakehouses in occupation numbered 104. The particulars of both these inspections will be found given in report of meetings of Health Committee of May 3rd and November 1st. 72a Wiustanley Road. These premises were unoccupied on the 1st January, 1896, and in accordance with the general interpretation of Sect. 27 (3) of the Factory and Workshops Act, 1895, were apparently prohibited from further use as a bakehouse. The Act provides that a place underground shall not be used as a bakehouse unless it is so used at the commencement of this Act, and if any place is so used in contravention of this Act, it shall be deemed to be a workshop not kept in conformity with the principal Act. It will be remembered that the Vestry therefore decided to take proceedings in the matter, and the case came before the magistrates, at the South Western Police Court, who made an order for the closing of the bakehouse and inflicted a fine. 94 Notice of appeal against the magistrate's decision was lodged, which came before Mr. Justice Wright and Mr. Justice Darling on the 18th March, 1898, when it was held that the temporary cessation of business was not sufficient to bring the premises within the Statute, and that it could not be held as a matter of law that, because the premises happened to be untenanted on a particular date, the section of the Act applied, and that they could not be further used as a bakehouse. The appeal was therefore allowed, with costs, tha Court holding that the determination of the Magistrate was wrong in law, and that he ought not to have convicted the appellant. Cowhouses In October last, a Sub-Committee of the Health Slaughter- Committee visited the whole of the Cow-houses and Houses. Slaughter-houses in the Parish for which applications had been made for the renewal of licenses, the results were given at the meeting of November 1st. The under-mentioned matters have from time to time been submitted to the Health Committee by the Chief Sanitary Inspector, Mr. Isaac Young, during the year under report, the dates being appended for convenience of reference. 18th January, 1898.—He submitted report at this meeting with reference to the condition of the drains in connection with the Dovedale Almshouses, Battersea Park Road, that upon testing they were found to be in defective condition, which necessitated their entire re-construction, and this has been carried into effect upon plans approved by the Vestry. 1st February.—By direction of the Health Committee, at this meeting he submitted report relative to the ground at the rear of houses in Stainforth Road, being occupied by van dwellers, and also with reference to a wooden shed or structure erected upon the same, in the occupation of the tenant of the ground. The land in question is usually occupied by a large number of van 95 dwellers, but upon the date of inspection there were only four vans upon the same, and these were in good and cleanly condition, and in no way overcrowded. The shed previously referred to as being occupied by the tenant, consisted of one large room, used for living and sleeping purposes, provided with fireplace, and the floor constructed some 18 inches above the ground. The sanitary conveniences used by the occupants are those provided for the use of the van dwellers, but were in defective condition upon the date of inspection. The shed had been occupied for some seven or eight months, but as no nuisance existed upon the premises, the Health Committee considered it was not a matter in which they could interfere. He further leported with reference to nuisance arising upon this ground from the storing of animal and vegetable matter in one of the railway arches, and also from the fish offal vans, usually standing thereon, during the intervals of collecting. Notices were served with reference to the cleansing of the fish offal vans, and also as to the periodical removal of animal and vegetable refuse, and this has resulted in considerable improvement being effected. At this meeting the Health Committee also considered letter complaining of effluvium nuisance arising from the Nine Elms Gas Works, and in connection with the same a report of the Chief Sanitary Inspector relative to the manufacture of carburetted water gas at the works in question, and which was believed to be the cause of the complaints which had been made in the neighbourhood. This nuisance had been observed by residents in the locality, and also by the District Inspector upon two or three occasions. Upon visiting the premises the Chief Sanitary Inspector discovered that the manufacture of water gas had only been recently established at the works, and it was anticipated that in a short time such improvements would be effected in the. plant as would prevent any further nuisance 96 arising. No nuisance was discovered to arise from the manufacturing or purifying processes, but close to the boundary of the works aud adjoining the district in which nuisance had been most experienced, the tar pits were situated; the products passed into the pits being at such a temperature as to give off a certain amount of steam, more or less offensive. He suggested as a remedy, the covering in of these pits, and although upon one or two subsequent occasions slight nuisance has been observed, it has only been of very short duration, and he is of opinion that proper precautions are now being taken by the Manager of the works in the matter. 15th March.—At this meeting the Chief Sanitary Inspector submitted report relative to his attendance before the Licensing Justices on the 4th inst., with reference to the 9 cases in which the Vestry had directed that the licences of the undermentioned houses should be opposed in consequence of the need of urinal accommodation, or, that which already existed, being either insufficient or defective. In order to assist the Justices in dealing with the cases, he had prepared plans with reference to each of the premises, as follows:— "The Black Swan," York Road. "The Waterman's Arms," Nine Elms Lane. "The Royal Arms," Battersea Park Road. "The Eagle," Battersea Park Road. "The Prodigal's Return," Bridge Road. "The Collingwood Arms," Plough Road. "The Rose & Crown," Culvert Road. "The True Briton," Stewarts Road. "The New Park Tavern," Bridge Road. In the case of the "Black Swan," the Vestry's opposition was objected to by Mr. Bodkin, barrister, who reviewed the opposition by the Vestry in 1891, and again in 1894, and stated that the Vestry had their remedy under the Public Health 97 (London) Act. This the Chief Inspector pointed out to the Justices was not the case; if there had been existing accommodawhich was insanitary, the Vestry could proceed for the abatement of the nuisance under the Public Health (London) Act, but the question in this case was that no urinal accommodation existed. The Justices decided to view the premises (although they had twice previously adopted a similar course upon the Vestry's representation), and consequently adjourned the renewal of the licence for this purpose. The renewal of the licences in respect of the under-mentioned premises were also adjourned in order that the Justices might view the same. "The Waterman's Arms," "The Royal Arms," "The Eagle," "The Prodigal's Return," "The Collingwood Arms," whilst the following cases, the "Rose & Crown," "The True Briton," and the "New Park Tavern," were adjourned in order that plans might be submitted to them respecting the alterations which the proprietors of the premises proposed to make. At this meeting he also submitted report, by direction of the Health Committee, relative to an application by Mr. Lane to slaughter cattle at No. 82 Usk Road, that the facts which were laid before the Licensing Committee of the London County Council on the 25th October, 1897 (when application to renew the licence was refused) respecting the premises were reiterated, and that the Licensing Committee decided not to grant the licence. He also reported with reference to the sanitary conveniences provided in connection with the London Steam Saw Mills, at which some eighty-six men were employed, that the water-closet and urinal accommodation were not in a satisfactory condition. The Committee gave directions for notices to be served, and the necessary works were subsequently carried out to meet the requirements of the Public Health (London) Act. G 98 He further reported at this meeting that acting under the directions of the Health Committee, he had entered upon the premises No. 58 Marmion Road, and opened up the drains for the purpose of testing, &c., when he had found they were in a very defective condition, and that the necessity for this action was brought about by the fact that the owner of the property who had been served with a notice, had executed certain works to the drains without giving notice to the Department, as is usual in such cases. The drains had been tested in the first instance, owing to cases of diphtheria occurring in the house, and the works subsequently carried out not having been executed under the supervision of the Vestry's Officers, the Committee deemed it necessary that they should be opened up and tested by water, as when tested in the first instance by smoke, they were defective. Upon a second test being applied, they revealed no defect. This was believed to be occasioned by the fact that a plug in connection with the interceptor had been removed with a view to lessening the pressure of smoke in the drain during the testing. The Committee gave directions for proceedings to be taken for the recovery of penalties to which the owner had rendered himself liable in the matter, and for enforcing compliance with the notice which had been served. The defendant promising to comply fully with the Vestry's requirements and paying 12s, costs, the summons was adjourned until the 8th of June, upon which date it was withdrawn, the works having been completed. He also reported, as directed by the Health Committee with reference to the condition of Garden Cottages, York Road, the entrances to which were alleged to be used as public conveniences, &c., that the cottages in question were approached by three entrances, one leading from Plough Road through Field Place, a second through Edmund's Place, and a third by a passage way between 253 & 255 York Road. The number of cottages situated in this area were ten, eight having only two rooms, the remainder having three, and being very old 99 property, they were more or less in a decayed condition, that the yards, waterclosets and wash-houses were badly paved, the roofs defective, the walls and ceilings in several instances dirty, and that some of the walls were covered with several thicknesses of paper. The yards at the rear of the houses were only a few superficial feet in area, but the front gardens were some 40 or more feet in length, and about 14 feet wide. The approaches to the houses from the end of the passage, and likewise from Edmund's Place and Fields Place, were both unpaved and undrained, but lighted by lamps at each end. He recommended that the making up and paving of the passages should, if possible, be carried out by the Vestry, and the cost apportioned the owners, subject to the opinion of the Solicitor. The Committee therefore directed notices to be served for enforcing compliance with their requirements, except as to the paving of the passage way. It was subsequently found that the whole of the drainage was in a very defective condition and required entire reconstruction. The cost of certain portions of this work fell upon the Vestry, owing to the decisions which have been given that a combined system might under certain circumstances be a sewer for which the Vestry would be responsible. The Vestry upon a later date adopted the recommendation of the Health Committee to pave the passage way and to apportion the cost thereof upon the owners. When this is carried out a much needed improvement will have been effected and add to the comfort of the tenants of the houses. He further reported that at the rear of certain houses in Latchmere Grove there were very large sheds in which wood-chopping was carried on, that during the inspection of these by Miss Thurgood, Sanitary Inspector, she had found both males and females were employed in the business for whom there was not separate and sufficient sanitary convenience. Many of the 100 persons employed in the workshops resided in the immediate locality. The Health Committee after careful consideration,determined that proper sanitary conveniences should be provided, and directed notices to be served accordingly under Section 38 of the Public Health (London) Act, which were subsequently complied with. He also submitted report with reference to a stone mason's yard which has recently been opened at the rear of Nos. 35 and 37 Granfield Street that several workmen were employed upon the premises for whom proper and sufficient sanitary accommodation had not been provided. The Committee gave directions for notices to be served, requiring such to be constructed, and for the demolition of the existing privy accommodation, and they were subsequently complied with, but not until the proprietor had been cautioned that summary proceedings would be taken in the matter. He also submitted report with reference to the overcrowded condition of a workroom at No. 14 Parkside Street, in which three men were employed, the cubic capacity of the shed being only 526 feet or a deficiency of 225 feet for those employed during ordinary working hours. The workshops, except as to the overcrowding were found to be in good condition. The Committee gave directions for notices to be served and these were subsequently complied with. 5th April. At this meeting he submitted a further report with reference to the licensing of public-houses, in respect of which he had opposed, on behalf of the Vestry, the granting of the licences in view of the unsatisfactory urinal accommodation provided ; that on the 25th March he had attended the adjourned Licensing Meeting and was pleased to be able to report that the action taken by the Vestry might be regarded as perfectly justified, judging from the decisions of the Justices in respect of most of the cases. 101 In two cases only, viz., the "Rose and Crown," Culvert Road, and the "Black Swan," York Road, had the Justices decided to renew the licence without enforcing the Vestry's requirements. In these two cases the licences had been previously opposed by the Vestry upon several occasions, and the Justices had viewed the premises and subsequently renewed the licences, each year the opposition had been placed before them, but as reported on the 15th March, the Justices had decided to again view the premises. In the case of the "Black Swan," they renewed the licence without comment, whilst in the case of the "Rose and Crown," in which the Justices had requested plans to be furnished to them as to the re-building of the premises, and which provided for urinal accommodation to be constructed, the Justices did not approve of the plans submitted for the proposed alterations and thereupon renewed the licence without requiring urinal accommodation to be provided. In respect of the "Collingwood Arms," Plough Road, and the "Royal Arms," Battersea Park Road, the Justices having viewed the premises, renewed the licences upon condition that the urinals were enlarged within a reasonable time. With regard to the "Eagle," Battersea Park Road, which they had also visited, they decided to renew the licence subject to proper urinal accommodation being provided. The "Waterman's Arms," Nine Elms Lane. Here also the Justices had viewed the premises and renewed the licence subject to the urinal which had been demolished, being re-instated. The "True Britain," Stewarts Road. This case had been adjourned for a copy of the plan submitted to and approved by the Health Committee to be submitted to the Justices. Having approved the same, the licence was renewed on condition that the Vestry's requirements were carried out in accordance with the plan. The "New Park Tavern," Bridge Road. The works herein having been completed in accordance with the plan submitted to and approved by the Health Committee, the opposition was withdrawn and the 102 licenced renewed. The "Prodigal's Return," Bridge Road. The Justices having viewed the premises renewed the licence subject to the proprietor giving proper access to the urinal already provided at the rear of the premises. The Health Committee subsequently submitted a report of these cases to the Vestry who expressed their appreciation of the manner in which the Chief Sanitary Inspector had successfully conducted the opposition of the Vestry. He also submitted further report with reference to offensive effluvia alleged to arise from certain chemical works in the parish and which were reported by him to the Health Committee on the 5th October, 1897, although the premises had been kept under continued observation both by day and night, no nuisance of a serious character had been observed to arise therefrom. Complaints had been made relative to the discoloration of premises in the neighbourhood of the works, which was believed to arise from the manufacture of cyanide of potassium. During a night observation on the 25th March, at 12.30 a.m., acid fumes were given out which were found to be slightly irritating to the nose and throat. Except for this, no nuisance was discovered during continued observations which had been kept for four or five hours. The Manager of certain other works in the neighbourhood of the chemical works, had given him permission to enter the premises at any hour by day or night for the purpose of making more complete observation upon th e chemical works in question, and upon several occasions he has availed himself, in company with the District Inspector, of this permission, but up to the time of reporting, had discovered no nuisance which would justify him in advising the Committee to take any peremptory measures in the matter. He also reported, as directed by the Committee, as to a special house to house inspection which had been ordered by them to be made of Broughton Street, that fifty-two drains had 103 been tested and in seven instances were found defective. The houses generally, with the exception of these defective drains and minor sanitary defects at others, were found to be in a very good sanitary condition. The previous house to house inspection had taken place in 1896, and the several defects that were then discovered had been dealt with. Only three complaints had been received during the two years preceding the date of report, two of which were in respect of one house and related to flushing cistern to water closet and want of suitable dust-bin. Scarlet fever had occurred in six houses in the street, diphtheria in two and erysipelas in one during the twelve months preceding the date of report. The drains in each case were tested but no defect discovered. The Committee also gave directions for Stanley Street to be inspected, when the following was found to be the result. Out of fifty-nine drains tested fifteen were found defective. In both this street and Broughton Street, all defects in drains were made good by relaying and repairing. 19th April. At this meeting he submitted special report relative to the condition of the drains at Nos. 1, 7, 8, 13 and 15 Froude Street; that upon testing they were found to be defective, and the drains being combined the owners considered that the Vestry were responsible for a portion of the work. The latter repudiated liability in the matter owing to the fact that the records in their possession provided that a combined system of drainage was to be laid down for each pair of houses. The owners neglecting to comply with the notice served, a summons was issued in respect of No. 1, which had been opened up by them and found to be drained in combination with No. 2, and as shewn upon the Vestry's records. At the hearing of the summons a letter was received by the Vestry's Solictor from the Solicitors to the owners, who wrote stating that they would be prepared, without prejudice, to execute certain works in connection with 104 the drains of the whole of the houses for which notices had been served, but were not prepared to fully comply with the usual requirements of the Vestry, viz., by constructing inspection chamber in front of the premises. Having regard to the opinion of the Solicitor, this course was adopted, and eventually the whole of the houses were redrained with the necessary inspection chambers at the rear for the purpose of receiving the branch drains, &c. It was subsequently found, however, that certain of the houses had a connection from a third house, and that in these cases, therefore, the plans approved by the Wandsworth District Board of Works at the time the houses were erected had not been carried into effect. Nevertheless, the owners having agreed to execute the necessary works to the drains in the manner above described, no further difficulty arose. He also submitted report, by direction of the Committee, as to a special inspection which had been made by himself and the staff on Good Friday and Easter Monday, of the various stalls, &c., in certain parts of the Parish, from which confectionery, shell-fish, &c., were sold; that in no instance was it found that the goods so sold or exposed for sale were unfit for human consumption. In some instances they were inferior in quality, but were in all cases in such condition that no interference with their sale/would have been justified. He also submitted report, relative to a request of the Coroner, Mr. Braxton Hicks, that an inspection of St. Saviour's Hall should be made and the drains tested, in view of the deaths recently occurring, it was alleged, through vaccination; that upon testing the drains they were found to be defective, the water closet pans foul and offensive, the water supply defective, and considerable deposits of excremental filth upon the open space round the building and at the side thereof. Notice was therefore served, and the drains being opened they were found to be broken and badly constructed with fourinch pipes connecting into six-inch without the necessary reducing 105 pipes, portions of the drains having a backward fall, and where bends should have been used in the construction of the works straight pipes had been inserted. That it was found necessary to reconstruct a considerable portion of the drainage and provide in connection therewith suitable inspection chamber and ventilation, in addition to which new water-closets were fixed and the flushing tanks put into proper working order. The urinals were also cleansed and the refuse removed from the ground, and the Committee were satisfied that the persons responsible for the premises had been properly called upon to execute the works reported as being carried out. He also submitted report relative to certain defective drains at Nos. 86 and 88 Gwynne Road, in respect of which notice had been served, that the owner, without giving any notice to the Vestry, proceeded to execute works thereto, and that upon a date subsequent to these works being carried out, the drains had again been tested and found to be defective. By direction of the Committee, statutory notice had been served, and the owner of the property had again, without giving any notice, proceeded to open up and execute such works he deemed necessary. Subsequent to the second repairs, the drains had again been tested, when no defect was discovered. The Committee therefore, upon the advice of the Chief Sanitary Inspector, directed that the drains should be opened up and examined with a view to ascertaining what works had been executed, and as to whether any further works were necessary. It was afterwards found necessary to condemn the entire system on account of its defective condition, the Vestry executing part of the work, the drains being combined. He also reported that during the fortnight under report no nuisances had been discovered to arise from certain chemical works previously reported upon, also that he had visited the works and found that the process which had been the subject of complaint was transferred to a new building at the side of the river, and that it was hoped by this 106 arrangement further nuisance would be prevented, although the Manager did not admit that anything escaped from the works likely to be injurious to the health of any person. It was, however, admitted that at times a certain amount of dust was given off during the removal of chemicals from one portion of the works to another, but it was anticipated that the steps which had been taken would considerably minimise, if not actually remove any cause for complaint in this respect. 3rd May. At this meeting, as directed by the Committee, he submitted report, relative to an underground bakehouse situated at Winstanley Road, that he had visited these premises on the 30th April, whilst the baking of bread was in progress, and at a time when it was possible to judge as to the effective ventilation or otherwise of the premises. The bakehouse, he stated was entirely underground, six feet in height from the floor to the underside of the joists, the latter being seven inches deep; a small portion of the underside of the joists above the kneading troughs, is boarded over to prevent the dust working through from the shop floor into the bread. The bakehouse was well paved and more efficiently ventilated than it had been on previous occasions when he had visited, the openings in the external walls, of which there were several being provided with air bricks, in addition to which a large grating in the front of the shop door, and also two chimney openings, assisted in the more efficient ventilation of the premises. That the cubic air space was 1,620 feet and as a rule only one person was engaged therein. That the walls, &c., were very clean and the bakehouse generally in better conditions than it had been for some considerable time. He also also ascertained from the occupier that only upon one occasion during his tenancy had sewage matter escaped into the bakehouse, and this was alleged to be due to the surcharging of the local sewers in the neighbourhood during heavy storms. This occured a few days prior to a visit paid to the premises by a Sub-Committee of the Health Committee. 107 He also submitted reports at this meeting relative to the alleged overcrowding of No. 117 Battersea Park Road, that it was found upon inspection of these premises that there were eleven rooms in the house, occupied by five families, but that in no instance was overcrowding found to exist, each family having not less than two rooms. The number of adult persons occupying the house was ten and of children five, or fifteen persons in all. For these five families, however, only one water closet existed, and the Committee gave directions that the owner should be required to provide further accommodation. Notice was subsequently served and complied with by the owner reducing the number of families in the house. Also with reference to the alleged overcrowding of a certain house in Stanmer Street, that upon inspection of the premises complained of no overcrowding was found to exist, but that at the adjoining house it was found that there were two small ante rooms occupied by a man, wife and four children, the ages of the latter being respectively 14, 8, 4½, and 2 years. There was a deficiency of air space of about 773 cubic feet. The Committee in this case directed proceedings to be taken for the abatement of the nuisance. Notice was accordingly served and complied with without recourse to summary proceedings in the matter. He also reported as to the half yearly inspection of bake-houses in the parish that there were 108 of such premises, divided up in the eight Sanitary Districts as follows:— No. 1 District 14 bakehouses. „ 2 „ 16 ,, „ 3 „ 16 „ „ 4 „ 16 „ „ 5 „ 11 „ „ 6 ,, 23 „ „ 7 „ 8 „ „ 8 ,, 4 „ 108 j 108 and that except in 15 instances the half yearly cleansing and limewhiting of the walls, &c., had been carried out. The Committee gave directions that the necessary notices should be served and if not complied with, further proceedings taken. The works of cleansing, &c., were, however, carried out upon the notices being served and it was unnecessary to resort to summary proceedings in any case for enforcing the requirements of the Act. In one case out of the 108, the bakehouse was being rebuilt, the old one having become somewhat dilapidated. 14th June.—At this meeting he submitted report that a builder had, without having given the necessary notice as required by the Bye-laws of the London County Council under Sec. 39 (1) Public Health (London) Act, 1891, constructed a water closet in connection with the common lodging house at 75 Falcon Road, and further that he had made certain alterations to the drains, consequently rendering himself liable to penalties. The Committee gave the directions for the necessary proceedings to be taken in the matter and the defendant was subsequently fined 5s. and 2s. costs. The Committee also considered report relative to similar works which had been carried out in connection with No. 14 Sisters Avenue, at which premises, a builder, acting on behalf of the owner, had fixed two water closets without giving notice, and had connected the trap of the water closet to an iron junction in the soil pipe, contrary to the Bye-laws, that the owner had subsequently called upon him with reference to the matter and expressed his regret for not having given notice, his builder had been instructed to do so but had neglected to casry out such instructions. The Committee directed that the Chief Sanitary Inspector should caution the latter and also the owner in respect of the matter. He also submitted report relative to the occupation of Petworth House, Boundaries Road, without the necessary certificate of water supply having first been obtained. The Committee, 109 however, decided not to prosecute in the matter, inasmuch as the house had been sold at least a fortnight, and that the builder was unaware that the purchaser had intended to occupy the house so soon. He also at this meeting submitted report as to the inadequate water-closet and urinal accommodation in connection with the Projectile Company's Work, New Road, at which there were at the time of his inspection about 540 men, working in two shifts of 340 during the day, and 200 during the night. He found that for this number, eight water-closet, in addition to urinal accommodation, was provided, and that these upon inspection were in good and cleanly condition, having been altered, upon his suggestion, two or three years previously, at which time less than 200 workmen were employed. He suggested that eight additional water closets be provided, which would give accommodation for 400 men. This view the Committee adopted, and the works were subsequently carried out. He also reported with reference to Messrs. Arding & Hobbs' workshops, St. Johns Hill, that upon inspection there were some 16 male and 7 female persons employed in the upholstering, carpentering and cabinet-making trades. The work rooms in each case were found to be in cleanly condition and not overcrowded. The water closet accommodation was insufficient, there being one w.c. for the use of the two sexes. The arrangement was a temporary one pending the completion of the new premises the firm were erecting in Ilminster Gardens, and so soon as these were completed, the work-people employed at the workshops in question would be removed to the new building. He therefore suggested that subject to the present apparatus being put into proper condition, the Committee should not require accommodation to be provided at present. 110 The Committee after careful consideration of the matter, decided to agree to these recommendations, and in due course the necessary repairs were made to the water closet, since which, the workpeople have been transferred to the new building. 5th July. At this meeting he submitted further report relative to the alleged nuisance arising from the manufacture of water gas at the Nine Elms Gas Works that the premises had been kept under constant observation, and that he found there was no cause for complaint. The Chief Sanitary Inspector also submitted report with reference to the nuisance arising from the manner in which kitchen and hotel refuse is received and dealt with at the premises No. 69 Stainforth Road, the work of sorting being conducted in some sheds at the rear, and that a similar business is also conducted at No. 11 Latchmere Grove, and at No. 22 Latchmere Grove. He was of opinion, that this was a business which ought to be conducted under proper Bye-laws made by a central Authority, and administered by the Local Sanitary Authority both as to the structure of the buildings in which the business was carried on, and also the conduct of the business, and had previously had to call the attention of the Committee to nuisances arising from the sorting, &c. of the animal and vegetable refuse, and suggested that the owners should be required to properly pave and drain the premises in which the business was conducted. The Committee gave the necessary directions in the matter. The Committee also considered report of the Chief Inspector relative to the drains of No. 16 Rushhill Road which connected with a combined system of drainage at the rear, serving Nos. 2 to 14, the whole of which had been re-constructed, except the drain serving No. 16. That notice had been served upon the the owner of this property (who through her representative disputed that the drains were defective) that he had, with the District Inspector, visited thepremises, tested the drains, and found 111 them defective. The owner's representative thereupon promised to give notice when remedying the defect, in order that the works might be examined. No such notice, however, having been given, a further inspection of the property was made when it was found that a new water-closet, &c. had been fixed, and certain repairs made to the drains. That on the 2nd inst., not being satisfied as to the works which had been carried out, application was made to test the drains with water, but the Inspector was refused admission to the premises without a Magistrate's Order. The Chief Sanitary Inspector then asked the authority of the Committee to apply to a Court for a warrant for the purpose, and they gave directions that application should be made for the same, if found necessary. See report of proceedings at following meeting of the Committee. 19th July.—At this meeting he submitted report with reference to the urinal accommodation in connection with the "Collingwood Arms," Plough Road, that the licence of these premises was one which he had opposed in March, at which time the Justices viewed and ordered that the urinal should be enlarged to meet the Vestry's requirements; that he had been in communication with the Clerk to the Justices relative to Mr. Pott's neglect to comply with the order made upon him by the Bench. The Clerk to the Justices had summoned Mr. Potts to attend before the Justices at their next meeting, and being himself ill, the Chief Inspector had directed the District Inspector to attend and explain to the Bench the action which had been taken, and it was satisfactory to be able to report to the Committee that the Justices intimated to Mr. Potts that if the requirements of the Vestry were not carried out by their next meeting, his license would be seriously imperilled, since which the licence holder has considerably enlarged the urinal, giving a superficial area of from 24 to 30 feet. 6th September.—The Committee also considered report of the Chief Sanitary Inspector relative to several houses in Savona 112 Street and other parts of the Parish at the rear of which wooden structures existed, and were used for the purpose of keeping ponies, donkeys, &c.; that these structures had doubtless been erected from time to time without the sanction of the Authority and being used as stables, to comply with the Bye-laws of the Vestry, should be properly paved and drained. As, however, in several cases it would be difficult to provide proper paving and drainage, he suggested to the Committee that where this was impossible, the owners should be permitted to use peat litter or sawdust, subject to the refuse accummulating being properly removed. 20th September.—At this meeting the Committee also considered a complaint which had been made relative to alleged nuisance arising from the manufacture of water gas at the Nine Elms Gas Works, and also in connection therewith a report of the Chief Sanitary Inspector upon the matter; that the premises had been the subject of previous reports upon the matter, and had been kept for months past under constant observation. The complainant referred to stench, smoke and noise. Enquiries had been made in the neighbourhood of the Works, which did not bear out the complaints so far as stench and smoke were concerned, neither did the observations which had been kept upon the premises by the Vestry's own officers, and that since his report of the 1st February he had again visited the premises and found the greatest precautions being taken, he was of opinion there was no cause for complaint. He reported, however, that the premises would be still kept under observation, and that as soon as nuisance was observed, the matter would be reported to the Committee. The question of noise was one outside the Committee's jurisdiction under the Public Health (London) Act. He also submitted report to the effect that the Inspector for No. 2 District had seized a quantity of apples exposed for sale at a shop in Culvert Road, and that the Magistrate at the South Western Police Court had condemned the same, and ordered their destruction. 113 The Committee gave directions for proceedings to be taken. He also submitted report to the effect that he had been desired by the Chairman of the Vestry to report to the Committee as to the conditions under which ice-creams were manufactured in the Parish, that there were unfortunately no regulations or bye-laws in existence governing the construction of premises in which ice-creams are manufactured, or the conduct of the business, the consequence being that such articles might be manufactured in places which are totally unfit for the purpose, and that it had been found necessary in the past to serve notices with reference to the insanitary conditions existing at buildings in which ice-creams were manufactured; that the Vestry had previously directed the attention of the Local Government Board to the matter, as arising out of the previous reports that he had furnished to the Committee upon the subject. 4th October.—At this meeting the Chief Sanitary Inspector submitted report with reference to certain proceedings taken against a Mr. Chapman for constructing a watercloset without first having given notice to the Vestry, as required by the bye-laws of the London County Council under Sec 39 (1) of the Public Health (London) Act, and that he had been fined on the 29th June, 5/- and 2/- costs in respect of the offence. That in view of the water-closet having been constructed without supervision, the drains had been tested and found defective, and in due course notice was served to take up and relay the drains where necessary. He thereupon proceeded to make considerable alterations in the drainage, constructing an inspection chamber in the yard, and diverting the various drains from the water-closets, &c., into the same, but without providing suitable channel curves and bends to direct the flow of sewage into the main drain, consequently the tributuary drains entered the inspection chamber at right angles to the main drain, so that during the discharge of the said H 114 drains, the soil, &c., was washed across to the opposite side of the inspection chamber, contrary to the regulations of the Vestry. Considerable correspondence ensued, and eventually he submitted a plan which was approved by the Vestry, and the works were ordered to be carried out in accordance with the Drainage regulations. As however, certain works had been executed which were not shown upon his plan, he was requested to furnish an amended application, but in the meantime, he had taken up and diverted a considerable portion of the general system of drainage, and had further substituted a four inch drain for the six inch main drain. The Committee approved of the action of the Chief Sanitary Inspector, in refusing to test the drains which had not been sanctioned, and directed that the matter should be placed in the hands of the Vestry's Solicitor with a view to proceedings being taken. These were subsequently instituted, a summons being granted. Upon service however, it was discovered that the defendant had gone to Australia, and was not expected back for several months. 18th October.—At this meeting the Chief Sanitary Inspector reported with reference to a nuisance alleged to arise from the manufacture of gas at the London and South Western Railway Co.'s Works in Plough Road, that in the early hours of the morning of the 7th October, the residents in the locality of Plough and Maysoule Roads, suffered from offensive effluvia gaining access to the houses and producing a considerable amount of sickness. Upon receipt of the complaint, certain of the houses were visited and the smell of gas was distinctly noticeable, which at first caused suspicion that the drains of the houses were defective, and that the smell must have arisen from some matter passed into the sewer and escaping through the defects in the drains. As however there were houses similarly affected in which the drains were known to be in sound condition, he was of opinion that 115 the nuisance could not arise from this cause, and consequently visited the works of the Railway Company at which oil gas is manufactured, for the purpose of lighting the railway carriages, the gas being produced from shale oil, passed into the retorts, which are heated by coke. Certain purifying processes follow, principally by lime, and the gas is then stored in stationary vessels, suitable for the purpose, and also in drums upon an open site upon the ground, the latter having been sanctioned as a suitable position, as he was given to understand, by the London County Council. He was not able to ascertain from the drainage in connection with the works, that any of the products of manufacture had been allowed to enter the drains, and therefore the sewers in the locality. The gas is known as hydrocarbon and he was of opinion that the nuisance must have arisen through a large quantity of the gas having inadvertently been allowed to escape into the atmosphere, as the houses which were affected were in close proximity to the works, and no nuisance was noticeable along the line of sewer, except in the immediate vicinity of the works. He further ascertained that this gas had been manufactured at the works in question for the past 18 years, and this was the first occasion to his knowledge that any nuisance had been ascertained to arise. No further nuisance has been discovered, although the premises have been kept under observation continually since the date of report. He also submitted report to the effect that Mr. Barker of Philpot Street, Mile End, a builder erecting property in Leveson Road, Clapham Common, had allowed No. 19 to be occupied by a family as caretakers without first having made application for the certificate of water supply as required by section 48 Public Health (London) Act. Also that in connection with the house the drains had not been finally tested and passed. The Committee therefore gave directions that proceedings should be taken against Mr. Barker in the matter and he was subsequently fined for the offence. 116 During 1897, the Chief Sanitary Inspector reported with reference to an offensive business which had been carried on at certain premises in High Street, the nuisance being the scraping and drying of skate skins. At the meeting of the 18th October, 1898, it had been found that, although the shop had changed hands since the report in 1897, the business of cleansing and drying fish skins had been recommenced, but the occupier, upon being cautioned by the District Inspector as to the nuisance arising from this business, and hearing that the previous occupier of the premises had been threatened with proceedings, discontinued the scraping, &c., of the fish skins. On the 12th October it was found that the occupier was again engaged in the business. Preliminary notice was therefore served, and by direction of the Health Committee, statutory notice was also served, since which time no further nuisance has been discovered by the officers of the Health Department. The Chief Sanitary Inspector drew attention to the fact that it was a most offensive business, and in many respects resembled gut scraping, and was undoubtedly one of those businesses which should be conducted in properly constructed buildings and under similar bye-laws to those which regulated the business of the gut scraper. 1st November. At this meeting the Chief Sanitary Inspector submitted report in accordance with the directions of the Committee, relative to the disposal of goods entrusted to a firm of disinfectors for the purpose of disinfecting after infectious disease, that he had ascertained it was the practice of the firm to disinfect articles of clothing, &c., which had been subjected to the various diseases classed as notifiable under the Public Health (London) Act 1891; and that after the disinfection was carried out, all goods were returned to the houses from which they had been brought, except in those cases where the instructions of the Sanitary Authority were that the goods should be destroyed. In the latter case, this 117 was carried out in a specially constructed furnace in connection with the works, and the greatest possible precautions were taken to prevent the spread of disease in bringing the articles to the works, and that none of the workmen in their employ were allowed to take away or dispose of any such articles. He also submitted report to the effect that he had attended the Annual Meeting of the Licensing Committee of the London County Council in connection with the licensing of the Slaughterhouses, cowhouses and knacker's yards, which was held on the 24th October, that the number of slaughter-houses in the Parish for which application had been made was nine, that in one case, conditions were attached to the licence, and in another objection was taken to the Licence by the London County Councils Officer, this being in respect of the slaughterhouse, No. 139 Bridge Road West, at which premises it was shewn the occupier had infringed the Bye-laws of the Council in not cleansing the floor of slaughterhouse and fat board, on completion of slaughtering, in placing a quantity of offal and foul liquid in a receptacle intended for stable manure, and placing intestines from slaughtered animals in uncovered receptacles, that as summary proceedings were being taken against the proprietors, the Committee adjourned the case until their next meeting. On the 28th inst., the result of the proceedings taken against the proprietor were reported to the Committee of the Council, and the proprietor having been fined 20s. and 4s. costs, his licence was renewed. He also submitted report relative to the half yearly inspections of bakehouses, that twelve of the bakehouses situated in No. 1 District the half yearly cleansing and limewhiting, had been carried out, the remainder not being in use. In No. 2 District, the Committee directed notices to be served in two cases for cleansing and limewhiting, one bakehouse was not occupied whilst the remaining 14 were in cleanly condition. 118 In No. 3 District, out of 16 bakehouses the usual cleansing, &c., had not been carried out in 12 instances, in 1 case the bakehouse was closed. In No. 4 District, the Committee gave directions for 2 notices to be served, 14 bakehouses being in satisfactory condition, and 1 being closed. In No. 5 District, 11 bakehouses, and in No. 6 District 23 were all in cleanly and satisfactory condition. In No. 7 District there were 8 bakehouses, and the Committee gave directions for notices to be served requiring the cleansing and limewhiting to be carried out in 4 instances. In No. 8 District there were 4 bakehouses, all of which were in cleanly condition. The total number of bakehouses in use at this time was 104, and the number unoccupied 5. 1st November.—The Chief Inspector reported on the 1st November as to a report that he had submitted on the 5th July concerning the defective condition of drains at No. 16 Rush Hill Road, at which time the Committee gave directions that if necessary warrant should be obtained for opening up the drains. That as advised by the Solicitor he had given notice to the occupier of his intention to apply for such warrant if he was not admitted to the premises, and on the 22nd October, having been again refused admission, he made application to the Magistrate at the South Western Police Court to enter the premises, open up and examine the drains. The issue of the warrant being opposed by the owner. Mr. Francis, the Magistrate, however, on the sworn information of the Chief Sanitary Inspector, held that there was reasonable ground for entry, and that there had been a refusal or failure to admit the Inspector to the premises by the occupier, 119 and granted the warrant. That upon entering the house by virtue of the warrant on the 24th October with the District Inspector and the Vestry s workmen, and opening the drains he had found them seriously defective throughout their entire length. The owner's representative being present during the examination eventually agreed to take up and relay the entire system in accordance with the Vestry's requirements, and the works were subsequently carried out. This was the first occasion that he had found it necessary to apply for a warrant for the purpose of enforcing the Vestry's requirements, and the Magistrate expressed the opinion that the owner had acted very unwisely in refusing the Sanitary Authority admittance to the premises in question. 15th November. At this meeting, the Chief Sanitary Inspector reported to the effect that a railway company was constructing water closets, and making alterations to the drains without first having given notice to the Vestry as required by the Bye-laws of the London County Council, that upon this being discovered he had communicated with the railway company who had replied that they were not subject to the Bye-laws of the London County Council governing the construction of water closets, they having power to make and maintain drains within the limits of deviation under their own private Acts of Parliament, that he had consulted the Solicitor upon the matter, who was of opinion that the Company were acting within their rights in making these alterations without the sanction or approval of the Vestry. He also reported relative to a seizure of apples made by No. 5 District Inspector, which were afterwards condemned and ordered to be destroyed by the Magistrate at the South Western Police Court. The Committee gave directions for proceedings to be taken, but subsequently cancelled this order upon the 120 owner of the apples paying the cost the Vestry had incurred in the matter. 6th December.—At this meeting the Chief Sanitary Inspector submitted report relative to the inspection of gipsy vans which had been made throughout the Parish, that in No. 2 District there were 10 vans, in No. 4 District 38 vans and in No. 5 District 7, making a total of 55 as compared with 68 in 1895. That these structures were regulated by bye-laws made under the Housing of the Working Classes Act, 1885, and which amongst other things requires that 150 cubic feet of air space shall be provided for adults and 75 cubic feet per child under 12 years. Than in one van in No. 2 District the cubic air space was 52½ feet deficient, whilst in No. 4 District there were four vans overcrowded, one of which had a deficiency of 200 cubic feet, being occupied by three adults and two children under 12 years; in a further case the van was occupied by a man, wife and two lads, 15 and 19 years respectively. In this case the deficiency in air space being 243 cubic feet. In No. 5 District five out of the seven vans were overcrowded; in two of these however the deficiency of air space was only 25 and 30 feet respectively, in the three remaining cases the deficiency was 110 cubic feet in a van occupied by two adults and two children, a deficiency of 175 cubic feet in a van occupied by two adults and three children, and a deficiency of 150 feet in a van occupied by two adults and two children. The Committee gave directions for notices to be served in all cases except the two where the deficiency in air space was slight, and these were subsequently complied with. The Chief Sanitary Inspector further reported that the result of this inspection showed marked improvement as compared with that which was made in 1895, when it was found that out of 68 vans then standing in the Parish, no less than 46 were 121 overcrowded, many seriously so, while at the recent inspection only 8 out of a total of 54 were found to be overcrowded. That the vans taken as a whole were in much better condition, in only one case was the van dirty and dilapidated. In this instance the Committee gave directions for notice to be served. At this meeting be also reported relative to the unsuitable water closet accommodation provided for workmen at the rear of Nos. 28 and 29 Sarsfeld Road by a builder erecting houses in Boundaries Road in the Parish of Streatham. The Committee gave directions for notices to be served requiring him to provide proper accommodation, and these were subsequently complied with. The Committee at this meeting upon a report of the Chief Sanitary Inspector gave directions for notices to be served upon the occupiers of houses adjoining the Railway Embankment at the rear of Nos. 21 to 100 Knowsley Road, who were in the habit of depositing offensive matter upon the Embankment. Also upon the occupiers of certain houses in Benham Street and Britannia Place, who deposited refuse upon the playground in connection with the British Girls' School. 20th December.—At this meeting the Chief Sanitary Inspector submitted report relative to the sanitary convenience's in connection with certain stoneworks in Stewarts Road, which were improperly supplied with water. The Committee gave the necessary directions and the works were subsequently carried out to comply with their requirements. At a subsequent meeting the Committee considered a report of the Chief Sanitary Inspector to the effect that certain water closet apparatus had been fixed at No. 4 Dulka Road without notice having first been given, as required by the Bye-laws of the London County Council. That the builder had been previously convicted of a similar offence in 1896. The Committee gave directions that proceedings should be taken and he was fined by the magistrate before whom the casewas taken. 122 Female Sanitary Inspector Miss Bertha Thurgood was appointed a Sanitary Inspector to take charge of premises in which women' young persons or children worked, and also visited registered houses let in lodgings. At the end of about 14 months she resigned for the purpose joining a relative in South Africa. On leaving the Vestry's service she handed in the following report which gives in detail the work done by her whilst acting in this parish. "As this will be the last occasion on which I shall report to you I would like to give a brief summary of the work done while I have been in your service:— I have inspected and registered 17 factories with 900 female workers. 187 laundries (including factory, workshops and domestic laundries, with 1,800 female workers). 72 dressmakers with 370 ,, ,, 23 milliners ,, 50 „ „ 18 tailors „ 40 „ „ 20 miscellaneous workshops ,, 100 ,, ,, 337 3260 I have inspected but kept no register of tailors, domestic workshops, also of shops where female assistants are employed. 35 Private schools with an attendance of 1,100 pupils have been inspected and registered. During the last three months I have constantly visited 50 houses in Orville Road and Green Lane, registered as tenement houses, giving numerous instructions and intimations, I feel that it is only by regular and constant inspection that any permanen good will be done with this class of work. 123 The following defects have been attended to, and improvements made:— 116 Premises cleansed. 34 W.C. accommodation, dirty, defective or insufficient. 31 Cisterns cleansed, draw-off taps or flushing apparatus provided. 32 Sanitary dustbins provided. 10 Defective roofs and gutterings. 26 Cases of overcrowding. 19 Defects of a structural nature. 15 Wash-houses and yards paved. 283 All cases of drain complaints have been referred to the District Inspectors. Fourteen complaints received from the Factory Inspector and other sources have been attended to. Fifty-one addresses of workplaces not previously notified have been forwarded to the Home Office. In the course of this year's work I have inspected 1,674 premises, reinspected 788 and paid 1,086 other visits, making a total of 3,548 premises visited. In addition to this I have assisted in taking samples under the Food and Drugs Act." In conclusion I must again refer to the generally good health of the parish during the year, with the exception of the months of July, August and September, when the long continued high temperature combined with an almost total absence of rainfall, led to much sickness, more especially amongst infants, deaths 7 24 from Diarrhœa and other heat-produced diseases being numerous The total mortality for the year, as shewn earlier in this report was the lowest in the forty-three years included in Table V. with four exceptions. This condition, I beg to submit, is to a great extent due to the sedulous care exercised by the Health Committee and the staff acting under it to remove any probable cause of disease. To the members of the Health Committee and to the Vestry generally, I owe many thanks for the support I have received in carrying out the duties of my office. I have also to thank my colleagues for their ready assistance at all times and I feel that I owe much to the unremitting labours of the staff of the Public Health Department. I have the honor to be, gentlemen, Yours obediently, W. H. KEMPSTER, M.D. Medical Officer of Health. 125 APPENDIX LIST OF STREETS AND PLACES CONTAINED IN EACH OF THE EIGHT SANITARY DISTRICTS OF BATTERSEA. District No. i. Boundaries:—North, River Thames; South, Parish Boundary; East, Parish Boundary: West, L.B. & S.C.Ry. [southward to L. & S.W.Ry.] the latter railway [westward] and Beaufoy Road. Inspector—Mr. J. Herrin. Acre Street Mundella Terrace Ægis Grove New Road Arden Street Nine Elms Lane Ascalon Street Patmore Street Battersea Park Road (From L.C. & D.Ry. bridge to Nine Elms.) Ponton Road Ponton Street Porson Street Belfour Street Portslade Road Bewick Street Power Street Brandon Street Prairie Street Brewery Cottages Queens Road (South of L. & S.W.Ry Station.) Broughton Street Ceylon Street Cherwell Street Queens Square Corunna Place Robertson Street Corunna Road Ruskin Street Corunna Terrace St. Andrews Street Crichton Street St. Phillips Street Cringle Street Savona Place Currie Street Savona Street Dashwood Road Seldon Street Dickens Street Seymour Street Emu Road Silverthorne Road Etruria Street Sleaford Street Everett Street Stanley Street Foot's Row Sterndale Road Froude Street Stewarts Road Gambetta Street Stockdale Road Gonsalva Road Tennyson Street Haines Street Thackeray Street Haward Street Thessaly Square Ingelow Road Tidbury Street John Street Tidemore Street Kirtling Street Trollope Street Linford Street Tweed Street Montefiore Street Wadhurst Road Motley Street William Street Mundella Road Woodgate Street 126 District No. 2. Boundaries:—North, River Thames; South, W.L.E. and L. & S.W. Railways; East, L.B. & S.C. Railway; West, Albert Bridge Road (Southward to Cambridge Road), Cambridge Road, Bridge Road (from Cambridge Road, Southward) and Battersea Park Road (Westward to W.L.E. Railway Bridge). Inspector—Mr. A. Chuter. Abercrombie Street Kilton Street Albert Road (East Side and West Side from Cambridge Road to Battersea Park Road) Landseer Street Landseer Terrace Latchmere Road (From W.L.E. Railway to Battersea Park Road). Alexandra Avenue Alfred Street Latchmere Street Anerley Street Lockington Road Arthur Street Longhedge Street Atherton Street Lurline Gardens Austin Road Macduff Road Battersea Park Meath Street Battersea Park Road Millgrove Street Beechmore Road Orkney Street Berkley Street Oulton Street Blondel Street Pagden Street Brighton Terrace Palmerston Street Brougham Street Palmerston Terrace Brynmaer Road Park Grove Cambridge Road Parkside Street Carlton Grove Prince of Wales Road (From Albert Road to Victoria Road) Carpenter Street Chatham Street Chesney Street Queen's Road (From Battersea Park Road to Queen's Road Station) Culvert Road (From Battersea Park Road to L. & S.W. Railway). Raywood Street Cupar Road Rollo Street Doddington Grove Russell Street Forfar Road St. George's Street Foxmore Street St. James' Grove Frere Street Sheepcote Lane Gaines' Cottages Soudan Road Gladstone Street Southolm Street Gladstone Terrace Stewart's Lane West Havelock Terrace Victoria Circus Henley Street Victoria Road Kassala Road Warriner Gardens Kennard Street Warriner Mews Kersley Mews Warsill Street Kersley Street 127 District No. 3. Boundaries:—North, River Thames; South, W. L. E. Ry. East, District No. 2 ; West, River Thames. Inspector—Mr. J. Lawrence. Albert Road (West side) (From River Thames to Cambridge Road.) Henry Street High Street Home Road Alfred Place Howie Street Althorpe Grove Hyde Lane Anhalt Road Inworth Street Ashton's Buildings Tuer Street Ashurst Street Little Europa Place Baltern Street Miles Cottages Banbury Street Octavia Street Battersea Park Road (North side from W.L.E. Railway to Bridge Road.) Orbell Street Orville Road Bolan Street Park Road Bolingbroke Road Parkham Street Bourne's Place Petworth Street Bridge Road Peveril Street Bridge Road West Phoenix Wharf Lane Bullen Street Prince of Wales Road (From Albert Road to Bridge Road.) Cambridge Road (North side) Castle Street Radstock Street Church Lane Randall Street Church Road Rosenau Crescent Colestown Street Rosenau Road Cottage Place Somerset Street Crescent Place Spencer Street Edna Street Spicer Street Elcho Street Stanmer Street Ethelburga Street Surrey Lane Ford's Place Surrey Lane South Frances Street Trott Street Freeland Street Ursula Street Goulden Street Vicarage Road Granfield Street Watford Villas Green Lane Wellington Road Harley btreet Winstead Street Hart Street Worfield Street Henning Street 128 District No. 4. Boundaries:—North, W.L.E. Railway; South, York Place Winstanley Road, and L. & S.W. Railway; East, outer circle of W.L.E. Railway ; West, River Thames. Inspector—Mr. A. E. Purnell. Afghan Road Latchmere Grove Andoe Road Lavender Road Barmore Street Lavender Terrace Battersea Park Road (From High Street to w.l.e. Railway Bridge, odd Nos. 575 to 583, even Nos. 326 to 356) Lithgow Street Livingstone Road (odd Nos. 1 to 23 and the Board School) Benfield Street Lombard Road Buckton Street Lubeck Street Cabul Road Mantua Street Candahar Road Meyrick Road Creek Street Musjid Road Currie Road (odd Nos., 1-23; even Nos. 2-20) Natal Road Nepaul Road Darien Road (odd Nos., 1-23; even Nos., 2-20) Newcomen Road (odd Nos. 1-15; even Nos. 2-12) Duffield Street Este Road Newman Street Falcon Grove Patience Road Falcon Road (From Prince's Head to Railway Bridges, odd Nos. 1 to 135, even Nos. 2 to 134) Pearson Street Rowena Crescent Shillington Street Simpson Street Falcon Terrace Speke Road (odd Nos. 1-37 ; even Nos. 2-50) Grant Road (even Nos. 2-38a ; odd Nos. 1-21) Stainforth Road Gwynne Road Thibet Street Harroway Road Totteridge Road Heaver Road Urswicke Road High Street (Battersea Station to York Road. odd Nos. 137 and even Nos., 110 upwards.) Verona Street Wayford Street Winders Road Holman Road Winstanley Road (even Nos.) Ingrave Street Kamballa Road Wye Street Kerrison Road Yelverton Road Khyber Road York Road Knox Road (odd Nos. 1-21; even Nos 220) (odd Nos. 1-199; even Nos. 2-112.) 129 District No. 5. Boundaries: North, District 2; South, Lavender Hill; East, Beaufoy Road and Parish Boundary; West, District 4 and Falcon Road. Inspector—Mr. J. T. Baxter. Acanthus Road Holden Street Amies Street Kathleen Road Arliss Road Kingsley Street Ashbury Road Knowsley Road Basnett Road Latchmere Road (From W.L.E Railway Bridge to Lavender Hill). Beaufoy Road Birley Street Brassey Square Lavender Hill (North side) Culvert Place Morrison Street Culvert Road (From L. & s.W Rly., southward) Mossbury Road Pountney Road Dorothy Road Poyntz Road Eland Road Sabine Road Elsley Road Shellwood Road Eversleigh Road Shirley Grove Falcon Road (From Railway Bridge to Lavender Hill.) Theatre Street Tipthorpe Road Town Hall Road Gideon Road Tyneham Road Glycena Road Wickersley Road Grayshott Road Wycliffe Road Hanbury Road District No. 6. Boundaries:—North, District 4; South, Bramfield Road, a line continued westward across Wandsworth Common to Parish Boundary; East, Falcon Road, St. John's Road, and Northcote Road; West, River Thames and Parish Boundary. Inspector—Mr. H. Marrable. Abyssinia Road Bennerley Road (From Northcote Road to Wandsworth Common.) Aliwal Road Auckland Road Battersea Rise (From Northcote Road Westward.) Bolingbroke Grove (From Battersea Rise to Bramfield Road.) Benham Street Boutflower Road Belleville Road (From Northcote Road to Wandsworth Common.) Bramfield Road (North side) (From Northcote Road to Wands worth Common.) I 130 District No. 6—continued. Britannia Place Park Road, Wandsworth Common Brussels Road Cairns Road Plough Road Canterbury Place Plough Terrace Chivalry Road Prested Road Clapham Junction St. John's Hill Cologne Road St. John's Hill Grove Comyn Road St. John's Road (West side) Currie Road Darien Road (From Plough Koad to Winstanley Road.) St. Peter's Place Salcott Road (From Northcote Road to Wandsworth Common.) Eckstein Road Emma Street Sangora Road Field's Place Severus Road Grant Road (From Plough Road to Winstanley Road.) Sewell Road Shelgate Road (From Cemetery to Northcote Road ) Harbut Road Hermitage Gardens. Hibbert Street Speke Road (From Plough Road to WinStanley Road.) Hope Street John Street, York Road Spencer Road Kelmscott Road (From Northcote Road to Wandsworth Common.) Starch Factory Road Stockwood Street Strath Terrace Knox Road (From Darien Road to Winstanley Road). Strathblaine Road Tritton Street Linda Street Usk Road Livingstone Road (From Plough Road to Winstanley Road.) Vardens Road Wakehurst Road (From Northcote Road to Wandsworth Common.) Lothair Street Louvaine Road Wandsworth Common North side Mallinson Road (From Northcote Road to Wandsworth Common.) Wayland Road Weston Street Maysoule Road Wilson Street Mendip Road Windmill Road Middleton Road Winstanley Road (South side) (odd Nos.) Newcomen Road (From Plough Road to Winstanley Road.) York Place Northcote Road (West side—From Battersea Rise to Bramfield Road ) Oberstein Road York Road (From junction with Plough Road to Parish Boundary). 131 District No. 7. Boundaries: North, Lavender Hill; South, Bramfield Road, Burland Road and a line eastward across Clapham Common known as "Bishop's Walk"; East, Parish Boundary; West, St. John's Road and Northcote Road. Inspector—Mr. A. Odell. Almeric Road Leathwaite Road (From Clapham Common to Burland Road.) Altenburg Gardens Ashness Road Battersea Rise (From Northcote Road, Eastward.) Limburg Road Lindore Road Beauchamp Road Longbeach Road Belleville Road (From Webbs Road to Northcote Road.) Mallinson Road (From Leathwaite Road to Northcote Road.) Bennerley Road (From Leathwaite Road to Northcote Road.) Marjorie Grove Marmion Road Marney Road Berber Road Meteor Street Bramfield Road (North side) (From Northcote Road to Webbs Road.) Mysore Road Northcote Road (East side from Battersea Rise to Bramfield Road.) Burland Road (North side) Clapham Common North side Parma Crescent Clapham Common West side (From Battersea Rise to "Bishop's Rush Hill Road St. John's Road (East side) Eccles Road Salcott Road (From Leathwaite Road to Northcote Road.) Elspeth Road Fontarabia Road Shelgate Road (From Leathwaite Road to Northcote Road.) Forthbridge Road Freke Road Garfield Road Sisters Avenue Gowrie Road Stormont Road Grandison Road (Clapham Common to Burland Road.) Sugden Road Taybridge Road Thirsk Road Green Lane Tregarvon Road Hafer Road Wakehurst Road (From Grandison Road to Northcote Road.) Haubeck Road Ilminster Gardens ledburgh Street Webbs Road (From Battersea Rise to Bramfield Road.) Kelmscott Road Kieldon Road Winifred Grove Lavender Gardens Wix Lane Lavender Hill (South Side) Lavender Sweep 132 District No. 8. Boundaries: North, Districts 6 & 7; South, Parish Boundary East, Parish Boundary; West, Parish Boundary. Inspector—Mr. H. H. May. Althorpe Road Honeywell Road Amner Road Kyrle Road Balharn Park Road Leathwaite Road (From Bramfield Road to Chatto Road) Ballingdon Road Belleville Road Blenkarne Road Mayfield Road Bolingbroke Grove (From Bramfield Road to Nightingale Lane) Montholme Road Morella Road Nightingale Lane (North Side) Boundaries Koad Bramfield Road (South Side) Northcote Road (From Bramfield Road to Broomwood Road) Broadlands Terrace Brodrick Road Broomwood Gardens Nottingham Road Broomwood Road Old Park Avenue Burland Koad Ouseley Road Chatham Road Ramsden Road Chatto Road Ravenslea Road Clapham Common (West Side) (From Bishop's Walk southward) Rusham Road St. James' Road Culmstock Road Sarsfeld Road Darley Road Stonnell's Road Dents Road Sudbrook Road Devereux Road Thurleigh Road Dulka Road Trinity Road Estcourt Road Webbs Road (From Bramfield Road to Broomwood Road) Gayville Road Gorst Road Granard Road W exford Road Grandison Road (From Burland Road to Chatto Road) Winsham Street Wiseton Road Wroughton Road Hillier Road