BAT 9 Bat Ham Metropolitan Borough of Battersea. REPORT ON THE HEALTH OF THE Metropolitan Borough of Battersea, FOR THE YEAR 1902. BY G F. McCLEARY, BA..MD..D.P.H MEDICAL OFFICER OF HEALTH. BAT 9 Metropolitan Borough of Battersea. REPORT ON THE HEALTH OF THE Metropolitan Borough of Battersea, FOR THE YEAR 1902. BY G. F. McCLEARY. BA.. MD.. D.P.H MEDICAL OFFICER OF HEALTH. Battersea Borough of Battersea Council. Chart indicating number of Births and Deaths registered weekly as occurring within the Borough during the year 1902. Mr. Mayor and Gentlemen, I have the honour to place before you my Annual Report for the year 1902. Included is a report on the Small-pox outbreak, which lasted from October, 1901, to the beginning of August, 1902, an isolated case occurring in September, 1902. The total number of cases — 220, is small when all the circumstances of the outbreak are taken into account. In accordance with Section 132 of the Factory and Workshop Act, 1901, a special report on the administration of the Act by the Borough Council is included. In the year 1902 a systematic supervision of the workshops and workplaces in Battersea was begun, but as the two special inspectors appointed for this purpose only entered upon their duties when the year was well advanced, the report deals with little more than six months' work. Next year it will be possible to present a more comprehensive report on the work of the Council in relation to the sanitation of factories, workshops and workplaces. The third special report deals with the Infants Milk Depôt. The work of the Depot has grown so considerably that the premises at York Road, where the humanising and sterilising processes are performed, have become inadequate for this work, which, especially in hot weather, is carried out under great difficulties. I am glad to acknowledge the excellent work of the Staff of the Health Department during the year. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, G. F. McCLEARY, Medical Officer of Health CONTENTS Page Alcoholism 43 Births 7 Causes of Death 21 Chalets 55 Chicken-pox 26 Coroner's Court 48 Cow-houses 56 Customs and Inland Revenue Acts 59 Deaths 11 „ in Public Institutions 13 Diarrhœa 40 Disinfection 48 Diphtheria 34 Enteric Fever 36 Erysipelas 38 House-to-house Inspection 52 Houses let in lodgings 53 Ice Cream 57 Infantile Mortality 18 Inquests 44 Milk Shops 56 Mortuary 45 Marriages 10 Membranous Croup 34 Measles 38 Notifications, Table of 32 „ Cost of 30 Officers 5 Population 7 Proceedings 62 Page Puerperal Fever 37 Small-pox 33 & 73 Senile Mortality 20 Scarlet Fever 33 Shelter, Temporary 51 Sanitary Work 51 Slaughter-houses 56 Smoke Nuisances 59 Sale of Food and Drugs Acts 60 Tuberculosis 41 Unsound Food 57 Van Dwellings 54 Whooping Cough 39 Zymotic Mortality 21 Special Reports : Small-pox Outbreak 73 Cost of Outbreak 90 Preventive Methods 86 Sources of Infection 77 Vaccination 82 Factory and Workshop Act, 1901 95 Bakehouses 100 Factories 110 Workplaces 108 Outworkers 111 Sanitary Conveniences 114 Sanitary Condition of Workshops 99 Workshops 95 Infants Milk Depot 119 Staff of the public Health Department. Medical Officer of Health. G. F. McCleary, M.D. Chief Sanitary Inspector. I. Young, Assoc.San.Inst. Sanitary Inspectors. No. 1 District J. Herrin, Cert.San.Inst. „ 2 „ A.Chuter. „ „ „ 3„ J.Lawrence. „ „ „ 4„ A.E.Purnell, „ „ „ 5 „ H. T. Baxter, „ „ „ 6 „ H.Marrable, „ „ „ 7 „ A.Odell, „ „ „ 8 „ H.H. May, „ „ Workshop Inspector W. E. Benjamin, „ „ Lady Sanitary Inspector, Miss E. Dawson, San.Insp. Board's Cert. Clerks. Senior Office Clerk A. P. Coke, Cert.San.Inst. Office Clerk B. W. Sears. H. C. Norman. Junior Clerks F. H. Preston, Cert.San.Inst. E. Barnes. Manageress of Milk Depot. Miss A. Lowe. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper. G. Streat. Summary of Vital Statistics for 1902. Area of Borough (excluding water) 2,139.9 acres. Population (Census 1901) 168,907 „ Estimated to middle of 1902 171,401 Density 80 persons per acre. Inhabited Houses (Census 1901) 23,462 Marriages 1,372 Births 4,844 Birth=rate 28.2 Deaths 2,581 Death=rate 15.0 Infantile Mortality 136 per 1,000 births. REPORT. POPULATION. The population of Battersea at the middle of 1902, as estimated by the Registrar-General, was 171,401. This estimate is based on the assumption that the rate of increase of population during the last intercensal period was maintained during 1901 and 1902, and although it is almost certainly too high, it has been adopted in this Report, so that the Battersea statistics may be comparable with those in other districts. Births. The births registered were 4,844, of which 2,411 were males, and 2,433 females, the proportion of female to male births being 1,009 to 1,000. The births were 320 below the decennial average, and 146 less than the number in 1892, when the population was only 153,778. The births in the subdistricts were as follows:— Males. Females. Total. The Borough 2,433 4,844 2,411 East Battersea 1,109 1,099 2,208 794 North-West Battersea 1,643 849 993 508 South-West Battersea 485 The birth-rate per 1,000 persons living was 28.2, or 3.3 below the decennial average. This is the lowest birth-rate ever recorded in Battersea, the lowest rates in any previous years being 3o .6 in 1900, and 29.7 in 1901. The birth-rate has been steadily declining since 1884, when it was 43.4. In the eleven years 1891-1902 it has fallen from to per 1,000 population, a decrease of 6.5 per 1,000. The decline in the birth-rate has not been associated with a decline in the marriage rate, which, on the contrary, has risen considerably during the last ten years. The phenomenon of a declining birth-rate is not peculiar to Battersea; it is observed in many civilised communities, especially those peopled by the Anglo-Saxon race. The birth-rate in England and Wales has fallen from 36.3 in 1876 to 28.6 in 1902, and in the matter of fertility this country is approaching our Australian Colonies, where the birth-rate is almost as low as that of France. Table I. shows the birth-rate in each of the sub-districts and in London during the decennium 1892-1901, and in 1902. TABLE I. Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea London. 1892 32.4 35.3 30.9 34.1 24.5 1893 33.3 34.7 38.6 23.7 30.9 1894 31.4 32.6 36.6 30.2 23.2 1895 32.3 34.3 37.9 30.6 22.2 1896 3 2.4 34.8 37.8 30.2 22.2 1897 31.7 33.8 30.2 36.6 22.7 1898 33.6 29.7 30.9 35.0 21.9 1899 30.9 29.6 36.0 33.6 21.0 1900 33.5 29.2 35.2 30.6 21.3 1901 29.7 32.6 33.3 21.3 29.0 Average 1892-1901 33.8 22.4 30.0 36.1 31.5 1902 28.2 33.1 20.2 29.0 30.3 In each sub-district there has been a considerable decrease in the birth-rate during the decennium, the decrease being rather more marked in East Battersea. The rate varies greatly in the three sub-districts, being low in South-West Battersea, where the standard of comfort is relatively high, higher in East Battersea, where the standard is lower, and highest in North-West Battersea, in which district is the greatest poverty. It will be noted that in each year of the decennium 1892-1901, the Battersea birth-rate was higher than that of London, and that in 1902 it was distinctly lower. A full discussion of the social forces which have brought about the decline of the birth-rate would occupy many pages, and cannot be attempted here. There has possibly been a physiological loss of fertility, but there is no reason to doubt that the chief cause is to be found in the fact that an increasing number of married persons voluntarily limit the size of the family. The excess of births over deaths in the whole Borough was 2,263. In East Battersea the births exceeded the deaths by 1,075, in North-West Battersea by 732, and in South-West Battersea the excess was 456. The births registered as illegitimate numbered 94, or 21 less than in 1901. The number of illegitimate births and the proportion of the total births during the decennium are given in the subjoined table. TABLE II. Year. Battersea. London. Illegitimate Births to 1,000 Births. Illegitimate Births to 1,000 Births. No. of Illegitimate Births. 1892 134 26 37 1893 120 22 36 894 143 28 37 1895 114 21 35 1896 109 20 37 1897 109 20 36 1898 112 21 37 1899 125 22 36 1900 114 22 36 1901 115 22 36 Average 1892-1901 22 3 6 119 1902 19 ... 94 Marriages. The marriages registered during the year were 1,372, or 67 more than the decennial average. The marriage rate, i.e., the number of persons married to 1,000 living was 16 o, which is slightly higher than the decennial average, but falls somewhat below the rate in the years 1898-1900. The Battersea marriage rate steadily increased during the past decennium, but the increase was not maintained in the last two years. TABLE III. Year. Battersea. London. No. of Marriages. Marriage-rate. Marriage-rate. 1892 14.2 17.4 1,095 1893 1,141 14.4 17.2 1894 1,158 14.4 17.0 1895 1,241 15.2 17.2 1896 1,334 16.1 18.0 1897 1,357 16.2 18.5 1898 1,441 17.2 18.8 1899 1,429 17.0 18.6 1900 1,451 17.2 18.0 1901 1,407 16.6 17.6 17.8 Average 1892-1901 1,305 15.8 1902 1,372 16.0 17.8 Deaths. During- the year 2,451 deaths were registered. This number includes 298 deaths of non-residents registered in public institutions in the district. Deducting these and adding 428 deaths of Battersea residents registered in public institutions outside the district, a net total of 2,581 deaths (males 1,265, females 1,316) is obtained. This gives a death-rate of 15.0, the lowest death-rate ever recorded in Battersea. 1,133 deaths belong to East Battersea, 911 to North-West Battersea, and 537 to South-West Battersea. The number of deaths registered of males and females in each quarter of the year is set out as follows:— Males. Females. Total. First quarter 414 791 377 Second quarter 308 584 276 Third quarter 562 263 299 33 1 644 Fourth quarter 313 The death-rates in the Borough and in the sub-districts in 1902 and in the preceding decennium are given in the subjoined table. TABLE IV. Death Rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1892 19.4 19.8 13 .1 18.1 1893 18.9 21.0 21.4 11.9 1894 16.6 19.5 10.8 16.1 1895 18.1 19.9 21.1 11.7 1896 18.1 20.5 10.4 21.3 1897 16.4 17.6 20.2 10.4 1898 17.3 19.4 10.5 20.4 1899 17.3 19.6 19.1 11.7 1900 17.6 18.9 21.0 12.1 1901 16.3 16.4 18.7 11.9 Average 1892-1901 17.4 18.9 20.2 11.4 1902 15.0 18.3 10.9 15.5 The decline in the death-rate during 1902 affected all three sub-districts, but was most marked in East and South-West Battersea. It will be noted that the three sub-districts differ almost as much in their death-rates as they do in their birth-rates. In each district there has been a distinct decline in the death-rate during the decennium. Deaths in Public Institutions. The deaths of Battersea residents occurring in public institutions numbered 723. 308 occurred within, and 415 without the Borough. 356 deaths occurred in Workhouses or Workhouse Infirmaries. Table VI. gives a list of the institutions in which the deaths occurred. Table V. shows the number of deaths of Battersea residents in public institutions in the years 1892-1902, and the proportion in each year of such deaths to the total number of deaths. TABLE V. Year. Total Deaths. Proportion per cent. of Deaths in Public Institutions to Total Deaths. Deaths in Public Institutions. 1892 2782 18.0 501 1893 2974 537 18.0 1894 2577 527 20.4 1895 2961 537 16.1 1896 2994 560 187 1897 2737 576 20.6 1898 2892 625 21.6 1899 2905 644 22.1 1900 2978 625 20.9 1901 2766 640 23.1 Average 1892-1901 2856 577 19.9 1902 723 28.0 2581 TABLE VI. Deaths of Battersea Residents in Public Institutions. Institution. Total. Group Totals. Infirmaries and Workhouses. — Chelsea Infirmary 1 Holborn Workhouse, Mitcham 3 Hackney Infirmary 2 Lambeth Infirmary 3 St. Giles' Workhouse 1 356 St. George's Infirmary, Fulham 2 356 St. Pancras Workhouse 1 Tooting Home 52 Wandsworth and Clapham Union Infirmary 286 Wandsworth and Clapham Union Workhouse 5 Metropolitan Asylums Board's Hospitals. Fountain Hospital 16 Grove „ 19 Gore Farm „ 2 North-Western „ 1 71 South-Western „ 10 Western „ 19 Small Pox Ships 4 General Hospitals. \ Belgrave Hospital for Children 4 Bolingbroke Hospital 22 Brompton Hospital 7 Cancer Hospital, Chelsea 4 Children's Hospital, Great Ormond Street 2 Children's Hospital, Sydenham 1 Charing Cross Hospital 7 Clapham Maternity Hospital 1 Crole-Wyndham Home, Plumstead 1 General Lying-in Hospital 2 Great Northern Hospital 1 Grosvenor Hospital 1 Gordon Hospital 1 Guy's Hospital 3 Homœopathic Hospital 1 Home Hospital, Fitzroy Square 1 Hospital of St. John and St. Elizabeth 1 Heart Hospital, Soho 1 Hostel of God 13 296 King's College Hospital 2 * London Hospital 3 London Fever Hospital 1 London Temperance Hospital 1 Metropolitan Hospital 1 Middlesex Hospital 5 Nightingale Home, Clapham 1 National Hospital 1 Royal Free Hospital 2 Royal Hospital 1 Royal Chest Hospital 1 St. Bartholomew's Hospital 1 St. George's Hospital 36 St. Peter's Home, Kensington 2 St. Thomas' Hospital 56 St. Mary's Hospital 2 Victoria Hospital 18 Westminster Hospital 13 H.M. Prison, Wandsworth 1 County and other Lunatic Asylums 74 723 All the above Institutions, except the Wandsworth and Clapham Union Infirmary and the Bolingbroke Hospital, are outside the Borough. TABLE VII. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of health.) Vital Statistics of Whole District during 1902 and Previous Years. Year 1 Population estimated to middle of each Year. 2 Births. TOTAL DEATHS REGISTERED IN THE DISTRICT Total Deaths in Public Institutions in the District. 9 Deaths of Non- Residents registered in Public Institutions in the District. 10 Deaths of Residents registered in Public Institutions beyond the District. 11 Nett Deaths at all Ages belonging to the District. UNDER 1 YEAR OF AGE. AT ALL AGES. Number. 3 Rate per 1,000 Births registered 6 Number. 7 Rate* 4 Number. 5 Rate* 8 Number. 12 Rate* 13 1892 153,778 4,990 32.4 158 2,692 17.5 411 294 18.1 791 204 2,782 17.8 1893 156,719 5,225 33.3 842 161 2,801 364 204 377 2,974 18.9 1894 159,724 5,024 31.4 718 1 4 2 2,404 15 .6 354 204 377 2,577 16.1 1895 162,787 5,264 907 2,901 17.8 477 247 307 2,961 18.1 32.3 172 1896 165,309 5,358 32.4 937 174 507 266 2,994 18.1 2,941 17.7 319 1897 166,059 5,266 31.7 845 160 2,620 15.7 459 270 387 2,737 16.4 1898 166,814 5,157 30.9 840 162 2,762 16.5 495 258 388 2,892 17.3 1899 167,570 5,179 30.9 838 161 2,858 17.0 597 301 348 2,905 17.3 1900 168,339 5 ,161 30.6 826 157 2,951 17.5 598 293 320 2,978 17.6 1901 169,100 5,025 29.7 828 164 2,729 16.1 603 3 11 348 2,766 16.3 Averages for years 1892-01. 163,619 5,164 31.5 837 2,765 16.9 486 255 346 2,856 17.4 161 1902 4,844 135 2,451 14.2 601 298 2,581 15.0 171,401 28.2 654 428 * Rates calculated per 1.000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the Borough. The deaths included in Column 12 are the number in Column 7 corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the Borough on account of sickness and infirmity, and dying in public institutions there; and by the term "residents " is meant persons who have been taken out of the Borough 011 account of sickness or infirmity and have died in public institutions elsewhere. The "Public Institutions " taken into account for the purpose of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Area of District in acres (exclusive of area covered by water), 2139.9 acres. Total population at all ages, 168,907; number of inhabited houses, 23,462; average number of persons per house, 7.19—at Census of 1901. TABLE VIII. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Separate Localities in 1902 and Previous Years. Names of Localities. 1. Borough of Battersea. 2. East Battersea. 3. North-West Battersea. 4. South-West Battersea. Year. Population estimated to middle of each year. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each Year. Deaths under 1 year. Births registered. Deaths at all ages. Deaths under 1 year. Births registered. Births registered. Births registered. Deaths at all ages. Population estimated to middle of each year. 1892 153,778 4990 814 68,064 2407 1324 404 49,917 1703 989 303 35,797 880 469 107 2782 1893 156,719 5225 2974 883 69,023 2399 1456 415 49,889 1929 1069 358 37,807 897 449 110 1894 159,724 5024 2577 734 69,995 2284 1168 345 49,861 1825 975 308 39,868 915 81 434 1895 162,787 5264 2961 930 70,981 2439 1418 435 49,832 1892 1052 365 41,974 933 130 491 1896 165,309 5358 2994 947 71,753 2500 1472 465 49,804 1886 1064 365 43,752 972 458 117 1897 166,059 5266 2737 853 71,848 2431 1265 411 49,775 1824 1007 326 44,436 1011 465 116 1898 166,814 5157 2892 855 71,942 2424 1400 44 1 49,747 1744 101 7 311 45,125 989 475 103 964 1899 167,570 5179 2905 837 72,020 2424 1412 437 49,719 1791 954 299 45,831 539 101 1900 168,339 5161 2978 822 1370 411 49,691 1749 1044 314 46,529 994 564 97 72,119 2418 1901 169,100 5025 2766 821 72,226 2357 1271 407 49,663 1658 296 47,211 118 932 1010 563 Averages of Years 1892 to 1901 163,619 5164 2856 849 70,997 2408 1355 417 49,789 1010 324 42,833 956 490 108 1800 1902 171,401 4,844 2,581 657 72,797 2208 1133 312 49,631 1643 911 270 48,973 993 537 75 * Note—Deaths of residents occurring in public institutions, whether within or without the Borough, are allotted to the respective localities according to the addresses of the deceased. TABLE IX. Comparative Statistics of Births, Mortality, &c. Mean Population for Year. Birth Rate. Death Rate. Zymotic Deaths. Natural Increase. Year. Births. Deaths 1856 15,069 536 36.2 320 21.2 45 216 1857 582 36.0 343 21.4 4 6 15,970 239 1858 16,872 562 33.3 380 22.5 100 182 1859 685 38.5 394 22.1 96 17,774 292 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 18 65 33,688 40.2 785 1,357 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 4 2.5 870 86 4 40,741 1,734 21.3 122 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 51,320 2,170 42.2 1,375 26.7 4 04 795 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 1,387 19.5 238 40.3 1,478 1875 76,354 3,080 40.3 1,724 22.5 1,356 307 1876 81,704 3,455 42.2 1,745 21.3 340 1,7 10 87,094 1877 3,48 1 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 97,834 1879 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 41.8 2,033 18.7 381 4,452 2,419 1882 112,661 39.9 2,214 19.6 4,504 353 2,190 1883 116,980 40.2 2,344 369 2,367 4,711 20.0 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 2,088 432 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 5,161 142,884 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 398 5,237 34.7 2,697 17.9 2,540 153,778 1892 32.4 2,782 18.1 2,208 4,990 473 1893 156,719 5,225 33.3 2,974 18 .9 5 6 4 2,251 31.4 2,577 16.1 1894 159,724 5,024 468 2,447 162,787 1895 5,264 3 2.3 2,961 18.1 491 2,303 1896 165,309 5,358 32.4 2,994 18.1 608 2,364 1897 166,059 5,266 31.7 2,737 16.4 391 2, 5 29 166,814 1898 30.9 2,892 17.3 5,157 517 2,265 167,570 1899 5,179 30.9 2,905 17.3 377 2,274 168,339 5,161 30.6 2,978 17.6 2,183 1900 442 169,100 1901 5,025 29.7 2,766 16.3 4 81 2,259 1902 171,401 4,844 28.2 2,581 15.0 421 2,263 The years marked thus ... were census years Infantile Mortality. The deaths of infants under one year numbered 657, and formed 25*4 per cent, of the total deaths. The " infantile mortality, ' i.e., the number of deaths under one year per 1,000 births registered, was 136, being no less than twentyseven below the decennial average. This is the lowest infantile mortality figure ever recorded in Battersea, the lowest figure reached in previous years being 146 in 1894. The infantile mortality in the County of London was 139. The mortality in the Borough and in each of the sub-districts is given in the following table:— TABLE X. Year. East Battersea. North-West Battersea. South-West Battkrsea. The Borough. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. 1 Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. 1892 814 404 167 177 107 121 163 303 1893 883 169 415 172 185 110 122 358 1894 734 146 345 151 308 168 81 88 1895 176 435 178 192 130 139 930 365 1896 947 176 465 186 365 193 117 120 1897 853 161 411 169 3 26 178 116 114 1898 855 44 1 181 311 178 103 104 165 1899 837 161 437 180 299 166 101 104 1900 822 1 59 411 169 314 179 97 97 1901 821 163 407 172 2 96 178 118 116 Average 1892-1901 849 163 417 172 324 179 108 112 1902 136 312 270 164 75 75 657 141 The infantile mortality in 1902 was well below the decennial average in each of the sub-districts, but the decline was comparatively slight in North-West Battersea. The following table gives the age distribution of infants' deaths in 1902. The mortality was high in the first week, and 338 deaths, or more than one-half the total occurred in the first three months. Age in Months. Under 1 Month. 2 and under 3 weeks 3 and under 4 weeks. Total Under 1 Month. 1- DISTRICT. Under 1 week. 1 and under 2 weeks. 10- 11- 2- 9- 3- 5- 6- 7- 8- 4- 108 28 East Battersea 58 14 8 29 21 20 16 18 13 15 19 19 15 19 North-West Battersea 6 23 15 10 16 22 16 10 15 14 15 54 12 23 95 19 South-West Battersea 21 3 1 8 33 2 2 6 10 4 2 5 2 1 3 5 Borough of Battersea 133 29 15 59 236 62 40 32 37 42 31 31 36 34 33 43 The chief causes of infant deaths are set out as follows:— Cause of Death. No. of Deaths. Rate per 1,000 Births. Measles 24 5.0 Whooping Cough 30 6.1 Diarrhœa 84 17.3 Enteritis 23 4.7 Tuberculosis 28 5.8 Premature Birth 102 21.1 Debility, Marasmus 14.4 70 Convulsions 13 2.7 Bronchitis 66 13.6 Pneumonia 14.2 69 9 Suffocated in bed 1.9 All other causes 139 28.7 Total 136 657 The deaths from diarrhoea were eighty-four in number, as against 177 in 1901. The lessened number of deaths from this disease was the chief factor in the decline in infantile mortality in 1902, and is explained by the meteorological conditions in July, August and September. These months were unusually cold, and the rainfall exceptionally heavy for the time of the year, and Battersea, in common with the whole country, was in consequence comparatively free from diarrhoea. The subject is considered more fully later in this report, under the heading of " Diarrhoea." The Council's Infants Milk Depot was opened on June 5th. Its effect on the infantile mortality rate is discussed in the section of this report dealing with the work of the Depot. Senile Mortality. Four hundred and forty-five deaths of Battersea residents occurred at ages of sixty-five and upwards. The age distribution of these deaths in the sub-districts is given below :— District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. East Battersea 104 53 8 165 North-West Battersea 66 50 7 123 South-West Battersea 77 67 13 157 Borough of Battersea 247 170 28 445 The deaths over sixty-five were 506, 564 and 434 in the years 1899, 1900 and 1901 respectively. The 445 deaths over sixty-five in 1902 were equivalent to 172 per 1,000 deaths at all ages. Causes of Death. The causes of death are tabulated in Table XII. (Table IV. of the Local Government Board series), and, are set out in greater detail in Table XIII. Zymotic Mortality. Table XI. shows the deaths from the chief zymotic diseases for the ten years 1892-1901, and the year 1902 respectively. The figures for 1902 compare favourably, on the whole, with those in the preceding years, although small-pox makes an unwelcome appearance. The great and progressive reduction in the number of diphtheria deaths since 1898 is a striking feature of the table. TABLE XI. Comparative Table of Zymotic Mortality during the past ten years. 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 Decen-nial average Small Pox 1 12 1 ... ... ... ... ... 4 2 2 Measles 90 90 151 99 185 76 103 81 126 112 119 Erysipelas 23 31 6 16 11 18 17 10 17 17 17 Scarlet Fever 42 32 30 28 47 28 14 13 9 2 7 32 Diphtheria 57 176 118 94 108 120 63 32 20 82 87 Enteric Fevers,&c. 22 29 23 17 18 15 39 32 18 22 10 Puerperal Fever 16 9 6 4 6 7 3 8 8 17 3 Whooping Cough 100 115 77 52 137 82 71 52 108 79 87 Epidemic Diarrhœa 99 120 93 151 169 141 154 123 149 217 142 Totals 439 526 460 486 531 418 435 491 614 642 504 TABLE XII. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Causes of, and Ages at, Death during the Year 1902. CAUSES OF DEATH. Deaths in or belonging to Whole District at Subjoined Ages. Deaths in or belonging to Localities at all Ages. Total Deaths In Public Institutions in the District. All Ages. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 65 years. Under 1 year. 65 years and upwards. East Battersea. North-West Battersea. South-West Battersea. Small-pox 2 5 3 6 5 9 1 6 6 ... 13 1 Measles 99 24 72 ... 1 ... 62 8 3 2 29 Scarlet Fever 23 1 11 3 2 ... 14 4 5 ... 22 6 Whooping Cough 63 28 ... ... ... 20 28 15 7 30 5 Diphtheria and Membranous Croup 18 2 12 2 ... 2 ... 9 5 4 ... Croup 2 1 1 ... ... ... ... 1 1 1 ... Fever Typhus ... ... ... ... ... ... ... ... ... ... .. Enteric 16 ... ... ... 8 1 8 3 5 ... 7 Other Continued 2 1 1 ... ... ... ... 1 1 ... ... Epidemic Influenza 23 1 3 6 12 ... 6 9 8 2 1 Cholera ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... 8 Diarrhœa 98 84 10 ... ... 2 2 49 41 6 17 8 4 19 Enteritis 29 2 3 1 1 ... 4 ... 8 6 ... 6 3 5 3 Puerperal Fever 14 ... ... ... 1 3 7 1 11 ... 1 2 ... 7 11 Erysipelas 7 2 9 14 1 4 1 6 2 2 3 9 46 73 6 5 Other Septic Diseases 3 103 43 3 162 222 1 10 Phthisis 6 20 16 1 33 26 21 4 52 69 13 4 4 1 Other Tubercular Diseases 51 6 12 7 15 59 1 ... Cancer, Malignant Disease 151 2 124 47 59 70 139 98 20 3 66 1 90 47 Bronchitis 284 115 38 21 5 6 79 69 5 13 5 23 Pneumonia 2 2 43 1 5 7 ... 4 ... ... 3 8 2 Pleurisy 11 6 12 7 13 1 1 5 6 Other Diseases of Respiratory Organs 27 ... 5 8 11 10 ... 23 1 Alcoholism Cirrhosis of Liver ... 9 ... 1 29 ... ... ... 1 4 4 2 Venereal Diseases ... 5 ... ... 51 38 13 ... ... 102 ... Premature Birth 102 ... ... ... 1 8 ... 3 2 4 4 9 Diseases and Accidents of Parturition 26 22 ... 21 2 ... 8 11 20 36 43 Heart Diseases 84 28 21 10 7 10 7 40 2 5 14 79 24 2 Accidents 3 3 ... ... ... 7 4 5 11 ... Suicides 233 184 47 16 293 231 335 283 191 38 All other Causes 809 657 308 142 919 445 11 33 9 11 537 601 All Causes 2 581 110 The next table gives the death-rate from each of the chief zymotic diseases compared with the mean death-rate in the preceding deciennium, and the gain or loss in each case is also given :— TABLE XIV. Death-rate per 1000 1902. Gain in 1902. Loss in 1902. Mean Deathrate per 1000 1892-1901. Diseases. .02 .14 .12 ... Small-Pox .1 ... .6 Measles .5 .03 ... Erysipelas .09 .06 .03 ... Scarlet Fever .16 .13 ... Diphtheria .43 .53 .1 Enteric Fever .04 ... .13 .09 ... .04 Puerperal Fever .08 .04 .2 ... Whooping Cough .5 .3 Diarrhœa .8 .5 .3 ... It will be seen from the above table that the death-rate from diphtheria, diarrhoea, scarlet fever, measles, whooping cough, enteric fever and erysipelas in 1902 was below the mean death-rate for the preceding ten years. The reduction is most marked in the case of diphtheria, but is also considerable in diarrhoea and whooping cough. The increase in puerperal fever is more apparent than real, being partly accounted for by improved certification. The death-rate from the seven principal zymotic diseases—viz., small-pox, scarlet fever, diphtheria, enteric fever, measles, whooping cough and diarrhoea, was 176, the death-rate from these diseases in the County of London being 2.21. TABLE XIII. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1902. (Exclusive of the deaths of Non-Residents in Public Institutions within the Borough, but inclusive of the deaths of Residents in Public Institutions without the Borough. AGES. All Ages. Sub-Districts. Causes of Death. Under 1. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 85 and upwards. Males. Females. Total. East Battersea. Nth.- West Battersea. Sth- West Battersea 75 and under 85. Small-pox 3 ... 2 3 2 3 4 ... 1 ... ... 15 10 25 13 6 6 6 1 Measles 24 2 ... ... ... 1 ... ... ... ... 48 51 99 29 62 8 72 ... ... Scarlet Fever 1 11 6 ... 1 2 2 ... ... ... ... ... 11 12 23 14 4 5 ... Epidemic Influenza 1 1 2 1 3 3 3 2 5 2 ... ... 13 10 23 6 9 8 ... Whooping Cough 30 28 4 1 ... ... ... ... 2 ... ... ... ... 22 41 63 20 28 15 Diphtheria 2 12 1 1 ... ... ... 2 ... ... ... ... 10 5 18 9 5 4 ... Enteric Fever ... ... ... 4 4 3 2 1 1 1 ... ... 8 8 16 8 3 5 ... Diarrhœa, Dysentery 50 7 ... ... ... ... ... 1 1 1 1 ... 26 35 61 28 25 8 ... Epidemic Enteritis 34 3 ... ... ... ... ... ... ... ... ... ... 19 18 37 21 16 ... ... Other Allied Diseases 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2 2 1 1 ... Tetanus ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... ... Syphilis 4 ... ... ... ... ... ... ... ... 1 ... ... ... 3 2 5 1 4 ... Erysipelas 4 1 ... 2 ... ... 1 1 3 2 1 ... 6 5 11 3 7 1 ... Puerperal Fever ... ... ... 2 6 5 1 ... ... ... ... ... 14 14 6 3 5 ... ... Pyæmia 6 ... 1 ... ... ... 1 1 1 ... 1 ... 5 6 11 7 3 1 ... Infective Endocarditis ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... Other Allied Diseases 3 1 ... 2 ... 1 1 ... 1 1 ... 1 ... 6 5 11 6 4 1 Rheumatic Fever ... 2 3 2 ... ... 2 ... 1 ... ... ... ... 6 4 10 3 4 3 Tuberculosis of Brain 8 11 4 1 ... ... ... ... ... ... ... ... ... 24 13 3 8 14 10 Tuberculosis of Larynx ... 4 ... ... ... ... ... 1 1 1 ... ... 3 3 2 ... 1 ... ... Phthisis 1 3 5 5 21 22 53 49 38 22 2 1 ... 132 90 222 103 73 46 Abdominal Tuberculosis 11 5 2 ... 2 1 ... ... 1 ... ... ... ... 13 8 21 10 8 3 General Tuberculosis 7 5 2 4 1 1 1 ... 1 ... ... ... 14 7 21 8 9 4 ... Other forms Tuberculosis Scurvy 1 1 ... ... 1 1 2 ... 1 1 ... ... ... 4 4 8 5 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... Acute Alcoholism ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... Chronic Alcoholism ... ... ... ... ... ... ... 3 ... 4 I ... ... 3 5 8 1 4 3 Chronic Industrial Poisonings ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 1 ... ... Osteo-arthritis ... ... ... ... ... ... ... 1 ... 2 6 1 ... 4 6 10 2 4 4 Gout ... ... ... ... ... ... ... ... 1 1 1 1 ... 3 1 4 2 2 ... Cancer 1 ... 1 1 2 4 17 38 38 34 14 1 ... 4 6 10 5 151 59 4 1 51 Diabetes Mellitus ... ... ... ... 1 1 2 3 3 4 1 ... 6 9 15 6 4 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... 1 ... Purpura Hæmorrhagica Anæmia ... 2 1 1 ... ... 1 1 3 1 ... ... ... 5 4 9 3 2 4 Lymphadenoma ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... Premature Birth 102 ... ... ... ... ... ... ... ... ... ... ... ... 47 55 102 5 1 38 13 2 ... ... ... ... ... ... ... ... ... ... ... 2 2 1 1 ... ... 9 Injury at Birth Debility at Birth 25 ... ... ... ... ... ... ... ... ... ... ... ... 16 9 25 5 15 5 Atelectasis 10 ... ... ... ... ... ... ... 1 ... ... ... ... 6 5 11 7 2 2 Congenital Defects 18 ... 1 ... ... ... ... ... ... ... ... ... 8 11 19 12 6 1 ... Want of Breast Milk 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... Atrophy, Debility, Marasmus 45 ... ... ... ... ... ... ... ... 1 ... ... ... 18 28 46 20 22 4 Dentition 9 6 ... ... ... ... ... ... ... ... ... ... 8 7 15 8 4 3 ... Rickets 14 6 ... ... ... ... ... ... ... ... ... ... 14 6 20 14 5 1 ... Old Age, Senile Decay ... ... ... ... ... ... ... ... ... ... 19 50 17 26 60 86 37 26 23 Convulsions 13 3 ... ... ... ... ... ... ... ... ... ... ... 10 6 16 8 7 1 Meningitis 14 12 2 3 ... 1 1 1 ... ... ... ... ... 20 14 34 15 14 5 Encephalitis ... ... ... ... ... 2 1 5 1 5 1 ... 1 3 4 2 2 6 ... Apoplexy ... ... ... ... ... ... ... 5 3 5 1 ... 6 8 14 6 2 6 ... ... Softening of Brain 1 ... ... ... ... ... ... 2 2 1 4 ... 3 7 10 2 3 5 Hemiplegia ... ... ... ... ... ... 1 2 10 4 9 5 ... 11 10 21 9 7 5 General Paralysis of Insane ... ... ... ... ... ... 1 10 6 1 ... ... ... 14 4 18 4 8 6 Other forms of Insanity ... ... ... ... ... ... 3 1 ... 2 ... ... 1 5 6 1 5 ... ... Chorea ... ... 1 2 1 ... ... ... ... ... ... ... ... 3 1 4 ... 2 2 Cerebral Tumour ... ... ... ... ... ... 2 1 1 ... ... ... ... 1 3 4 2 1 1 Epilepsy ... ... 1 ... ... 1 1 1 1 1 2 ... ... 5 3 8 2 3 3 Laryngismus Stridulus 2 ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 2 ... 1 Locomotor Ataxy ... 1 ... 1 1 ... ... 3 ... 1 1 ... 4 ... 4 2 1 1 ... Paraplegia 2 1 ... ... 1 1 ... 2 2 4 3 1 ... 10 5 15 3 6 5 Other forms, Brain Diseases 2 ... ... ... ... ... 3 ... 2 4 1 1 ... 7 6 13 3 7 3 Otitis ... 2 ... 1 ... ... ... ... ... ... ... 1 2 2 4 3 ... 1 ... Pericarditis 2 ... 1 2 1 6 ... 1 6 1 ... 6 ... 6 2 8 2 5 1 Endocarditis ... ... 1 5 4 6 9 10 6 14 14 6 ... 29 46 75 33 21 21 Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 Angina Pectoris ... ... ... ... ... ... 1 ... 1 2 ... 1 ... 3 2 5 2 1 2 Aneurism ... ... ... ... 1 2 1 3 ... 7 1 8 2 4 2 ... ... 1 ... ... 2 1 Senile Gangrene ... ... ... ... ... 1 2 ... 1 ... ... ... ... ... 1 ... 1 8 4 Embolism, Thrombosis ... ... 1 ... 1 1 2 4 4 2 2 ... ... ... 2 ... Other Diseases, Heart and Vessels 3 1 7 2 4 1 11 17 26 31 37 21 2 74 89 163 64 60 39 Laryngitis 1 6 ... ... ... ... ... ... 1 ... ... ... 3 5 8 2 5 1 ... Croup 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 1 1 Other Diseases, Larynx and Trachea ... 1 ... ... ... ... ... ... 8 ... ... ... ... 63 1 1 68 1 20 Acute Bronchitis 66 20 ... ... 1 2 2 5 8 15 9 3 3 63 71 134 68 46 20 Chronic Bronchitis ... ... 1 ... ... ... 1 1 9 29 62 44 3 62 88 150 71 52 27 Lobar Pneumonia 4 3 1 2 ... 2 2 4 10 5 2 2 ... 28 9 37 19 9 9 Lobular Pneumonia 50 40 1 ... ... 2 1 3 4 4 ... 2 1 47 61 108 41 57 10 Pneumonia 15 13 1 ... 4 5 2 16 16 12 7 7 ... 58 40 9 8 55 2 4 19 Emphysema, Asthma ... ... ... ... 1 5 2 2 2 5 3 7 ... 6 7 13 7 1 5 Pleurisy ... ... ... ... 1 2 2 4 ... 1 1 ... ... 4 7 11 4 5 2 Other Diseases, Respiratory System ... ... ... ... ... ... 1 1 1 ... 2 1 ... 2 4 6 3 1 2 Diseases of Mouth and Annexa 3 1 ... ... ... ... ... ... ... ... ... ... ... 3 1 4 2 2 ... Diseases of Pharynx ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... 1 ... Ulcer of Stomach and Duodenum ... ... ... ... ... ... ... 1 2 1 ... ... ... 2 2 4 4 ... ... Other Diseases of Stomach 6 2 1 ... ... ... ... 2 2 ... 1 ... ... 5 9 14 5 6 3 Enteritis 23 1 1 ... ... ... 1 3 ... ... ... ... ... 15 14 29 17 8 4 Appendicitis ... ... 2 ... 1 1 ... 1 2 ... 1 ... ... 7 1 8 5 ... 3 2 Obstruction of Intestine ... 1 ... ... ... ... 4 1 3 1 ... 9 3 12 6 3 3 ... 1 Cirrhosis of Liver ... ... ... ... 3 2 4 6 2 2 ... 11 9 20 6 7 7 ... TABLE XV. Comparison of Prevalence of Sickness and Death from Infectious Diseases (Rates calculated per 1,000 persons on the population estimated to the middle of each year). Years. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Enteric and Continued Fever. Puerperal Fever. Deaths. Cases. Deaths. Cases. Deaths. Cases. Cases. Deaths. Cases. Deaths. Cases. Deaths. 0.02 0.27 1892 0.00 2.16 0.11 2.38 0.37 7.61 0.53 0.06 0.10 0.1 1 1893 0.7 2 0.07 2.80 0.20 4.35 1.12 8.97 0.20 0.88 0.1 4 0.11 0.10 1894 0.07 0.01 2.03 0.10 3.16 0.73 5.24 0.18 0.96 0.18 0.06 0.08 1895 0.12 0.00 1.49 0.03 2.52 0.57 5.09 0.17 0.86 0.14 0.06 0.03 1896 0.04 0.00 1.59 0.09 2.57 0.49 6.72 0.13 0.67 0.10 0.06 0.02 1897 0.03 0.00 1.35 0.05 3.69 0.65 9.76 0.28 0.57 0.10 0.04 0.01 1898 0.02 0.00 1.06 0.13 4.74 0.71 4.84 0.16 0.56 0.08 0.05 0.03 1899 0.00 0.00 1.21 0.10 3.61 0.37 4.30 0.08 0.93 0.23 0.08 0.04 1900 0.00 0.00 0.98 0.10 1.81 0.19 3.25 0.07 1.22 0.19 0.03 0.01 1901 0.30 0.02 0.74 0.04 1.56 0.11 3.60 0.05 0.53 0.10 0.04 0.04 Average 1892-1901 0.13 0.01 1.54 0.09 3.03 0.53 5.93 0.15 0.77 0.13 0.06 0.04 1902 0.98 0.14 1.14 0.06 1.60 0.10 4.98 0.13 0.51 0.09 0.08 0.08 This table is recommended for use by the Society of Medical Officers of Health, as a record of " the frequency and mortality of infectious diseases in the whole district for a series of years." Notifiable Infectious Disease. Compulsory notification of certain infectious diseases came into force in Battersea in the year 1889 by the adoption of the Infectious Diseases (Notification) Act, 1889. The diseases at present notifiable are:—Small-pox, Scarlet Fever, Diphtheria and Membranous Croup, Cholera, Erysipelas, Typhus, Typhoid, Continued, Relapsing and Puerperal Fevers. By an order of the Local Government Board, of September 19th, 1900, Bubonic Plague was also made notifiable. On the 28th January, the London County Council made an order under Section 56, Sub-section 6, of the Public Health (London) Act, 1891, making Chicken-pox a notifiable disease in the County of London for a period of three calendar months. The order came into force on the 7th Febuarary, and on expiring on the 7th May, was renewed for a period of six calendar months. It was again renewed for the two calendar months ending 7th January, 1903. The number of cases notified during the year was 1,597, excluding Chicken-pox cases. In East Battersea 800 cases were notified; in North-West Battersea, 438; in South-West Battersea, 359. The number of cases notified and the proportion per 1,000 population are set out as follows:— Notifications per 1,000 of the population, excluding Chicken-pox. No. of cases notified, excluding Chicken-pox. Total number of cases notified. The Borough 2,801 1,597 9.3 East Battersea 1,259 800 11.1 North-West Battersea 880 438 8.8 South-West Battersea 662 359 7.3 The notifications included 168 cases of Small-pox, a disease which has not appreciably affected the notification returns in any year since 1890, with the exception of the years. 1893, 1895 and 1901, when 108, 20 and 51 cases respectively were notified. TABLE XVI. Year. No. of Notifications received. Notifications per 1000 of the population. Percentage of cases removed to hospital. 1892 1972 12.8 43.3 1893 2798 17.9 31.3 1894 1845 11.5 43.0 1895 1657 10.1 40.5 1896 1929 11.6 46.8 1897 2569 15.4 52.5 1898 1887 11.3 62.9 1899 1702 10.1 70 .5 1900 1231 7.3 68.9 1901 11 48 6.7 72.1 Average 1892-1901 1873 11.4 53.1 1902 1597 9.3 78.0 In the above table the Chicken-pox notifications are excluded. The largest number of notifications received during any one week was 101, and this occurred in the last week of the year, the number including 60 cases of Chicken-pox. The lowest number notified was 20, this being the number notified in the first week. The cost of the notification of infectious disease in Battersea in each year since 1891 is given below:— Amount paid to Medical Practitioners. £ s. d. Cost per 1,000 Population. £ s. d. YEAR. 1891 150 1 0 0 19 10 1892 224 18 6 1 9 3 1893 3 21 2 6 2 0 11 1894 208 12 0 1 6 1 1895 197 19 6 1 4 2 1896 229 16 0 1 7 9 1897 3 10 3 0 1 17 4 1898 229 0 6 1 7 5 1899 203 17 6 1 4 3 1900 146 12 6 0 17 5 136 10 0 0 16 1 1901 1902 (including Chicken-pox) 343 19 0 2 0 1 The amount paid to medical practitioners for notification certificates of cases of Chicken-pox was 17s. The notification fees are repaid to the sanitary authorities by the Metropolitan Asylums Board. Table XVII. gives the number of cases of each of the notifiable diseases in each week of the year, and the same information is recorded in a graphic form on the chart. TABLE XVII. Weekly Summaries of Notifications Received During the Year 1902. (excluding duplicates). Week of Year. Cases of Infectious Disease Notified. Totals. Small-Pox. Diphtheria and Membranous Croup. Scarlet Fever. Typhus Fever. Continued and Relapsing Fever Including ChickenPox. Excluding ChickenPox. Erysipelas. Enteric Fever. Cholera. Chicken-Pox. Puerperal Fever. 1902 1902 1901 1 1 6 ... 1 4 8 ... 1 ... ... 16 ... 20 20 2 ... ... 45 45 21 15 ... 3 7 20 ... ... ... 3 8 ... 5 1 23 ... 1 ... 2 ... 40 40 13 4 5 ... 9 5 20 ... ... ... ... ... 39 39 16 5 7 ... 6 ... 15 ... 1 ... ... ... 29 14 29 6 5 5 6 6 12 ... ... ... ... ... 34 29 14 7 4 26 4 3 11 ... 2 ... ... ... 50 24 13 8 9 17 6 5 20 ... ... ... ... ... 57 40 9 9 2 28 8 3 17 ... 1 ... ... ... 59 31 18 10 15 34 3 4 19 ... 1 ... ... ... 76 42 11 6 26 2 ... 14 ... ... ... ... ... 4 8 22 9 12 2 19 8 3 9 ... ... ... ... ... 41 22 12 13 6 7 5 1 17 ... 1 ... ... ... 37 30 9 14 19 4 5 17 1 ... 1 ... 51 32 4 ... 15 4 2 4 20 ... 2 ... ... ... 50 32 18 16 6 22 4 16 ... ... ... ... ... 28 2 50 17 4 5 20 21 ... 2 ... ... ... 55 35 17 3 18 2 25 ... 22 ... 2 ... ... ... 53 28 16 2 19 5 26 4 3 17 ... 1 ... ... ... 56 30 20 3 26 2 3 20 ... 1 ... 1 ... 56 30 23 21 18 22 3 ... 8 ... ... ... ... ... 51 29 27 22 8 47 4 6 8 ... 1 ... ... ... 74 27 23 23 2 44 5 5 8 ... 1 ... 1 ... 66 22 24 ... 30 1 1 6 ... 3 ... ... ... 11 41 25 2 50 5 3 14 ... 1 ... ... ... 25 75 26 2 26 10 2 11 ... 3 ... ... ... 54 28 10 16 14 13 15 TABLE XVII.—continued. Week of Year. Cases of Infectious Disease Notified. Totals. Small-Pox. Chicken-Pox. Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Continued and Relapsing Fever Puerperal Fever. Cholera. Including Chicken Pox. Excluding Chicken Pox. 1902 1902 1901 27 6 43 3 7 ... ... ... 24 12 3 ... 67 5 28 2 30 13 3 9 ... 4 ... ... ... 61 31 26 29 4 29 5 1 15 ... 2 ... ... ... 56 27 19 30 1 21 6 5 18 ... 4 ... ... ... 55 34 16 31 1 14 4 3 21 ... 1 ... ... ... 44 30 14 32 3 45 7 5 14 ... 3 ... ... ... 77 32 23 33 ... 21 4 5 10 ... 2 ... ... ... 42 21 17 34 ... 25 7 6 6 ... 2 ... ... ... 46 21 16 35 1 13 5 2 11 ... 1 1 ... 34 21 13 — 36 ... 10 3 1 20 ... ... ... ... ... 34 24 24 37 ... 9 5 ... 17 ... 3 ... 1 ... 35 26 22 38 ... 6 5 10 15 ... 1 ... 1 ... 38 32 33 39 1 6 6 4 21 ... 3 ... 1 ... 42 36 30 40 ... 13 10 4 31 ... 6 ... ... ... 6 4 51 30 41 ... 11 4 4 39 ... 3 ... ... ... 6 1 50 46 42 ... 12 5 8 24 ... 4 ... 1 ... 54 42 52 43 ... 26 2 6 24 ... 3 ... ... ... 35 38 61 44 ... 16 2 6 15 ... 2 ... ... ... 41 25 42 45 ... 31 9 4 25 ... 2 ... 1 ... 72 41 37 46 ... 26 6 13 17 ... 5 ... 1 ... 68 42 28 47 ... 33 4 6 10 ... 1 ... ... ... 54 21 34 4 8 ... 32 6 6 19 ... 1 ... ... ... 64 32 15 49 ... 50 5 4 15 ... 2 ... ... ... 76 26 31 ... 40 5 1 17 ... ... ... 1 ... 64 24 34 50 51 ... 45 12 1 22 ... 1 ... 2 ... 83 38 27 52 ... 60 15 4 19 ... 3 ... ... ... 101 41 55 120 4 196 854 ... 88 ... 15 ... 2801 1597 1148 169 275 Battrrsea Borough Council. Chart indicating the prevalence of notifiable infectious disease during each week of the year 1902. TABLE XVIII. Notifications of Infectious Disease received during the Year 1902 arranged in Wards. Small-pox. Chickenpox. Diphtheria & Membranous Croup. Erysipelas. Scarlet Fever. Typhoid or Enteric Fever. Puerperal Fever. Ward 38 203 5 2 218 18 No. 1 (Nine Elms) 29 5 35 124 93 15 24 „ 2 (Park) - 31 „ 3 (Latchmere) 19 154 29 11 24 50 3 „ 4 (Shaftesbury) 10 72 20 6 27 128 1 „ 5 (Church) 2 4 190 31 2 3 57 11 1 „ 6 (Winstanley) 22 157 53 29 109 10 1 „ 7 (St. John) 7 58 9 10 28 - 2 „ 8 (Bolingbroke) 7 75 28 17 109 9 2 „ 9 (Broomwood) 7 27 8 62 171 6 2 169 275 196 88 Totals 854 1204 15 Table XIX. is one of the tables required by the Local Government Board, and Table XV. is recommended for use by the Society of Medical Officers of Health. Table XV 111. gives the cases of each disease occurring in the Wards. TABLE XIX. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1902. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. East Battersea. N.-West Battersea. East Battersea. N.-West Battersea. S.-West Battersea. S.-West Battersea. Under 1. 1 to 5. 5 to 15. 15 to 25. 2 5 to 65. 65 and upwards. Small-pox 3 12 34 82 3 90 58 21 88 58 21 169 35 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 273 4 73 146 27 23 ... 112 93 68 89 78 34 Membranous croup 2 ... 2 ... ... ... ... 2 ... ... 1 ... ... Erysipelas 31 22 6 196 3 6 15 18 142 12 92 66 38 Scarlet fever 854 7 217 503 96 31 ... 452 191 211 423 179 147 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... 88 ... 4 17 3 2 34 1 44 27 17 Enteric fever 3 6 20 9 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 15 ... ... ... 5 10 8 3 4 3 1 ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox 1204 89 5 2 7 562 21 5 ... 459 44 2 303 ... ... ... Totals 2,801 106 841 1277 234 327 16 1259 662 358 217 880 671 Small-pox. The outbreak of Small-pox, which began in the autumn of 1901, continued during- the first seven months of 1902; five cases were notified in August, and the last case of the year occurred in the fourth week in September. During 1902, 169 cases occurred, of which 25 were fatal. The whole outbreak is fully discussed in a later part of this Report. Scarlet Fever. The number of Scarlet Fever cases occurring in 1902 was 854, of which 23 were fatal. In 1901 there occurred 609 cases, with 9 deaths. The Scarlet Fever case-rate, death-rate, and case-mortality in 1891 and the subsequent eleven years are given below :— Year. Case-rate per 1,000 living. Death-rate per 1,000 living. Case-mortality per cent. 1891 4.89 0.25 5.1 1892 7.61 0.27 3.5 1893 8.97 0.20 0.18 2.2 1894 5 .24 3.4 3.3 1895 5.09 0.17 1896 6.72 1.9 0.13 2.8 1897 9.76 0.28 1898 4.84 0.16 3.3 1899 4.30 0.08 1.8 1900 3.25 0.07 2.1 3.60 0.05 1.0 2.6 1901 4.98 1902 0.13 In the sub-districts, the number of cases per 1,000 population was as follows East Battersea, 7*20; North-West Battersea, 3.84; South-West Battersea, 4*30. The number of cases per 1,000 population in the County of London was 3-9, and the death-rate 0-12. The following table gives the age distribution of the cases notified, and of the fatal cases:— Age Periods —Years. Total. Under 1 1-2 3-4 2-3 4-5 5-10 10-13 15-25 25-65 I 854 Cases 20 35 74 88 374 96 31 7 129 Deaths 1 3 4 2 2 6 - 3 2 23 Further particulars as to Scarlet Fever incidence and mortality during' the last ten years are given in Table XIV. Scarlet Fever has greatly diminished in fatality during recent years, and now gives rise to far less mortality than Measles or Whooping Cough. Many cases are of so mild a type that medical advice is not sought by the parents, and the nature of the disease is not recognised. The mild cases are, however, infectious, and play an important part in the spread of the disease. The number of cases removed to hospital was 749 or 87 *7 per cent, of the cases notified. In 1901 Bo*6 per cent., and in 1900 80 - 1 per cent, of the cases notified were removed to hospital. In the sub-districts the percentage of cases removed to total cases was as follows:—East Battersea, 93*5: North-West Battersea, 93.7; South-West Battersea, 69.6. The high percentage of removals is an indication of the popular confidence in the' Metropolitan Asylums Board's hospitals, for in no case was it found necessary to exercise compulsion to effect a removal. The prevalence of the disease varied greatly during the year, ranging from 39 cases in June to 118 in October. The greatest prevalence was, as usual, during the last three months of the year. Diphtheria and Membranous Croup. The case-rate, death-rate and case-mortality from Diphtheria and Membranous Croup since 1891 are set out below: — Year. Death-rate per 1,000 population. Case-mortality per cent. Case-rate per 1,000 population. 1891 1.72 0.45 26.1 1892 2.38 0.37 15.5 1893 4.35 1.12 25.4 1894 3.16 0.73 23.1 1896 2.52 0.57 22.6 1896 2.57 0.49 15.1 1897 3.69 0.65 17.6 1898 4.74 0.71 14.9 1899 3.61 0.37 10.2 1900 1.81 0-19 10.4 1901 1.56 0.11 7.0 1902 1.60 0.10 6.2 The case-rate in the sub-districts in 1902 was as follows :— hast Battersea, 1.42; North-West Battersea, 1*87; South- West Battersea, 1.30. In the County of London the case-rate was 2*3, the death-rate 0.25, and the case-mortality 10.8 per cent. The number of cases removed to hospital was 202, or 73-4 per cent, of the total number of cases notified. In 1901 the percentage of cases removed to hospital was 78 7, and in 1900 72.5. Ihe percentage of cases removed in the sub-districts was as follows:—East Battersea, 78.9; North-West Battersea, 83*8; South-West Battersea, 50*0. Thirteen deaths occurred in hospital and five at home, the case-mortality at hospital and at home being 6.8. The following- table gives the age distribution of the cases notified, and of the fatal cases:— Age Periods—Years. 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 At all ages Under 1 Cases 4 12 16 21 26 111 35 27 23 2 75 Deaths 2 5 3 3 1 1 - 2 18 1 The total number of houses invaded by diphtheria was 240. In 19 houses the drainage was defective, and in 31 insanitary conditions other than drainage defects were found. Enteric Fever. The case-rate, death-rate and case-mortality from Enteric Fever since 1891 are set out below:— Year. Case-rate per 1,000 population. Death-rate per 1,000 population. Case-mortality per cent. 1891 0.78 19.1 0.15 1892 0.53 0.06 11.3 1893 0.88 0.14 15.9 1894 0.96 0.18 18.7 1895 0.86 0.14 16.4 1896 0.67 0.10 14.7 1897 0.57 0.10 17.5 1898 0.56 0.08 14.4 1899 0.93 24.7 0.23 1900 1.22 15.7 0.19 1901 0.53 0.10 15.7 1902 0.51 0.09 17.6 The reduction in Enteric Fever prevalence and mortality during the last few years, to which attention was called in previous annual reports, was maintained in 1902, both the case-rate and death-rate being exceptionally low. The death-rate and case-rate in the sub-districts are set out below:— Case-rate per 1,000 population. Death-rate per 1,000 population. East Battersea 0.60 0.10 North-West Battersea 0.06 0.54 South-West Battersea 0.34 0.10 In the County of London the case-rate was 0.74, and the death-rate 0.12. Sixty-five cases, or 73-8 per cent, of the total were removed to hospital, compared with 64'4 per cent, in 1901, and per cent, in 1900. In twelve cases there was a definite history of the patients having eaten shell-fish at such a date as would correspond with the date of infection. In five cases mussels had been eaten, in five cases cockles, and in two cases oysters. In most of these cases the shellfish had been obtained from street barrows, and it was not possible to obtain exact knowledge as to the original source of the fish. In two cases, however, where the patients had eaten cockles, it was found that the fish originally came from a certain gathering ground at Leigh-on-Sea, Essex, which is known to be a polluted source. The Medical Officer of Health of the district was advised as to the circumstances relating to these cases. In nine cases there was evidence that the disease had been contracted outside the district, one of the cases being infected at Cairo. One patient was a sewer flusher. In ten cases the patient was infected by a previous case. The number of houses invaded by the disease was 81. In 14 houses the drainage was found to be defective, and in 25 houses defects other than drainage defects were found to exist. Puerperal Fever. The number of cases notified was 15, that number being nine above the decennial average. 8 cases were notified in 1901 and 6 cases in 1900. The case-rate was o8 or 02 above the mean case-rate for the preceding ten years, which was -06. Fourteen cases were fatal. The death-rate was '08 or *04 above the decennial average, 04. The death-rate for London was *04. 8 cases occurred in East Battersea, 3 North-West Battersea, and 4 in South-West Battersea. Puerperal Fever is now considerably less prevalent than was the case in the early part of the preceding decennium, as is shown by Table XV. In each case the nurse attending upon the patient was cautioned personally by the Medical Officer of Health against attending parturient women until after a period of three to four weeks. The clothing of the nurse was disinfected after every case. The value of these measures is shown by the fact that no secondary case attended by the same person occurred. Erysipelas. One hundred and ninety-six cases were notified, 11 of which were fatal. The case-rate was 1.14, or .4 below the decennial average, and the death-rate 06, or 03 below the decennial average. 59 cases were removed to hospital, the majority going to Union infirmaries, and the remainder to general hospitals. Measles. The deaths from this disease numbered 99, or 13 above the decennial average. 29 deaths occurred in East Battersea, 62 in North-West Battersea, and 8 in South-West Battersca. The death-rate was *5, as compared with '6, the mean death-rate for the preceding ten years, and 51, the death-rate in the County of London. The death-rate in the sub-districts was as follows :East Battersea 30, North-West Battersea 1.2, South-West Battersea, 10. Twenty-four deaths were of infants under one year, 72 of children from one to five years, and 2 from five to ten years. The deaths in each of the four quarters of the year were as follows:— First quarter 30 Second „ 50 Third „ 9 Fourth „ 10 The mortality from Measles in 1902, though lower than in the previous year, was heavy, and as will be seen on referring to Table XII., the disease caused almost as many deaths as all the notifiable diseases put together. Unfortunately, the mortality does not tend to diminish. Most of the deaths from Measles are really due to the serious pulmonary affections, bronchitis and broncho-pneumonia, which often complicate the disease, particularly in patients who are not carefully nursed. There is a tendency in many quarters to make light of Measles, and to treat it as a disease requiring but little attention. This ignorance is undoubtedly the source of many deaths. No hospital accommodation is provided for Measles, and in the poorer districts the parents are too often unable, however good their intentions may be, to secure proper accommodation and attention for their sick children. Hospital accommodation for Measles would be a great boon to the poor, and even a small hospital to which children could be removed from exceptionally insanitary and over-crowded houses would be productive of much good. Such a hospital would serve as an object-lesson, showing the importance of the disease and the extent to which its fatality can be reduced by proper treatment. In the early part of the year, a leaflet describing the first symptoms of Measles, and setting out the chief precautions to be observed against the spread of the disease, was distributed house-to-house in the parts of the Borough mainly affected. A copy was also sent to any house known to contain a case of measles. Whooping Cough. Whooping Cough caused 63 deaths during the year, or 24 less than the decennial average. The deaths were equivalent to a death-rate of *3 per 1,000, or -a lower than the mean death-rate for the preceding ten years, which was 5. The death-rate in the County of London was 4. The death-rate in the sub-districts was as follows :— East Battersea, .27, North-West Battersea, '56, South-West Battersea, .30. Thirty deaths were of infants under one year, and 28 of children from one to five. The deaths in each quarter of the year were as follows:— First quarter 13 Second „ 23 Third 18 Fourth 9 Whooping Cough in 1902 caused more deaths than any of the notifiable diseases, but its fatality was distinctly less than in the previous year. Like Measles, Whooping Cough is fatal chiefly from pulmonary complications, which could in a large measure be guarded against by proper care and attention. Like Measles also, Whooping Cough too often leaves the respiratory organs so seriously impaired that they are rendered peculiarly susceptible to the bacillus of tuberculosis. Diarrhoea. Diarrhoea was the cause of 98 deaths, including 37 registered as due to epidemic or zymotic enteritis. The death-rate was .5 per 1,000, .3 above the decennial average .8. The death-rate in the County of London was .53. The number of deaths and the death-rate in the sub-districts are set out below:— No. of Deaths. Death-rate per 1,000 East Battersea 67 49 North-West Battersea 4 1 82 South-West Battersea 8 16 Eighty-four deaths, or 85.7 per cent, of the whole, were of infants under one year, and 10 deaths were of children aged from one to five years. The deaths in each quarter of the year were as follows:— First quarter 4 Second 7 Third 77 Fourth 10 The reduction in the number of Diarrhoea deaths from 217 in 1901 to 98 in 1902 is largely explained by the meteorological conditions prevailing during the summer of the latter year. Diarrhoea is a disease which is closely dependent on temperature and rainfall, and attains its greatest virulence in hot, dry weather. The summer of 1902 was exceptionally cold and wet, and the diarrhoea mortality exceptionally low. I have no doubt that the mortality was also influenced by the Infants Milk Depot, which was opened on June 5th; but the subject is dealt with at greater length in the special report on the Depøt in pages Diarrhoea is due to the contamination of food by bacterialaden dust, and the food may be contaminated either before or after reaching the consumer. The disease can be prevented only by strict cleanliness, and the sanitary authority can do much in this way by efficient street cleansing and watering, and by frequent removal of house-refuse. It is to be hoped that an arrangement may be made in future by which, in certain streets where the disease is exceptionally prevalent, the usual weekly removal of house-refuse may be replaced by a more frequent removal during the months of July, August and September. Each death from Diarrhoea was investigated, and information as to the methods of feeding obtained. Out of 67 deaths of infants under one year, in regard to whom reliable information could be obtained, only one was breast-fed, 29 were fed on cow's milk more or less modified with barleywater, &c., and 37 were fed on condensed milk, patent foods, and the comprehensive dietary described as "what we have ourselves." Tuberculosis. The following table shows the death-rate from Phthisis and other Tubercular Diseases per 100,000 persons in each year since 1892. TABLE XX. Deaths from other Tubercular Diseases per 100,000 persons. Deaths from Phthisis per 100,000 persons. Year. 135 18 1892 1893 143 82 1894 137 53 1895 151 65 1896 146 79 1897 62 151 154 1898 7 1 162 56 1899 1900 155 53 146 60 1901 129 1902 44 The figures for 1902 show a marked reduction on those of the previous year, but otherwise the above table gives little cause for congratulation, and it would seem that measures of prevention, more special and definitely directed than those which have hitherto been employed, are needed to attack this disease. The total number of deaths from Tuberculosis in 1902 was 299, as compared with 351 in 1901. The deaths from the various forms of the disease were as follows:— Tuberculosis of the Lungs (Consumption) 222 Tuberculosis of the Brain 24 Tuberculosis of the Larynx 3 Abdominal Tuberculosis 21 General Tuberculosis 21 Other forms of Tuberculosis 8 The number of deaths from Phthisis and other Tubercular diseases, and the death-rate per 1,000 in each of the subdistricts is set out in the following table:— TABLE XXI. District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. No. of Deaths. Rate. No. of Deaths. Rate. Rate. East Battersea) 103 1.41 38 .52 141 1.93 Nth.-West Battersea 73 1.47 .44 95 1.91 22 Sth.-West. Battersea 46 .93 17 .34 1.28 63 The Borough 222 1.29 77 .44 299 1.74 The deaths from Tuberculosis formed 11*5 per cent, of the total deaths, and the disease caused a greater mortality than all the zymotic diseases, with the exception of diarrhoea, put together. Tuberculosis is a preventable disease, and an organised attempt is being made in many districts to check its spread. In Battersea the special measures adopted for the prevention of 1 überculosis have been limited to the house-to-house distribution of leaflets containing information as to the precautions to be adopted against Consumption, and to the disinfection of premises after fatal cases of the disease. In 1902 disinfection was carried out in 63 per cent, of the fatal cases occurring in private houses. In the year 1899, the Health Committee had under consideration the question of the compulsory notification of Consumption, but in their final report, which was adopted by the late Vestry on November 8th, 1899, the Committee were unable to recommend that any steps be taken in that direction. Compulsory notification of Consumption is a drastic measure for which public opinion at the present time is hardly sufficiently prepared. Voluntary notification is, however, quite another matter. This measure has come into operation in Manchester, Brighton, and many other districts, and the success which has attended its working has proved that public opinion is ripe for notification without compulsion. Alcoholism. Nine deaths were returned as due to acute and chronic alcoholism, 4 of the cases being males, and 5 females. 20 deaths (males 11, females 9) were due to cirrhosis of the liver, a disease which, in practically every case, is caused by alcohol. This gives a total of 29 cases in which alcohol was the cause of death; but there is no doubt that this number greatly understates the real mortality from alcoholism. Deaths really due to this cause are usually certified under such headings as Apoplexy, Bright's Disease, Heart Disease, &c. The mortality from alcohol cannot, therefore, be even approximately estimated from the death returns. Inquests. Inquests were held in 224 cases, and verdicts were returned as follows:— Natural Causes 129 Open Verdict- Found dead 7 Found drowned, &c. 6 -13 Accidental- Misadventure 4 Suffocation in bed with parents 9 Falls, &c. 9 Run over in streets and on railway 8 Burns and scalds 11 Poisoning 2 Asphyxia 8 Want of attention at birth 2 Improper feeding 2 Other injuries, &c. 9 64 Suicide— Gun Shot I Poisoning 3 Cut throat 3 Hanging 6 Drowning 1 14 Homicide- Suffocation 2 Parental neglect 1 Cut throat 1 4 224 The deaths from suffocation in bed with parents were 9 in number, compared with 17 in 1901. The number of deaths in each year since 1896 is shown in the following table, together with the number of deaths occurring on each day of the week. The day refers to the morning on which the death of the child was discovered. TABLE XXII. 1896. 1897. 1898. 1899. 1900. 1901. 1902. Total Sunday 6 4 3 4 4 5 3 29 Monday 4 3 3 2 1 3 2 18 Tuesday 4 4 2 1 1 1 1 14 Wednesday 1 5 4 4 1 - 16 1 Thursday 1 2 2 4 3 1 14 1 Friday 4 1 1 2 2 1 15 4 Saturday - 3 - 3 2 1 11 2 Total 21 18 17 15 17 9 117 20 Mortuary. The new Public Mortuary in Sheepcote Lane was opened for use on the 5th April, 1902. The Mortuary has been long needed, the old building having proved quite inadequate for the purpose for which it was intended. The appended plan shows the arrangement and dimensions of the rooms. The bodies are received in catacombs roofed with charcoal, and tanks, specially constructed and ventilated, are provided for the reception of decomposed bodies. There is a special chamber for the bodies of patients dying from infectious disease. A marble slab runs along the whole length of the western side of the post-mortem room, which also contains two fixed white glazed earthenware post-mortem tables, and one movable slate table. The walls of the rooms are lined with opalite, and the floors are constructed of terrazzo. The following table shows the number of admissions to the Mortuary, the number of post-mortem examinations made, and the number of Coroner's inquests held during 1902, and in the fourteen preceding years :— TABLE XXIII. Number of bodies received in the Mortuary. Number of bodies upon which postmortem examinations were held. Number of bodies upon which Coroner's inquests were held. 1888 106 134 134 1889 118 140 140 1890 148 199 194 1891 176 139 169 1892 193 163 18 7 1893 200 2 43 2 37 1894 208 224 197 1895 259 210 2 3 2 1896 278 293 242 1897 289 246 273 1898 238 294 267 1899 2 74 221 260 1900 291 234 273 271 1901 321 304 198 1902 239 224 The largest number of bodies received during any one day of the year was on December 5th, when five bodies were admitted. The following bye-laws in respect to the management of a Mortuary, drafted and approved by the Council, were allowed by the Local Government Board on the 31st July, 1902 :— 1. Throughout these bye-laws the expression "the Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. 2. Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of an infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of three days from the date of death. Provided that if an inquest is about to be held on the body, such persons shall not cause the body to be removed except with the authority or on the certificate of the Coroner, but such person shall cause the body to be removed within twenty-four hours after the issue of such authority or certificate. 3. Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of a non-infectious disease to be deposited in the Mortuary, shall cause the body to be removed therefrom for the purpose of interment within a period of five days from the date of death. Provided that if an inquest is about to be held on the body such person shall not cause the body to be removed except with the authority or on the certificate of the Coroner, but such person shall cause the body to be removed within twenty-four hours after the issue of such authority or certificate. 4. Every person for the time being employed in depositing a body in the Mortuary, or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 5. Every person who, being a friend or relative of one whose body has been deposited in the Mortuary, has been admitted to view the body shall, while on the premises, conduct himself in all respects with decency and propriety. 6. Every person who, for the purpose of depositing a body in the Mortuary, uses a shell which has not been provided by the Council shall, in every case where the body is transferred from the shell before being carried from the premises to the place of burial, cause the shell, as soon as conveniently may be after the transfer of the body therefrom, to be removed from the premises. 7. Every person who shall offend against any of the foregoing bye-laws shall be liable for every such offence to a penalty of Five Pounds, and in the case of a continuing offence to a further penalty of Forty Shillings for each day after written notice of the offence from the Council. Provided, nevertheless, that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this bye-law. Coroner's Court. The new Coroner's Court, which adjoins the Mortuary in Sheepcote Lane, was, with the latter, opened on April sth, 1902. The Court is one of the largest and most completely fitted courts in London, and has, like the Mortuary, long been needed. The dimensions and arrangement of the Court and adjoining rooms are shown on the plan fronting page 50. For the use of the Court the London County Council pays a rent of £150 per annum under an arrangement authorised by Section 92 of the Public Health (London) Act. Disinfection. The Council's Disinfection Station was opened on the 25th March, 1902. Until that date the removal and disinfection of bedding, clothing, etc., had been undertaken by a contractor. The plan facing page 50 gives the dimensions of the station, and shows the arrangement of the infected and non-infected portions of the building. It will be seen that the two sides are effectually separated from each other, it being necessary to traverse the Highways Depøt in passing from one to the other. The building is seventeen feet in height. Steam disinfection is carried out in two Equifex disinfecting machines, the steam being generated in a six horse-power vertical boiler. A zinc-lined chamber is provided for the chemical disinfection of articles which might be damaged by steam; formic aldehyde is the agent employed. Two specially constructed zinc-lined vans with well and crankaxle are employed, one for removing infected articles, the other for returning- the same after disinfection has been carried out. Each side of the station is provided with lavatory accommodation, including- bath and w.c. When the station was opened the disinfecting- staff was re-organised. Mr. C. H. Woodhouse, who had had twelve years' experience as a disinfector was appointed Disinfection Superintendent, and made responsible for the whole of the work of disinfection. Each side of the station has a separate staff. On the non-infected side are employed an engineer, driver and driver's assistant, while the staff of the infected side consists of a driver, driver's assistant, disinfecting- assistant and two room disinfectors. No interchange of duties is allowed to occur between the workers employed on opposite sides, and the danger of infection being carried from the infected to the disinfected side is in this way prevented. The disinfectors work in special suits of clothes provided by the Council, and each man changes his clothes and takes a bath every day at the end of his day's work. The total weight of articles removed and disinfected at the station from the date of its opening to the 25th December, 1902, was 131 tons, 16 cwts., 2 qrs., 13 lbs. The disinfection of this weight of articles at contractor's charges, viz., 15s. per cwt. would have cost the Council ,£1,977 9s. 3d. The actual cost of disinfecting these articles at the station was £996 12s. 5d., so that by carrying out the work of disinfection without the intervention of a contractor, the Council has saved £980 16s. 10d. in nine months. During the year 1,161 premises were disinfected by fumigation. In many cases sulphur di-oxide gas was used, but latterly formic aldehyde has been chiefly employed, as it is in many ways a more satisfactory disinfectant. After Smallpox cases the infected rooms were stripped of paper and washed with a solution of chloride of lime. Disinfectants were gratuitously supplied in 4,793 instances, either at the houses or upon application at the Disinfectant Stores, Municipal Buildings. The disinfectants distributed consisted of 2lb. packets of carbolic powder and 1 pint bottles of sanitas fluid. The following table gives a summary of the disinfection work carried out from the opening of the disinfection station to the end of December, a period of nine months:— TABLE XXIV. No. of Dwelling houses disinfected Schoolrooms Other premises Total premises disinfected Rooms disinfected by Formic Aldehyde By Spray only By SO2 Total rooms disinfected Rooms stripped Staircases and passages disinfected Palliasses. Mattresses. No. of articles disinfected 1595 1070 Small-pox 77 - 1 78 260 5 6 261 577 74 75 Beds. 1 435 Scarlet Fever. 606 1 607 255 - 411 666 4 Bolsters. Pillows. 1177 2852 Diphtheria. 189 - - - 18 9 7 2 12 3 195 - - - Cushions. 1491 Enteric Fever. 72 - - 72 40 - - 36 76 - 1 Blankets. 309 2 Erysipelas. 90 - - 90 2 4 - 73 - 4 Sheets. 2871 Puerperal Fever. 13 - - 13 7 - 6 13 - - Quilts. 1639 Phthisis. 79 - - 79 43 - 43 86 - 1 Carpets. 1515 Other Diseases. 33 - - 33 11 - 50 61 - - Wearing Apparel, &c. 64129 9,5 02 articles were subjected to chemical disinfection. In 61 cases bedding was lent to families whose bedding had been removed for disinfection. Temporary Shelter or House Accommodation. The Public Health (London) Act, 1891 (Section 60, Sub-Section 4) imposes an obligation upon Sanitary Authorities to provide accommodation for persons who have been compelled to leave their dwellings on account of disinfection being carried on therein. The sub-section is as follows:— "The Sanitary Authority shall provide, free of charge, "temporary shelter or house accommodation with any "necessary attendants for the members of any family "in which any dangerous infectious disease has "appeared, who have been compelled to leave their "dwellings for the purpose of enabling such dwellings "to be disinfected by the Sanitary Authority." The need of such accommodation was much felt during the outbreak of Small-pox. In many instances the work of disinfection was carried on under considerable difficulty, and in the poorer districts much hardship was inflicted on the inmates of dwellings under disinfection. In one case three persons had to spend the night in a wash-house. On the 14th May the Council decided to erect a shelter, and plans have been approved for a two-storied building on the piece of ground adjoining the Public Mortuary. The shelter will provide accommodation for three families in separate tenements, and the building will also include a residence for the Mortuary Keeper. The estimated cost is £996 and application for a loan for this amount has been made to the Local Government Board. General Sanitary Work. Table XXV. gives a summary of the work of the sanitary inspectors, so far as it can be summarised. TABLE XXV. Total Sanitary Operations 77923 Dust receptacles provided Number of house inspections 34004 Leaky house-roofs and gutters repaired Bakehouse inspections 561 Bakehouse nuisances abated Houses supplied with water, and fittings repaired 41 Urinal—inspections 414 Do. altered, repaired, or water laid on Water closets supplied with water or supply disconnected from drinking water cisterns 75 Intimations served, under Sec. 3 3430 Notices served under Sec. 4 802 Cisterns covered, cleansed and repaired Notices served under Sec. 62 & 65 1447 Keeping of animals in unfit state discontinued Complaints received & attended to 291 1 Number of houses disinfected 1612 Houses supplied with disinfectants 4793 Smoke nuisances dealt with House drains flushed with disinfectants after infectious disease Certificates of disinfection granted Houses inspected and certificates granted (Sec. 48) 1712 Overcrowding abated 71 Proceedings Ordered by Council and Health Committee Premises cleansed and repaired 698 Drains tested By smoke 1616 Summonses issued 5888 Magisterial Orders obtained and enforced „ water Drains cleansed and repaired 223 Drains relaid 848 Factories & Workshops inspections Frontage drains constructed or re-constructed 170 Sanitary conveniences provided or improvements effected in Factories & Workshops. Soil-pipes and drains ventilated 1275 Sink and rain water pipes disconnected or repaired Underground sleeping rooms disused 325 Water Closets cleansed & repaired 384 Cesspools abolished 2 Gipsy van inspections Mews & Stables drained & paved 16 Drains laid to new houses and tenements Yards drained and paved 5 10 Accumulations of manure and other obnoxious matter removed or proper receptacles provided Samples taken under the Sale of Food and Drugs Acts Other Sanitary operations 109 House-to-House Inspection. The total number of houses inspected in house-to-house inspection was 1,740, and defects were found in 744 houses, or 43 per cent, of the total number inspected. Systematic house-to-house inspection is an important feature of sanitary work, and it is to be regretted that last year the calls on the staff in other directions, particularly in connection with Small-pox, rendered it impossible to carry out more work in this direction. With the present staff it will be impossible to complete a house-to-house inspection of the whole district in less than eight years without seriously neglecting other important work. Houses Let in Lodgings. Forty-nine houses were on the register as houses let in lodgings at the beginning of the year, and thirty-three houses were added in 1902. It is to be hoped that that number will be materially increased this year. There are many houses in Battersea which come within the definition of "houses let in lodgings," but in the case of many, perhaps most of them, nothing would be gained, for obvious reasons, by placing them upon the register. But there are many houses, particularly in North-West Battersea, where a judicious administration of the bye-laws would be productive of much good in promoting cleanliness and preventing overcrowding. In districts where the bye-laws have been enforced the evils predicted by the owners of tenement houses have not as a matter of fact arisen, and the bye-laws have proved to be of great assistance in enabling the Sanitary Authority to maintain a relatively decent standard of housing accommodation in the poorer districts, where the people, being too poor to pick and choose their houses, have to take such accommodation as they can get and be thankful. Bye-laws relating to houses let in lodgings usually contain a clause by which tenements above a certain rental are exempt from the operation of the bye-laws. In Battersea this limit is fixed at 7s. 6d. for unfurnished and 10s. for furnished tenements. In the early part of the year the London County Council asked the opinion of Mr. C. A. Cripps, K.C., as to the legality of a clause of this kind. Mr. Cripps gave the following opinion, which was sent by the County Council to each of the Metropolitan Sanitary Authorities:— "In my opinion Section 94 of the Act of 1891 is imperative, and there is no power to exempt from the operation of bye-laws for the registration of lodging-houses any houses so occupied as to come within the lodging-house definition. A bye-law in the Bethnal Green form, which enables the local authority to exempt any or all lodging-houses within their district, is not a compliance with the requirements of the Act, and I am unable to agree with the view put forward by the Local Government Board." Apart, however, from the question as to whether the exemption clause is ultra vires, it is difficult to see what purpose is served by such a clause, while its disadvantages are obvious. In Battersea it has been found that landlords will raise the rents of their dwellings in order to take them out of the scope of the byelaws. No sanitary authority has as yet displayed a tendency to register an excessively large number of houses or to maintain a too rigorous supervision. The tendency has rather been in the other direction, and will probably continue to be so. The Council, on March 26th, 1903, decided to submit to the Local Government Board for comfirmation a revised set of bye-laws containing no exemption clause, and these are now being considered by the Board. Van Dwellings. There are 74 dwellings of this description in Battersea, situated as follows:— Situation of Vans. No. of Vans. No. of Occupants. Males F'males Mill's Yard, 88 Sheepcote Lane 4 7 9 „ 80 „ 4 6 2 Gurling's Yard, High Street 7 12 13 „ York Road 9 17 13 Manley's Yard, Falcon Road 3 4 3 „ Cabul Road 16 16 20 Donovan's Ground, „ 16 21 24 Mill's Yard, Culvert Road 15 25 29 Total 74 108 113 These dwellings, most of which are practically permanent, are regularly supervised and inspected. It has been found that sources of nuisance arise from the defective paving of the yards in which these vans were placed. The ground is specially liable to pollution unless great care is exercised, and the bye-laws now in force in regard to van dwellings do not contain adequate provision for the prevention of insanitary conditions in this connection. A set of revised bye-laws has accordingly been submitted to the Local Government Board, and is now receiving the Board's consideration. Chalets. The following chalets are now in use, under the control of the Health Committee:— (1) Lavender Hill, at junction with Falcon Road. (2) Battersea Park Road, at corner of Cabul Road. (3) Victoria Road, by Victoria Suspension Bridge. (4) Victoria Circus (opened 1899). (5) York Road, at corner of Plough Road (opened 1900). (6) Bridge Road, at corner of Cambridge Road (opened 1902). Each of the chalets is provided with free accommodation for both sexes, and has two lavatories, one for each sex, attached. There are also nine public urinals maintained by the Borough Council at: — Town Hall Road. Nine Elms Lane (near steam-boat pier). Do. (by Rifleman public-house). Battersea Park Road (near S.E. & C.D. Railway Station). Do. (near L.B. & S.C. Railway Station). Forfar Road. Church Dock, Church Road. Wye Street. Vicarage Road. Urinal accommodation, accessible to the general public, is also provided at one hundred and sixteen public-houses. The number of public conveniences in Battersea is therefore one hundred and thirty-one, and these are all kept under the close and constant supervision of the sanitary staff. It cannot be said that the number of conveniences is adequate for the needs of the Borough, as additional accommodation is required in the Bolingbroke and Broomwood Wards. Slaughter-houses. Under the London Government Act, 1899, the duty of inspecting slaughter-houses, cow-houses and milk-shops was transferred from the London County Council to the Borough Councils. There are now eight slaughter-houses in Battersea, all of which are frequently inspected. They are generally kept in a clean condition. The following is a list of the premises licensed as slaughter-houses:— 205 St. John's Hill. 109 Bridge Road, West. 163 St. John's Hill. 345 Battersea Park Road. 351 York Road. 235 Battersea Park Road. 49 York Road. 96 Falcon Road. Cow-houses. A list of the cow-houses in the Borough is given below:— 14 Belle Vue Road. 122 Usk Road. 17 Wiseton Road. The cow-houses and slaughter-houses were visited by a sub-committee of the Health Committee before the annual licensing meeting, and it was decided not to oppose the renewal of any of the licenses. Milk Shops. Milk purveyors are now registered by the Borough Councils instead of, as formerly, by the County Council. The number on the County Council's register when the powers were transferred was 242. Since that time 59 dealers have removed and 30 have been registered by the Borough Council, making a total at the end of the year of 213. The premises have been systematically inspected, and any defects found remedied. Unsound Food. The sources of food supply received constant and careful supervision during the year, particularly on Saturdays. In cases where a retail vendor has unknowingly purchased articles of food unfit for human consumption, and has made no attempt to sell the articles, it is the practice, when the latter are brought to the Health Office, to grant a certificate which enables the retailer to claim the return of the money paid in respect of the articles to the wholesale dealer. The food is subsequently destroyed at the destructor. Nineteen such certificates were granted during the year, relating to the following articles:—Bananas, haddocks, kippers, lobsters, mackerel, plaice, plums, potatoes, skate, sprats, tomatoes, and witches. Ice Cream Premises. Part VIII. of the London County Council (General Powers) Act, 1902, which came into operation on the 1st November, 1902, contains the following important provisions relating to the manufacture and storage of ice creams:— Any person being a manufacturer of or merchant or dealer in ice creams or other similar commodity who within the County— (a) Causes or permits ice creams or any similar commodity to be manufactured sold or stored in any cellar shed or room in which there is any inlet or opening to a drain or which is used as a living room or sleeping room; (b) In the manufacture sale or storage of any such commodity does any act or thing likely to expose such commodity to infection or contamination or omits to take any proper precaution for the due protection of such commodity from infection or contamination; or (c) Omits on the outbreak of any infectious disease amongst the persons employed in his business or living or working in on or about the premises in or on any part of which any such commodity as aforesaid is manufactured sold or stored to give notice thereof forthwith to the Medical Officer of the Sanitary District in which such business is carried on or such premises are situate; shall be liable for every such offence on conviction in a Court of Summary Jurisdiction to a penalty not exceeding forty shillings. Every itinerant vendor of any such commodity as aforesaid shall if not himself the manufacturer thereof exhibit in a legible manner on a conspicuous part of his barrow a notice stating the name and address of the person from whom he obtains such commodity and if such vendor is himself the manufacturer of such commodity he shall in the same manner exhibit his own name and address. Every such itinerant vendor who shall fail to comply with the provisions of this Section shall be liable for each offence on conviction as aforesaid to a penalty not exceeding forty shillings. Proceedings for the recovery of the penalties shall be instituted by the Sanitary Authority for the District in which the offence was committed or of the District to the Medical Officer of which such notification as aforesaid ought to have been made or in which such itinerant vendor as aforesaid shall offer any such commodity as aforesaid for sale as the case may be. In November and December, Inspector Benjamin made a systematic inspection of the premises where ice cream is made and stored in Battersea. There are 80 premises of this description; 12 are occupied by Italians. Many of these places were found to be unsuitable for the purpose and their condition generally afforded evidence that provisions of the County Council's Act were badly needed. The following is a statement of the defects found and remedied. Rooms dirty 7 Defective refuse receptacles 16 Defective w.c. apparatus 5 Defective yards 3 Drains defective 4 Ice cream made in living rooms 29 Inlet to drain in such rooms 2 Rooms where ice cream is made in communication with w.c.'s 7 Ice cream made in washhouse 1 Dirty, ice cream utensils 3 In six instances it was found necessary to carry out structural alterations to comply with the special provisions of the Act. Smoke Nuisances The energetic action taken in 1900 by the Health Committee against this form of nuisance has had an excellent effect, the complaints being now fewer than was formerly the case. During the year, sixty-six observations were made, and fifty-nine intimations and twelve statutory notices were issued. Proceedings were taken in twenty-two instances, and fines amounting to £40 58. were inflicted. Customs and Inland Revenue Acts. The following is a list of certificates for exemption from inhabited house duty granted by the Medical Officer of Health in each year since 1890: — No. of Certificates Granted. No. of Certificates Granted. Year. Year. 1890 243 1897 27 113 1891 1898 82 1892 165 1899 68 1893 201 1900 93 1901 1894 91 3 2 1902 28 1895 91 1896 120 ... ... ... ... ... ... The total number of houses inspected by the Medical Officer of Health during 1902 was 56, but in 28 instances the certificates were refused, owing to the existence of sanitary defects. Sale of Food and Drugs Acts. Table XXVI. shows the number of samples taken under the above Acts during the year, and the number found to be adulterated. Proceedings were taken in sixty-five instances, and fines amounting, with costs, to £111 2s. were imposed. The details of proceedings are appended to this report. Since the beginning of this year a change has been made in the administration of the Sale of Food and Drugs Acts. Formerly it was the practice for the eight district inspectors to take samples in turn, but from the experience of some other districts it was thought that better results could be obtained if these duties were entrusted to one or two inspectors specially selected to devote attention to the task of tracking out the adulterating traders. Since January the work of taking samples has been performed by Inspectors Chuter and Herrin, and the change in administration has been so far successful. The percentage of adulterated samples has materially increased, and convictions have been secured against some offenders who had long been suspected, but who had hitherto successfully evaded the law. TABLE XXVI. Description of Article. Total No. of Samples Taken. Genuine. Adulterated. Inferior. Arrowroot 6 6 ... ... Brandy 2 4 23 1 ... Bread 9 9 ... 2 Butter 99 84 13 ... ... 2 Cheese 8 8 Cocoa 4 6 11 1 Coffee 48 43 5 ... Coffee & Chicory 2 1 1 ... Cream 4 1 ... 5 Demerara Sugar ... 1 1 2 Flour 9 ... ... 9 Gin 3 2 1 ... Honey 2 2 ... ... Lard 4 4 ... ... Margarine 3 3 ... ... 106 27 Milk 15 2 19 „ (separated) 1 1 ... ... „ (skim) 1 1 ... ... „ (sterilized) 4 2 2 ... Milk of Sulphur 9 9 ... ... Mustard 2 2 ... ... ... ... ... ... ... Oatmeal 9 9 Olive Oil 2 2 ... ... Pepper (Black) 2 2 ... „ (Cayenne) 2 2 ... „ (White) 2 2 ... Rum 4 3 1 Sago 8 7 1 ... ... ... ... ... Sweets 12 12 ... Tapioca 6 6 ... Tea 12 12 ... Vinegar 19 13 2 4 Whisky 18 18 ... ... 1902-3 Totals 500 4 11 27 62 1901-2 Totals 500 409 43 4 8 Legal Proceedings under Sale of Food and Drugs Acts and Margarine Act. No. of Sam Date of Hearing. Name of Magistrate. Name and Address of Defendant. Description of Article. Nature of Offence. Result of Proceedings. 3 June 19 Mr. Rose W. V., 4a Savona Street Milk 8 per cent. devoid of fat Fined £2 and 12s. 6d. costs 5 G. W., 209 Battersea Park Road 22 per cent. extraneous water „ „ „ Fined £3 and 12s. 6d. costs „ „ W. P., 14 Candahar Road 19 „ „ 16 per cent. devoid of fat Fined £1 and 12s. 6d. costs „ „ H. P., 116 Latchmere Grove 21 10 per cent. devoid of fat „ „ Fined £1 and 12s 6d. costs „ „ F. 8., 64 Musjid Road 22 4.5 per cent. extraneous water June 25 „ „ Fined £1 and 12s. 6d. costs „ H. A. B., 12 Althorp Terrace, Wandsworth 23 „ „ „ 6 per cent. devoid of fat Fined 10s. and 12s. 6d. costs „ 8 per cent. extraneous water „ 25 A. L., 114 Ingrave Street „ „ Fined £1 and 12s. 6d. costs „ 34 per cent. devoid of fat 29 ... S. R., 117 Meyrick Road „ June 19 Fined 10s. and 12s. 6d. costs E. W., 126 Ingrave Street 40 Coffee 50 per cent. chicory Fined £1 and 12s 6d. costs „ ... L. P., 4 Boutflower Road Vinegar 10 per cent. extraneous water 63 July 9 „ Mr. Garrett Fined £1 and 12s. 6d. costs W. P., 47 Bridge Road 68 „ „ 5 per cent. extraneous water „ Ordered to pay 12s. 6d. costs No. of Sample. Date of Hearing. Description of Article. Name of Magistrate. Name and Address of Defendant. Nature of Offence. Result of Proceedings. 79 July 9 B. & W. C. Soc. 144 Bridge Road Mr. Garrett 45 per cent. chicory Coffee Fined £2 and 12s. 6d. costs „ „ 57 per cent. chicory 83 Fined £1 and 12s. 6d. costs „ 23 M. S., 14 Howie Street „ 107 0.0805 percent boric acid „ „ Sept. 17 J. J., 42 Battersea Park Road Milk Fined £1 and 12s. 6d. costs 121 Mr. Rose 80 per cent. foreign fat Sept. 3 A M.J, 507 Battersea Park Road Butter Fined £2 and 12s. 6d. costs Selling margarine in a plain wrapper 168 Mr. Garrett Do. do. Ordered to pay 2s. costs Selling margarine from unlabelled bulk Do. do. Ordered to pay 2s. costs Sept. 17 W. & C., Ltd., 47 Princes Street, Notting Hill Milk 0.0557 P er cent. boric acid Summons dismissed (Warranty defence) 169 „ „ Giving a false warranty (Sample No. 168) Oct. 29 P. E. D., Wickham Farm, Marston Magna Fined £10 and 12s. 6d. costs „ Mr. Rose 3 per cent. extraneous water Sep. 3 J. G., 33 High Street Fined £5 and 12s. 6d. costs „ Mr. Garrett 190 73 per cent. foreign fat Oct. 15 C. B., 27 Queen's Road Butter Fined £1 and 12s. 6d. costs „ 204 „ „ L. O. E., 44 York Road 87 per cent. foreign fat Fined 10s. and 12s. 6d. costs „ No. of Sample. Date of Hearing. Name and Address of Defendant. Description of Article. Nature of Offence. Result of Proceedings. Name of Magistrate. J. B., 323 York Road 87.6 per cent. foreign fat Fined £1 and 12s. 6d. costs Oct. 15 207 Mr. Garrett Butter Fined £1 and 12s. 6d. costs 29 L. G. V., 81 Battersea Rise Coffee 75 per cent. chicory 214 „ „ Nov. 26 O. O., 27 Plough Road Summons dismissed, £5 5s. costs allowed Defendant Mr. Plowden Milk 20 per cent. extraneous water 227 Fined 10s. and 12s. 6d. costs Oct. 29 J. B., 50 Lavender Hill Mr. Garrett 10 per cent. extraneous water 233 „ Nov. 26 A. H., 2 Tennyson Street Summons withdrawn 12s. 6d. costs allowed Defendant Mr. Plowden 82.75 grains per gallon boracic acid 234 „ Oct. 29 M. J., 127 Lavender Hill Fined £5 and 12s. 6d. costs Mr. Garrett 12 per cent. extraneous water 2 35 „ 1903 Jan. 7 J. S., 593 Wandsworth Road Fined £7 and 23s. costs 280 Mr. Dickinson 16 per cent. extraneous water „ Summons dismissed (Warranty defence) M. D., 2 Hyde Lane „ 10 per cent. extraneous water 28 4 „ „ „ Summons dismissed (Warranty defence) Jan. 21 H. E. B., 245 Lavender Hill 298 Mr. Lane 10 per cent. extraneous water „ I. G., Manor Farm, Newton Toney Mar. 4 Giving a false warranty (Sample No. 298) Summons dismissed Mr. Francis „ No. of Sample. Date of Hearing. Name of Magistrate. Description OF Article. Nature of Offence. Name and Address of Defendant. Result of Proceedings. Milk 10 per cent. extraneous water 301 Mr. Lane Jan. 21 B. Bros., 2 Ashness Road Summons dismissed (Warranty defence) 21s. costs allowed Defendants 302 „ „ H. E., 73 East Hill 6 per cent. extraneous water „ Summons dismissed (Warranty defence) „ S. A., 63 Surrey Lane 314 Feb. 4 „ „ Fined £4 and 12s. 6d. costs 70 per cent. chicory Coffee 78 per cent. foreign fat Fined £2 and 12s. 6d. costs 355 Mr. Francis Feb. 18 H. P., 84 Plough Road Butter „ „ 357 F. C., 221b Eversleigh Road 11.64 grains per pint boracic acid Fined £1 and 12s. 6d. costs „ Milk „ G. 8., Senr, 22 Henley Street „ „ 10 per cent. devoid of fat Fined £2 and 12s. 6d. costs 363 „ Mar. 18 T. Bros., 64a Winstanley Road 381 Fined £1 and 12s. 6d. costs 75 per cent. chicory „ „ Coffee 35 per cent. added starch 35 per cent. sugar „ „ B. L. Q., 36 Prairie Street Fined 10s. and 12s. 6d. costs 390 „ Cocoa „ „ E. C., 133 St. Phillip Street Fined 10s. and 12s. 6d. costs „ 35 per cent. added starch 35 per cent. sugar 392 „ A. P., 66 Knowsley Road Fined £1 and 12s. 6d. April 1 Mr. Garrett 86 per cent. foreign fat 406 Butter „ „ S. C., 15 Carpenter Street 72 per. cent. foreign fat Fined 10s. and 12s. 6d. costs 408 „ „ Date of Hearing. Name of Magistrate. Description of Article. Nature of Offence. Result of Proceedings. Name and Address of Defendant. Demerara Sugar 100 per cent. dyed sugar crystals Fined 10s. and 12s. 6d. costs Mr. Garrett April 1 W. C., 38 Arliss Road Mr. Sheil 15 per cent. devoid of fat Fined £5 and 12s. 6d. costs G. W., 209 Battersea Park Road Milk „ 15 „ „ Fined £3 and 12s. 6d. costs 80 per cent. foreign fat J. E., 80 Taybridge Road Butter „ „ „ 30 per cent. added starch 35 per cent. sugar 0.143 per cent, red oxide of iron Fined £2 and 12s. 6d. costs H. B., 17 Latchmere Grove Cocoa „ Fined £2 and 12s. 6d. costs „ „ 25 per cent. added starch 40 per cent. sugar J. J., 151 High Street „ „ „ „ Fined £5 and 12s. 6d. costs 78 per cent. foreign fat J. B., 50 Lavender Hill Butter „ Mr. Rose J. McG., 3 Savona Street April 29 Cocoa 20 per cent. added starch 25 per cent. sugar Fined 10s. and 12s. 6d. costs „ „ W. W., 31 Longhedge Street 25 per cent. added starch 40 per cent. sugar Fined 10s. and 12s. 6d. costs „ „ W. P. K., 66 Falcon Road „ „ Sago 100 per cent. tapioca Fined 10s. and 12s. 6d. costs „ M. J., 127 Lavender Hill May 27 „ „ Milk 16 per cent. extraneous water Summons withdrawn Morris (the seller) was fined £3 and 12s.6d. costs or, in default. 21 days Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Management Act, 1855, and Railway Clauses Consolidation Act, 1845. Date of Hearing. Name of Magistrate. Name and Address of Defendant. Nature of Offence. Result of Proceedings. Mr. Rose G. C., 191, 192 Fleet Street Occupied dwelling-house, No. 90 Stewarts Road, without proper and sufficient supply of water Closing order if nuisance not remedied within seven days May 28 Do. do. „ „ Water supply having been put on, summonses withdrawn on payment by Defendant of £1 1s. costs Do. do. June 11 & 25 „ Do. do. Non-compliance with notice to abate above nuisance „ „ R. H. R., Sunbury Common, Sunbury Mr. Fenwick Mr. Rose Defective condition of gutters at 38 Musjid Road April 30 May 28 June 11 19 & 25 Nuisances having been remedied, Defendant ordered to pay £2 2s. Do. do. Non-compliance with notice to abate above nuisance „ „ „ Do. do. Defective condition of gutters at 48 Musjid Road „ „ „ Order to abate within 21 days and 5s. costs Do. do. Non-compliance with notice to abate above nuisance „ „ „ Mr. Garrett Sept. 17 A. B., 8 Lessar Avenue Defective condition of drains at 25 Morella Road ) I Date of Hearing Name of Magistrate. Name and Address of Defendant. Nature of Offence. Result of Proceedings. A. B., 8 Lessar Avenue Sept. 17 Mr. Garrett Non-compliance with notice to abate above nuisance Defendant ordered to pay 2s. costs Do. do. „ Non-compliance with notice to provide proper water supply to water closet Defendant ordered to pay 2s. costs „ „ April 30 May 28 June 25 July 23 Sept. 17 G. G., 36 York Road Defective condition of drains at Gurling's Yard, High Street Order to abate nuisance within 1 month and 5s. costs Mr. Fenwick Mr. Rose „ „ Mr. Garrett J. W., Dermot House, Boundaries Road. Permitting Nos. 200, 218 & 222 Boundaries Road to be occupied without first obtaining water certificate „ „ „ Defendant fined £1 and 2s. costs on each (3) summons „ „ L. G., 76 Sterndale Road July 23 Fined £2 and 2s. costs Failing to notify a case of Smallpox R. H., 120 Culvert Road Oct. 15 „ „ Removing fish offal in vessels insufficiently covered Fined 10s. and 2s. costs „ „ Do. do. „ Removing fish offal during prohibited hours. Fined 10s. and 2s. costs Fined £1 and 2S. costs „ W. S., 1 The Osiers, Wandsworth Causing fish offal to be removed during prohibited hours „ „ Date of Hearing. Name of Magistrate. Name and Address Defendant. Nature of Offence. Result of Proceedings. April 30 May 28 June 25 Mr. Fenwick Mr. Rose Requirements of bye-laws complied with and summonses withdrawn on payment of £1 17s. 6d. costs F. B., 34 Deodar Road, Putney Breach of County Council bye-law under Metropolis Management Act, at No. 6 Candahar Road „ „ „ Do. do. Do. do. „ „ „ Do. do. Do. do. Fined £1 and 2s. costs Sept. 3 „ „ A. W., 21 Gideon Road Breachof bye-law of L.C.C. under Public Health (London) Act at 2 Shirley Grove Sept. 13 Fined £1 and 2s. costs „ „ Breach of bye-law of L.C.C. under Public Health (London) Act at 56 Nightingale Lane G. T., 24 Oldridge Road, Balham „ „ „ Defendant having done required works, ordered to pay cost of summons, 2s. Breach of bye-law of L.C.C. under Public Health (London) Act at 38 St. Andrew's Street J. H., 40 Turret Grove, Clapham „ „ Breach of bye-law of L.C.C. under sec. 202 of the Metropolis Management Act at 38 St. Andrew's Street Defendant having done required works, ordered to pay cost of summons, 2s. „ Do. do. „ „ „ Fined £1 and 2s. costs. Breach of bye-law of L.C.C. under sec.202 of Metropolis Management Act at 50 Taybridge Road J.W.H., 50 Taybridge Road Mr. Garrett Defendant ordered to pay cost of summons, 2s. Oct. 29 Breach of bye-law of L.C.C. with respect to w.c. on ground floor at 35 Elspeth Road A T. & Son, 11 Mossbury Road Date of Hearing Name of Magistrate Name and Address Defendant. Nature of Offence. Result of Proceedings. A. T. & Son, 11 Mossbury Road Breach of bye-law of L.C.C. with respect to w.c. on first floor at 35 Elspeth Road Defendant ordered to pay cost of summons, 2s. Mr. Garrett. Oct. 29 A. T., 11 Mossbury Road Work having been done, Defendant ordered to pay cost of summons, 2s. Breach of bye-law of L.C.C. with respect to watertight inspection chambers at 53 York Road „ „ „ May 28 T. W., Lombard Road Nuisance from the emission of black smoke Fined £5 and 2s. costs Mr. Rose Oct. 29 Fined £5 and 2s. costs Do. do. Do. do. Mr. Garrett June 25 Mr. Rose L. & N. W. R. Co., Euston Station, Euston Road Nuisance from the emission of black smoke from engine Fined £3 and 23s. costs Fined £5 and 2s. costs May 28 G. H. & C., York Place Nuisance from the emission of black smoke Mr. Garrett July 23 Fined £5 and 2s. costs C. K., 64 Northcote Road Do. do. „ „ „ Fined £2 and 2s. costs Do. do. Do. do. Prohibition order obtained Sept. 13 Nuisance from the emission of black smoke from General Electric Lighting Station Mr. Rose Battersea Borough Council July 23 M. N. & Co., Ltd., Albert Bridge Flour Mills, Anhalt Road Fined £5 and 2s. costs Nuisance from the emission of black smoke Mr. Garrett Fined £2 and 2s. costs „ Do. do. Do. do. „ „ The Small=Pox Outbreak, 1901 =1902. Small-Pox. The following table gives the number of Small-pox cases and deaths in Battersea and in the County of London since 1891: — Year. Battersea. London. Cases. Deaths. Deaths. Cases. 8 1891 - - 114 1 4 2 5 1892 2 41 108 2,815 12 206 1893 1894 1,193 89 8 2 1895 1 980 20 55 1896 - 9 4 225 - 16 1897 1 104 1898 33 1 1 - 1899 - 3 29 - 86 1900 4 - 1901 4 1,700 229 5 1 1.314 1902 25 7,797 169 Battersea, in common with the rest of London, had been remarkably free from Small-pox since 1891, except for a comparatively small outbreak in 1893-4. The London outbreak of 1901-2 began in St. Pancras in August, 1901, the disease being in all probability imported from Paris. No case was known to occur in Battersea until October 12th, when a case was discovered in Abercrombie Street. This patient's son, however, had had a mild attack of the disease some three weeks previously, but the nature of his complaint had not been recognised. From October 12th, 1901, cases occurred practically every week until August 4th, 1902. A case was - notified on August 24th, and another, the last of the outbreak, on September 27th. The largest weekly number of cases (eighteeen) occurred in the week ending May 21st. The number of cases occurring in each week is set out on the chart facing page 30. Fifty-one cases occurred in 1901, and 169 in 1902, or 220 in all. The following table gives the number of cases notified in each of the Metropolitan Boroughs during the outbreak, and the rate per 100,000 population. In order to compare the different districts, it has been necessary to compare the number of cases notified, not the number actually occurring, which would be in every case a lower figure. The Boroughs are given in the order of the case-rates: — District. No. of Notifications. Case-rate per 100,000. Hampstead 3 2 27 Chelsea 44 59 Kensington 63 113 Wandsworth 70 173 Fulham 71 103 Lewisham 9 8 74 Paddington 134 92 Islington 356 10 5 Greenwich 114 112 Hammersmith 121 139 Deptford 129 145 Stoke Newington 70 135 Lambeth 416 136 Battersea 241 140 Camberwell 408 155 Marylebone 231 174 City of London 47 183 Westminster 184 333 Hackney 461 207 Woolwich 257 219 Bermondsey 249 235 St. Pancras 261 616 Southwark 606 293 Finsbury 302 300 Shoreditch 455 390 Poplar 697 4 11 546 Bethnal Green 420 Stepney 512 1,539 Holborn 435 743 The following table gives the number of cases and the case-rate in each of the sub-districts and wards in the Borough:— - No. of Cases. Case-rate per 100,000. East Battersea 112 153 North-West Battersea 74 149 South West Battersea 34 69 Wards— 144 43 Nine Elms Park 45 243 Latchmere 32 166 104 Shaftesbury 17 20 Church 101 Winstanley 29 139 6 71 St. John Bolingbroke 20 105 8 Broomwood 44 The disease appeared in nearly every part of the Borough, but its greatest incidence was in the group of streets between Battersea Park Road and the railway, and in the vicinity of Sterndale Road and Dashwood Road. A list of the streets in which cases of Small-pox occurred, and the number of cases occurring in each street is given below:— 76 East Battersea. North-West Battersea. South-West Battersea. Street. No. of Cases. Street. No. of Cases. Street. No. of Cases. 1 Abercrombie Street 9 Aliwal Road Acanthus Road 1 Alfred Street 7 Battersea Park Road 1 Broxash Road 1 Arliss Road 1 Bullen Street 3 Chatham Road 2 Arthur Street Cabul Road 1 1 Chivalry Road 1 Austin Road 1 Castle Street 3 Eccles Road 3 Battersea Park Road 4 Church Lane Elspeth Road 1 2 Beaufoy Road Este Road 3 2 Fontarabia Road 1 Blondel Street 1 Falcon Road 1 Forthbridge Road 4 Brougham Street 5 Granfield Street Garfield Road 4 5 Carpenter Street 12 Gwynne Road Hillier Road 1 1 Chesney Street 4 Ingrave Street 10 Leathwaite Road 2 Culvert Road 1 Kerrison Road 1 Marney Road 3 Dashwood Road Latchmere Grove 7 8 Northcote Road 1 Doddington Grove 1 Latchmere Road 1 St. John's Hill Grove 4 Etruria Street 1 Lavender Road 5 Salcott Road 1 Grayshott Road 1 Livingstone Road 1 Strathblaine Road 1 Henley Street 4 Lombard Dwellings 3 Winifred Grove Juer Street 1 1 Maysoule Road 2 Knowsley Road 3 Mendip Road 3 Total 34 Landseer Street 1 Meyrick Road 3 Latchmere Road 1 Nepaul Road 1 Lavender Hill 2 Starch Factory Road 3 Longhedge Street 5 Surrey Lane 2 Montefiore Street Totteridge Road 1 2 Palmerston Street 1 Yelverton Road 1 Rollo Street 1 York Road 2 St. Andrew's Street 2 Total Savona Place 7 74 Seymour Street 1 Sheepcote Lane 1 Southolm Street 1 Sterndale Road 18 Stewarts Road 2 Theatre Street 1 Tidemore Street 1 Trollope Street 1 Tyneham Road 1 Warriner Gardens 1 Wycliffe Road 4 Total 112 The age-distribution of the cases is given below:- Age Periods—Years. Under 1 1-5 5-10 10-15 25-35 55 -65 65-75 15-25 35-45 45-55 57 4 5 25 46 Cases 15 17 2 33 16 2 Deaths 4 6 1 - - 1 5 6 4 The number of cases under five was 20, or 8.9 per cent, of the total. The number of cases under ten was 37, or 16.8 per cent, of the total. It will be noted that the mortality of the cases under five years of age was very heavy, no less than 50 per cent. These patients were all unvaccinated. The Sources of Infection. Small-pox is a disease which is spread by personal infection. In 80.4 per cent, of cases a definite history of infection from a previous case was obtained, and there is no doubt that the remaining cases were infected in the same way. It is often difficult to trace the source of infection, as it may be impossible to obtain an adequate history of the patient's movements at the period of infection. Not infrequently the patient is the only person who can give the required information, and he may be removed to hospital before the inquiries can be made, or he may be too ill to be troubled with questions. The disease was repeatedly imported into Battersea, and the following is a list of the districts from which it was introduced:-Camberwell, Chelsea, Hammersmith, Holborn, Lambeth, St. Pancras, Stepney, Wandsworth, Westminster, Dartford, Glasgow, Kingston and Walthamstow. The spread of the disease was very largely due to unrecognised or concealed cases. This is the usual experience, and constitutes the chief difficulty in dealing with an outbreak of Small-pox. In some cases the disease was of so mild a type that the patient thought he had merely caught a "heavy cold," and, not troubling to see a doctor, went about his work after a few days at home, as if nothing had happened. In three instances there was reason to suspect that the cases were wilfully concealed, in order to avoid removal to hospital, and temporary loss of employment for the other inmates of the house. In two of these cases wilful concealment, though suspected, could not be proved, but in the third case the evidence was stronger, and the offender was prosecuted, and the maximum penalty —a fine of forty shillings—inflicted. There were cases, too, where, although medical advice was sought, the doctor, owing to lack of experience in Small-pox cases, failed to make a correct diagnosis, and the nature of the disease was not recognised until subsequent cases made the diagnosis clear. Eight cases of Small-pox were treated as cases of either Chicken-pox, Influenza or Syphilis. It is, of course, not surprising that mistakes of diagnosis were made. Small-pox is now happily a rare disease, and comparatively few medical men have had any opportunity to make themselves familiar with its clinical features. Most of the cases occurred in groups, each group consisting of a number of patients who contracted the disease directly or indirectly from a common source of infection. The following are examples of these groups of cases. The cases are numbered in the order in which they were reported to, or discovered by, the Medical Officer of Health:— Group I. The first case notified in Battersea was removed on October 12th, 1901. This patient had nursed her son, who had had a mild attack of Small-pox and was treated for Influenza, the nature of his complaint not being discovered until his mother was taken ill, when he had become free from infection. He was employed at a second-hand clothing establishment in Soho, which was at that time an infected area. Nos. 2, 3, 4 and 5 contracted the disease from Case 1. Group II. Nos. 6 and 7 were notified on November 18th. It appears they were taken ill on November nth, the rash coming out on November 14th. They remained indoors, but did not seek medical advice till November 18th, when they visited University College Hospital, travelling by rail from Clapham Junction to Waterloo, and thence by omnibus. At the hospital the disease was at once recognised, and the patients promptly removed to the Small-pox Hospital. On visiting their home, 1 ascertained that Nos. 8 and 9 were also suffering from Small-pox. No. 9 had been ill since October 28th, but as the attack was very mild, a doctor had not been called in. She had undoubtedly infected Nos. 6, 7 and 8, but the source of infection in her own case was not quite clear. Her father, however, had been working in a street near Clare Market, whence several cases had been removed, and it is possible that he had brought home some infected article. Group III. No. 10 was a young man employed in a pawnbroker's shop, and was possibly infected at his place of work, although this could not be definitely proved. This patient infected Cases 18, 19, 20, 21 and 30. Group IV. Nos. 12 and 13 were removed to hospital on December 1st, the eruption having appeared on that day. Upon enquiry, I ascertained that an old man, H. P., had died three doors lower- down the street on November 15th, after an illness of thirty hours. On November 16th his widow removed to the house in which Nos. 12 and 13 were living, her bedding, &c., being carried by T. C. (No. 23), who was taken ill a fortnight later, his rash appearing on December 2nd. The cause of H. P.'s death was given as "serous apoplexy," but after discussing his case with his medical attendant, after the above cases had occurred, I have no doubt he died of Small-pox. No. 23 infected Nos. 31, 32, 39, 40, 41, 44, 46, and, probably, Nos. 42 and 43. No. 46 infected Nos. 52, 53, 54, 64, 68, 82, 83 and 84. No. 82 infected No. 87, and No. 87 infected No. 94. No. 42 infected No. 71. No. 43 infected Nos. 51, 55, 56 and 60. Group V. No. 17 was infected by his brother, who lived in a neighbouring 1 district, and who had a mild, unrecognised attack of Small-pox. After infecting No. 17, this man visited some relatives in West Ham, who also contracted the disease. No. 17 infected Nos. 15, 16 and 50. Group VI. No. 29 was treated for Chicken-pox for nearly three weeks. Nos. 26, 27, 28 and 34 contracted the disease from this source. Group VII. Nos. 61, 62, 63 and 69 were infected by a previous case in the same house, who was treated for Chicken-pox. The above cases occurred before the notification of Chicken-pox came into operation. Group VIII. No. 164 visited her sister, who was said to be suffering from Chicken-pox, in another part of London. The sister was afterwards found to have had Small-pox. Nos. 180, 183, 184, 185, 186 and 187 contracted the disease from 164. Group IX. This group .of cases occurred during May and June in the vicinity of Dashwood Road and Sterndale Road. The first case in this group, No. 166, an unvaccinated child, was infected by her mother, who contracted Small-pox in a common lodging-house in Westminster, and who had the disease in so mild a form that medical advice was not sought. No. 164 had a severe attack, but the parents did not call in a doctor until the child was dying, after an illness of ten days. Nos. 168, 169, 171, 172, 182, 189, 190, 191, 192, 193 and 196 contracted the disease from No. 166. No. 182 infected her sister, No. 201, who was concealed by her mother in order to escape removal to hospital. The following cases contracted the disease from No. 201:—Nos. 202, 203, 204, 205, 206, 207, 209, 210, 211, 212, 213 and 215. Proceedings were taken against the mother of No. 201, Mrs. Gilham, of 68 Sterndale Road, under Section 55 of the Public Health (London) Act, 1891, for failure to notify the case of her daughter, and a fine of 40s. and costs was imposed. Group X. This group consists of a number of workmen who were employed in erecting additional buildings to the Small-pox Hospital at Long Reach, and of persons infected by them. During the early months of 1902 many workmen were employed by the contractors to the Metropolitan Asylums Board in increasing the hospital accommodation for Small-pox cases. It was found impossible to secure the re-vaccination of all of these men, and in consequence many of those who refused to be re-vaccinated contracted Small-pox. Of the workmen living at Battersea, seven were infected, viz., Nos. 86, 106, 109, 110, 113, 129 and 134. No. 106 infected No. 118. No. no infected, directly or indirectly, Nos. 128, 131 and 139. No. 129 infected No. 154, who was employed in cleaning a place of worship in Church Ward. She had a mild attack, and was treated as a case of Influenza, and after staying indoors for a few days, resumed her occupation. Nos. 150, 151, 152, 153, 155, 157, 160, 161 and 163, most of whom attended this place of worship, contracted the disease, directly or indirectly, from No. 154. Group XI. This group consists of men employed in the work of disinfecting houses where "Small-pox had occurred, and of persons infected by them. Six disinfectors were attacked, five being employed by the Battersea Borough Council, and one by a private firm of disinfectors and cleaners in Battersea, who disinfect for another Metropolitan Borough. All these men had refused re-vaccination. Additional facts relating to these disinfectors are given on page 84. The disinfectors employed by the Borough Council were Nos. 25, 67, 72, 108 and 148. No. 108 infected his wife, No. 115. No. 214 was employed by a private firm in collecting infected bedding, &c., in a neighbouring Borough. Nos. 216, 217 and 218 contracted the disease from him. Out of the total number of 220 cases, the source of infection was definitely traced in 177 cases, or 80.4 per cent. of the total, and was found to be personal contact with infected persons, or infected garments or bedding. In seven cases personal infection was suspected, but could not be proved, and in thirty-six cases the source of infection could not be traced. So far as could be ascertained, what are known as insanitary conditions appeared to play little or no part in the spread of the disease. Out of the 150 houses invaded tew had serious defects, and only four were overcrowded. None of the patients belonged to the "tramp" class, and only two were inmates of common lodging-houses. Vaccination. The following table gives the cases and deaths amongst the vaccinated and unvaccinated respectively. Dr. Ricketts, the Medical Superintendent of the Small-pox Hospital Ships, has kindly given me particulars as to the vaccination of all the cases removed to hospital:— Age-Period. Vaccinated. Unvaccinated. Deaths. Cases. Deaths. Cases. - 1-5 - 9 19 - 14 1 5—10 3 10—15 - - 9 15 2 2 15-25 9 36 3 - 25-35 1 55 2 1 35—45 32 - 6 45 —55 - - 14 - 55— 6 5 - - 2 - 65 and upwards - - 3 53 13 12 Totals 160 22.6 per cent, of the unvaccinated cases were fatal, as against 8.1 per cent, in the vaccinated class. Seven cases are classed as doubtful; in six of these no vaccination scars could be seen, although the patients were stated to have been vaccinated; four of these cases were fatal. Four patients bore evidence of successful re-vaccination, the dates of the re-vaccinations being as follows: 1872, 1873, 1877 and 1882. Three patients stated that they had been re-vaccinated, but no evidence could be seen. In these cases re-vaccination was said to have been performed in the following years: 1876, 1883 and 1892. In no case was there any evidence whatever of re-vaccination having been performed at a later date than 1892. Three children under ten who were vaccinated in infancy were attacked; two were eight years and one nine years old when attacked. During the outbreak, upwards of 27,000 persons were re-vaccinated, and not one was attacked, with the exception of a few who were re-vaccinated after they had contracted the disease. Information as to the number of scars of primary vaccination was obtained in 157 cases. The following table shows that the greatest mortality occurred amongst the patients having only one scar:— No. of Scars. No. of Cases. No. of Deaths. 5 1 25 32 2 2 3 37 - 4 3 5 2 5 - 9 - 6 2 The influence of vaccination in mitigating the severity of the disease is shown by the following table, which gives the average number of days the patients remained in hospital in the vaccinated and unvaccinated classes respectively. Fatal cases have been excluded from this table:— Age Period. Vaccinated. Unvaccinated. No. of Cases. Average Number of Days in Hospital. Average Number of Days in Hospital. No. of Cases. 0-5 - - 58 10 3 3 2 5-10 63 12 27 10—15 14 9 4 8 15—25 30 34 7 65 27 51 2 5—35 66 1 30 35—45 28 58 1 7 45—55 36 - - 2 31 - - 55—65 - - 65 and upwards 3 17 28 144 40 59 Totals In connection with the above table, five cases should be mentioned which occurred in the family of Mr. X., who was, before these cases occurred, a prominent local opponent of vaccination. Mr. X.'s eldest son, a lad of seventeen, was vaccinated in infancy, and subsequently had a severe illness which was attributed to vaccination, and the other children in the family were, in consequence, not vaccinated. During the outbreak he was exposed to a source of infection, not affecting the other members of the family, and contracted Small-pox. His attack was very mild, and he was discharged from hospital at the expiration of ten days. The four remaining children contracted the disease from this patient and all were severely ill, the duration of the disease in the four cases being 50, 56, 78 and 125 days. The Staff and Vaccination.—In most of the districts affected by the outbreak, the Sanitary Authority insisted that all persons in their employ whose duties brought them into contact with infection should be re-vaccinated. In Battersea the Sanitary Authority held that it was unjustifiable to make such an order, and that no compulsion should be exercised as to the re-vaccination of any of the Council's employes. At the beginning of the outbreak, however, I urged upon the staff of the Health Department the necessity of immediate re-vaccination, and my advice was taken by the members of the staff, with the exception of some of the disinfectors. During the outbreak, 27 men were employed by the Council in the work of disinfection. Two of these were protected by a previous attack of Small-pox, and 14 had been recently re-vaccinated. The remaining disinfectors, eleven in number, had been vaccinated in infancy, but refused re-vaccination. Five of these men contracted Small-pox, but not one case occurred amongst the remaining members of the staff. The total number of persons officially brought into contact with infection in Battersea during the outbreak was 42. The re-vaccinated class included the Medical Officer, 9 inspectors, 14 disinfectors employed by the Council, and 5 men employed by the disinfection contractor in removing infected bedding, &c. The number of re-vaccinated persons was therefore 29, and not one contracted Small-pox; 11 persons refused re-vaccination, and 5 were attacked. After the second week in April it was found possible to employ as disinfectors only those who were protected by re-vaccination, or by a previous attack of Small-pox, and no further cases occurred. PREVENTIVE METHODS. Notification. —If the prompt notification of every case of Small-pox could be secured, it would be an easy matter to deal with an outbreak. Unfortunately, many cases are not notified at all, or not until the infection has spread. Some patients, either innocently or designedly, do not seek medical advice, and in other cases, although a doctor is seen, the clinical features are so modified that the diagnosis of Small-pox is not made. Fortunately, the medical men practising in the Borough did not hesitate to avail themselves of such assistance as I was able to give them in this respect. I was asked to see 112 doubtful cases in all, 45 of which were Small-pox, and the remainder other diseases, chiefly Chicken-pox. The question of making Chicken-pox a notifiable disease was discussed by the Health Committee, and it was decided that this course should not be taken. On January 28th the London County Council made an order, the effect of which was to make Chicken-pox a notifiable disease over the whole of the County of London. This order was renewed from time to time, and finally expired on January 7th, 1903. The County Council also appointed, in certain parts of London, medical referees to whom medical practitioners could apply for aid in the diagnosis of doubtful cases. This action of the County Council was severely criticised by several of the Borough Councils, who contended that the appointment of medical referees was a matter for them, and that the County Council, in making these appointments, was trespassing on their preserves; but it is not easy to see how the County Council's action prevented any Borough Council from appointing as many medical referees as it liked. The two gentlemen appointed to act in Battersea had had considerable experience in Small-pox, and rendered valuable assistance. In Battersea, at all events, the action of the County Council was productive of nothing- but good. Every case notified was promptly investigated by the Medical Officer of Health, and in this way, by tracing the source of the disease, upwards, so to speak, many other cases were brought to light. Isolation.—Every case of Small-pox notified in Battersea was at once removed to hospital, except four patients, who died before they could be removed. The bodies of these patients were removed to the infectious chamber in the public mortuary and promptly buried, the strictest precautions against infection being observed. Mention should be made of the admirable ambulance arrangements of the Metropolitan Asylums Board. There was no difficulty in securing the speedy removal of a patient at any hour of the day or night. The ambulance service was worked in the most efficient manner, and reflects great credit on the Board and its officers. Credit is also due to Dr. Wanklyn, the diagnostician at the South Wharf Station, whose work throughout the whole outbreak was of the highest excellence. Disinfection. —After every case the house was disinfected throughout. All bedding, &c., in the rooms which had actually been occupied by the patient was removed and disinfected by steam. These rooms were then fumigated with either sulphur dioxide gas or formic aldehyde, and afterwards stripped of paper and washed with a solution of chloride of lime. The staircases and passages were washed down with the same solution, or sprayed with a solution of formalin. The remaining rooms were fumigated, but not stripped. The disinfecting work was in every instance well done, and no case occurred owing to inefficient disinfection. Quarantine. —In the early part of the outbreak, when the disease had only attacked ten houses, the method of quarantine was adopted. The inmates of these houses were induced to remain in seclusion indoors for fourteen days after the removal of the patient to hospital, compensation being given to the wage-earners for loss of time. It was found, however, that whatever advantages this method may have in isolated districts in the early stage of an outbreak, it is of very doubtful value when employed in a Metropolitan district. The disease was repeatedly imported, and in December quarantine was discontinued. The total expense incurred in this connection was 9s. 8d., and the Local Government Board, upon application, sanctioned this expenditure under the Local Authorities Expenses Act (1887). Supervision of Contacts.—The names and addresses of all persons who had been in contact with the patients were obtained where possible, and a close supervision was kept over such persons by the Inspectors and Medical Officer of Health. A considerable number of cases were discovered in this way. Information respecting contacts was freely exchanged with the Medical Officers of Health in other districts, the telephone being found invaluable in this connection. In all, seventy cases were brought to light by the staff of the Health Department in the course of our investigations. Vaccination.—As soon as a case was discovered, a notification was at once sent to the Vaccination Officer and to the Public Vaccinator of the district, and every effort was made to secure the vaccination or re-vaccination of every person who had come in contact with the patient. These efforts were usually successful. In spite of the strong local feeling against vaccination, a considerable number of persons were vaccinated during the outbreak. From information supplied me by local medical practitioners, I have estimated that the number of vaccinations and re-vaccinations, exclusive of primary vaccinations of infants, performed in Battersea from October Ist, 1901, to June 30th, 1902, was about 27,000. Not one of these persons was attacked, except a few who were re-vaccinated after Small-pox had been contracted. In February a meeting of the London Sanitary Authorities, convened by the Holborn Borough Council, was held at the offices of the Metropolitan Asylums Board to consider "whether the measures adopted in dealing with the outbreak could be improved, with a view to the more effective suppression of the disease." The London County Council and upwards of twenty Borough Councils sent delegates, Battersea being represented by Councillors Dr. McManus, W. Watts, A. W. Raynor and the Medical Officer of Health. The resolutions adopted were as follows:— I. That, in the opinion of the Conference, the powers and duties at present vested in Guardians of the Poor, with regard to Vaccination and re-Vaccination, should be transferred to and enforced by Borough Councils. 2. That, in the opinion of the Conference, an amendment of the law is necessary to ensure compulsory Vaccination and re-Vaccination of all persons in a dwelling-house wherein Small-pox has broken out. 3. That, in the opinion of the Conference, it should be declared an offence, under the Public Health (London) Act, 1891, to refuse or withhold information, or give false information, with respect to persons living in a house in which Small-pox has broken out, with regard to (a) their names, (b) employment or occupation, (c) schools attended by their children, or (d) as to any persons not living in such house, but employed therein. 4. That, in the opinion of the Conference, all disinfections should be carried out by the Sanitary Authority. 5. That, in the opinion of the Conference, the provisions of the Public Health (London) Act, 1891, with regard to the prevention of infectious diseases, require amendment by (a) shortening the period of twenty-four hours, allowed by Section 60, for the master of a house to decide whether he will undertake the disinfection or allow the Sanitary Authority to do so, and (b) extending the provisions of Section 64 to the taking of any house or part of a house by a person suffering from an infectious disease, or who has been exposed to infection. 6. That, in the opinion of the Conference, it is advisable that application be made to the Metropolitan Asylums Board to send out to every Medical Officer of Health in London daily lists of Small-pox cases only, with ages and addresses of patients, as is done weekly in the case of all infectious diseases. 7. That the Conference approve the communication addressed by the Town Clerk of the Royal Borough of Kensington to the Local Government Board, requesting them to undertake the supply of lymph to any registered medical practitioner who may apply for the same, instead of to public vaccinators only. 8. That, in the opinion of this Conference, an amendment of the law is necessary to the effect that any person inhabiting any part of a house which has been infected by Small-pox, and who knowingly associates with other persons without having his person and clothes cleansed and disinfected to the satisfaction of the Sanitary Authority, shall be liable to a fine not exceeding £20. 9. That, in the opinion of this Conference, Borough Councils should be allowed to make provision for "contacts" for whom they may have no accommodation available in their shelters. Cost of the Outbreak. The cost of the outbreak to the ratepayers of Dattersea, so far as it can be ascertained, is set out below :— £ s. d. Wages of additional disinfectors ... 289 3 8 Amounts paid to staff in recognition of special work in connection with Small-pox:— Inspectors 95 0 0 Clerks 32 2 10 Disinfectors 84 9 8 Amount paid to contractor for disinfecting bedding, &c. 613 9 4 Compensation for articles destroyed 21 5 0 Expenses in connection with quarantine 37 9 8 Fees to medical practitioners for Chicken-pox notifications 148 17 0 The total amount expended in connection with disinfection, quarantine, &c., was £1,321 17s. 2d., or £6 os. 2d. per case. To this must be added Battersea's share of the amount spent in ambulance and hospital accommodation by the Asylums Board, which was £500,000, a sum equal to a threepenny rate. The portion of this sum falling on the Battersea ratepayers was, therefore, £11,850. The total cost of the outbreak to the ratepayers, exclusive of expenses in connection with Vaccination, was £13,171 17s. 2 d. The Clerk to the Guardians, Mr. F. W. Piper, has kindly furnished me with information relating to the amounts paid by the Guardians in respect to Vaccination during the outbreak. The total sum paid to the five Public Vaccinators and the Vaccination Officer during the nine months ending Midsummer, 1902, was Bs. 3d. This statement of expenses does not take into account the fees paid to private practitioners for vaccination, nor the losses sustained by individuals by reason of the outbreak. Many wage-earners lost their employment because Small-pox had occurred in the houses in which they were living, and much hardship was experienced in this way by the poor. Small-pox brings many evils in its train quite apart from the actual suffering caused by the disease. In concluding this report, I must acknowledge the great services rendered in connection with the outbreak by the Chief Sanitary Inspector and the whole of the staff of the Health Department. Where all have worked so well, and with such devotion to duty, it is perhaps invidious to particularise, but special mention should be made of the ability and zest with which Inspector Chuter carried out his work. Factory and Workshop Act, 1901. Factory and Workshop Act, 1901. Section 132 of the Factory and Workshop Act, 1901, provides as follows:—"The Medical Officer of Health of every District Council shall, in his Annual Report to them, report specifically on the administration of this Act in workshops and workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject to the Secretary of State." Before last year the sanitary supervision of workshops and workplaces, and such supervision of factories as devolves upon the local authority, was carried out in Battersea by the district sanitary inspectors, but owing to the heavy calls upon the staff in other directions, it was not found possible to maintain the close and systematic supervision of these premises which is necessary for the efficient administration of the law. When the Factory Act of 1901, which imposes new and important duties upon local authorities, was passed, it became evident that the existing inspectorial staff was quite inadequate for the work, and accordingly, in January, 1902, the Council decided to appoint two additional inspectors. Mr. W. E. Benjamin, of Portsmouth, and Miss Edna Dawson, of Gateshead, both experienced workshop inspectors, were appointed and entered upon their duties on June 21st and September 22nd respectively. Workshops. The new inspectors at once began a systematic inspection of the workshops in the Borough on the following lines:— Every workroom in the workshop is measured up and the dimensions and cubic capacity entered upon a printed form. Upon the same form are entered particulars as to the number, sex and age of the persons employed in each workroom; the means of ventilation, lighting and warming; the number, position and condition of the sanitary conveniences for each sex, and the general sanitary condition of the premises. Any special circumstances are also noted. The form is submitted to the Medical Officer of Health, who directs what action shall be taken, and it is then filed in a folder in which are also kept all the documents relating to that particular workshop. An abstract of the above particulars is entered upon a card which is filed in a card register, and on the card are also recorded the results of subsequent inspections and of proceedings taken in connection therewith. Cards are distributed to the occupiers of workshops setting forth for each workroom the maximum number of persons who may be legally employed (a) During ordinary working hours when the workroom is not used as a sleeping-room; (b) When overtime is being- worked; (c) When the workroom is used as a sleeping-room. One of these cards is posted up in each workroom, so that both the occupier and the workers need be under no misapprehension as to what constitutes overcrowding. By Section 131 of the Factory and Workshop Act, 1901, every district council is obliged to keep a register of all workshops within their district. As indicated above, a card register is used in this office for the purpose. It has been found of great service, and to have many advantages over a book register, being easily adjusted to meet the continual variations in the number of workshops, and affording a readilyaccessible record of the history of each particular workshop. A similar register is kept of all the factories, workplaces, and out-workers' premises in the Borough. A list of the workshops inspected up to the 31st December, 1902, with the number of persons of each sex employed therein is given below. WORKSHOPS. No. of Workshops registered. Persons employed. TRADE. Males Females Bakers 89 196 - Bootmakers 1 - 46 120 Builders 18 4 Blindmakers 16 - 2 15 - Billiard Table Makers 2 1 Boot Polishers 12 1 15 42 Cycle Makers - - Coach Builders 5 43 Carpenters 6 29 - Crayon Makers 2 2 4 Coffin Makers 3 6 Dressmakers - - 198 87 5 Dyers and Cleaners 2 1 Electrical Engineers 1 8 — 2 Firewood Cutters 2 7 Farriers - 2 9 Furniture Makers 1 8 Ironmongers 3 8 - - 4 9 Jewellers - Laundries 73 7 552 30 112 Milliners 3 Masons 4 27 - Musical Instrument Makers 33 4 - Photographers 1 2 2 2 17 - Plaster Modellers 7 Picklers 1 1 3 8 Picture Frame Makers - Plumbers 2 9 - 1 Rag Sorters 2 4 3 9 - Saddlers Sugar Boilers 2 11 - 18 Smiths 5 - Tailors 31 5 6 63 Upholsterers 5 21 6 9 51 2 3 Other Trades 826 454 977 Total 97 The above list is far from comprising the whole number of workshops in Battersea, which is probably between 600 and 700. The inspection is still proceeding, and next year it will be possible to report upon the whole of the workshops in the Borough. Section 133 of the Act of 1901 provides that "When any woman, young person, or child is employed in a workshop in which no abstract of this Act is affixed as by this Act required, and the Medical Officer of Health of the district council becomes aware thereof, he shall forthwith give written notice thereof to the inspector for the district." In pursuance of this section, notices were sent to H.M. Inspector in respect of the following 76 workshops:— Workshops notified to H.M. Inspector in pursuance of Section 133 of the Factory and Workshop Act, 1901. TRADE. Number of Workshops. Protected Persons employed. Women Young Persons Total. Chil- dren. 1 - 1 - 1 Baker Blousemaker 4 6 3 - 10 Bootmaker 6 6 - 6 - Carpenter - 6 6 3 - Cycle Maker - 6 6 5 - 38 Dressmaker 15 2 4 53 - Electric Accumulator 1 1 - - 1 Embroideress 1 1 4 - 5 Ironmonger 2 2 - - 2 68 Laundry 16 - - 68 Milliner 4 5 - - 5 Photographer 1 2 - - 2 Picture Frame Maker 1 1 - - 1 1 1 Rag Sorter - - 1 Sugar Boiler 1 - 1 - 1 Tailor 6 13 1 - 14 76 - 135 Totals 47 182 The following domestic workshops were also notified to H.M. Inspector:— Dressmakers 2 Tailors 2 Laundries 2 Sanitary Condition of Workshops. Cleanliness.—In the matter of cleanliness, the condition of the workshops in certain trades was found to be unsatisfactory. No less than 127 work-rooms, or rather more than 12 per cent, of the total, were in a dirty condition at the time of inspection. The workshops in which dirty work-rooms were found were chiefly laundries, tailors, and cycle makers. Air Space.—The work-rooms found to be overcrowded were thirteen in number, most of these being in tailors' workshops. The standard of air space adopted is, of course, that laid down in Section 3 of the Act, which prescribes 250 cubic feet per head during ordinary hours. In a considerable number of work-rooms the provisions of the Act were only just complied with, there being practically 110 excess of air space. Ventilation.— On the whole, it may be said that the means of ventilation provided are not inadequate. The difficulty is that the means provided are not used, the workers themselves being chiefly to blame in this respect. In some cases it was found that considerable ingenuity had been exercised to block up most of the available openings. Drainage of Floors on which wet processes are carried on. —Fifteen workshops, all of which were laundries, failed to comply with Section 8 of the Act, which prescribes that in workshops where "wet processes" are carried on, adequate means shall be provided for draining off the wet from the floors. Provision oj sufficient and suitable sanitary conveniences. —This matter is dealt with more fully on page 114. In thirtyseven workshops the sanitary conveniences were unsatisfactory. The defects in this connection are usually found on premises which have been hastily adapted for the purposes of the business. Where, as often happens, this process involves the conversion of the back-yard into a covered work-room, the water-closet may open directly into the work-room. Considerable difficulty was experienced in dealing with some of these cases. The following is a tabulated statement of the work done in connection with workshop inspection during the year, so far as it admits of tabulation:— Workshop inspections and re-inspections 1,919 Workrooms measured 1,025 Workshops notified to H.M. Inspector (including domestic workshops) 82 Cards distributed 354 Written intimations issued 240 Statutory notices served 18 Defects discovered and remedied:— Workrooms in a dirty condition 127 Workrooms overcrowded 13 Workrooms badly lighted and ventilated 4 Defective washhouse floors in laundries 15 Defective walls and ceilings 9 Defective w.c. accommodation 37 Defective yard paving 2 Choked or defective drains 18 Absence of dust-bins 30 Other defects 5 Five notices were received from H.M. Inspectors of Factories relating to sanitary defects in workshops and received prompt attention. Bakehouses. There are 89 bakehouses in Battersea, 49 of which are underground bakehouses within the meaning of the Factory Act of 1901. A list of the bakehouses is given below. There are also fifteen premises in the Borough, which were formerly used as bakehouses, but which are now unoccupied or used for other purposes. 101 BAKEHOUSES. Above Ground. Address. Address. 25 Battersea Park Road 64 Latchmere Road 257 „ 89 New Road 292 148 „ „ 343 „ „ 10 Northcote Road 78 Battersea Rise 23 31 Bridge Road 177 „ „ 84 „ „ 76 Plough Road 64 Castle Street 112 „ „ 45 Culvert Road 41 Queen's Road 83 „ „ 121 „ 139 Chatham Road 93 Stewarts Road 29 Stockdale Road 47 Este Road 29 Falcon Road 10 St. Philip Street 90 St. John's Hill 45 Harroway Road 47 Tyneham Road 11 Hanbury Road 80 High Street 102 Usk Road 73 „ „ 46 York Road 40 Lavender Hill 70 „ „ 187 „ „ 137 213 „ „ 287 „ „ Underground. 33 Anerley Street 163 Battersea Park Road 189 „ „ 200 „ „ 219 „ „ 265 „ „ 310 373 50 1 „ „ 525 „ „ 1 The Parade, Battersea Rise 44 Bridge Road 122 Bridge Road West 48 Broomwood Road 2 Burland Road 35 Castle Street 83 Chatham Road 83 Church Road 4 Currie Street 28 „ „ 43 Falcon Road 103 „ „ 46 Francis Street 29 Gideon Road 49 High Street 30 Lavender Hill 291 „ „ 123 Maysoule Road 29 Meyrick Road 133 „ „ 205 New Road 64 Northcote Road 94 „ „ 36 Orkney Street 23 Plough Road 34 „ „ 62 „ „ 109 Salcott Road 46 St. John's Road 140 St. John's Hill 8 Tyneham Road 23 Webbs Road 33 Winstanley Road 47 „ „ 7 2a „ „ 79 „ „ 6 York Road 198 „ „ 345 „ „ In April and October the usual half-yearly bakehouse inspections were made, and it was found necessary to serve notices to enforce compliance with the Factory and Workshop Act and the Public Health Act in 12 instances in April, and in 29 instances in October. The Factory and Workshop Act, 1901, contains the latest of a long series of enactments for the sanitary regulation of bakehouses. The first of these was the Bakehouse Regulation Act of 1863, which brought the sanitation of bakehouses under the control of the sanitary authorities. It would appear, however, that the sanitary authorities were not particularly zealous in carrying out their duties in this connection, and by the Factory and Workshop Act, 1878, the sanitary control of bakehouses was transferred to the Home Office. The latter arrangement was no more successful than the former, as the small staff of factory inspectors was found to be unable to cope with the heavy additional duties, and the Factory Act of 1883 restored to the sanitary authorities their former powers, which were increased by the Factory Act of 1891. In the Factory Act of 1895, which was in many respects a notable landmark in the ever-increasing field of industrial legislation, a definite step was taken to limit the number of underground bakehouses. Section 27, Sub-Section 3 provided that: "A place underground shall not be used as a bakehouse unless it is so used at the commencement of this Act," i.e., January 1st, 1896. This sub-section obviously made it illegal to open as a bakehouse an underground place which had not before been used for that purpose, but it was hoped that it would also have the effect of enabling sanitary authorities to close insanitary underground bakehouses as the premises were vacated. This hope was disappointed by the decision of the High Court in the case of Schweitzerhof v. Wilkins, where it was held that temporary closing did not necessarily constitute disuse. Mr. Schweitzerhof was the occupier of certain premises in Winstanley Road, which had been occupied by another tenant as an underground bakehouse from 1879 down to October 1895. The premises were then closed while the owner carried out certain repairs, and re-opened as a bakehouse in February, 1896. The Vestry contended that the place had not been used as a bakehouse on January 1st, 1896, and could not, therefore, be used as such subsequently. The Magistrate who tried the case took the same view and decided accordingly, but his decision was reversed in the High Court, and the bakehouse in question is in use at the present time. A serious defect in the Act of 1895 was the absence of a legal definition of the word "underground," but this defect has been remedied in the Act of 1901, which in many respects marks a great advance in the sanitary regulation of underground bakehouses. The main provisions of the Act in this connection are given below:— 101. (i) An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of this Act, i.e., August 17th, 1901. (2) Subject to the foregoing provision, after the first day of January one thousand nine hundred and four, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose. In the next sub-section a definition is given of the term "underground bakehouse":— (3) For the purpose of this section an underground bakehouse shall mean a bakehouse, any baking room, of which is so situate that the surface of the floor is more than three feet below the surface of the footway of the adjoining street, or of the ground adjoining or nearest to the room. The expression "baking room" means any room used for baking, or for any process incidental thereto. (4) An underground bakehouse shall not be certified as suitable unless the District Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects. Sub-section 7 provides the baker with his remedy should the Sanitary Authority refuse to grant him a certificate:— (7) In the event of a refusal of a certificate by the District Council, the occupier of the bakehouse may, within twenty-one days from the refusal, by complaint, apply to a court of summary jurisdiction, and if it appears to the satisfaction of the court that the bakehouse is suitable for use as regards construction, light, ventilation, and in all other respects, the court shall thereupon grant a certificate of suitability of the bakehouse, which shall have effect as if granted by the District Council. The next sub-section provides that the owner may be called upon to bear part of the expenses of any structural alterations which may be necessary to fulfil the requirements of the Sanitary Authority :— (8) When any place has been let as a bakehouse, and the certificate required by this section cannot be obtained unless structural alterations are made, and the occupier alleges that the whole or part of the expenses of the alterations ought to be borne by the owner, he may by complaint, apply to a court of summary jurisdiction, and that court may make such order concerning the expenses or their apportionment as appears to the court to be just and equitable, under the circumstances of the case, regard being had to the terms of any contract between the parties, or in the alternative the court may, at the request of the occupier, determine the lease. The effect of these provisions, briefly, is that after January 1st, 1904, it will be illegal to use an underground bakehouse without a certificate of suitability. The sanitary regulation of underground bakehouses is obviously a matter of great importance, for not only are these bakehouses places where a considerable number of men spend their working day, but in them is made a most important article of human food. It is evident that the Legislature in passing the Act of 1901 intended that the Sanitary Authorities in granting certificates of suitability, should not adopt a low standard of sanitation, as the Act expressly states that the Sanitary Authority shall not give a certificate unless it is satisfied that the bakehouse "is suitable as regards construction, light, ventilation, and in all other respects." Whether the intention of the Legislature will be generally carried into effect is another question; but as the certificate is granted for an unlimited period, and is equivalent to a declaration by the Sanitary Authority that the bakehouse is in a condition of perfect sanitation, it is much to be hoped that a reasonably high standard of sanitation will be generally adopted. Otherwise the effect of the Act will be to perpetuate conditions which it was the intention of the Legislature to abolish. There are 49 underground bakehouses in Battersea, and in no case can the certificate of suitability be granted unless more or less extensive alterations are carried out. In the early part of last year a circular letter was addressed by the Health Committee to the occupiers of underground bakehouses, asking them to inform the Committee whether it was their wish to continue to use their bakehouses after January Ist, 1904, and if so, to make an application to that effect, and to submit plans and sections of the bakehouses. Applications and plans have since been received from the occupiers of nearly all the underground bakehouses in the Borough, and have been duly considered by the Health Committee. It was decided at first not to issue a general list of requirements to apply to all bakehouses, but to consider each individual case on its merits, but upon considering the plans, it was found that the list of requirements given below would apply to a large number of the underground bakehouses in the Borough, and this list has been issued to the occupiers of those bakehouses. There were three underground bakehouses which the Committee decided could not be made suitable, and the occupiers were informed that the certificate could not be granted. One of these was the bakehouse which figured in the case of Schweitzerhof v Wilkins. Factory and Workshop Act, 1901. —Section 101. Requirements in respect of the underground Bakehouse at occupied by (1) The bakehouse shall be not less than Bft. in height throughout, measured from the floor vertically to the ceiling. (2) The bakehouse shall have a cubic capacity clear of the oven of not less than 1,500 feet. (3) The floor shall consist of a hard, smooth, and durable surface on a bed of concrete not less than 6ins. thick. (4) The walls shall be constructed of a material which is hard, smooth, durable and impervious to damp. (5) The ceiling shall be smooth and durable, and impermeable to damp and dust. (6) Any drain or sewer under the bakehouse shall be constructed of gas and water-tight pipes. No drain opening, trapped or otherwise, shall be within the bakehouse. The bakehouse must be effectually secured against flooding from drains or sewers, and from the entrance of wet or damp from any source. (7) The bakehouse shall be approached by a suitable staircase, adequately ventilated and lighted. No outside staircase shall terminate within the bakehouse, and such staircase must be so constructed as to prevent the entrance of dust into the bakehouse. Any entrance from the shop must be so constructed as to prevent the entrance of dust. (8) The bakehouse shall be adequately lighted with daylight throughout to the satisfaction of the Sanitary Authority, by means which shall exclude the entrance of dust, and the lighting maintained shall be such that the official copy of the abstract of the Factory Act may be ordinarily read in all parts of such bakehouse between the hours of 11 a.m. and 3 p.m. (9) The bakehouse shall be properly ventilated to the satisfaction of the Sanitary Authority by permanent inlets and outlets, other than the windows, communicating directly with the open-air in such a way and at such a height above the street level as to prevent the entrance of dust. Over the furnace door a properly constructed hood shall be provided, connected with a shaft opening into the external air. Mechanical means of ventilation shall be provided where, in the opinion of the Sanitary Authority, such are necessary. (10) All troughs, tables or other furniture standing on the floor of the bakehouse shall be provided with castors or wheels, so as to be readily movable for cleansing purposes. (11) The water supply shall be drawn from the rising main service. (12) Conveniences for personal ablution shall be provided in a suitable position, not within the bakehouse, and shall include a water tap and a sink or lavatory basin of an approved character. (13) Proper provision shall be made for the depositing of wearing apparel not within the bakehouse. (14) There shall be no opening into the bakehouse for any purpose which will tend unduly to the admission of dust from the adjoining street or ground. (15) Proper provision shall be made for the storage of coal. (16) Properly covered receptacles shall be provided for the storage of all refuse matters, and such receptacles shall be emptied and cleansed at least once every twentyfour hours. (17) No animal shall be allowed in or have access to the bakehouse. (18) The bakehouse shall not be used as a room for washing or drying clothes. (19) All statutory obligations shall be fulfilled. (20) Before making any alterations with a view to meeting these requirements the owner or occupier of the bakehouse shall submit to the Sanitary Authority a specification of the alterations which it is proposed to make, and no work shall be begun until the applicant has been informed that the specification has been approved. The chief difficulty in underground bakehouse sanitation is the question of ventilation. The problem is to provide for the admission of a sufficient amount of fresh air without at the same time affording free access for dust from the road or adjoining ground. In some of the bakehouses in the low-lying parts of Battersea it will not be an easy matter to secure the bakehouse from wet. A considerably number of specifications have been sent in and approved, and in eleven bakehouses the alterations necessary to obtain a certificate have already been begun. The work of prescribing in detail the alterations necessary for each particular bakehouse to fulfil the Council's requirements, and of supervising the builder's work when begun, has been heavy, and has occupied a considerable amount of the time of the Council's officers. The Chief Sanitary Inspector has done excellent work in this connection, his practical knowledge of building construction being of great assistance. Workplaces. The term workplace is not defined in the Factory Act nor in the Public Health (London) Act, although it occurs in both, but in a case, Bennett v. Harding, under Section 38 of the latter Act, it was held that the word "workplace" includes any "place where work is done permanently, and where people assemble together to do work permanently of some kind or other." In this case a stable and stable yard, where men were employed as cab-cleaners and horse-keepers, was held to be a workplace. The Home Secretary has been advised that kitchens of restaurants, etc., come within the meaning of the term "workplace." In October and November a systematic inspection of the Battersea restaurant kitchens, which number 83, was made by Inspector Benjamin. A list of these premises is given below:— Premises. 4 Abercrombie Street. 1 Andoe Road. 11 „ „ 16 Battersea Park Road. 1 7 „ „ 24 „ „ „ 35 „ „ „ 126 „ „ „ 141c „ „ „ 157 „ „ „ 160 „ „ „ 178 „ „ „ 183 „ „ „ 262 „ „ „ 295 „ „ „ 335 „ „ „ 431 „ „ „ 49 1 „ „ „ 509 „ „ „ 575 „ „ „ 583 „ „ „ 64 Battersea Rise. 94 „ „ 21 Bridge Road 4 1 „ „ 42 „ „ 70 Chatham Road. 50 Church Road. 114 Culvert Road. 17 St. John's Hill. 39 „ „ 64b „ „ 73 „ „ 93 „ „ 14 6 „ „ 45 St. John's Road 62 „ „ 73 Stewarts Road. 159 Usk Road. 45 Webbs Road. 24 Winstanley Road. Premises. 23 Falcon Road. 101 „ „ 125 „ „ 135 „ „ 166 „ „ 184 „ „ „ 19 High Street. 22 „ „ „ 30 „ „ „ 86 „ „ „ 130 „ „ „ 93 Latchmere Road. 119 Lavender Hill. 235 266 „ „ „ 23 New Road. 64 „ „ „ 10 Nine Elms Lane. 39 „ „ 93 „ „ 4 Northcote Road 13 Park Road 30 Plough Road. 96 „ „ 138 „ „ 35 Queen's Road. 38 „ „ 174 „ „ 218 „ „ 35 St. Andrew's Street. 1c St. John's Hill. 10 York Road. 25 „ „ 42 „ „ 73 „ „ 76 „ „ 139 „ „ 159 „ „ 167 „ „ 183 „ „ 201 „ „ 216 „ „ With three exceptions the kitchens are above ground, and as regards lighting and ventilation their condition was found to be fairly satisfactory. The chief defects found were in connection with the treatment of the kitchen refuse. It is highly important that refuse of this kind or indeed of any kind, should be quickly removed from places where food is prepared. It was, however, found that in many instances the refuse was heaped up in the yard close to the kitchen and removed at infrequent intervals. In some cases it was thrown under the kitchen table. Since these premises have been brought under regular supervision a great improvement in this and in other respects has been secured. There is, however, need for bye-laws to restaurant kitchens and other places where food is prepared and stored. The following is a list of the defects found during the inspection of the kitchens. In two cases it was found necessary to serve statutory notices to remedy the defects. No receptacle for refuse provided 9 Refuse stored in uncovered vessels in kitchen 1 Refuse receptacles defective 23 Accumulation of refuse in kitchen 7 Accumulation of refuse in yards 16 Deficient ventilation 1 Dirty cisterns 2 Dirty walls, etc. 6 Defective drains 6 Factories. The sanitation of factories is for the most part under the control of the Home Office Inspectors, but duties of considerable importance devolve upon the sanitary authorities, the most important being that of securing "sufficient and suitable accommodation in the way of sanitary conveniences." The following is a list of the factories inspected during the year. This year a systematic inspection of all the factories in the district is being carried out: — Trades. Number of Factories. Persons Employed. Males. Females. 1 Candle making 283 1,100 Coffin making - 10 1 Confectioner 43 1 13 1 20 Dyers 15 4 - 116 Engineers 21 Firewood cutters 2 50 - 1 Instrument maker 5 2 Joiners - 19 117 Laundries 4 8 - Mason 1 9 Patent food makers 2 1 4 - Printers 2 14 1 - Stone turners 2 - Tool maker 1 3 23 486 Totals 1,368 Outworkers. The Factory Act of 1901 provides that in certain trades to be specified by the Home Secretary, the employers shall twice a year send to the sanitary authority lists of the outworkers employed by them. The trades so far specified by the Home Secretary are as follows:— The making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel and any work incidental thereto; The making, ornamenting and finishing of lace and of lace curtains and nets; Cabinet and furniture making and upholstery work; The making of electro-plate; The making of files; Fur-pulling; The making- of iron and steel cables and chains; The making - of iron and steel anchors and grapnels; The making- of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; The making of locks, latches and keys. In the early part of the year advertisements were inserted by the Council in the local newspapers, calling the attention of the employers in these trades in Battersea to the provisions of the Act, and a circular letter to the same effect was sent to as many as could be ascertained were in the district. During the year the names and addresses of 320 out-workers were received from employers and from the Medical Officers of Health of other districts. 78 lists were received from employers, and the following table shows the number received from the various Medical Officers:— Medical Officer of Health, Chelsea 4 „ „ Camberwell 1 „ „ City of London 3 „ „ Finsbury 2 „ „ Kensington 3 „ „ St. Marylebone 3 „ „ Southwark 1 „ „ Wandsworth 27 „ „ Westminster 12 Seventy-two out-workers whose names were sent in by employers were found to live outside the district and their names and addresses were forwarded to the Medical Officers of Health of the respective districts. The premises occupied by the out-workers are registered and regularly inspected. The appended table shows the number of such places which have been registered together with the trades and the numbers of persons employed:— Persons Employed. Trade. Number. Males. Females. Blouse makers ... 4 4 2 Cleaners and Dyers 2 1 7 Dressmakers 6 ... 62 Embroiderers 51 ... 51 Glove makers 41 ... ... Shoemakers 9 11 16 Tailors 20 7 3 Upholsterers 1 ... Total 19 145 134 The following is a tabulated statement of work done in connection with out-workers' premises during the year:— No. of inspections and re-inspections 196 „ workrooms measured 140 „ workshops found during inspection of out-workers' premises 12 „ written intimations issued 8 Defects discovered and remedied:— Dirty walls and ceilings 7 Foul water-closets 2 Damp condition of walls 1 In two cases during the year infectious disease occurred in out-workers' homes, and work was prevented from beingsent there until the danger of infection had passed. Sanitary Conveniences. One of the most important duties of local authorities in connection with factories, workshops and workplaces is that of securing suitable and sufficient sanitary accommodation for the workers. The powers of the Metropolitan sanitary authorities in this respect, however, are not granted by section 9 of the Factory and Workshop Act, 1901, which does not apply to London, but by section 38 of the Public Health (London) Act 1891, which reads as follows:— "Every factory, workshop, and workplace, whether erected before or after the passing of this Act, shall be provided with sufficient and suitable accommodation in the way of sanitary conveniences, regard being had to the number of persons employed in or in attendance at such building, and also where persons of both sexes are, or are intended to be, employed, or in attendance, with proper separate accommodation for persons of each sex." The standard of "suitable and sufficient" sanitary accommodation varies in different districts, some authorities taking a much higher standard than others. On February 4th, 1903, the Home Secretary issued an Order determining what "accommodation in the way of sanitary conveniences provided in a factory or workshop shall be deemed sufficient and suitable within the meaning of the said section" (i.e., section 9 of the Factory and Workshop Act, 1901). The Order being made under this section of the Act does not technically apply to London, but the standard laid down in it has been adopted in this district, and a good deal of work is being carried out in accordance with its provisions. The provisions of the Order are set out below:— 1. In factories or workshops where females are employed or in attendance there shall be one sanitary convenience for every 25 females. In factories or workshops where males are employed or in attendance there shall be one sanitary convenience for every 25 males: provided that— (a) In factories or workshops where the number of males employed or in attendance exceeds 100, and sufficient urinal accommodation is also provided, it shall be sufficient if there is one sanitary convenience for every 25 males up to the first 100, and one for every 40 after; (b) In factories or workshops where the number of males employed or in attendance exceeds 500, and the District Inspector of Factories certifies in writing that by means of a check system, or otherwise, proper supervision and control in regard to the use of the conveniences are exercised by officers specially appointed for that purpose it shall be sufficient if one sanitary convenience is provided for every 60 males, in addition to sufficient urinal accommodation. Any certificate given by an Inspector shall be kept attached to the general register, and shall be liable at any time to be revoked by notice in writing from the Inspector. In calculating the number of conveniences required by this order, any odd number of persons less than 25, 40, or 60, as the case may be, shall be reckoned as 25, 40, or 60. 2. Every sanitary convenience shall be kept in a cleanly state, shall be sufficiently ventilated and lighted, and shall not communicate with any work-room except through the open air or through an intervening ventilated space: provided that in work-rooms in use prior to Ist January, 1903, and mechanically ventilated in such manner that air cannot be drawn into the work-room through the sanitary convenience, an intervening ventilated space shall not be required. 3. Every sanitary convenience shall be under cover and so partitioned off as to secure privacy, and if for the use of females shall have a proper door and fastenings. 4. The sanitary conveniences in a factory or workshop shall be so arranged and maintained as to be conveniently accessible to all persons employed therein at all times during their employment. 5. Where persons of both sexes are employed, the conveniences for each sex shall be so placed or so screened that the interior shall not be visible, even when the door of any convenience is open, from any place where persons of the other sex have to work or pass; and, if the conveniences for one sex adjoin those for the other sex, the approaches shall be separate. 6. This order shall come into force on the 1st day of July, 1903. 7. This order may be referred to as the Sanitary Accommodation Order of 4th February, 1903. Infants' Milk Depot. Infants Milk Depot. The Depot is the outcome of an enquiry by a sub-committee of the Health Committee, which was appointed in the spring of 1901 to enquire into the conditions giving rise to the high rate of infantile mortality in Battersea, and to recommend measures for its reduction. The sub-committee enquired fully into the subject, and the conclusion to which they came may be stated as follows:— A very large proportion of the infantile mortality is due directly or indirectly to improper feeding. This is not a matter for surprise, having regard to the enormous importance of the food question to the infant. The well-being of every animal depends directly on its ability to secure an adequate amount of food suited to the capacity of its digestive organs; and especially is this the case with the human infant, who at five or six months old should weigh twice its weight at birth. Nature has provided a supply of food of inimitable excellence from the breast of the mother, but owing to the deplorable spread of the practice of artificial feeding, this food is, in a large number of cases, not available. The substitution of a satisfactory artificial food for the natural food which has been elaborated during ages of evolution is not an easy task for the wisest in the present state of human knowledge, and, as a matter of fact, the food and methods of feeding adopted in many cases are such as to make it a matter for surprise that the number of infantile deaths is not greater than is actually the case. It should be remembered, however, that many of the survivors are left with constitutions more or less seriously weakened and impaired to continue the struggle for existence. Not infrequently such articles as boiled eggs, potatoes, carrots, fruit, cheese, tea, coffee, and even beer and spirits are given to young babies, and a large proportion of children are fed on condensed milks and proprietary foods which are deficient in nutritive properties, especially fat. Rickets and other diseases of malnutrition are common amongst children so fed. Cow's milk is the best substitute for human milk generally available, but cow's milk is particularly subject to contamination by disease-producing germs, especially the germ of summer diarrhoea. Such contamination may take place:— 1. Before the milk reaches the consumer. 2. In the home of the consumer. But cow's milk, even when free from germs and free also from chemical preservatives, is not a suitable food for a young baby without preliminary treatment. Cow's milk is the natural food of the calf —an animal with four stomachs, and it is with difficulty digested in the single stomach of the human infant. From these considerations it appeared that the infantile deaths due to improper feeding could, to a very great extent, be prevented if an adequate supply of cow's milk, rendered more digestible by special treatment, free from germs and chemicals, and with the proper quantities for each meal unmistakably indicated, could be brought within the reach of the poor in such a form as to reduce the possibility of contamination within the home to a minimum. The method initiated by Dr. Leon Dufour at the Goutte de Lait, Fecamp, seemed to fulfil these conditions. It consists of supplying humanised sterilised milk in stoppered bottles, each bottle containing sufficient food for one meal and no more. The process of humanisation adapts the milk to the infant's digestive organs, the sterilisation kills the germs, and as the bottle is not opened—or should not be opened—from the time it enters the steriliser until the baby is ready to take his meal from it direct (no feeding-bottle should be used), home contamination, unless it is wilful or due to extreme carelessness, is prevented. This method was adopted by the St. Helens Corporation in 1899, and by Liverpool and Ashtonunder-Lyne in the following year. Upon the recommendation of the Health Committee, the Borough Council decided, on the 10th July, 1901, to adopt this method, and voted a sum of to start the scheme. Premises were taken at 28 York Road, and adapted for the work at a cost of The remaining was devoted to the purchase of appliances, and the Depot was opened on June 5th, 1902. The appliances in use when the Depot was opened were as follows:— 1 Sterilising chamber with two trolleys, as shown in the illustration. 1 Bottle-filling machine. 1 Mechanical bottle-washing brush, with rinser and draining racks. 250 Wire baskets. 25 Gross graduated 7 oz. of bottles. 1 Baby weighing machine. 2 Milk churns, cans, strainers, measures, etc. Additional appliances have since been purchased as the work has increased, and additional alterations have been made to the premises. The following table gives the quantities of milk given to the children at different ages. The quantities are based on the Instructions on Infant Feeding issued by the Medical Committee of the Hospital for Sick Children, Great Ormond Street. Preparation A contains 1 part milk and 2 parts water. Preparation B contains 2 parts milk and 2 parts water. Preparation C contains 2 parts milk and 1 part water. Cream and milk sugar are added in sufficient quantities. The amounts of the humanised milk given vary with the age of the child, as follows: — No. of Bottles Amount Amount Age. per day. per bottle. per day. 1. Below 2 weeks old 9 1 1/2oz 13 1/2 OZ. 2. Between 2 weeks and 2 months old 9 2 1/2 oz. 22 1/2 oz. 3. Between 2 and 3 months old 8 3 oz. 24 oz. The above receive preparation A. 4. Between 3 and 4 months old 7 4 oz. 28 oz. 5. Between 4 and 5 months old 7 4 1/2 oz. 31 1/2 oz. 6. Between 5 and 6 months old 7 5 oz. 35 oz. The above receive preparation B. 7. Between 6 and 8 months old 6 6 oz. 36 oz. 8. Between 8 and 12 months old 6 7 oz. 42 oz. The above receive preparation C. When a baby is entered at the Depot, the mother is instructed as to the proper use of the milk, and a leaflet containing- the following instructions is handed to her. The Lady Sanitary Inspector visits the homes of the children who are using the milk, and endeavours to get the instructions properly carried out. INSTRUCTIONS FOR THE USE OK HUMANISED MILK. 1. The charge for the full weekly supply of humanised milk for infants under six months is 1s. 6d., payable in advance. If a day's supply only is taken, the charge is 3d. For infants aged from six to eight months, who receive 6 ozs. per bottle, the charge is is. 9d. per week, while for older children receiving 7 ozs. per bottle, the charge is 2s. per week, or 4d. per day. The Depot is open from 11 a.m. to 6 p.m. on week-days, and is closed on Sundays. 2. The milk will be supplied in bottles in a basket, each bottle containing sufficient milk for one meal, the amount varying with the age of the child. Infants under two months receive nine bottles per day; older children receive fewer bottles, as they should be fed less frequently. 3. If children are sent for the milk, they must be warned not to tamper with the stoppers of the bottles. On no account must a bottle be opened until the infant is ready to be fed. 4. Every person using the milk will be supplied with a teat, which should be kept scrupulously clean. Extra teats will be charged for at the rate of 3d. each. 5. Just before using, each bottle should be placed unopened in a basin or jug of hot water, and warmed to the proper temperature. The bottle should then be opened, and the teat put on. The child should be fed at regular intervals, and fed from these bottles only. On no account should any other feeding-bottle be used. 6. When all the milk in one bottle is not used, the remainder must not be warmed up again, but a fresh bottle opened for the next meal. Where there are other children this milk need not be wasted. 7. On no account should bread be given with the milk. 1 he milk will be found quite sufficient if given regularly. 8. After using, the bottle should be thoroughly rinsed in cold water. 9. Breakages will be charged for at the rate of id. per bottle, and damage to baskets must be made good. All bottles, baskets and rubber rings not returned to the Depot will be charged full value. 10. The child should be brought once a fortnight to be weighed. 11. The presence of infectious disease in a house must be at once notified to the Medical Officer of Health. N.B.—The milk should never be used in preference to mother's milk, which is the best of all foods for young infants. When the Depôt was first opened, a uniform charge of is. 6d. per week was made, but it was found that this amount barely covered the cost of the milk in the case of the older children, and in December the charge for infants between six and eight months old was raised to is. 9d. per week, and for children over eight months to 2s. per week. An extra 6d. per week is now charged for children living outside Battersea. An arrangement has been made with the Board of Guardians, whereby the Relieving Officer is empowered to issue weekly orders for milk in lieu of giving money in outdoor relief. The milk is given out from the central station, 28 York Road, and at the Municipal Buildings, the Public Baths and the Branch Libraries. There has been a good demand for the milk from the first. At the end of the year, 360 children were being fed on the milk, and the number has since increased to 400. The premises at York Road are too small to deal with any material increase in the demand. When the Depôt was opened, the staff consisted of the Manageress and one assistant, who have rooms above the Depôt. Four additional assistants have since been engaged, but the staff is still barely able to cope with the work. The labour involved in washing and filling an enormous number of small bottles every day is considerable, and satisfactory labour-saving appliances adapted for this particular work are difficult to obtain. A good bottle-filling machine, accurate, time-saving, capable of rapid adjustment to fill the varying quantities and easily cleaned, is badly wanted. From what has been already stated, it is evident that the existence of the Milk Depot can be amply justified from the principles of pathology and hygiene. We have, however, more direct evidence of the Depot's good work during the first six months of its existence. This evidence is of two kinds:— (a) The testimony of medical practitioners who have had practical experience of the effect of the milk (b) Statistical evidence. In January last 1 addressed a circular letter to the medical practitioners in the Borough, asking for an expression of opinion as to the efficacy of the milk. The following are a few typical extracts from the replies received, which were in nearly all cases highly satisfactory:— "The milk provided by the Battersea Borough Council I have tried most extensively since its introduction. I consider it a great boon to the working-class and those uneducated in the proper feeding of infants. It has been fruitful of very great benefit to all the children taking it from my recommendation. I shall continue to recommend it, and heartily wish that the good work begun shall continue." "I have used it in a number of cases of infants of various ages, and have always found it satisfactory and reliable. It is a great benefit to have such an article of diet so convenient and accessible." "I have found the most marked benefit in almost every case. It has reduced my infant mortality fifty per cent., and is a God-send to the poor of this parish." "The humanised milk supplied by the Borough Council in my opinion fills a long-felt want. The patients of mine who have used it have greatly improved immediately, diarrhoea has stopped, and the children have soon increased in weight." "I have been well satisfied with the results of the milk as dietary, and cannot remember having had to discontinue it and try another food. lam certain that it was the means of saving life." "I have pleasure in stating that my results obtained from the humanised milk supplied by the Borough Council have been very satisfactory." "I have found it a great help, especially in those gastric disorders which are so common, and claim such a terrible toll from among the children of the poor during the summer and autumn months every year. Perhaps I can best assure you of my belief in the Depôt's humanised milk by expressing the hope that it has come to stay." "In cases of illness accompanied by wasting, such as diarrhoea and allied conditions, it has proved of great value to children, also in cases of wrong feeding and newly-born children, where the mother has been unable to suckle. I have had great satisfaction and good results from its adoption." "In all cases in which I have recommended it the results are most satisfactory." Several medical practitioners in the district have given practical proof of their confidence in the Council's milk by feeding their own babies on it. Turning to the statistical evidence, it should be said at once that it is doubtful whether the full value of the work of the Depôt can be expressed in figures. To compare the infantile mortality in the Borough last year with that in the previous years is fallacious. The summer of 1902 was cold and wet, summer diarrhoea was not prevalent, and the mortality was low all over the country. It is suggestive, however, to compare the infantile mortality in the Borough during the last six months of the year with that in the three neighbouring Boroughs which mostly resemble Battersea in social conditions, etc., and in the County of London. '1 he following table shows that in all these districts the mortality was greatly diminished in 1902, but that the diminution was more marked in Battersea:— Period. Fulham Deaths under 1 year to 1,000 births. Lambeth Deaths under 1 year to 1,000 Births. Camber- Well. Deaths under 1 year to 1,000 Births. COUNTY OF LONDON Deaths under 1 year to 1,000 Births. Battersea. Deaths under 1 year to 1,000 Births. Six months ended Dec. 31, 1897 197 169 202 196 197 185 200 1898 205 198 198 213 203 249 1899 204 201 1900 184 186 177 163 195 177 182 163 1901 168 202 190 202 177 194 Average 1897-1901 198 168 140 152 Six months ended Dec., 1902 143 161 21.6 20.9 15.2 16.8 Percentage reduction 2 7.7 The above table shows that the reduction in infantile mortality was distinctly greater in Rattersea than in the other districts, and without attaching too much importance to these figures, I see no reason to doubt that the Depôt has contributed to this result. Additional evidence of the value of the Depôt is afforded by comparing the mortality amongst the children fed from it with the infantile mortality in the Borough. During the six months ending December 31st, 1902, 558 children were fed on the milk for varying periods; thirty-two of these lived outside the Borough, and in sixty additional cases, owing to wrong addresses being given and to removals, no information could be obtained as to the subsequent history of the child. Deducting these cases, there remain 466 children of whom definite information was obtained. The ages and the deaths at each age period are given in the following table:— Age on Admission. No. of Children. No. of Deaths. 13 Below one week - 1—2 weeks 1 12 2—3 „ 10 1 11 3-4 - 46 2 Total below one month 1—2 months 55 6 2-3 7 37 3-4 46 3 4 6 4-5 1 5—6 29 4 6—7 42 5 7-8 32 5 8-9 17 2 9—10 „ 22 1 10—11 „ 15 2 11—12 „ 7 1 Total below one year 394 39 12 —18 months 4 2 1 18—24 „ 16 2 2 —3 years 11 3 3—4 „ 1 - 1 4—5 1 1 5—6 „ - Total 466 46 The death-rate amongst the children fed upon the milk was therefore 98.7. This rate cannot, however, be compared with the infantile mortality in the Borough, i.e., the number of deaths under one year per 1,000 births, as seventy-two of the Depôt-fed children were above one year old. On deducting these children there remain 394 infants under one year, of whom thirty-nine died. This is equivalent to a rate of 98.9 per 1,000, which compares favourably with the infantile mortality in the Borough, which was in the six months July to December, 1902, 143 per 1,000 births. This comparison, however, does scant justice to the Depôt. The Borough includes the South-Western sub-district, where the infantile mortality is low, whereas the Depôt children were nearly all drawn from East and North-West Battersea, where it is high. In the following table no account is taken of the children from South-West Battersea:— No. of Infants attending the Depôt from East and North-West Battersea, July-December, 1902. Mortality per 1,000 births. Deaths. Deathrate per 1,000. Number of Deaths under one year in East and North-West Battersea, July-December, 1902. 99.1 36 315 363 163.5 But even this comparison is not fair to the Depôt. A large number of the children attending were already seriously ill on admission, and some died before the milk had had a fair trial. Of the thirty-nine infants under one year, fed from the Depôt who died, no fewer than fourteen had taken the milk for less than one week. A fairer comparison is to deduct these deaths, and to deduct also from the deaths in the Borough and in the sub-districts, the deaths occurring in the first seven days of life. When this is done, the following results are obtained:— Death-rate per 1,000 of Depot-fed Infants, excluding deaths of infants taking the milk for less than one week. Death-rate of Infants attending from the whole Borough. Death-rate of Infants attending from E. & N.W. Battersea. 68.8 63.4 Infantile mortality per 1,000 births excluding deaths of infants under 7 days old. Mortality in E. & N.W. Batter sea. Mortality in whole Borough. 118.9 139.7 From these figures it appears that the mortality of infants in the Borough during the last six months of 1902 was 87.5 per cent, higher than the mortality in the Depot-fed children, and that taking the mortality in East and North-West Battersea only, the difference is no less than 103 per cent. It may be argued that the above comparison is fallacious, on the ground that the mothers of the children attending the Depôt may be asumed to be more intelligent and alive to the children's welfare than the average mother, and that in any case these children would have had a better chance of survival. There is an element of truth in the contention, but that this influence is more than counteracted is apparent, in my opinion, from the following considerations:— 1. By far the greater number of children attending the Depot were in a state of ill-health on admission, and a large number were already seriously ill. The milk is in many cases regarded more as a medicine than as a food, and when the baby has recovered from the illness which brought it to the Depôt, the milk is often discontinued, and the usual condensed milk is resumed. The Depot death-rate should, therefore, be regarded as somewhat analogous to a dispensary death-rate. Moreover, the milk is frequently misused, being poured from the sterilised bottle into the ordinary lethal bottle with the long rubber tube. 2. Most of the Depôt infants were under six months old, whereas the majority of the infants outside would be aged between six and twelve months. This is an important point, as the mortality is always much greater in the first period than in the latter; in fact, no less than 50 per cent, of the infant deaths occur in the first three months. If the ages of the Depôt infants and those outside were the same, the figures would be still more favourable to the former. 3. The Depôt children are all artificially fed, whereas a considerable number of those outside are fed from the breast. It is not claimed that the Council's milk is anything but a poor substitute for human milk. No artificial food can be, or probably ever will be, anything else. The Depôt children should be compared with children outside who are fed artificially. But figures for this comparison are not available. 4. Illegitimate children, formed an undue proportion of the Depot babies, and it is well known that the mortality amongst such children is considerably greater than amongst those born in wedlock. Battersea contains a larger number of houses registered under the Infant Life Protection Act than any Borough in London, and many children in these establishments are fed on the Council's milk. I think that the above figures, taken together with the medical testimony, afford substantial evidence that the Depot has had a distinctly beneficial effect on the health of the child-population of Battersea, and I have no doubt that when the system has been in operation for a longer period, and on a larger scale, even more striking results will be obtained.