BAT 13 3-H Metropolitan Borough of Battersea. REPORT ON THE HEALTH OF THE Metropolitan Borough of Battersea, FOR THE YEAR 1907. BY G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. BAT 13 Health Committee. Chairman: Councillor W. RINES. HIS WORSHIP THE MAYOR (Alderman F.W. Worthy, J.P.). Councillor W. A. ANDREWS. Councillor J. R. ARCHER. Councillor T. P. BROGAN. Councillor W. CROWE. Councillor A. EMERY. Councillor P. P. HAYTHORNTHWAITE. Councillor G. T. KETTLEY. Councillor L. S. McMANUS, M. D. Councillor W. NEWMAN. Councillor B. T. PRICE. Councillor W. RAYMOND. Councillor W. RINES. Staff of the Public Health Department. Chief Sanitary Inspector. I. Young, m.r.s.i. Lady Sanitary Inspectors. Miss A. E. Moss, San. Insp. Board's Cert. Miss L. M. Fairbairn „ Food Inspector. A. Chuter, Cert. San. Inst., and Meat Insp. Cert. Workshop Inspector. W. E. Benjamin, Cert. San. Inst. District Sanitary Inspectors. No. 1 District J. Herrin, Cert. San. Inst. ,, 2 „ J. J. Burgess, San. Insp. Board's Cert. „ 3 ,, J. Lawrence, Cert. San. Inst. and Meat Insp. Cert. „ 4 „ A. E. Purnell, Cert. San. Inst. „ 5 „ J. T. Baxter „ „ „ 6 „ H. Marrable „ „ „ 7 „ A. Odell, Cert. San. Inst. and Meat Insp. Cert. „ 8 „ H. H. May, Cert. San. Inst. Clerks. First-Class Clerk B. W. Sears. Second-Class Clerk F. H. Preston, Cert. San. Inst. Third-Class Clerks E. Cole. J. H. Lloyd. Office Youth B. Hayman. Manageress of Milk Depot. Miss A. Lowe. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper. G. Streat. Medical Officer of Health. G. Quin Lennane, F.R.C.S., L.R.C.P., D.P.H. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, and Gentlemen,— I have the honour to present to you my second Annual Report on the Health and Sanitary Condition of the Borough for the year ending 31st of December, 1907. I have pleasure in drawing your attention to its satisfactory nature. The mortality rates are well below the averages, and the morbidity—or sickness rates—are, having regard to the prevalence of certain infectious diseases in the County of London during 1907, on the whole also low. The Borough is benefiting from the strict sanitary control which you and your predecessors have exercised during the past; and you are to be congratulated on the high place which the Borough of Battersea takes amongst the Metropolitan Boroughs. It is now one of the healthiest in the County of London, and compares very favourably with any of the large provincial towns of similar size. I would draw special attention to the good work that has been accomplished during the year under report in connection with the Battersea Municipal Milk Depot. The Sanitary Staff, both individually and collectively, have worked well, as will be apparent from a perusal of the records tabulated in this Report. To the Heads of Departments my thanks are due, as also to the Members of the Borough Council, for support readily given. I have the honour to be, Mr. Mayor, and Gentlemen, Your obedient Servant, G. QUIN LENNANE, Medical Officer of Health. CONTENTS. page. Births, Marriages and Deaths. Births 12 Deaths 16 Deaths in Public Institutions 20 Infantile Mortality 24 Marriages 15 Population 11 Senile Mortality 52 Vital Statistics of the Latchmere Estate 53 Infectious and other Diseases. Alcoholism 116 Bacteriological Examination 117 Cancer 114 Diarrhoea 104 Diphtheria 80 Enteric Fever 83 Epidemic Cerebro-spinal Fever 90 Erysipelas 90 Measles 97 Notifications, Table of 66 Notifications, Cost of 64 Puerperal Fever 89 Scarlet Fever 70 Small Pox 69 Tuberculosis 107 Whooping Cough 103 Zymotic Diseases 57 General Sanitary Administration. Ambulances 154 Block Dwellings 130 Cleansing of Persons Act, 1897 147 Common Lodging Houses 130 Customs and Inland Revenue Acts 137 Disinfection 140 House-to-house Inspection 123 page. General Sanitary Administration (Continued). Houses Let in Lodgings 127 Hygienic Street Paving 134 Midwives Act 150 Mortuary 151 Paving of Back-yards and Forecourts 129 Sanitation of House Property 122 Sewer Ventilation 132 Shelter, Temporary 146 Smoke Nuisances 138 Van Dwellings 131 Water Supply 138 Protection of the Food Supply. Butchers' Shops 172 Cow-houses 162 Fish Shops 171 Ice Cream 163 Milkshops 166 Restaurants, &c. 163 Sale of Food and Drugs Acts 172 Slaughter-houses 162 Unsound Food 157 Factory and Workshop Act, 1901. Bakehouses 195 Factories 183 Homework 199 Underground Workrooms 195 Workplaces 206 Workshops 185 Legal Proceedings 209 Infants' Milk Depot 36 Appendix. Tables 229 Reports— Housing 245 Notification of Births 243 Summary of Vital Statistics for 1907. Area of Borough (excluding water) 2,139.9 acres. Population (Census 1901) 168,907 ,, Estimated to middle of 1907 181,736 Density 84.9 persons per acre. Inhabited Houses (Census 1901) 23,462 Marriages 1,427 Births 4,574 Birth-rate 25.1 Deaths 2,406 Death-rate 13.2 Infantile Mortality 115 per 1,000 births. Births, Marriages, Deaths. Births, Marriages and Deaths. Population. The population of the Metropolitan Borough of Battersea (created in November, 1900, under the provisions of the London Government Act, 1899, and formed from the old Parish of Battersea, after some rearrangement between the two districts of Wandsworth and Battersea, to define the boundary line), as estimated by the Registrar-General, at the middle of 1907, was 181,736, made up as follows:— East Battersea 75,740 North-West Battersea 49,481 South-West Battersea 56,515 181,736 The estimate of the Registrar-General is based on the assumption that the rate of increase of population during the last intercensal period was maintained during the subsequent years. It is probably somewhat too high, but it has been adopted in this report, so that the Battersea statistics may be comparable with those of other districts. The numbers of the population of each sex, and at various ages (at the Census, 1901) was as follows:— Totals at all ages. Under 5. 5—14. 15—19. 20—49. 50—75. Above 75. Males 81,749 10,140 17,842 7,911 39,601 5,782 473 Females 85,158 10,207 17,974 8,239 42,646 7,107 985 168,907 20,347 35,8l6 16,150 82,247 12,889 1,458 The character and status of the population of Battersea may be said in the main to be industrial. Its proximity to the West End makes it a convenient residential district for the large number of workers who are employed in that quarter, and there are also a large number of railway employees residing 12 in the Borough, which is traversed by three important railway systems. There are signs that a change is taking place in the character of the population, the artisan element, which until lately constituted a fairly considerable proportion of the industrial class, tending to move further out. The increased facilities of transit provided by the new London County Council Electric Tramway System make this more practicable. It is to be feared that these are being replaced, to some extent at least, by a less desirable class of inhabitant. The recent improvement schemes which have been carried out in Chelsea necessitated the pulling down of large areas in that district, and the consequent dispersal of the inhabitants, many of whom migrated to Battersea. Births. The total number of births belonging to the Borough of Battersea during 1907 was 4,574.* Of the total births 2,345 were males and 2,229 females, showing an excess of 116 males. The number of births was 421 below the decennial average 1897-1906, and 701 less than the number in 1884, when the population was only 121,299. The births in the sub-districts were as follows:— Males. Females. Total. The Borough 2,345 2,229 4,574 East Battersea 1,076 1,063 2,139 North-West Battersea 822 730 1,552 South-West Battersea 447 436 883 * According to the Registrar General the number of births belonging to Battersea, after the distribution of births occurring in Lying-in Institutions, including the 77 occurring in the Wandsworth Union Workhouse, during 1907 was 4,692. If these figures are to be accepted the birth-rate for the Borough for the year under report would be 25.8. Note.—Included in the above numbers (Births) are 77 occurring in the Wandsworth Workhouse, and reported by the M. O. H., Wandsworth. † East Battersea consists of that portion of the Borough lying East of Bridge Road and Latchmere Road, and North of Lavender Hill. North-West Battersea consists of that portion of the Borough lying West of Bridge Road and Latchmere Road, and North of the Windsor Line of the London & South Western Railway. Sooth-West Battersea consists of that portion of the Borough lying South of Lavender Hill and South of the Windsor Line of the London & South Western Railway, and West of Latchmere Road. 13 The birth-rate, i.e., the number of births per 1,000 of the inhabitants at all ages, was 25.1 per 1,000. This is the lowest birth-rate ever recorded in Battersea, and is 4.0 below the average for the previous ten years. The birth-rate for Battersea (Parish and Borough) has been in recent years steadily declining. During the ten years 1875-1884 it was usually over 40 per 1,000, and reached its highest point in 1884, when it was no less than 43.4 per 1,000. During the last twenty years, however, there has been a steady and remarkable decline. This decline in the birth-rate is not peculiar to Battersea alone, but is general all over the country, and the same feature characterises the birth-rates in almost all civilised countries. That this decrease is even greater than appears at first sight, is manifest when it is remembered that side by side with the declining birth-rate is an equally remarkable decrease in the death-rate. The decline in the birth-rate in Battersea as compared with that in London and in England and Wales is shown in the following table:— Birth-rate per 1,000 Population. Years. England and Wales. London. Battersea. 1877-81 34.9 35.3 40.5 1882-86 33.3 34.0 40.0 1887-91 33.2 33.9 36.1 1892-96 30.1 30.6 32.4 1897-1901 29.0 29.5 30.8 1902-06 27.8 27.7 27.5 1907 26.3 25.8 25.1 The next table shows the birth-rate in the Borough and in each of the sub-districts during the ten years 1897-1906 and in 1907. 14 Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1897 31.7 33.8 36.6 22.7 1898 30.9 33.6 35.0 21.9 1899 30.3 33.6 36.0 21.0 1900 30.6 33.5 35.2 21.3 1901 29.7 32.6 33.3 21.3 1902 28.2 30.3 33.1 20.2 1903 28.6 31.3 34.1 19.4 1904 27.5 30.4 31.9 19.5 1905 27.3 30.5 32.7 17.7 1906 25.9 28.6 31.7 17.0 Average 1897-1906 29.1 31.8 33.9 20.3 1907 25.1 28.2 31.3 15.6 A glance at the figures in the above tables will show that the decline in the birth-rate is general, and not peculiar to any particular area of the Borough. In all three of the registration sub-districts there has been a steady and progressive decrease in natality. In South-West Battersea, where the more prosperous portion of the community resides, the decline is, perhaps, on the whole, more marked, but it is none the less evident that a similar state of affairs prevails in the other two localities, which are mainly inhabited by a working-class population. 15 The decline in the birth-rate of Great Britain is becoming a matter of serious importance, and demands more than passing attention. In New South Wales, where, as in all the other Australasian Colonies, a similar decline has taken place, the subject was considered of such great importance as to give rise to the appointment of a Royal Commission, which extended its investigations into the other Australian Colonies and New Zealand. The report of the Commission appeared to establish the fact that the diminishing birth-rate was due to a growing reluctance on the part of the wealthier classes to incur the responsibilities and sacrifices incidental to parenthood. While it is undoubtedly true that the same reproach attaches to the wealthy classes in this country, it is apparent that even amongst the less fortunately situated classes of our population the decline in the birth-rate is progressive, and will in the near future become a national menace. The birth-rate of a country is its most important asset, and the steady and progressive decline which has been going on in the British birth-rate in recent years is a matter of serious import to the future of the nation. Marriages. The marriages registered in Battersea during 1907 number 1,427, or 6 more than the decennial average. The marriagerate, i.e., the number of persons married per 1,000 of the population, was 15.7, or 0.8 below the decennial average. The following table shows the variation in the marriage-rate in Battersea and London since 1897:— 16 Year. Battersea. No. of Marriages Marriage-rate. London. Marriage-rate. 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 1902 1,372 16.0 17.8 1903 1,442 16.6 17.4 1904 1,465 16.7 17.0 1905 1,412 15.9 16.9 1906 1,420 15.8 17.1 1907 1,427 15.7 17.0 Deaths. The total number of deaths registered in the Borough of Battersea during the year 1907 was 2,431, as compared with 2,425 during 1906, and a yearly average of 2,849.7 in the old Parish of Battersea for the decennium 1891-1900. Of the total 2,431 deaths, 1,223 were males and 1,208 females, showing an excess of 15 males. The death-rate for Battersea is, therefore, 13.37 per 1,000 inhabitants, as compared with 14.9 for London. This rate is, however, uncorrected, and, on analysing the 2,431 deaths registered in the Borough of 17 Battersea, it is found that 446 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted; but on the other hand, there are 421 deaths registered outside the Borough, of Battersea residents, and these must be added, giving a corrected number of deaths for Battersea during 1907 of 2,406 (1,225 males and 1,181 females), an excess of 44 males, and a corrected deathrate of 13.2 per 1,000 inhabitants, as compared with 14.6 for London (the total corrected number of London deaths being 69,268). The death-rate for the Borough of Battersea as a whole is very satisfactory, being, curiously enough, exactly the same as the death-rate for 1906, which was the lowest death-rate ever previously recorded in the Borough, and 2.4 per 1,000 below the average for the ten years 1897-1906. Sub-dividing the death-rates amongst the three registration sub-districts, it will be noted that in East and North-West Battersea the rates are slightly higher than in 1906, while in South-West Battersea the rate is lower. In the following table the rates in the Borough and the sub-districts are compared with those for the last ten years:— 18 Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1897 16.4 17.6 20.2 10.4 1898 17.3 19.4 20.4 10.5 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 1902 15.0 15.5 18.3 10.9 1903 14.2 15.0 17.1 10.3 1904 14.4 15.6 17.0 10.3 1905 14.4 15.5 17.6 9.9 1906 13.2 14.7 15.5 9.5 Average 1897-1906. 15.6 16.8 18.5 10.7 1907 13.2 14.8 16.0 8.6 In the following table is shown the number of deaths, and death-rates, in the nine Wards into which the Borough is divided:— 19 Ward. Population Estimated to middle of 1907. Number of Deaths. Death Rates. Nine Elms 31,192 467 14.9 Park 19,629 322 16.4 Latchmere 22,207 275 12.4 Shaftesbury 17,319 215 12.4 Church 21,102 304 14.4 Winstanley 22,210 357 16.0 St. John's 8,941 76 8.5 Bolingbroke 20,198 203 10.0 Broomwood 19,181 187 9.7 From the above table it will be seen that Park has the highest and St. John the lowest general death-rate; and on comparing with the table on page 27, it will be seen that Winstanley has the highest and Broomwood the lowest zymotic death-rates. It is only by sub-dividing the rates up in this way that it is possible to see where the (sanitarily) unsatisfactory parts of the Borough are situated, and where, consequently, most care and attention are still required at the hands of the Borough Council. It is interesting to note the place that the Borough of Battersea takes during 1907, in the Registrar-General's corrected Return, amongst the 29 Metropolitan Boroughs. There are only 7 Boroughs with a less general death-rate, 13 with a less zymotic death-rate, and 13 with a less infantile mortality rate. Taking the 10 South Metropolitan Boroughs, Lewisham has the lowest general death-rate, viz., 11.5, and Bermondsey the highest, 18.3; only 4 of the 10 southern districts having a lower death-rate than Battersea. 20 London as a whole has a birth-rate of 25.6, a corrected death-rate of 14.6, a corrected zymotic (death) rate of 1.42 per 1,000 population, and an infantile mortality (corrected) of 116 per 1,000 births. For England and Wales the figures are:— Birth-rate, 26.3; death-rate, 15.0; infantile mortality, 118. The corrected number of deaths of males and females registered in each quarter of the year is set out as follows:— Males. Females. Total. First quarter 371 381 752 Second quarter 280 268 548 Third quarter 273 254 527 Fourth quarter 314 302 616 Deaths in Public Institutions. During the year 1907, the deaths of Battersea residents occurring in public institutions numbered 816, as compared with 745 in 1906. Of this number 395 occurred within and 421 outside the Borough. 444 deaths occurred in Workhouses or Union Infirmaries, as against 373 in 1906, and 422 in 1905. The table on page 22 gives a list of the institutions in which the deaths occurred. The following table shows the number of deaths of Battersea residents occurring in public institutions in the years 1897-1906, and the proportion in each year of such deaths to the total number of deaths:— 21 Year. Total Deaths. Deaths in Public Institutions. Proportion per cent. of Deaths in Public Institutions to Total Deaths. 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 1902 2581 731 28.3 1903 2476 673 27.1 1904 2543 751 29.5 1905 2561 777 30.3 1906 2384 745 31.7 Average 1897-1906 2682 678 25.3 1907 2406 816 33.9 22 Deaths of Battersea Residents in Public Institutions. Institution. Total. Group Totals. Infirmaries and Workhouses. Chelsea Infirmary 4 444 Hampstead Workhouse 1 Holborn Infirmary 1 Holborn Workhouse, Mitcham 6 Lambeth Infirmary 1 St. George's Infirmary, Fulham Road 2 Plumstead Infirmary 1 Tooting Home 68 Wandsworth and Clapham Union Infirmary 356 Wandsworth and Clapham Union Workhouse 4 Metropolitan Asylums Board's Hospitals. Fountain Hospital 1 55 Gore Farm „ 1 Grove „ 47 South Western ,, 2 Western ,, 4 General Hospitals. Anti-Vivisection Hospital 9 238 Belgrave Hospital 4 Bolingbroke Hospital 30 Brompton Hospital 5 Cancer Hospital 6 Central London Sick Asylum, St. Pancras 1 Charing Cross Hospital 6 Children's Hospital Gt. Ormond Street 2 Clapham Maternity Hospital 3 Evelina Hospital 2 Friedenheim Hospital 1 General Lying-in Hospital 3 Great Northern Hospital 2 Hostel of God 3 Infants' Hospital, Vincent Square 1 Kings College Hospital 4 London Hospital 3 Metropolitan Hospital 1 Middlesex Hospital 2 National Hospital, Queen Square 2 Royal Hospital, Waterloo Road 2 Royal Free Hospital, St. Pancras 1 Queen Alexandra Military Hospital 1 St. Bartholomew's Hospital 2 St. George's Hospital 29 St. Peter's Home, Meadow Road 5 St. Thomas' Hospital 54 Salvation Army Maternity Home, Hackney 1 Victoria Hospital 42 West London Hospital 4 Westminster Hospital 7 County and other Lunatic Asylums ... 72 Elsewhere ... 7 816 All the above Institutions, except the Wandsworth and Clapham Union Infirmary, the St. James' Road branch of the Wandsworth and Clapham Union Workhouse, the Anti-Vivisection Hospital, and the Bolingbroke Hospital are outside the Borough. 23 Comparative Statistics of Births, Mortality, &c. Year. Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.0 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 292 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.7 669 22.1 129 471 1865 33,688 1,357 40.2 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47.749 2,096 43.8 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,190 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 5,237 34.7 2,697 17.9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16.1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2,303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31.7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901 169,100 5,025 29.7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4.843 27.3 2,561 14.4 375 2,282 1906 179,622 4,654 25.9 2,384 13.2 338 2,270 1907 181,736 4,574 25.1 2,406 13.2 255 2,168 The years marked thus were census years. 24 INFANT MORTALITY. Infant Mortality has reference to the deaths of children under one year of age, i.e., the proportion which the deaths of such infants in any given year bears to every thousand children born in the same year. The infant mortality varies widely in different districts, being as low as 80 per 1,000 in some localities, and as high as 250 per 1,000 in others. The infant mortality of a district has come to be recognised as a sensitive index of the sanitary condition of that district, as at this period of its life the infant is very susceptible to its environment, a low rate indicating, other things being equal, a healthy community, a high rate the reverse. Of recent years the subject of infant mortality has assumed great importance, and sanitarians have given great attention to the problem. This is not to be wondered at, when it is remembered that, notwithstanding the great advance that has taken place during the last twenty or thirty years in sanitation, as shown by the decline that has taken place in the general death-rate of the nation, and in the incidence and mortality from most forms of infectious disease, such has not been the case as regards infant mortality, which has either actually increased or at least remained stationary. Furthermore, the situation is becoming serious, having regard to the steady and progressive decline which is taking place in the birth-rate all over the country. This state of things must, in course of time, end in a serious decline in the population of the country. Each year, in England and Wales, there is a loss of 120,000 lives of infants under one year of age. During 1907 this loss was 108,214. The causes which give rise to this "Slaughter of the Innocents" are further inimical to the survivors, many of whom survive for a few months, while others grow up to adult life, to swell the ranks of the physically degenerate and recruit the army of the unemployable. The importance of the question, therefore, cannot be overestimated, and it has, in CHART showing the Infantile Mortality in the Borough of Battersea during the last ten years. 25 consequence, become one of the most pressing social problems of the day, bound up as it is with the existence of evils of an economic and social character in the industrial life of the nation. The causes of infantile mortality are composite in character, and require careful examination. These causes may be classified into ante-natal and post-natal, or those affecting the life of the child before and after birth. With regard to the first, the physical condition of the parents is a matter of material consideration, influencing as it does the viability of the unborn child. This is at once apparent in the fact that a large proportion of children born die in the first few weeks after birth. The health of the parents, and especially the mother, is therefore a matter of supreme importance. With regard to the second, or postnatal conditions, these may be regarded as being more associated with the suckling infant. Broadly speaking, infantile mortality is due to three main diseased conditions, dependent on either ante- or post-natal causes, or both— 1. Prematurity, debility and atrophy. 2. Diarrhœa and convulsions. 3. Respiratory diseases (bronchitis and pneumonia). Prematurity and debility are specially fatal in the first few days of life, and diarrhœa from the fourth to the ninth month. Respiratory diseases affect the child at any time during the first year of life. The inference to be drawn from a consideration of the factors associated with infantile mortality is that a certain proportion of these deaths is inevitable; that is, the children are born prematurely and start life so handicapped that they have not sufficient vitality to survive their new environment, the result of ante-natal causes or causes acting through the mother. The other diseased conditions, i.e., diarrhœa and lung affections, are due to causes which are largely preventable, such as unsuitable food, exposure, &c. 26 The problem resolves itself therefore into cause and effect. The primary object of preventive medicine in dealing with infant mortality, is to seek for the cause, with a view to its removal. The effect necessarily follows. Infant Mortality in Battersea. During- the year 1907, 526 deaths of infants were registered in the Borough of Battersea. The total number of births recorded during the year was 4,574,* and the infant mortality rate was 115 per 1,000 births. In 1906 the rate was 126 per 1,000, which had been the lowest death-rate ever previously recorded in the Borough. Although the rate during 1907 was 11 per 1,000 lower, it was not relatively so good as in 1906, the meteorological conditions which prevailed in the summer of that year being as favourable to a high infantile mortality as those in 1907 were the reverse. Since the formation of the Borough, and for the previous decennium, the infantile mortality has been as follows :— London. Battersea. 1891-00 158 162 1901 148 163 1902 139 136 1903 130 135 1904 144 147 1905 129 131 1906 129 126 1907 116 115 •The Registrar General gives as the total number of "corrected" births belonging to Battersea, 4,692. If these figures are to be accepted the infantile mortality rate for 1907 would be 112 per 1,000. In the above table, while the average rate in Battersea for the quinquennium 1902-1906 was 134 per 1,000, in 1906-7 it fell to 120 per 1,000. In the County of London during 1907, there was a total of 14,114 infant deaths, giving an infantile mortality rate of 116 per 1,000. 27 In the next table is shown the distribution of the 526 infant deaths in the sub-districts :— Registration Sub-Districts. Deaths of Infants under 1 year of age. Infantile Mortality per 1,000 births. East Battersea 257 120 North-West Battersea 211 135.9 South-West Battersea 58 66.8 The Borough 526 115 In the next table is shown the distribution in the wards :— Wards. Deaths of Infants under one year. Infantile Mortality per 1,000 births. i. Nine Elms 112 123.5 2. Park 76 138.1 3. Latchmere 65 111.3 4. Shaftesbury 45 102.2 5. Church 72 119.4 6. Winstanley 104 158.5 7. St. John's 16 110.7 8. Bolingbroke 19 51.2 9. Broomwood 17 53.1 Infant mortality diminishes from the first month onward to the twelfth. The following tables show the age incidence and the chief fatal diseases distributed in the sub-districts during 1907 28 Registration Sub-Districts. 0- 1- 2- 3- Age in Months. 8- 9- 10- 11- Totals. 4- 5- 6- 7- East Battersea 95 29 25 16 17 9 12 12 10 7 16 9 257 North-West Battersea 76 20 17 19 11 10 13 7 7 14 10 7 211 South-West Battersea 31 5 5 2 — 3 2 1 3 2 3 1 58 The Borough 202 54 47 37 28 22 27 20 20 23 29 17 526 Registration Sub-Districts. Causes of Death. Totals. Diarrhoea. Prematurity. Marasmus. Bronchitis. Pneumonia. Convulsions. Measles. Whooping cough Accidents. Tuberculosis. Diphtheria, Erysipelas, &c. Miscellaneous. East Battersea 33 62 36 37 17 5 7 8 1 12 1 38 257 North-West Battersea 27 37 28 32 23 4 8 7 3 2 1 39 211 South-West Battersea 7 27 4 3 3 2 — 8 — i — 9 58 The Borough 67 126 68 72 43 11 15 23 4 15 2 86 526 In the next table is shown the incidence of mortality from the chief diseases of infancy in the first and second three months and the last six months of the first year of life respectively :— 29 Certified Causes of Death. Months. 0-3 Months. 3-6. Months. 6-12. Total. Diarrhoea 16 21 30 67 Prematurity 119 1 — I 20 Marasmus and debility 16 20 6 42 Developmental disease 25 1 4 30 Bronchitis 38 14 20 72 Pneumonia 14 11 18 43 Convulsions 9 1 1 11 Suffocation — — — — Measles — — 15 15 Whooping cough 4 2 17 23 Tuberculosis 4 1 10 15 Meningitis 2 3 2 7 Miscellaneous 55 13 13 81 302 88 136 526 It will be noted in the above tables that the mortality is heaviest in the first three months of life, more than half the deaths occurring; at that age period. It will further be noted that three groups of diseases between them account for 374 (or 71 per cent.) of the total deaths of infants during 1907, i.e., prematurity, respiratory diseases, and diarrhoea. Looking more in detail into these figures, it will be seen that 192 (or 36.5 per cent.) of the 526 deaths were due to congenital or developmental diseases (which include prematurity, 30 marasmus, atrophy, debility, &c.). In other words, these 192 children came into the world so heavily handicapped that they were unable to accommodate themselves to their new environment. The causes which bring about this unfortunate state of things are not far to seek. Poverty, insufficient food, and overwork are largely responsible. It is only necessary to compare the figures for the three sub-districts of the Borough in this particular group to note the effect of environment. These are:— East Battersea 99 North-West Battersea 68 South-West Battersea 25 The Borough 192 The two first-named sub-districts contain between them 75 per cent, of the total population of the Borough. In both these there is a large amount of poverty. On the other hand, South-West Battersea is inhabited by, on the whole, a more prosperous class. This is even more strikingly evidenced by comparing the infantile mortality in the wards. Winstanley Ward is probably the poorest and most squalid district in the Borough. There the infantile mortality rate during 1907 reached the high figure of 158.5 per 1,000. Bolingbroke Ward is situate in the most prosperous part of the Borough, and in this area the rate was only 51.2 per 1,000. In Winstanley Ward the population, estimated to the middle of 1907, is roughly one-ninth of the total population of the Borough, and the number of deaths of infants under one year of age in that Ward was 104, i.e., 20 per cent, of the total number of infant deaths occurring in the Borough during the year. It is impossible, therefore, to avoid the conclusion that the physical condition of the mother, influenced adversely as it must necessarily be, under such circumstances, by poverty and lack of suitable and sufficient nourishment, reacts disastrously upon the infant. 31 The second group of diseases which have been responsible for a high percentage of infant deaths in Battersea during 1907 is the respiratory disease group (bronchitis and pneumonia). Of the total infant deaths 115 (i.e., 21.8 per cent.) were caused by bronchitis and pneumonia. Again the influence of environment is strongly emphasised. Of the 115 deaths from this group, 109 (i.e., 94.7 per cent.) occurred in East and NorthWest Battersea. These deaths are largely preventable, being due to carelessness in exposing infants, who are very susceptible to cold at that period of life. Diarrhoea, the third disease condition giving rise to a high infant mortality, is in most years the second most fatal disease of infancy. During 1907 the climatic conditions which favour a high rate of infant mortality from this cause were absent, and the year has been in consequence a most remarkable one. The subject of epidemic diarrhoea is dealt with elsewhere in this report. The causes which have given rise to these 526 infant deaths have been the subject of careful enquiry by the Health Department, and during the year 1907 the homes in which 411 of the total 526 deaths had taken place were visited, and enquiries made into the history of each case. The scope of these enquiries included the health and occupation of the mother, condition of the home, method of feeding, and the occupation of the father. The results of these enquiries are dealt with briefly, but will be found of interest in the bearing which they have on the question of infant mortality in Battersea. Health and Occupation.—Of the 411 deaths enquired into, in 263 cases (or 64 per cent.) the parents belonged to the labouring class. In only 60 instances (i.e., 14.6 per cent.) were the mothers of the dead infants engaged in other than domestic duties. In 42 instances (i.e., 10.2 per cent.) the mothers suffered from very bad health ; and in many of the remainder an unsatisfactory state of health was more or less evident. Conditions of the Homes.—In only 6.3 per cent, of the 32 homes were the conditions as regards cleanliness found to be unsatisfactory. The great majority of the homes in which these 411 infants died were described as being clean or very clean. It cannot, therefore, be said that want of cleanliness in the homes had much bearing on the deaths of these infants. Method of Feeding.—In 266 of the deaths the method of feeding was ascertained, and 46.2 per cent, of these were breast fed. Some striking differences are noticeable in this respect in regard to the three chief causes of death. Taking these in their order, the methods of feeding were as follows:— Breast fed. Artificial. Prematurity, &c 39 50 Respiratory 72 36 Diarrhoea 7 51 It should be noted that, as a large proportion of these infants died in the first few days of life, the question of feeding is not to be considered a factor of much importance. The case is different, however, as regards deaths from diarrhoea, which are most frequent from the fourth to the ninth month. For example, from this cause in Battersea, during 1907, 40 of the 58 deaths enquired into occurred between the fourth and the twelfth month; 34 of the 40 took place between the fourth and the ninth months. The conclusions to be drawn from the enquiries into the deaths of these 411 infants are :—That these deaths are mainly due to three chief causes: (a) prematurity and developmental diseases, (b) respiratory diseases, (c) diarrhoea; that the health of the mothers is a factor of the greatest importance; that mismanagement and improper methods of feeding are also important factors; and that environment, or, in other words, poverty, insufficient food, bad housing, &c., are largely responsible as predisposing causes to a high infantile death-rate, nearly 25 per cent, of the total death-rate of the Borough being due to this cause. 33 Preventive Methods. To cure a disease you must first find the cause. I have tried to indicate in the previous chapter the principal conditions which are associated with a high infant death-rate. The first of these is concerned with the physical well-being of the mother, and is, consequently, a social and economic problem of the first magnitude, towards which there are indications that the State is turning its attention. There can be little doubt but that a considerable proportion of the deaths of infants are due to industrial necessities, and that the employment of married women in factories is responsible for many of the deaths from prematurity and allied conditions. The recent conference on infantile mortality devoted a good deal of attention to this aspect of the question, and passed a resolution-demanding an amendment of the present Factory and Workshops Act, to extend the period during which a factory or workshop shall not "knowingly" employ a woman within four weeks after childbirth, to three months. It is clear, therefore, that measures which have for their object the physical welfare of the mothers must of necessity tend to raise the standard of motherhood, and thereby diminish the infantile mortality of the nation. The methods adopted in Battersea for the prevention of infantile mortality, in addition to general sanitary administration, are the employment of :— 1. Health Visitors. 2. Infants' Milk Depot. The object of the visits of the Lady Sanitary Inspector, part of whose time is taken up in this manner, is to secure by improved infant management the health of the babies. Ignorance of the mother, unfortunately, is largely responsible for a high death-rate amongst infants, and this is only to be combated by education. The large number of deaths of infants which result from lung disease, brought about by exposure, and which are largely preventable, can only be attributed to 34 ignorance and carelessness. It is the function of the Health Visitor, therefore, to instruct the mother in the proper care and management of the child. The advice of the trained Visitor is at times resented, and it is usually the most ignorant mother who is most aggrieved. The rearing and management of infants is largely a matter of intelligence, which can only be acquired by training and experience. It is a matter of great importance, therefore, to secure well-educated, experienced, tactful women for this important duty; and that the Council have been fortunate in their selections of these useful officers will be at once apparent from a comparison of the infant mortality rates since the Council began to utilise their services, with those which obtained in previous years. The experience of Battersea in this respect is the same in other Boroughs where Health Visitors are employed; and an extension of this administrative procedure would, I am convinced, lead to better results than even those upon which the Council are to be congratulated. It is satisfactory to note that the London County Council are applying for powers in their General Powers Bill for 1908, to enable them to return to Sanitary Authorities a moiety of the salaries of these officers, as they now do in the case of Sanitary Inspectors. It is to be hoped that this useful provision will receive the sanction of Parliament, so that Sanitary Authorities may be induced to appoint more of these useful officers. INFANT FEEDING. The Infants' Milk Depot. The proper nourishment of the infant is a matter of the greatest importance, as on this fact depends whether it is to grow up a useful citizen or sink into the grave before its time, or, what is even worse, to grow up to adult life a degenerate, to help to perpetuate a race of degenerates. The best food for infants is mother's milk, and the child that is deprived of its natural food is deprived of its birthright. The milk of each animal is specialised for that particular animal, and no other animal's milk can ever be found a satisfactory substitute. The 35 child that is fed on its mother's milk, other things being equal, invariably thrives. It is imbibing the nourishment designed by nature to suit its particular requirement, and free from risks of contamination. It is not surprising, therefore, to learn that infants fed on the breast are rarely attacked by diarrhoea, which, as we have already seen, is one of the three chief causes of a high infantile mortality. This has been expressed in a very practical manner, by comparing the greater probability of death from epidemic diarrhoea—viz., 48 and 94 to 1 respectively— among infants fed on cows' milk and condensed milk than among those fed on breast milk. The value of breast milk for infants is inestimable. Unfortunately, owing to various causes, this, especially in urban communities, is frequently a counsel of perfection, and recourse has to be had to substitutes more or less suitable. Cows' milk, suitably modified for the requirements of the infant at different age periods, is the nearest approach to its natural food that perhaps can be readily obtained; but, unfortunately, owing to the great risks to which cows' milk is exposed to contamination in its passage from the farm to the consumer—risks, it should be remembered, largely preventable were Sanitary Authorities invested by Parliament with more adequate powers of control than they at present possess— its value in this respect is seriously discounted. Milk is a pabulum for almost all pathogenic germs, and, in the present unsatisfactory conditions under which it is sold to the public, it is frequently the source of danger to the infant. Bearing these facts in mind, the question of providing a supply of pure cows' milk, suitably modified, was carefully considered by the Health Committee of the Council in 1901. The Committee reported to the Council that, after a careful enquiry, they were of opinion that improper and unsuitable feeding was to a large extent responsible for the high infant mortality which had for years prevailed in the Borough, and that the establishment of an Infants' Milk Depot, somewhat on the lines of those which had been so successfully in operation in France, would tend, in their opinion, to reduce this heavy death-rate. The Council adopted the report of the Committee, and resolved to establish an Infants' Milk Depôt. 36 The Battersea Infants' Milk Depot. The Battersea Infants' Milk Depot was established in June, 1901, as the outcome of a special report of the Health Committee to the Council. The Depot was the first of its kind established in London (though other Metropolitan Sanitary Authorities, viz., Finsbury, Lambeth, and Woolwich, have since followed suit), and the results obtained have more than realised the hopes which were at its inception entertained by the Committee. The principles aimed at by the Committee were :— (a) Absolute control of the milk, so that the article sold from the Milk Dep6t should, so far as it was possible to secure, be free from contamination previous to being modified and sterilized. The objections to sterilizing an article already probably polluted rendered it necessary to seek out a farm where the conditions were such as to fulfil the requirements of the Council in this respect. (b) The distribution of the milk with discrimination and care to infants mainly of the poorer class, whose mothers were physically incapable of feeding their children on the breast. (c) The systematic study of the effect of the milk on the children. (,d) The sale of the milk to be as far as practicable conducted without loss to the Council. With regard to (a), the method adopted was to invite tenders for the supply of a sufficient quantity of pure cows' milk under contract, from a farm, and under stringent conditions as to quality, freedom from risks of contamination, &c. This has not been an easy task, as the requirements of the Council were such as to apparently make it impossible for the ordinary farmer to comply—though these requirements are only in accordance with the minimum conditions laid down by sanitarians for the cleanly production of milk. It would appear to be at present a 37 most difficult undertaking to obtain under stringent conditions as to purity, &c., a supply of milk suitable for infants, and this has only been accomplished by the Council having to pay an enhanced price. This fact is a striking commentary on the milk supply of London. As regards (b), the milk is only supplied on the applicant producing a form signed by the medical attendant that the case is a suitable one for admission to the Milk Dep6t, or, in the alternative, satisfying the Medical Officer of Health to the like effect. As regards (c), this is to a large extent secured by the attendance of the majority of the infants at the weighing room, under the supervision of the Medical Officer of Health. With regard to (d), it is to be regretted that, under present conditions this would appear to be impossible of achievement. The working expenses of a Milk Dep6t must necessarily be heavy; and when it is remembered that the milk is sold at the market price, the impossibility of making a profit will be at once obvious. It will be convenient, therefore, to consider the work carried out by the Council in connection with the Infants' Milk Depot under three headings :— 1. The methods adopted. 2. The results obtained. 3. The financial outlay. 1. The Methods Adopted. The milk, which is at present obtained from a farm in Kent, on arrival at the Milk Depot, is placed in the cooling room until required for modification. This process begins about 7.30 a.m. The milk is first strained through Ulan strainers, to remove any suspended matter. It is then subjected to the following degrees of modification, which are based on those in operation at the Great Ormond Street Children's Hospital:— 38 a. One part milk, 2 parts of water, + 8 oz. cream, 6 oz. lactose to each gallon. b. One part milk, 1 part water, + 6 oz. cream, 4 oz. cane sugar to each gallon. c. Two parts of milk, 1 part water, + 4 oz. cream, 2 oz. cane sugar to each gallon. In addition to the above, various other modifications are prepared to suit individual cases, as may be found necessary. These three modifications are used as follows :— Standard of Modification. Age or Infant. No. of 1 ottles per day. Amount per bottle in ounces. Amount per day in ounces. A 1 Under 14 days old 9 1½ 13½ ,, 2 months old 9 2½ 22½ . B ,, 3 8 3½ 28 ,, 4 7 4½ 31½ C ,, 6 7 5 35 Milk Practically Unmodified. ,, 8 6 6 36 Over 8 6 7 42 Although the above modifications are those used by the majority of the infants fed daily, variations are made to suit the requirements of particular cases. This is done either at the request of the medical attendant, or by the Medical Officer of Health, when the infant is found not to be thriving. The milk is supplied from three distributing centres, one being the Milk Depot itself, at 28 York Road. Another is the Health Department at the Town Hall. The third is at the Branch Library, Lurline Gardens. These three centres are conveniently situated for customers from all parts of the Borough. 39 The milk is supplied only to infants recommended by medical practitioners, hospitals, and midwives, and in all other cases only after satisfying the Medical Officer of Health that they are suitable. The great majority of the infants fed reside in the Borough, but in a few suitable cases the milk is supplied for infants in adjoining districts, under similar conditions, and at a slight additional charge. The price charged to residents in the Borough is as follows :— Under 6 months 1 week's supply is. 6d. 6 to 12 months 1 week's supply 2s. od. 12 months and over 1 week's supply 2S 6d. Ninepence extra is charged for a week's supply, in addition to the above prices, to persons residing outside of the Borough. As soon as the applicant is registered on the books of the Depot, the parents or guardians pay the necessary price, and a card, stating the conditions under which the milk is supplied, is handed to them. These conditions require that the milk shall be given in accordance with the instructions printed on the card, and that no alteration shall be made, or any other food given, except under medical advice. The family history of the child, and all other particulars, are then entered in the record book. As soon as possible after the child has been admitted to the Milk Depot, it is visited in its own home. The mother is given instructions in the rearing and management of the child, and endeavours are made to induce her to bring her baby to the weighing room once a week, or fortnight, to be weighed. In the majority of instances these are successful, and it is both gratifying and surprising to find what a very large number are regularly brought to the weighing room each week for this purpose. In this way it is possible to exercise a regular supervision over the majority of the infants fed from the Milk Depot. Much credit is due to Miss Moss for the success -she has attained in this respect. The infant is duly weighed in a comfortable room at the Latchmere Road Baths—a very central 40 situation—placed at our disposal through the courtesy of the Baths Committee. The condition of the child is then noted, the weight recorded in the record book and on a card supplied to the mother, and any unfavourable circumstance commented on. No medicinal treatment is given. Should there be any necessity for this, the mother is advised to consult a medical man or go to a hospital. The Depot is simply and solely a Milk Clinic, not a dispensary. While visiting the home of the infant, the Health Visitor carefully notes any insanitary conditions which may be found to be present, and deals with such in the ordinary way in her capacity as a Sanitary Inspector. In this way the best results are obtained ; and the mothers find the visits of the Health Visitors of great assistance to them. Rarely is any difficulty met with by Miss Moss in carrying out her duties in this respect. Her visits are in most cases eagerly looked forward to and much esteemed. To sum up, the methods carried out at the Infants' Milk Dep6t have for their object the feeding of infants of the poor, whose mothers are physically incapable of breast feeding them :— (a) With properly modified milk, (b) Sufficient for each meal, (c) Supplied in separate bottles, (d) Securely stoppered, to prevent contamination. In this way each bottle is ready for immediate use, simply requiring to be placed in hot water for two or three minutes, the stopper undone, and a teat (which is supplied at cost price) slipped over the neck of the bottle ; the baby does the rest. The Results Obtained. The results obtained during 1907 were on the whole very satisfactory. The total number of infants dealt with during the year was 618, or 2 less than during 1906. Of this number 197 were still using the milk at the beginning of 1907. This very slight drop in the number of infants was not due to any loss in popularity.TheDepôt would seem, on the contrary, to have 41 gained in popularity, and this notwithstanding that no attempt has been made to advertise, the institution relying entirely on the cases sent for admission by the medical practitioners of the neighbourhood, whose continued support should be accepted as strong evidence of its suocess as a factor in the saving of infant life. It is not possible to deal conveniently with more than 230 to 250 infants daily with the means at present at our disposal. Although in the past a good many more than this number have been dealt with, the results obtained have not been so satisfactory as with our present number. Relatively speaking, during the year 1907 the number of infants fed daily was better than during the previous year, being more uniform. This was due to the fact that in former years there was usually a considerable increase in the numbers during the third quarter, owing to the prevalence of epidemic diarrhcea. This increase during the third quarter was absent during 1907, on account of the peculiar climatic conditions which prevailed during the summer of that year. The following table shows the number of infants, some of whom were already on the books of the Dep6t at the beginning of the year:— Started. Before 1907. During 1907. In Borough Out of Borough Total In Borough Out of Borough Total. Still using Milk 16 — 16 180 15 195 Discontinued (including dead) 149 12 161 224 22 246 Dead 7 i 8 38 3 41 Total No. Fed 165 12 177 404 37 441 Total 618 42 The ages of the infants when they commenced taking the milk are shown in the next table :— AGE STARTED. Under 1 week. 1 week & under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Over 12 months. Total. 41 111 238 156 46 19 7 618 The large percentage (88 3 per cent.) at the earlier ages under six months is noteworthy, having regard to its bearing on the death-rate. It is during this period, more especially so during the first three months, that the highest death-rate occurs among infants. In the next table is shown the length of time during which these children were fed from the Depot up to 31st December, 1907 :— PERIOD FED. Under 1 week. 1 week & under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Over 12 months. Total. 36 64 158 136 98 62 64 618 It will be noted that nearly 90 per cent, used the milk for periods from one month to six months and over, while only 10 per cent, used the milk for short periods varying from one week or under to one month. The reasons assigned for discontinuing the milk were various, such as :—(1) Unable or too far to send; (2) milk unsuitable; (3) unable to afford to pay; (4) by order of the medical attendant; and (5) in the case of older children, now able to take other food. In a large number of cases the milk had 43 to be discontinued owing to the bread-winner of the family being out of work. It is to be regretted that some provision in the shape of a fund could not be subscribed to meet cases of this kind. Frequently it has happened that the child has had to have its supply withdrawn while it was steadily improving, owing to the father having fallen out of work. The great majority of the infants fed from the Milk Depot were recommended by medical practitioners; a few were introduced by nurses and mid wives; a few by the Lady Sanitary Inspector of the Borough Council; while in a small number of instances cases were recommended by hospitals—principally by the Victoria Children's Hospital, Chelsea. The majority of the infants belonged to the poorer classes. The most important fact connected with the feeding of these infants was that more than 60 per cent, of the children admitted were more or less seriously ill at the time of admission—in some instances even in a dying condition, having been put on the milk as a last resource. The following is a list of the diseases or diseased conditions present in many of these children :— Wasting Congenital debility Prematurity Convulsions Constipation and Whooping Cough Indigestion Measles Diarrhoea Starved Abcesses Gastric Catarrh Pneumonia Bronchitis Marasmus Jaundice Many of the children were, when admitted to the Milk Depot, so seriously ill that they had to be sent to hospital for treatment. Improper feeding was in many instances responsible for their condition. It is surprising what a varied range the diet list of many of the children took. This embraced bread, biscuit, tinned milk, various kinds of prepared foods. 44 oatmeal, and prepared barley. As a general rule, they began to improve rapidly when put upon the Depô t Milk. In a very few cases, owing to the extremely weak digestive powers of the infants, it was found necessary to make special modifications to suit them, or to stop the milk for a time and try some other form of feeding. Most of these children were later able to resume the milk, with uninterrupted progress afterwards. The surest method of determining the progress made by an infant is to weigh it periodically. A thriving infant shows a steady and progressive gain in weight from the time of birth onwards. The average gain is usually at the rate of 4 ounces weekly, and this standard was in most instances exceeded in the children fed on the Depot Milk. A few typical cases may be cited, which will serve to convey an idea of the work accomplished. Most of these cases, it will be noted, were more or less seriously ill when they commenced taking the milk. (1) M. N. Born 5th December, 1906. Admitted 7th March, 1907, suffering from indigestion and flatulence. Weight on admission, 91b. 70Z. Last weight (12 months' old), 21 lb. 120Z. Gain, 12lb. 50Z. in ten months. (2) C. H. Born 24th February, 1907. Admitted 15th August, 1907; very anaemic and ill-nourished. First weight (12th September), 131b. 11oz. Last weight (3rd December), i81b. 30Z. Gain, 41b. 8oz. in three months. (3) G. W. (Delicate twin.) Born 22nd December, 1906. Admitted 7th January, 1907. Weight at birth, 3lb. First weight (13th February), 51b. 130Z. Last weight (2nd January, 1908), i61b. 150Z. Gain, 131b. 150Z. in 13 months. (4) P. M. (Premature baby, very small at birth.) Born 25th January, 1907. Admitted 4th March, 1907. First weight (6th March), 61b. iooz. Last weight (27th November), 191b. 150Z. Gain, 131b. 50Z. in 8 and a half months. 45 (5) M. Born 5th July, 1907. Admitted 17th August, 1907. Very ill (marasmus) on admission. Weight at birth, 51b. First weight, 61b. 2oz. Last weight, 71b. 6oz. This infant's progress was much interfered with, owing to an attack of bronchitis, but notwithstanding its weakly condition, gained 11b. 40Z. in five months. (6) B. Born 23rd December, 1906. Admitted 20th July, 1907. Premature child, very small at birth. Suffered from acute constipation and indigestion. First weight (31st July), 11 lb. 100z. Last weight (31st December), 131b. 140Z. (7) A. Born 9th July, 1907. Admitted 25th July, 1907. Very ill on admission. First weight, 71b. 140Z. Last weight (19th September), gib. 100z. Was sick more or less all the time, but yet gained l1b. 120Z. in two months. (8) A. Born 15th March. Admitted 30th May. Very delicate on admission (congenital debility). First weight (5th June), 81b. 120Z. Last weight (31st October), 12lb. 6oz. Gain, 31b. 100z. in four months. The number of deaths recorded among the children fed on the Depot milk during 1907 was 49. Sixteen of these deaths occurred amongst children who had been taking the milk for periods less than one week. This is equivalent therefore to a death-rate of 79.2 per 1,000; but if these 16 deaths were not included—which, strictly speaking should not be counted in the death-rate amongst the Depot-fed infants—the rate would be 53.3 Per 1,000. This method of calculating the death-rate is not perhaps the most correct, but it is that which is most usually employed. It should not be forgotten, either, that the infants fed on the Depôt milk are not a normal infant population, over 60 per cent, of them being in a more or less serious condition of ill health when they commenced taking the milk. Only 178 of the children were classed as healthy when admitted to the Depôt. 46 Taken as a whole, the year's work at the Milk Depot has been very satisfactory. The value of supplying a pure modified milk to infants of the poor, who otherwise would have had to depend on the frequently contaminated article which is retailed under circumstances which invite contamination, or on tinned milk or other unsatisfactory substitute, is sufficiently borne out in the low death-rate amongst the Depotfed children, and by the constant support which it has received from the medical practitioners of the district, who send by far the greater number of customers. Scarcely less important than the intrinsic value of the supply of a pure modified milk for hand-fed babies, is the value, as an educational institute for the teaching of infant feeding, of the Milk Depôt. In addition to the Visits of the Health Visitor to the homes of these infants, the attendance of the mothers at the weighing room once a week or fortnight, to see their infants weighed, and to note the progress made, is of great educational value. Much good work has been accomplished in this manner, which must necessarily bear good fruit in the future. Personally, I am inclined to view this aspect of the Depot as even more valuable than the actual supplying of the milk. The amount of interest shown by the mothers is evident from the very large weekly attendances at the Milk Clinic. In this way, i.e., by practical demonstration and instruction in the feeding and management of infants, the maximum results are obtained. It has frequently been alleged that sterilised milk predisposes to rickets in those infants fed on it. There may be theoretically some ground for this assertion, but practical experience amongst the infants fed at the Battersea Infants' Milk Depot does not support it. I have kept careful observation of many infants who on admission to the Milk Depot were suffering from rickets, but in only two instances did the condition become worse during the time these two children were using sterilised milk. If am inclined to think, therefore, that the risk, if any, is greatly exaggerated; and, so far as my own experience goes, I cannot find that any harmful effects ever 47 follow its use. Having regard to the condition of the majority of the infants when admitted, and who are using the milk for, in most cases, long periods, it would be reasonable to expect that rickets would be, under such circumstances, a very common affection if the use of sterilised milk favoured its development. The following is a summary of the work carried out by Miss Moss in connection with the prevention of infantile mortality during 1907 :— Total number of visits 2.387 Births visited (registered and midwives) 1,288 Number of visits and re-visits to homes of infants fed from Infants' Milk Dep6t 846 Sanitary defects remedied 61 Infantile deaths visited 127 Miscellaneous visits (sick children, neglected children, overcrowding, and dirty homes) 60 Attendances at weighing room 70 Number of weights registered 1,822 New milk customers visited 441 Number of babies who attended at weighing room 294 1 attendance 52 2 attendances 38 3 ,, 42 4 ,, 39 5 ,, 23 6 ,, 8 7 „ 11 8 ,, 13 9 ,, 14 10 ,, 7 11 ,, 10 12 ,, 7 13,, 5 14 ,, 4 15 „ 6 48 Number of babies who attended at weighing room—continued. 16 attendances 2 17 „ 1 18 ,, 2 20 „ 2 24 „ 1 25,, 2 27,, 1 29 „ 1 30 ,, 1 36 ,, 1 Intimation notices served 58 Statutory notices served 15 Children under observation at home 40 The value of the preventive methods adopted in Battersea for dealing with infantile mortality will be gauged from a perusal of the foregoing results. That these methods have been largely successful will be, I think, admitted. Much more remains to be done; and it is only by systematic and constant effort that success in this direction can be attained. The Notification of Births Act, 1907, which the Council by resolution adopted on the 27th November last, will prove a most useful measure in the prevention of infant mortality. The Act provides that the "duty" of notifying a birth to the Medical Officer of Health devolves in the first instance upon the father of the child, if he be living in the house at the time of the occurrence of the birth; and if not, then upon "any person in attendance upon the mother at the time of, or within six hours after, the birth." The notice must "be given by posting a prepaid letter or postcard . . . within thirtysix hours after the birth, or by delivering a written notice of the birth at the office or residence of the Medical Officer within the same time." The notification is "in addition to, and not in substitution for, the requirements of any Act relating to the registration of 49 births," and it applies to any child born "after the expiration of the twenty-eighth week of pregnancy, whether alive or dead." Liability to a penalty not exceeding twenty shillings is incurred by any person who fails to give notice of a birth in accordance with the Act. The administration of the Act will necessitate the appointment of an additional Health Visitor, whose duties will be entirely connected with the visiting at the homes from which births are notified. This Act, which is the first fruit of the efforts of the Conference on Infantile Mortality, held at the Caxton Hall in June, 1906 (at which I had the honour of representing the Council), will, by giving immediate notification of occurrence of all births to the Medical Officer of Health, instead of, as heretofore, waiting until the birth had been registered (under the Registration of Births Acts, births can be registered within 42 days from the date of birth), be found of considerable assistance in the prevention of infantile mortality. The Cost of the Milk Depot. The financial outlay involved in the working of the Milk Dep6t is a matter of considerable importance. Under present conditions it is impossible to keep the expenditure within the income derived from the sale of milk. This is due to the fact that, in the first place, the milk is sold at a very low rate, so as to bring it within the reach of those needing it most. And, secondly, the expenses involved in its production must necessarily be very heavy, having regard to the elaborate precautions which have to be adopted to secure a supply of pure modified milk for infants. Under present conditions it does not appear to be possible to make Milk Depôts pay. The most that can be hoped for is, by practising rigid economy, to keep the deficit down to the lowest possible figure. For the following balance sheet, setting out the income and expenditure for the year 1907, I am indebted to the courtesy of the Borough Accountant:— 50 INFANTS' MILK DEPOT. Statement of Income and Expenditure, 1907. Expenditure. Income. £ s. d. £ s. d. Wages 351 5 8 Cash received 839 12 4 Lighting, waterf& fuel 59 18 6 Excess of expenditure over income 715 10 0 Rent 32 0 0 Rates, taxes, insurance and telephone 29 6 0 Milk, cream & lactose 712 18 1 Repairs, stores, &c. 77 19 10 Bottles 96 5 2 Washers 23 14 9 Baskets 41 9 10 Teats 14 17 1 Weighing machine 1 5 0 Cleansers 2 16 3 Thermometers 1 14 0 Brushes 1 8 10 Use of Council's horses 108 3 4 £1,555 2 4 £1.555 2 4 An inspection of the above balance sheet will show that during 1907 the expenditure exceeded the income by £715 10S This loss on the year's working has, at first sight, been greater than that in 1906, but on analysis this will be found not to be the case. It is to a large extent accounted for by the increased price we have had to pay for our milk to ensure that the principle that guided the Committee, viz., the supply to the Depot of milk from a farm at which the sanitary requirements of the Committee were being fulfilled, was being upheld. The increased price paid for the milk has been more than balanced by the considerable increase in the income derived from the sale of milk, Additional expenditure was also incurred during 1907 owing to the fact that the milk has now to be collected at the railway station, instead of, as heretofore, being delivered by the contractor at the Milk Dep6t. Another increased item of expenditure was the provision of a supply of wire baskets, for holding the day's supply of milk. This was the first occasion since the Depot was started in 1901, on which it was found necessary to renew the stock of wire baskets. This last 51 item, which, with other small items, amounted to about £50, should more properly belong to capital account. This balance sheet, therefore, speaking purely from a commercial point of view, is the least satisfactory feature of the report. When weighed against the moral and material advantages which have been gained from the establishment of the Milk Depôt, there can be no question on which side the advantages lie. The small charge on the rates (about &d. in the cannot be considered a heavy price to pay, when the great reduction (which has taken place in the infantile mortality of the Borough coincidently with the establishment of the Depot, and for which there is no doubt that it has been to some considerable extent both directly and indirectly responsible) is borne in mind. It is to be regretted that the legislative action which was promised to enable Sanitary Authorities to provide Milk Depôts, has not been up to the present successfully carried into effect. It may be true to a large extent that when the promised Bill, which is to come before Parliament in 1908, dealing with the milk supply as a whole, will, when it has passed into law, do away with the need for Milk Depots. Much, of course, will depend on the nature of the Bill. Assuming that it is everything that sanitarians would desire, I am still convinced that, in large urban communities, Milk Depôts will still be found, amongst the poorer classes, a necessity. It has been said that, inferentially, Milk Depots discourage breast feeding. There are unfortunately not a sufficient number of them in this country—certainly not in the Metropolis—to support this statement. It is a curious fact that in the Metropolitan Boroughs in which Milk Depôs have been for some time in operation, the infantile mortality has fallen coincidently with their establishment; and it is only necessary to compare the infant mortality of many of the other Metropolitan Boroughs where the character and status of the inhabitants are similar to those in Battersea, to feel convinced that they do useful work. It cannot therefore, in my opinion, be asserted that Milk 52 Depots, carried on under proper medical supervision, help to discourage breast feeding. Certainly this is not so in Battersea. Fully 80 per cent, of the infants admitted to the Depôt are recommended by medical practitioners, who cannot be accused of wishing to encourage artificial methods of feeding in place of that which nature has provided. There is evidence, from enquiries, that something like 25 per cent, of the infants born in Battersea have never been breast fed. It is for this class, especially in the poorer and more congested districts, that Milk Depots will be found most useful; and it is to be hoped, therefore, that the Bill which has been promised for such a long time, and which was strongly advocated by the Conference on Infantile Mortality, to legalise this form of preventive medicine, will soon become law. Senile Mortality. During the year 1907, in the Borough of Battersea, 510 deaths of persons aged sixty-five and upwards were registered. The age distribution of these deaths in the sub-districts is set out in the following table:— District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. East Battersea 133 72 14 219 North-West Battersea 80 51 14 145 South-West Battersea 56 66 24 146 Borough of Battersea 269 189 52 510 The 510 deaths over sixty-five were equivalent to 21.1 per cent, of the deaths at all ages. The deaths over sixty-five in each year during the five years 1902-1906 are set out on next page :— 53 1902 445 1903 404 1904 508 1905 537 1906 495 Vital Statistics of the Latchmere Estate. During the year 1907 there were 39 births, all of which were legitimate. This gives a birth-rate of 26.3 per 1,000 persons on the Estatp. The birth-rate per 1,000 married women at the reproductive ages, viz., from 15 to 45 years, was 176.4. In 1906 the rates were 25.18 and 159.4 respectively. The number of deaths on the Estate was 17, as compared with 18 in 1906. The causes of death were as follows:— Measles 1 Whooping Cough 2 Phthisis 2 General Tuberculosis 1 Premature birth 1 Bronchitis 3 Pneumonia 2 Cancer 1 Bright's disease 1 Other diseases 3 The death-rate per 1,000 of the population on the Estate was 11.5, as compared with 12.2 in 1906. It should be remembered, however, that these figures are small, and consequently, for statistical purposes, of little value. It is sufficient to state that, from my own knowledge, the population on this Estate compares favourably with that of the rest of the Borough as regards the standard of health prevailing. 54 POPULATION OF THE LATCHMERE ESTATE. MALES. 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- Total. Single and Widowed 89 100 106 82 53 16 3 3 — 2 1 3 458 Married — — — — 1 31 55 49 60 45 29 20 290 Total 89 100 106 82 54 47 58 52 60 47 30 23 748 FEMALES. 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- Total. Single and Widowed 101 92 92 67 40 11 3 3 3 3 5 21 441 Married — — — — 8 42 61 57 53 32 21 16 290 Total 101 92 92 67 48 53 64 60 56 35 26 37 731 Infectious and other Diseases. CHART indicating the prevalence of notifiable Infectious Disease during each week of the year 1907. 57 Infectious and other Diseases. Zymotic Diseases. The principal zymotic diseases are seven in number, viz.: small-pox, measles, scarlet fever, diphtheria (including membranous croup) whooping-cough, "fever" (including typhus, enteric or typhoid, and simple or continued) and diarrhœa; and the zymotic death-rate is calculated from the total deaths from these diseases. The zymotic death-rate may be accepted, within certain limits, as an index of the sanitary condition of a community, and the statistics for the Borough of Battersea in 1907 will bear favourable comparison with those of former years. / In the Borough of Battersea during 1907, there were registered from the principal zymotic diseases 243 deaths, giving a zymotic corrected death-rate of 1.33 per 1,000; the corrected rate for London being 1.42, varying in the different Metropolitan Boroughs from .51 in Hampstead to 3.01 in Shoreditch. The zymotic death-rates vary also for the three registration sub-districts, East Battersea 1.5 per 1,000, NorthWest Battersea 1.8 per 1,000, South-West Battersea .72 per 1,000. North-West Battersea shows the highest, and SouthWest Battersea the lowest, a difference explainable from the crowding and absence of proper means of home isolation and nursing in North-West and East Battersea as against the latter district, in which the housing accommodation and general standard of comfort is on the whole superior. Similar conclusions are obtainable by comparing the death-rates and zymotic incidences for the different Wards of the Borough, as shown in the table on page 59, from which it will be seen that of the nine Wards, Winstanley shows the 58 highest and Broomwood the lowest zymotic death-rates; Church shows the highest and Bolingbroke the lowest zymotic incidences respectively. In the subjoined table are shown the deaths from the chief zymotic diseases for the ten years 1897-1906, and the year 1907 respectively. It will be seen that the number of deaths, 255, is the smallest number ever previously recorded in the Borough, being no less than 159 fewer than the average for the decennium. This is accounted for largely by the great decrease in the number of deaths from diarrhoea in 1907. In only one instance, viz., puerperal fever, will the figures be found to be higher than the decennial average. 18971189811899 1900 1901 1902 1903 1904! 1905! 1906 Decennial average 1907 Small Pox 4 25 3 Measles 76 119 103 81 126 99 107 58 124 44 94 72 Erysipelas 11 18 17 17 10 11 11 11 24 10 14 5 Scarlet Fever 47 28 14 13 9 23 7 11 24 24 20 20 Diphtheria 108 120 63 32 20 18 29 14 11 17 43 38 Enteric Fever, &c. 18 15 39 32 18 16 17 12 6 8 18 4 Puerperal Fever 367381452986 7 Whooping Cough 82 71 52 108 79 63 79 61 49 79 72 62 Epidemic Diarrhœa 141 154 123 149 217 98 92 184 128 149 144 47 Totals 486 531 418 435 491 367 347 353 375 339 414 255 The next table gives the death-rate from each of the chief zymotic diseases compared with the mean death-rate for the ten years 1897-1906, the grain or loss in each case being also shown. 59 Diseases. Mean Deathrate per 1,000 1897-1906. Death-rate per 1,000 1907. Gain in 1907. Loss in 1907. Small-pox 0.01 0.00 0.01 ... Measles 0.53 0.39 0.14 ... Erysipelas 0.07 0.02 0.05 ... Scarlet Fever 0.11 0.11 ... ... Diphtheria 0.25 0.20 0.05 ... Enteric Fever O.1O 0.02 0.08 ... Puerperal Fever 0.03 0.03 ... ... Whooping Cough 0.40 0.34 0.06 ... Diarrhœa 0.81 0.25 0.56 ... Death Rate per 1,000 population from the chief Zymotic Diseases arranged in Wards. Ward. Estimated Population. Small-pox. Measles. Erysipelas. Scarlet Fever. Diphtheria. Enteric, &c. Puerperal Fever. Whooping Cough. Epidemic Diarrhœa. 1. Nine Elms 31192 .00 .32 .03 .12 .06 .06 .09 .44 .41 2. Park 19629 .00 .86 .10 .15 .25 .00 .05 .35 .40 3. Latchmere 22207 .00 .63 .00 .04 .18 .00 .00 .36 .27 4. Shaftesbury 17319 .00 .00 .05 .11 .23 .05 .00 .34 .23 5. Church 21012 .00 .33 .04 .14 .19 .00 .00 .19 .38 6. Winstanley 22210 .00 .67 .00 .04 .49 .04 .04 .58 .18 7. St. John's 8941 .00 .22 .00 .11 .22 .00 .00 .11 .22 8. Bolingbroke 20198 .00 .14 .00 .04 .19 .00 .00 .29 .04 9. Broom wood 19181 .00 .20 .00 .20 .10 .00 .10 .15 .05 60 The seasonal mortality from the different important zymotic diseases is well shown by arranging the deaths quarterly, thus— Quarter No. Small-pox. Measles. Whooping Cough. Scarlet Fever Diphtheria. Fever. Diarrhœa. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1 — 4 12 2 12 — 1 — 6 — 5 — 9 51 2 — 17 23 7 10 — — — 5 3 — — 2 67 3 — 35 15 8 5 — 3 — 16 — 1 — — 83 4 — 16 12 3 11 — — — 20 2 1 — 11 76 Year — 72 62 20 38 — 4 — 47 5 7 — 22 277 Drains and sanitary fitting's are tested as a routine in all infected houses in cases of diphtheria and enteric and puerperal fever, but in the case of scarlet fever only in such instances as may be found necessary. It does not follow that when defects are found such defects are the cause of the diseases under investigation. They may indirectly be so. The tests used are the smoke test and chemical test (Kingzett's). When a positive result is obtained the drain (tested) is defective, but when a negative result is obtained it would be unsafe to assume that therefore the drain (tested) was sound. A negative result proves nothing'. The only reliable tests are the hydraulic (water) and the pneumatic (air) tests, but these are considered too severe for the routine testing of drains of old buildings. 61 Drainage Defects, &c., in Houses in which cases of Infectious Disease were notified. Sub-divided according to the different Notifiable Diseases, the results show as follows:— DISEASE No. of houses invaded. Number showing defects as to— Percentage showing drainage defects. Percentage showing no drainage defects. Drains. Traps, fittings and appliances. Total. Small-pox — — — — — — Cholera — — — — — — Diphtheria 281 34 65 99 35 65 Erysipelas 171 2 9 11 6 94 Scarlet Fever 722 38 70 108 14 86 Typhus — — — — — — Typhoid 29 7 4 11 38 62 Continued Fever 1 1 — 1 100 — Puerperal Fever 13 2 1 3 23 77 Total 1,217 84 149 233 19 81 62 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. Cerebro-spinal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1897 0.00 0.00 1.35 0.06 3.69 0.65 9.76 0.28 0.57 0.10 0.04 0.01 — — 1898 0.00 0.00 1.06 0.10 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 — — 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 — — 1903 0.19 0.00 0.85 0.06 1.62 0.16 2.58 0.04 0.49 0.09 0.04 0.02 — — 1904 0.03 0.00 0.90 0.06 1.13 0.07 2.13 0.06 0.29 0.06 0.04 0.01 — — 1905 0.00 0.00 0.99 0.13 0.93 0.06 4.51 0.13 0.15 0.03 0.09 0.05 — — 1906 0.00 0.00 0.89 0.05 1.39 0.09 5.62 0.13 0.22 0.04 0.07 0.04 — — Average 1897-1906 0.15 0.01 1.01 0.07 2.20 0.25 4.55 0.11 0.54 0.10 0.05 0.03 — — 1907 0.00 0.00 0.95 0.02 1.73 0.20 5.07 0.11 0.20 0.02 0.07 0.03 0.01 0.005 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." 63 Notifiable Infectious Diseases. During the year 1907 under the Notification Clauses of the Public Health (London) Act, 1891, 1,463 cases of infectious diseases have been reported, and of this number, 1,265, i.e. 86.5 per cent., were removed to the hospitals of the Metropolitan Asylums Board or to other hospitals, and 198, i.e. 13.5 per cent., remained under treatment at their homes. It is satisfactory to note the very large percentage (larger than in any previous year with the exception of 1906, when the rate was very slightly higher, viz., 88 per cent.) of cases removed to hospital, showing the growing favour with which the isolation hospitals are being looked upon. This must be considered a highly satisfactory state of things, and it is becoming increasingly evident that the public are beginning to realise the impossibility in the majority of instances of retaining these cases at home, and that only by prompt removal to, and isolation in hospital can the spread of dangerous infectious diseases be prevented, more especially in crowded localities. Examining the removals to hospital more in detail (e.g. nature of disease), it is seen that during 1907 in the Borough of Battersea, the following are the percentages:— Scarlet fever 96.3 Diphtheria and membranous croup 94.6 Enteric fever 81.0 Puerperal fever 53.8 Erysipelas 22.5 The number of cases notified in the three sub-districts of the Borough and the proportion per 1,000 of the inhabitants are as follows:— Total Number of cases notified. Notification per 1.000 of the Population. The Borough 1,463 8.0 East Battersea 590 7.7 North-West Battersea 569 11.4 South-West Battersea 304 5.3 64 No case of small-pox was notified during 1907 in Battersea. The following table gives the number of notifications, notifications per 1,000 population, and percentage of cases removed to hospital during the decennium 1897-1906, and 1907 respectively. Year. No. of Notifications received. Notifications per 1,000 of the population. Percentage of cases removed to hospital. 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 1148 6.7 72.1 1902 1597 9.3 78.0 1903 1003 5.7 74.6 1904 801 4.5 71.6 1905 1186 6.6 82.5 1906 1476 8.2 88.3 Average 1897-1906 1460 8.5 72.1 1907 1463 8.0 86.5 The fees paid to medical practitioners for notification of infectious disease in Battersea for each year since 1891 are set out below:— Year. Amount paid to Medical Practitioners. Cost per 1,000 Population. £ S. d. £ S. d. 1891 150 1 0 0 19 10 1892 224 18 6 1 9 3 1893 321 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 310 3 0 1 17 4 1898 229 0 6 1 7 5 65 Year. Amount paid to Medical Practitioners. Cost per 1,000 Population. £ s. d. £ S. d. 1899 203 17 6 1 4 3 1900 146 12 6 0 17 5 1901 136 10 0 0 16 1 1902 (including Chicken-pox) 343 19 0 2 0 1 1903 do. 137 11 0 0 15 10 1904 do. 171 4 0 0 19 5 1905 146 7 6 0 16 5 1906 183 6 6 1 0 5 1907 183 19 6 1 0 3 The increase in 1902 is accounted for by the fact that chicken-pox was very prevalent in that year, and had been temporarily added to the list of notifiable diseases on account of the outbreak of small-pox in that year. It should be noted that these fees are returned to the Sanitary Authorities by the Metropolitan Asylums Board. The chart inserted gives a graphic representation of the course of the rise and fall of infectious disease. This studied in connection with the tables on pages 66 and 67 is interesting, as showing the seasonal and other fluctuations peculiar to the incidence of infectious disease. There was a marked increase in the number of notifications of diphtheria received during 1907, i.e. 32.8 per cent. higher than the average for the five years 1901-05, but 36.4 per cent. lower than the average for the ten years 1891-00. The 315 diphtheria cases occurred in 281 infected houses, and in only 34 of these were the drains on testing found defective. The scarlet fever notifications were 5.9 below the average of the Borough statistics for the ten years 1891-00. The 922 cases occurred in 722 infected houses, and in 108 of these sanitary defects were found. The enteric fever (or typhoid) notifications received were 27.9 per cent. below the average for the ten years and represent 30 infected houses, 22.2 per cent. of the drains of which were, on testing, found to be defective. 66 Weekly Summaries of Cases of Infectious Disease Notified during the Year 1907. Month. Week of Year. Cases of Infectious Disease Notified. Totals. Small-Pox. Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Continued and Relapsing Fever Puerperal Fever. Cholera. Cerebrospinal Fever. 1907 1906 1905 January 1 ... 8 4 10 ... ... ... 1 ... ... 23 19 17 2 ... 4 4 14 ... 1 ... 1 ... ... 24 29 17 3 ... 8 5 24 ... ... ... ... ... ... 37 24 24 4 ... 4 3 16 ... ... ... ... ... ... 23 30 18 February 5 ... 5 4 16 ... ... ... ... ... ... 25 14 19 6 ... 6 1 13 ... 1 ... 1 ... ... 22 24 28 7 ... 15 1 19 ... 2 ... 1 ... ... 38 15 12 8 ... 7 6 14 ... 1 ... ... ... ... 28 15 16 March 9 ... 8 2 14 ... ... ... ... ... ... 24 16 14 10 ... 9 6 15 ... ... ... ... ... ... 30 15 18 11 ... 4 2 17 ... 1 ... ... ... ... 24 20 17 12 ... 6 6 14 ... 1 ... 2 ... ... 29 15 19 13 ... 8 3 12 ... ... ... ... ... ... 23 16 15 April 14 ... 9 1 24 ... 3 ... ... ... ... 37 23 12 15 ... 6 3 17 ... ... ... ... ... ... 26 21 13 16 ... 5 3 23 ... ... ... ... ... ... 31 20 9 17 ... 5 3 19 ... 1 ... ... ... ... 28 22 14 May 18 ... 8 1 21 ... ... ... ... ... ... 30 18 15 19 ... 6 3 19 ... ... ... 1 ... 1 30 21 22 20 ... 10 2 17 ... ... ... ... ... ... 29 28 17 21 ... 10 4 13 ... ... ... ... ... ... 27 24 20 June 22 ... 6 2 30 ... ... ... ... ... ... 38 19 27 23 ... 6 3 16 ... ... ... ... ... ... 23 15 21 24 ... 2 6 19 ... 1 ... ... ... ... 28 20 23 25 ... 2 1 13 ... ... ... ... ... ... 16 38 12 26 ... 2 5 14 ... ... ... 1 ... ... 22 21 18 67 Month. Week or Year. Cases of Infectious Disease Notified. Totals. Small-Pox Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Continued and Relapsing Fever Puerperal Fever. Cholera. Cerebrospinal Fever. 1907 1906 1905 July 27 ... 5 3 19 ... ... ... 1 ... ... 28 26 19 28 ... 4 1 16 ... ... ... ... ... 1 22 14 21 29 ... 6 6 22 ... ... ... ... ... ... 34 25 19 30 ... 2 1 24 ... ... ... ... ... ... 27 25 30 August 31 ... 2 4 10 ... ... ... ... ... ... 16 30 26 32 ... 7 3 17 ... ... ... ... ... ... 27 26 28 33 ... 2 2 13 ... 4 ... ... ... ... 21 25 23 34 ... 7 3 6 ... 4 ... ... ... ... 20 16 29 September 35 ... 1 2 19 ... 1 ... ... ... ... 23 19 18 36 ... 5 ... 16 ... ... ... ... ... 1 22 39 20 37 ... 3 3 8 ... ... ... ... ... ... 14 34 30 38 ... 5 2 20 ... ... ... ... ... ... 27 51 27 39 ... 7 5 22 ... 1 ... ... ... ... 35 48 31 October 40 ... 4 1 17 ... 4 ... 1 ... ... 27 54 37 41 ... 2 4 28 ... ... ... ... ... ... 34 56 32 42 ... 7 9 30 ... 1 ... 1 ... ... 48 39 38 43 ... 10 4 14 ... 1 ... ... ... ... 29 45 24 November 44 ... 5 3 29 ... 3 1 1 ... ... 42 39 37 45 ... 9 4 27 ... 1 ... ... ... ... 41 40 44 46 ... 8 6 19 ... 1 ... ... ... ... 34 47 27 47 ... 8 4 28 ... 1 ... 1 ... ... 42 41 33 December 48 ... 10 6 15 ... ... ... ... ... ... 31 35 36 49 ... 12 5 20 ... ... ... ... ... ... 37 47 22 50 ... 3 2 13 ... 1 ... ... ... ... 19 40 33 51 ... 9 2 12 ... ... ... ... ... ... 23 38 22 52 ... 3 4 15 ... 1 ... ... ... ... 23 35 23 Whole Year ... 315 173 922 ... 36 1 13 ... 3 1463 1476 1186 68 Notifications of Infectious Disease received during the Year 1907 arranged in Wards. Ward. Diphtheria & Membranous Croup. Erysipelas. Scarlet Fever. Typhoid or Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever Totals. No. 1 (Nine Elms) 60 32 167 5 ... 4 1 269 „ 2 (Park) 29 22 38 7 ... 2 ... 98 „ 3 (Latchmere) 34 28 118 1 ... ... ... 181 „ 4 (Shaftesbury) 34 14 94 1 ... 1 1 145 „ 5 (Church) 43 30 193 7 ... ... ... 273 „ 6 (Winstanley) 46 26 123 6 ... 1 1 203 „ 7 (St. John) 10 1 27 1 ... ... ... 39 „ 8 (Bolingbroke) 28 10 49 6 ... 1 ... 94 „ 9 (Broomwood) 31 10 113 2 1 4 ... 161 Totals 315 173 922 36 1 13 3 1,463 69 Case-rate per 1,000 Population in each Ward for each Notifiable Infectious Disease. Ward. Estimated Population. Diphtheria & Membranous Croup. Erysipelas. Scarlet Fever. Enteric & Continued Fever Puerperal Fever. Cerebrospinal Fever All Notifiable Infecti's diseases. No. 1 (Nine Elms) 31,192 1.92 1.02 5.35 .16 .12 .03 8.6 „ 2 (Park) 19,629 1.40 1.11 1.93 .35 .10 .00 4.9 „ 3 (Latchmere) 22,207 1.53 1.26 5.31 .04 .00 .00 8.1 ,, 4 (Shaftesbury) 17,319 1.96 0.80 5.42 .05 .05 .05 8.3 „ 5 (Church) 21,012 2.04 1.42 9.18 .33 .00 .00 12.9 ,, 6 (Winstanley) 22,210 2.07 1.17 5.53 .27 .04 .04 9.1 „ 7 (St. John) 8,941 1.11 0.11 3.01 .11 .00 .00 4.3 „ 8 (Bolingbroke) 20,198 1.38 0.49 2.42 .29 .04 .00 4.6 ,, 9 (Broomwood) 19,181 1.61 0.52 5.89 .15 .20 .00 8.3 Small Pox. It is satisfactory to record that no case of Small-pox was notified in Battersea in 1907. Three suspected cases were referred to me by medical practitioners, which, on investigation, proved not to be Small-pox. In the County of London no case occurred during the year. The following table gives the number of Small-pox cases and deaths in Battersea and in the County of London since 1891. 70 Year. Battersea. London. Cases. Deaths. Cases. Deaths. 1891 — — 114 8 1892 2 1 425 41 1893 108 12 2,815 206 1894 8 2 1,193 89 1895 20 1 980 55 1896 4 — 225 9 1897 1 — 104 16 1898 1 — 33 1 1899 — — 29 3 1900 — — 86 4 1901 51 4 1,700 229 1902 169 25 7,797 1,314 1903 33 — 416 13 1904 7 — 491 25 1905 — — 74 10 1906 — — 31 — 1907 — — — — Contacts were watched on their arrival within the Borough during 1907 in connection with Small-pox cases that had occurred on board vessels arriving from abroad. All these were kept under observation for a period of 16 days. Scarlet Fever. During 1907 in the Borough of Battersea, 922 cases of Scarlet Fever were notified, and 20 deaths were registered from the disease, giving a case mortality of 2.1 per cent. In 1906 there were 1,011 cases notified and 24 deaths registered, i.e. a case mortality of 2.3 per cent. The annual averages for the ten years (1891-1900) are: (1) notified cases, 979.3, and (2) deaths, 30.4. In the following tables are shown the number of cases and the case mortality per cent. in the Borough and subdistricts. In the following tables are shown the number of case: and the case mortality per cent. in the Borough and sub districts. CHART showing the number of cases of Scarlet Fever notified during each week of the year 1907. 71 Sub Registration Districts. East Battersea. Nth.-West Battersea. Sth.-West. Battersea. Borough. No. of Cases 348 378 196 922 Case-rate per 1,000 ulation 4.59 7.63 3.46 5.07 No. of Deaths ... 8 4 8 20 Death-rate per 1,000 „Q 0.10 0-08 0-14 0.11 population Case-moitality per cent. 2.2 1-o 4.0 2.1 In the next table are shown the case-rate per 1,000 of the population and the case mortality (i.e., the proportion of deaths to attacks) in 1891 and subsequent years. Year. Case-rate Cases. per 1,000 population. Deaths. Death-rate per i,ooo population. Casemortality per cent. 1891 738 4.89 38 0.25 5.1 1892 1,171 7.61 42 0.27 3.5 1893 1,407 8.97 32 0.20 2.2 1894 837 5.24 30 0.18 3.5 1895 830 5.09 28 0.17 3.3 1896 1,111 6.72 32 0.19 2.8 1897 1,621 9.76 47 0.28 2.9 1898 809 4.84 28 o.16 3.4 1899 721 4.30 14 0.08 1.9 1900 548 3.25 13 0.07 2.3 1901 609 3.60 9 0.05 1.4 1902 854 4.98 23 0.13 2.6 1903 448 2.58 7 0.04 1.5 1904 375 2.13 11 0.06 2.9 I905 801 4.51 24 0.13 2.8 1906 1,011 5.62 24 0.13 2.3 1907 922 5.07 20 O.11 2.1 72 The next table gives the age distribution of the cases notified and of the fatal cases. Age Periods— Years. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 Borough. No. of Cases 7 28 47 71 77 422 170 72 28 922 No. of Deaths 1 2 5 5 3 2 1 1 ... 20 Case Mortality per cent. 14.2 7.1 10.6 7.0 3.8 0.4 0.5 1.3 ... 2.1 It will be noted that of the total 922 persons reported as suffering from Scarlet Fever during 1907 within the Borough of Battersea, 230 (i.e. 24.9 per cent.) were under five years of age and 652 (i.e. 70.7 per cent.) under ten years of age; whilst the mortality was greatest amongst those under five years of age (i.e. 6.9 per cent.). Of the 270 persons over ten years of age 2 (i.e. 0.74 per cent.) died. Scarlet Fever showed a greatly increased prevalence in the County of London during the year 1907; 25,925 cases being notified as against 20,329 in 1906. Notwithstanding this great increase (25 per cent.) in the Metropolis in 1907, it is gratifying to be able to record that in Battersea there were 89 fewer cases notified in that year than in the previous year. Every precaution was taken by the Health Department to limit the outbreak, and the following leaflet relating to both Scarlet Fever and Diphtheria (which was also very prevalent) was by order or the Health Committee distributed throughout the Borough:— 73 BATTERSEA BOROUGH COUNCIL. Precautions against the spread of Scarlet Fever and Diphtheria. Owing to the prevalence of many mild unrecognised cases of Scarlet Fever and Diphtheria in certain parts of the Borough, and in order to prevent the spread of those diseases, it is very important that the earlier symptoms should be recognised. In Scarlet Fever the onset is sudden, and usually occurs within two to four days after infection. The patient vomits— and in very young children convulsions may occur. The skin is hot and dry, and the face is often flushed. The tongue is white with minute red dots showing through the white. The patient complains of headache and sore throat. After twentyfour hours the rash develops, appearing first on the neck and chest, and consists of small red dots on an area of red flushed skin, and does not appear on the face. The rash persists for two or three days. About a week after the onset the skin begins to peel about the neck and chest, and later on other parts of the body. The first symptoms of Diphtheria usually set in about two days after infection. There is slight chilliness and fever, aching pains in the back and limbs. The patient complains of sore throat. Small hard lumps may be felt on either side of the neck near the angle of the jaw, and greyish-white patches may be seen on the tonsils. In many cases of Scarlet Fever and Diphtheria the symptoms are so mild that the doctor is not called in and the disease is not recognised until other children have been infected by the patient. Cases of Scarlet Fever and Diphtheria, however mild they may be, are highly infectious. It is very desirable, therefore, in the interests of other children, that in every case of sore throat, especially when 74 associated with vomiting, or of a rash of any kind, the child should be immediately isolated from the rest of the family and a doctor sent for. Many of the symptoms mentioned above may be absent in mild cases, but sore throat is a very constant symptom. All cases of sore throat in children should, therefore, be regarded with suspicion, and should be isolated until the patients have been examined by a doctor. Attention to the cleanliness and ventilation of the homes is of great importance in preventing the spread of infectious disease. The more thoroughly a house is purified by fresh air or cleansed with soap and water the less likely is infection to enter it, or to spread when once there. G. Quin Lennane, Medical Officer of Health. A glance at the table at page 71 will show the wave of epidemicity which began to rise in 1905. In 1904 the lowest number of cases, viz., 375, ever previously reported in the Borough was recorded. During 1905, however, Scarlet Fever began to rise rapidly, and in that year 801 cases—more than double the number in 1904—were notified. This upward curve in the attack rate continued during 1906, when 210 attacks in excess of those in 1905 were recorded. That this upward curve did not continue in Battersea during 1907 is a matter for congratulation having regard to the very great increase (over 5,000 cases) which were recorded during the year in the County of London. Owing to the very mild nature of the infection, in a large number of instances the disease was unrecognised or mistaken for some other trifling ailment. For this reason very many persons were infected who, had the infecting cases been recognised and isolated before the "peeling" stage had brought the nature of the illness to light, would have escaped. In not a few instances several members of the same family, or persons living in the same house, were infected from this 75 source. Again, some of these unrecognised cases were found to have attended school, and in this way another channel by which infection was spread was provided, and many schools thereby became the foci of infection, rendering it necessary to close class-rooms in certain Council and non-provided schools, wherein it was evident infection was taking place. The number of cases notified during each week and month was fairly uniform throughout the year except during August, though the usual rise occurred in the fourth quarter, reaching a maximum in November. On referring to the tables on pages 66 and 67 it will be noted that there was a great reduction in the number of notifications received during August, pointing to the influence of the schools as a factor in the spread of the disease. There can be little doubt in my opinion, that the schools are a very common channel for the spread of this as well as of other infectious diseases. That the closure of the schools during the summer vacation, about the period of the ascending epidemicity of the disease, is the cause of the decline in the attack rate, and not (as is asserted by some) the annual exodus of children which takes place during the summer holidays, is a fact that will be apparent to any person who studies the question. Greater difficulty is, of course, experienced in tracing the source of infection in Scarlet Fever than in many other infections, but, after making due allowance for this, the higher incidence of the disease amongst children at school ages, and the effect which the closure of the schools during the summer holidays exerts is not, in my opinion, to be explained away by this annual migration. Moreover the same decline in the incidence of the disease on closure of the schools occurs in the provinces, where little or no exodus of children takes place during the summer holidays. The sources of infection were in 283 cases more or less definitely associated with the schools. In 177 cases there was a history of exposure to infection from a previous case; 47 were "return" cases; 12 were infected outside the 76 Borough; 6 were post-diphtheritic cases, notified from hospital; 4 were probably due to infection from fomites; and of the remainder no information as to the source of infection could be obtained. In three large boarding schools in the Borough cases occurred, but prompt removal to hospital and disinfection prevented the spread of the disease. As heretofore, considerable assistance was rendered by many school teachers to the Health Department, by sending immediate information of the absence or exclusion from school of children through illness, which enabled the Medical Officer of Health to make the necessary enquiries as to the nature of the illness. There is still a great deal of carelessness displayed by parents during the prevalence of epidemic diseases, in not seeking medical advice for their children, when suffering from what only appear to them to be slight ailments. This is responsible in many instances for a large number of cases of scarlet fever, which could have been prevented had timely medical aid been sought. The desire of the parents that their children should not lose their attendance medals is also responsible for the spread of scarlet fever.* But more incomprehensible still is the action of the Board of Education in abolishing Article 101 of the Elementary Education (1901) Code. By this Article a grant was made for all children excluded from attendance at school on account of epidemic disease; but the extraordinary action of the Board in removing this salutary provision is an inducement to teachers and others to keep up the attendance of school children who may be found at the time to be suffering from doubtful illness, and whose presence in the schools may be the cause of the spread of infectious disease. It was found necessary, owing to the prevalence of the disease, by arrangement with the Education Department of the London County Council, to close class rooms in six Council and one non-provided Schools. The following were the schools dealt with:— *Since the above was written, the London County Council (Education Authority) have revised the regulations as to school attendance medals, which are not now to be withheld in cases of non-attendance of children for infectious disease 77 Surrey Lane Tennyson Street Mantua Street Gideon Road Honeywell Road Christ Church Ethelburga Street Class rooms in the above schools were closed for periods varying from one to three weeks, and disinfected thoroughly. This action was in every case followed by satisfactory results. Of the 922 cases in the Borough of Battersea, 888, or 96.3 per cent., were removed to the Metropolitan Asylums Board's Hospitals. In 1906 96.6 per cent., in 1905 93.8 per cent., and in 1904 86.6 per cent., were removed to hospital. In the SubDistricts the percentage of cases removed were as follows:— East Battersea, 98.8; North-West Battersea, 98.9; and SouthWest Battersea, 86.7. This must be considered a highly satisfactory record in the percentage of cases of Scarlet Fever removed to hospital, more especially as regards East and North-West Battersea, in both of which districts, owing to the lack of proper means of isolation and nursing, it is most essential that cases of dangerous infectious diseases should be promptly removed to hospital. Forty-seven cases of Scarlet Fever occurred during 1907, in connection with which there was more or less evidence that the return of patients discharged from hospital to the houses from which these 47 cases were notified, had been the source of infection. It by no means follows that all these cases were genuine "return" cases; there can be little doubt that some at least of them were, as, after excluding all other possible sources, the conclusion was irresistible that the discharged patient must have been the source of infection. The difficulty of checking the spread of Scarlet Fever during 1907 was largely due to the great number of mild, unrecognised cases, which infected other members of the same family, or playmates. One or two typical cases, which will serve to exemplify this difficulty, may be cited. 78 A case of Scarlet Fever was notified from No. 10 Gonsalva Road, on the 7th March. The patient had been attending hospital since the 2nd March. He last visited the hospital on the 7th, coming home feeling very ill. On receipt of the notification that the patient was suffering from Scarlet Fever, enquiries were made by the Inspector, when he was informed no other member of the patient's family was ill. On the 8th March a child living in the same house was notified, and the following day (the 9th) two children of the first patient were notified, and removed to hospital. It was then ascertained that the two last patients had been ill, one three weeks previously, and the other a fortnight previously. Both of these children were "peeling" when notified, and had infected their father and the other child living in the house. Another case, which infected several other persons, occurred at Crescent Place. On the nth February two children were notified to be suffering from Scarlet Fever, from No. 3 Crescent Place. On making enquiries, I ascertained that a boy was lying ill at No. 1 Crescent Place, supposed to be suffering from Bright's disease. The mother of the two patients at No. 3 Crescent Place had visited the patient at No. 1 a week previously, spending some time with him. On visiting No. 1 I found the boy to be suffering from scarlatinal nephritis, and another child in the same house suffering from Scarlet Fever. A third child was notified a few days later, from No. 3. Making in all four cases infected from this unrecognised case. Numerous instances such as the above could be quoted, but the examples given sufficiently illustrate the difficulties met with in limiting the spread of infection. Ignorance and carelessness on the part of parents in not calling in medical aid in cases of doubtful illness is largely responsible for the spread of infection. Notwithstanding these difficulties, the fact that we had fewer cases of Scarlet Fever in the Borough during 1907 than in the previous year—although a very great increase was recorded in the number of cases in the County of London in 1907—is a very satisfactory feature of the year's work to be able to record, and speaks well for the activity of the Sanitary 79 Staff in following up and tracing doubtful cases, with a view to their prompt isolation. The question of "return" cases is still unsettled, the investigations which the Metropolitan Asylums Board's experts have been conducting into the matter yielding conflicting results. This is unfortunate, having regard to the importance of the matter, and to the need for adopting adequate precautions to prevent the spread of infection in this manner. As in the majority of instances the patients discharged from hospital return to houses where other children reside, and in which it is frequently impossible to secure even the most primitive isolation, it is absolutely essential that some definite conclusion should be arrived at, so that the necessary steps may be taken, e.g., extending the period of isolation of doubtful cases. The following are the numbers and percentages to total cases, of "return" cases of Scarlet Fever since 1905:— Total cases. "Return" cases. Per cent. 1905 801 23 2.87 1906 1,011 34 3.36 1907 922 47 5.09 The number of cases sent back from hospital notified as Scarlet Fever, and in which the diagnosis was found to be erroneous, was 55, or 5.9 per cent., as compared with 3.5 per cent. in 1906. A case in which the Health Committee found it necessary to take proceedings under the Public Health (London) Act, 1891, was that of a man, J. M., who, while suffering from Scarlet Fever, exposed himself in a public place. The case was notified on the 11th September, and Inspector Marrable, on visiting the house to make the usual enquiries, was satisfied that the case could not safely be isolated at home, and he accordingly persuaded, as he thought, the patient to go to hospital. When the ambulance arrived, however, the patient had left the house, and. all trace of his whereabouts were lost. Two days later he presented himself at the Grove Hospital, where he was detained. It was stated that during the two 80 days, he had lived and slept out on Wandsworth Common. On his discharge he was prosecuted, and fined 20s. and 2s. costs., the Magistrate taking into consideration the desire of the Health Committee not to press for a heavy penalty. Diphtheria and Membranous Croup. The number of Diphtheria notifications received during 1907 (including Membranous Croup) in the Borough of Battersea was 315, and show a marked increase over that of 1906. It will be noted that the ascending wave of epidemicity which started jn that year continued in 1907. In 1905 the lowest number of cases ever previously recorded in the Borough were notified, but during the following year there was a decided rise in the number of cases notified in Battersea, in common with the County of London, and there are signs that we have not yet reached the summit of this ascending wave of incidence. The case-rate, death-rate, and case-mortality from Diphtheria and Membranous Croup since 1891 are set out in the following table:— Year. Cases. Case-rate per 1,000 population. Deaths. Death-rate per 1,000 population. Casemortality per cent. 1891 260 1.72 68 0.45 26.1 1892 366 2.38 57 0.37 15.6 1893 682 4.35 176 1.12 25.8 1894 505 3.16 118 0.73 23.3 1895 411 2.52 94 0.57 22.8 1896 426 2.57 82 0.49 19.2 1897 614 3.69 108 0.65 17.6 1898 791 4.74 120 0.71 15.1 1899 606 3.61 63 0.37 10.4 1900 306 1.81 32 0.19 10.4 1901 264 1.56 20 0.11 7.5 1902 275 1.60 18 .010 6.5 1903 282 162 29 0.16 10.3 1904 199 1.13 14 0.07 7.0 1905 166 0.93 11 0.06 6.6 1906 251 1.39 17 0.09 6.7 1907 315 1.73 38 0.20 12.0 CHART showing the number of cases of Diphtheria notified daring each week of the year 1907. 81 It will be seen from the above table that, while the casemortality and the death-rate per 1,000 were higher than in 1906, taking the averages for the ten years 1891-1900, it will be found that these are considerably lower (i.e., 33 per cent. and 66 per cent. respectively). In the County of London the case-rate was 1.8, the deathrate 16, and the case mortality 8.9 per cent. The distribution of the disease in the three registration sub-districts of the Borough, together with the number of deaths among both hospital and home-treated patients during 1907, is shown in the following table:— Registration Sub-Districts. No. of cases notified. Cases treated at home. Cases removed to hospital. No. of Deaths. Case-mortality per cent. Case-rate per 1,000 population. At home. At hospital. Total. East Battersea 141 7 134 3 8 11 7.8 1.86 North-West Battersea 104 3 101 2 17 19 18.2 2.10 South-West Battersea 70 7 63 ... 8 8 11.4 1.23 It will be noted that the disease has been fairly uniformly distributed over the Borough, though on the whole South-West Battersea has suffered less than the other two registration subdistricts of the Borough. Generally speaking, the incidence of the disease is heavier in the poorer and more congested parts of the district. In the Wards this is even more strikingly manifest. Most cases occurred in winstanley Ward, and fewest in St. John. Two hundred and ninety-eight of the cases notified were removed to hospital, or 94.6 per cent, of the total. In 1906 the percentage of cases removed to hospital was 89.6, and in 1905 83.7 In the sub-districts the percentage of cases removed to 82 hospital was as follows:—East Battersea, 95.0; North-West Battersea, 97.1; South-West Battersea, 90.0. Thirty-three deaths occurred in hospital, and 5 at home, the case-mortality amongst the patients treated in hospital and at home being 11.07 and 29.4 per cent. respectively. The following table gives the age distribution of the cases notified, and of the fatal cases. Age Periods—Years. Boro'. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 No. of Cases 2 30 33 36 36 119 36 15 8 315 No. of Deaths ... 9 6 5 7 11 ... ... ... 38 Case Mortality per cent. ... 30.0 18.1 13.8 19.4 9.2 ... ... ... 12.0 It will be seen that the chief incidence of the disease has fallen upon young children. As many as 155 out of the 315 were of school age, which is almost the same proportion as last year. The total number of houses invaded by diphtheria was 281. In 34 houses (i.e., 12.09 per cent.) the drainage was found defective, and in 113 (i.e., 40.2 per cent.) insanitary conditions other than drainage defects were discovered. The source of infection in 213 of these cases was merely conjectural. In 54 instances there was strong evidence pointing to the school as the infecting source. In 24 cases there was a history of direct personal infection. In 10 cases the patient was infected outside the Borough. Six were cases of postscarlatinal diphtheria, which developed in hospital, while the patient was recovering from scarlet fever; and in 4 cases there were reasons to suspect that the house drains may have been the source of infection. CHART showing the number of cases of Enteric Fever notified during each week of the year 1907. 83 During 1907 only one "return" case of diphtheria was noted. Forty-five cases notified as suffering from diphtheria (or 14.2 per cent.), and removed to hospital, were found not to be suffering from the disease, and were returned to their homes. Three hundred and eighty-six bacteriological examinations were made during 1907, as compared with 235 in 1906, and 165 in 1905. In 116 cases a positive and in 270 a negative result was obtained. The value of the bacteriological diagnosis of diphtheria cannot be over-estimated. The London County Council (Educational Department) recognising this, have decided that when diphtheria is about, and children have been kept from school on account of attacks of sore throat, such children shall not be allowed to return to school without a medical certificate based on bacteriological examination, to the effect that they are free from infection. That this action on the part of the Educational Authority is a useful precautionary measure will be at once apparent when it is remembered that diphtheria is easily spread during an outbreak by persons who carry in their noses or throats the diphtheria germs, but who are, apparently, in good health. The infectivity of these so-called "carrier" cases is one of the most troublesome things to deal with, more especially in children, who always are more or less susceptible when aggregated together in schools or institutions. Enteric Fever. During 1907 37 cases of Typhoid Fever were notified in the Borough of Battersea (including one case of continued fever), as compared with 40 in 1906, and four deaths were registered, giving a case-mortality of 10.8 per cent. In the following table are set out the case-rate, death-rate, and case-mortality from enteric fever since 1891:— 84 Year. Cases. Case-rate per 1,000 population. Deaths. Death-rate per 1,000 population. Case mortality per cent. 1891 118 0.78 23 0.15 19.5 1892 82 0.53 10 0.06 12.1 1893 138 0.88 22 0.14 16.0 1894 154 0.96 29 0.18 18.8 1895 140 0.86 23 0.14 16.4 1896 111 0.67 17 0.10 15.4 1897 95 0.57 18 0.10 19.0 1898 94 0.56 15 0.08 16.0 1899 157 0.93 39 0.23 24.9 1900 206 1.22 32 0.19 15.5 1901 90 0.53 18 0.10 20.0 1902 88 0.51 16 0.09 18.2 1903 85 0.49 17 0.09 20.0 1904 51 0.29 12 0.06 23.5 1905 27 0.15 6 0.03 22.2 1906 40 0.22 8 0.04 20.0 1907 37 0.20 4 0.02 10.8 On inspection of the above table, if a comparison be made between the number of cases of typhoid notified, and the number of deaths from typhoid registered, in the Borough of Battersea during 1907, and the yearly averages for the ten years (1891-1900) in the old Parish of Battersea, it will be noted that there is a very notable decrease. The yearly average of cases notified in the parish is 129.5, and the yearly average of deaths registered was 22.8, as compared with 37 and 10.8 respectively as the number of notified cases and deaths in the Borough of Battersea during 1907. The age distribution of the cases was as follows:— Ages. Under 5. 5-15. 15-30 Above 30. Totals. Males 3 3 7 2 15 Females 2 7 9 4 22 Totals 5 10 16 6 37 85 The death-rate, case-rate, and case-mortality in the Borough and in the sub-districts are as follows:— Case-rate per 1,000 population. Death-rate per 1,000 population. Casemortality per cent. East Battersea 0.18 0.03 21.3 North-West Battersea 0.26 0.02 7.6 South-West Battersea 0.17 0.00 0.0 The Borough 0.2 0.02 10.8 The influence of environment as regards the incidence of, and mortality from, typhoid, is well shown by the above figures, the two first-mentioned districts being the more congested and less sanitary of the three registration sub-districts of the Borough. In the County of London the case-rate was 0.29, and the death-rate 0.04 per 1,000. Of the 29 typhoid-infected houses, 11 (i.e., 38 per cent.) showed on inspection defective drains, traps, fittings, or appliances. In 8 houses (i.e., 27 per cent.) the drains themselves were found to be defective. The source of infection in 5 cases was, there was reason to believe, due to the consumption of shell fish. Two cases were infected outside the Borough; and in 5 cases, occurring in one house, there was a strong suspicion that the defective condition of the drains was responsible for the outbreak. A rather curious and interesting outbreak, which occurred in August, while I was absent on my annual holiday, and necessitating my return, was that which arose in the neighbourhood of Lavender Hill. Between the 12th and 31st of August I received the following notifications:— 86 Date of Notification. Name. Age. Address. Date of Onset of Fever. 12 Aug. Bessie G. 15 24 Eccles Road 28 July 12 „ Lily S. 12 131 b Queens Road 30 „ 12 ,, William A.H. 3 111 Stormont Road 2 Aug. 15 „ Jeannie C. 39 1a Gambetta Street 14 July 19 „ Walter H. 23 19 Stewarts Lane.W. 3 Aug. 20 „ Mabel E. 16 9 Randall Street 13„ 21 ,, Henry B. 28 56 Jedburgh Street 5 „ 23 „ Frederick F. 27 33 Marmion Road 13 ,, 31 „ Herbert P. 3 23a Theatre Street 17 „ It will be noted that 8 of the 9 cases occurred in the same vicinity. Mabel E., who was a domestic servant, employed at 15 Lavender Hill, having been sent home ill to 9 Randall Street. Enteric fever may be spread in several ways, e.g. (a) by personal contact, (b) by an infected water supply, (c) by infected premises or materials, (d) by defective drainage, and (e) by infected food. Careful enquiries were made in each case, but the information obtained did not tend to throw much light on the source of infection. Two of these cases had been away for a holiday, one at Boxmoor and the other in Norfolk. Enquiries were made from the Sanitary Authorities of both localities, with negative results. It is possible, though there was no proof forthcoming, that these two patients, who returned to London about the critical period, may have contracted the disease from drinking polluted water or eating contaminated food. 87 The milk supply was carefully enquired into. Seven different milk vendors had supplied milk to these nine cases; and it is clear that no suspicion attached to the milk supply. The drainage was tested in each case, by means of the water test, with negative results, except in one instance, a w.c. at the top of the house being found defective; and a rain water pipe was found to connect direct with the house drain. The evidence as regards infection from eating contaminated food was vague and inconclusive. It is here, however, that, notwithstanding, there is most reason for suspicion, most of the cases occurring in Battersea being probably traceable to this cause. It is usually very difficult to get reliable intormation on this point, as the patient, as a rule, has been removed to hospital before the Inspector arrives at the house to pursue his enquiries. Furthermore, owing to the long incubation, and the insidious onset of the disease, the patient or his friends fail to recollect in many instances what suspicious food he may have partaken of during the previous month. The food theory, and, in fact, most of the other sources of origin are somewhat discounted in this outbreak, owing to the fact that only one case had occurred in each house and street. A review of the whole circumstances surrounding this little outbreak would seem to indicate that some common source of origin was present in 8 of these 9 cases, though what that may have been I have been unable to trace. Two other small outbreaks occurred in two houses in different parts of the Borough. In the first of these, two families occupied a house at 52 Harroway Road. James B., aged 35, was notified to be suffering from enteric fever on the 5th February. The patient worked at Chiswick, and had had his food away from home, and it was thought that fried fish, which he had frequently partaken of, and which had been procured near the works where he was employed, might have been the source of infection. On the 1st April the wife and child of the patient, and a child, 88 Gladys W., whose parents occupied the upper part of the house, were notified as suffering from typhoid, James B., the patient first attacked, being still in hospital. Careful enquiries were again made, and the drains again tested, when a slight defect was discovered in joint of outside w.c. On the 22nd April Edith W., mother of Gladys W., was notified and removed to hospital. The drains were again tested with the smoke and chemical tests, with negative results, and finally the water test was applied. With the latter test they were found to be very defective. Fifteen feet away from the front of the house there is a dead end to the sewer which drains the houses in the road. On lifting the manhole cover, which was situate directly opposite the house, the sewer, which has a low gradient, was found to be very foul. There was no intercepting trap between the house drains and the sewer. After eliminating all other probable sources of infection, it would seem to be highly probable that the defective condition of the house drains, opening directly into the manhole, without an intercepting trap, and at the dead end of the foul sewer, may have been the cause of this outbreak. The owner of the house was at once called upon to relay the drains and strip the walls, and the premises were thoroughly disinfected throughout by the Council's officers. The sewer was dragged and cleansed, and, in addition, a large upcast ventilating column was erected close to the dead end, for ventilating purposes. Another outbreak occurred in a house in Landseer Street. The premises were occupied by two families. The first case was notified on the 23rd September, in the person of William L., aged 2. Some plums which the patient had eaten a week previously were suspected to have been the source of infection, but this would appear to be doubtful, as he was unwell and under medical attention from the 30th August. Owing to the illness of the patient's mother, he had been looked after by the family living in the lower part of the house. On the 3rd and 4th October, Mrs. B. (who had looked after William L.) and her two children were notified to be suffering from enteric fever. 89 How the first ease became infected is not very clear, but it is extremely probable Mrs. B. and her two children were infected by William L. Forty-nine samples of blood were submitted for bacteriological examination for the Widal reaction for typhoid, and in 8 (i.e., 16.3 per cent.) a positive result was obtained. Improved methods of diagnosis have proved of great assistance in bringing to light the true nature of diseases such as typhoid, in which the symptoms are frequently obscure. In many of these mild obscure cases it is extremely important, in order to prevent the spread of infection, to be able to recognise the disease in the early stage. For this purpose the Widal reaction has been found most useful, and is being very generally employed by the medical practitioners in the Borough, with satisfactory results, as the records for the year sufficiently indicate. Puerperal Fever. During 1907, in the Borough of Battersea, 13 cases of Puerperal Fever were notified, and 7 deaths were registered, giving a case-mortality of 53.8 per cent. The case-rate was .07, or .02 above the mean case-rate for the preceding ten years. The death-rate was .03, and was equal to the decennial average. The death-rate for London was .05. Four deaths occurred in East Battersea, two in North-West Battersea, and one in SouthWest Battersea. In 1906 the case-mortality was 61.3 per cent. Puerperal fever is a preventable disease, and is caused by want of care by those in attendance on the lying-in woman. During 1906 4,574 births were registered in Battersea, and in only 13 cases was puerperal fever notified—a highly satisfactory record. In each case enquiries were made and the midwives in attendance were visited at their homes. Arrangements were at once made for their personal attendance at the Reception Shelter in Sheepcote Lane, where each of them had a sanitary 90 bath, and had her clothing and instruments sterilized at the steam disinfecting machine at the Disinfecting Station adjoining. The cases are at once reported to the London County Council, who are the Local Supervising Authority under the Midwives Act, 1902, the duty of disinfection devolving upon the Local Sanitary Authority. Eleven nurses and midwives who had been in attendance on puerperal fever cases during the year attended at the Reception Shelter for purposes of disinfection. Erysipelas. During 1907, in the Borough of Battersea, Erysipelas was slightly more prevalent than during 1906. One hundred and seventy-three cases were notified, and 5 deaths were recorded, as compared with 166 cases and 10 deaths in 1906. The casemortality was 2.89 per cent., as compared with 6.02 per cent. in the previous year. The case-rate was .95, and the deathrate .02, or .06 and .05 below the decennial average respectively. It will be noted that, although the disease was slightly more prevalent in 1907, the number of deaths recorded from erysipelas was exactly half that in 1906. Thirty-nine cases were removed to hospital, the majority going to Union Infirmaries, and the remainder to General Hospitals. In London, during 1907, 4,497 cases of erysipelas were notified, and 189 deaths were registered, giving a casemortality of 4.2 per cent. The advantages from the notification of erysipelas are few, and it might be with advantage discontinued, and some other dangerous infectious disease substituted. Epidemic Cerebro-Spinal Fever. Owing to the serious outbreaks of Epidemic Cerebrospinal Meningitis which began in May, 1906, and continued 91 during 1907, in Belfast and Glasgow, the attention of Sanitary Authorities all over the United Kingdom were directed towards the nature of the disease, and precautions were observed to prevent any possible spread of infection to other districts. In the County of London considerable uneasiness was felt that the disease might be carried to the Metropolis. A letter was received from the Local Government Board drawing the Council's attention to the existence of the disease in certain parts of Scotland and Ireland. The London County Council and the Metropolitan Borough Councils took the necessary steps to deal with any emergency that might arise, and on the 27th February the London County Council made an order extending the requirement of Notification to to the disease for a period of six months, and applied to the Local Government Board for confirmation of the Order, which came into force in the County on the 12th March, 1907. This order was extended for a further period of eighteen months from the 13th September, 1907. The following report on the nature and character of the disease was ordered by the Health Committee to be printed and circulated amongst members of the Council:— BATTERSEA BOROUGH COUNCIL. REPORT OF THE MEDICAL OFFICER OF HEALTH ON EPIDEMIC CEREBRO-SPINAL MENINGITIS. I have to report receipt of a communication from the Local Government Board in which they draw the Council's attention to the prevalence of Epidemic Cerebro-Spinal Meningitis in certain parts of Ireland and Scotland, and sporadic cases which have been reported in this country. The Board forward with their letter a copy of a memorandum by their Medical Officer on the character and symptoms of the disease, with special reference to its minor and anomalous manifestations. With a view to prevent the spread of the disease to the Metropolis the London County Council have added Cerebro-Spinal Meningitis to the list of those notifiable under Section 55 of the Public Health (London) Act, 1891. There does not seem to be 92 much evidence of the disease in London at the present time, but in view of its extremely fatal nature and of its epidemic character, it is desirable that sanitary authorities in the Metropolis should be on the alert to deal with any emergency that may arise. Cerebro-Spinal Meningitis is an infectious disease occurring sporadically and in epidemics, characterised by inflammation of the membranes of the brain and spinal cord and a very variable clinical course. The disease was first described in 1805, when a small outbreak occurred in Geneva. Since that time various epidemics of it have occurred, both in Europe and America. The epidemics are localised, occurring in certain regions, and not exhibiting the usual tendency to become widespread, which characterises certain other forms of epidemic disease. Country districts have been more affected than cities as a rule. Children and young adults are most susceptible to the disease, and it has shown a disposition to attack young soldiers concentrated in barracks and camps. Considerable doubt exists as to its infectious nature, or rather, as to the mode of infection and its degree of infectiveness. There can be little doubt that it is infectious, but there is evidence that it is not so to any very great degree; and that it is materially influenced in this respect by environment, the incidence of the disease being mainly confined to the more crowded and destitute portions of towns and cities. The real nature of the disease was first disclosed through the isolation by Weichselbaum, of Vienna, in 1887, of an organism from the cerebro-spinal fluid, to which he gave the name of Diplococcus Intracellularis Meningitidis, which was invariably present in cases of the disease. Other investigators confirmed Weichselbaum's observations; and later researches by Von Lingelsheim, who reproduced the disease in monkeys by injecting into the spinal canal of the animals the meningococcus or specific organism, when lesions identical to those found after death in man were found at the post mortem, placed the origin of the disease beyond doubt. Recent investigations have been carried out by Dr. Gordon on the bacteriology of the disease, and his report has been published by the Local Government Board, and forms a valuable contribution to the literature of the subject. Dr. Gordon has also found the organism in the secretions from the upper air passages; and, in addition to providing a readier and more accessible method of obtaining the organism for diagnostic purposes, suggests a highly probable mode of entry of the disease into the system and the means by which the disease is spread. 93 Various forms of the disease are recognised, differing markedly in their clinical characters. Considerable difficulty arises in consequence in diagnosing the more obscure forms of the malady, and the only reliable test is by bacteriological examination. The disease has been classified into three main groups:— 1. Malignant form, in which the onset is very sudden and death occurs within a few hours (in one case recorded, within five hours) from the first symptoms. 2. Ordinary form. The onset is also sudden, but there are usually premonitory symptoms, and the characteristic symptoms of the disease are more or less evident. The course of the disease in these cases is very variable, ranging from a few hours to several months. More than half the deaths occur within the first week. The cases that recover are mainly those which survive the first week, a gradual lessening of the symptoms and gradual restoration to convalescence ensuing. 3. Abortive forms— (a) An abortive type in which the symptoms set in with great severity but in a day or two rapidly subside and the patient rapidly improves. (b) Intermittent type, Commonly observed in epidemics, characterised by exacerbations of the fever which occur daily or every other day. (c) Chronic form, and stated by some authorities to be a relatively frequent form. In this form the disease may be prolonged for many months, giving rise to great weakness. Numerous complications arise in the course of the disease. The mortality varies in different epidemics, ranging from 20 to 75 per cent. The disease is extremely fatal to children. It is a very difficult disease to diagnose at times, and without a bacteriological examination it is impossible, in the majority of instances, to recognise its nature. The quickest method of obtaining material for bacteriological examination is by spinal puncture, a method which requires a certain degree of skill which can only be acquired from experience and practice. For other obvious reasons also it is not desirable that this method of diagnosis should be carried out in the patients' houses. When cases are notified they can be at once removed to the Metropolitan Asylums Board's hospitals, which are, I understand, prepared to receive 94 these cases, and the necessary bacteriological examination can then be made with safety to the patient. While it is best to prepare for emergencies, I do not consider that there is reason to apprehend the spread of the disease to the Metropolis. The action of the London County Council in making the disease notifiable for a period of six months is a wise precaution, and should the necessity arise, will strengthen the hands of the Council in dealing with any outbreak that may occur in their district. In the absence of evidence of the existence of the disease in the Borough at the present time, I have not considered it necessary to to draw up a leaflet for distribution to the public. If the disease should make its appearance in Battersea, I will_ask the Committee's authority to issue the usual notice to the inhabitants as to the nature of the disease, prominent symptoms, and precautions to be adopted to prevent the spread of infection. G. QUIN LENNANE. Since the disease was made notifiable 10 cases were notified, but in only 3 of these did the bacteriological results show evidence of the presence of the meningococcus, or specific organism which is associated with the clinical manifestation of the disease. These 3 cases are as follows:— Case 1.—E. F., age 6, female, residing at 30 Roundell Street, was notified on the 9th May from St. Thomas' Hospital. The child had been ill for a month previous to being sent to hospital. The medical attendant stated the illness began with an attack of ulcerative tonsillitis, which lasted four or five days; pneumonia supervened, and on the third day of the appearance of the latter, retraction of the head set in. There was a history of a fall on the back of the head. Patient was removed to hospital on the 1st May. The Hospital report was as follows:— "Lumbar puncture has been performed on two or three occasions. The (cerebro-spinal) fluid is turbid and contains numerous leucocytes of the polymorphorm clear type. Many 95 intracellular diplococci were observed in film preparations. The culture unfortunately remained sterile. The clinical features were those of cerebro-spinal fever. Retraction and opisthotonos have been well marked. Case doing fairly well and may recover. No spots have been observed." An interesting point connected with this case was the discovery by the Sanitary Inspector on visiting the patient's house, of a brother lying very ill in bed. He was at once removed to St. Thomas' Hospital, but on arrival there he was found to be suffering from scarlet fever, and was sent on to the Metropolitan Asylums Board's Hospital. Case No. 2. On the 10th June, I was asked to see a suspicious case by the Medical Attendant in the person of W. G., age 9 months, of 4 Mendip Place. I formed the opinion that the case was probably one of cerebro-spinal meningitis, and advised removal to hospital. The child was removed in one of the Metropolitan Asylums Board's ambulances to the Victoria Children's Hospital, Chelsea. It was at first thought by the Hospital staff to be a case of tubercular meningitis. The patient died on the 9th July. The results of the bacteriological examination carried out at the Lister Institute were as follows:— " Re Material obtained from post-mortem:— "In the pus from the meninges numerous gram-negative intracellular diplococci were found. The same organisms were obtained on culture. "Diagnosis.—Cerebro-spinal meningitis, due to infection by the meningococcus of Weichselbaum." The clinical symptoms noted while patient was lying in hospital were as follows:—Vomiting (cerebral type), convulsions, fever, paralysis of soft palate, no head retraction. The post-mortem examination revealed acute leptomeningitis, base of brain being covered with a thick flaking fibrino-purulent lymph, the posterior cistern, third, fourth and lateral ventricles being distended with creamy fluid. 96 Case 3.—H.T., age 18, residing at 30 Wickersley Road. I was asked by the Medical Attendant, on the 6th September, to see this case with him. The patient was by occupation a' plumber's mate. I formed the opinion that the patient was probably suffering from cerebro-spinal fever, and advised his removal to hospital. He was removed the same day to St. Thomas' Hospital. On the 4th October, in reply to my inquiries, I was informed that the case was regarded as one of cerebro-spinal fever, as on several occasions pus has been present in the cerebro-spinal fluid, and an intracellular diplococcus has been seen, though no culture had been up to then obtained. These were the only cases in which the results of bacteriological examination gave positive results, and in two of them the results must be considered in the absence of evidence of cultivation inconclusive. With regard to the other cases, although the clinical evidence pointed to the disease being suspiciously like cerebro-spinal fever, in some of these in which a bacteriological examination was carried out, the organism form was either the tubercle bacillus or the pneumococcus. There can be little doubt that Case No. 2 was a sporadic case of epidemic cerebro-spinal fever, as both the bacteriological and post-mortem examinations confirmed the clinical evidence of the disease. A very considerable amount of research has taken place into the occurrence of cerebro-spinal fever since the recent epidemics in Belfast and Glasgow, which it is to be hoped will result in increasing our knowledge of the exact nature of the disease, more especially as regards its spread, and its differential diagnosis from other forms of cerebro-spinal meningitis, which clinically resemble it. That the disease can occur in a dangerous epidemic form (e.g., the mortality in the Glasgow outbreak was 72.1 per cent.) the experience of these two large cities sufficiently testifies, and the publication of the facts associated with the outbreaks will be awaited with interest. 97 With regard to the houses from which these ten cases of epidemic cerebro-spinal fever were notified, disinfection was carried out in every case, and in the cases in which the bacteriological evidence was positive, the walls were in addition stripped. All drains were tested, and any insanitary conditions or defects found were remedied. It is a fact worthy of note that although most of these ten cases were notified from houses where the patient had been in contact with several other members of the family or occupants of the same house, no second case occurred in the same house in any instance. This would seem to suggest that the disease is not infectious to any very marked extent, as is the case with many of the more common infections, or it may be that there are certain conditions or special circumstances surrounding these cases, rendering the patient liable to infection. What these factors are is not at present clear, but bearing in mind the extremely fatal nature of the disease and the experiences of past epidemics which have at various times been recorded, it is important that the degree of infectiousness and the channels by which it is spread should be cleared up, and, as I have said, the results of the recent outbreaks in Glasgow and Belfast when published, may help to throw light on the subject. Meanwhile, it is the safest course to treat the disease as a dangerous infectious disease, with respect to which every precaution should be taken by a sanitary authority to prevent any possible spread of infection. Measles. As Measles is not a notifiable disease, we are dependent on the school returns and the death returns for our knowledge of its prevalence and severity. During 1907 there were 72 deaths recorded from the disease, or 22 below the average for the ten years, 1897-1906, as compared with 44 in 1906, and 124 in 1905. .The death-rate was .39 per 1,000 population, as compared with .53 per 1,000, the mean death-rate for the preceding ten 98 years. The death-rate in East Battersea was .47; North-West Battersea, .54; South-West Battersea, .15. The London death-rate for measles was .38 per 1,000, there being 1,801 deaths registered from this cause. It is probable that these figures do not fully represent the total loss of life due to this disease, many deaths being registered as due to bronchitis and other respiratory diseases, which are common complications and sequelae of measles, and which should more properly have been registered as due to measles. Measles and whooping cough caused more deaths in Battersea (viz., 134) during 1907 than all the other notifiable infectious diseases put together. The number of deaths registered in each of the registration sub-districts in 1905, 1906 and 1907 was as follows:— 1907. 1906. 1905. East Battersea 36 28 53 North-West Battersea 27 14 67 South-West Battersea 9 2 4 The variability of incidence in mortality during the last three years is exemplified in the above figures. Fifteen deaths were of infants under one year, and 54 of children aged one to five years, and only three deaths occurred among children over five years of age. The deaths in each of the four quarters of the year were as follows:— First quarter 4 Second quarter 17 Third quarter 35 Fourth quarter 16 Measles is usually looked upon as a trifling ailment, and it is difficult to get parents to realise what a really formidable disease it is, especially in the case of very young children. It 99 is, of course, a counsel of perfection to expect parents of the poorer class, living as many of them have to do, with several children in two or three rooms, to secure isolation, but many lives would be saved if they would only learn to regard the disease as a dangerous one, and exercise due care in protecting the patients, more especially in the earlier stages, from complications, which, in the majority of instances, give rise to a fatal issue. Measles is chiefly spread through the medium of schools, especially the infant departments. Closure of these latter should, during the earlier stages of an outbreak, be more freely resorted to, and would tend to reduce the high rate of mortality from this disease in the Metropolis. It will be remembered that in 1903 new powers were granted to the Local Authority in respect of measles, which was to be treated as a dangerous infectious disease, to which all the provisions of the infectious disease sections of the Public Health (London) Act were made applicable, with the exception of notification. During 1907, however, 931 cases of measles were reported to the Medical Officer of Health by the Head Teachers of the Public Elementary Schools. This practice has proved to be of considerable assistance in checking the spread of infection. Below will be found a table giving a list of schools, and showing the number of cases of non-notifiable infectious diseases reported during 1907. 100 Infectious Illness Reported from Schools during the Year 1907. SCHOOLS. Measles. Mumps. Whooping Cough. Chickenpox. Other diseases. Total. *S NS S NS S NS S NS S NS S NS Basnett Road 11 4 2 ... ... 1 2 9 12 3 27 17 Battersea Park Road 68 28 7 ... 4 7 28 14 13 1 120 50 Belleville Road 21 28 29 8 1 2 4 24 3 79 41 Bolingbroke Koad 23 61 ... ... 7 ... 1 2 10 ... 41 63 Ethelburga Street 57 18 7 5 12 5 3 1 r7 1 96 30 Gideon Road 42 47 10 12 10 1 8 7 37 6 107 73 Holden Street 41 26 8 2 28 6 12 3 21 2 110 39 Honeywell Road 4 10 6 5 38 5 15 11 11 ... 74 31 The Latchmere 15 20 24 4 8 2 18 16 42 ... 107 45 Lavender Hill 34 18 33 15 47 9 26 6 42 ... 182 49 Mantua Street 55 41 3 1 10 1 20 15 19 ... 107 58 New Road 63 65 5 30 16 6 14 7 ... hi 95 Plough Road 36 26 21 1 51 2 14 14 29 ... 151 45 Ponton Road 6 25 ... ... ... ... 2 7 ... ... 8 32 Raywood Street 78 81 20 14 22 13 41 63 86 ... 247 174 St. Andrew's Street 9 8 ... ... 3 ... 3 2 7 ... 22 10 St. George's ... 4 ... ... ... ... 4 2 ... ... 4 6 St. John's 5 13 ... 2 3 ... ... 1 ... ... 8 19 St. Mark's 4 7 7 2 ... ... 9 ... 1 ... 21 9 St. Mary's (Green Lane) 22 43 2 ... 12 13 6 20 10 ... 52 77 Shillington Street 48 21 20 1 23 1 3 1 6 ... 100 24 Sleaford Street 40 42 2 ... 31 8 25 26 44 ... 142 77 Surrey Lane 18 24 ... ... 3 ... ... ... 4 ... 25 24 Tennyson Street 97 3° 3 ... 7 3 38 6 9 ... 154 40 Winstanley Road 55 34 10 2 91 24 6 11 35 ... 197 71 Wix jane 75 17 20 8 22 ... 23 8 6 ... 146 34 Wycliffe Road ... 3 1 ... ... ... 1 3 ... ... 2 6 SCHOOLS OUT OF THE BOROUGH. Aristotle Road 1 ... ... ... ... ... ... ... ... ... 1 ... Eltringham Street 2 2 1 2 ... 3 ... 1 4 3 7 11 Springfield 1 ... ... ... ... ... ... ... ... ... 1 ... Total 931 746 241 84 463 124 3'8 263 496 33 2.449 1,250 * Note—S = Suffering. NS = Excluded owing to infection in house. All cases reported are visited by the district Inspectors, and enquiries made as to sanitary conditions, &c. Endeavours are made to secure such isolation as is possible, and disinfection is carried out after each case. The following leaflet of instructions has been widely distributed by the Inspectors, to 101 check outbreaks of the disease, which, with whooping cough, are responsible for more deaths than all the other infectious diseases put together. BATTERSEA BOROUGH COUNCIL. Measles. Measles is unfortunately very prevalent in certain districts of Battersea at the present time, and it is important that precautions should be taken to prevent the spread of the disease. It cannot be too clearly understood that Measles is a most dangerous disease, especially to very young children, and large numbers of deaths occur from the disease yearly in Battersea, as well as in other Metropolitan districts, and the disease is, as a rule, much more fatal than other forms of dangerous infectious disease which the public regard with greater dread. Measles, though frequently occurring in a mild form, at all times requires careful nursing, and particularly protection from cold. Bronchitis and pneumonia are common complications, and cause many deaths. These complications, which greatly increase the danger to life, are largely preventable, and it is highly desirable that medical advice should be obtained with this object at an early stage of the disease. Infected children should be kept from school for at least one month, and other children from the same family attending Infants' School must also be kept at home for fourteen days. Rooms must be disinfected in all cases (by the Sanitary Authority). Intimation of fresh cases of measles should be made to the undersigned. G. Quin Lennane, Medical Officer of Health 102 It will be remembered that the Education Department, London County Council, adopted new regulations for the exclusion of children suffering- from measles, or coming from houses where measles exists. These regulations are as follows:— Children suffering from measles must be excluded for at least one month. Children coming from houses where measles exists, but who are not themselves suffering from the disease, should be dealt with as follows:— 1. A child attending school, other than an infants' school, who has had measles, must not be excluded from attendance at school. 2. A child attending other than an infants' school, who has not had measles, must be excluded from attendance at school until the Monday following the expiration of 14 days from the occurrence of the first case. 3. A child attending an infants' school, whether or not it has made measles, must be excluded from attendance at school until the Monday following the expiration of 14 days from the occurrence of the last case. The above regulations do not appear to have had any effect, so far as the Borough of Battersea is concerned, in checking the spread of the disease, as will be noted when comparing the mortality statistics for 1906 and 1907 respectively. Much more effectual, in my opinion, would it be to exclude from attendance at school children (at least) under five years of age. When it is remembered that 72 deaths of children from this disease (which probably understates the mortality from measles, as there are many deaths registered as being due to bronchitis and pneumonia which should more properly be registered as due to measles), and that 69 of these deaths (i.e., 95 per cent.) were of children under five years of age, the necessity for this reform will be at once apparent. 103 Whooping Cough. Whooping Cough, like measles, is a very fatal disease of childhood, especially to very young children. During 1907, in the Borough of Battersea, 62 deaths from this disease were registered, as compared with 78 in 1906. The deaths were 10 below the average for the preceding ten years, and were equivalent to a death-rate of .34 per 1,000, as compared with .40, the mean death-rate for the previous ten years. In the sub-districts the number of deaths and the deathrate per 1,000 of the population were as follows:— Death-rate per 1,000 of No. of Deaths. the population. East Battersea 29 0.38 North-West Battersea 21 0.42 South-West Battersea 12 0.21 It will be noted, as showing the influence of environment, that North-West Battersea suffered most, and South-West Battersea least from the disease. The death-rate per cent. under one year of age was 37.2, and from one to five years 62.8 per cent. The total percentage fatality under five years of age was 100. The extremely fatal character of this disease to children under five years of age is strikingly exemplified in the above figures. The disease, like measles, is especially dangerous to children of tender years, mainly spreads through the medium of the infant departments of the Public Elementary Schools, and this fact provides a strong argument, in my opinion, against the attendance at school of children under at least five years of age. It is very difficult to get the mothers of children suffering from measles and whooping cough to recognise the serious nature of these diseases. The old traditions in regard to them are still maintained, and rarely are any steps taken to secure isolation or to obtain medical aid, especially amongst the poorer classes, until too late. 104 Efforts are made by the Department to educate the parents up to the dangerous nature of the disease, and the Sanitary Staff visit the homes of the patients in the more crowded and congested parts of the Borough in every case reported from the schools or from other sources. Disinfection is carried out in cases where it is required. Some good is effected by these means, but much more requires to be done. This will only be accomplished by teaching the younger generation in the Public Elementary Schools the elementary principles of hygiene, and a knowledge of the signs and symptoms of the common infections. Elementary hygiene should form part of the school curriculum, and the lessons thus learnt would be found to form in after life a most useful safeguard against outbreaks of epidemic diseases, which are so frequently spread through ignorance of the dangerous nature of these diseases, and neglect of the most elementary precautions to prevent their spread. No school or class room was closed in 1907 on account of whooping cough. Diarrhœa. During the year 1907 the number of deaths from Diarrhœa registered in the Borough of Battersea was exceptionally low. Only 47 deaths were registered, as compared with 149 in 1906. Seventeen of these deaths were registered as being due to epidemic or zymotic enteritis. The death-rate was .25 per 1,000, or .56 below the decennial average, .81. The death-rate in the County of London was .32. Of the 47 deaths, 45, or 95 per cent., were of children under five years of age, and 36, or The deaths in each of the four quarters of the year were as follows:— First quarter 12 Second quarter 23 Third quarter 15 Fourth quarter 12 105 76 per oent., of infants under one year of age. During 1906 149 deaths from diarrhoea were registered, of which 108, or 72 per cent., were of infants under one year of age. The number of deaths and the death-rate in the subdistricts in 1906 and 1907 are set out below:— No. of Deaths. 1907. 1906. Death-rate per 1,000 population. 1907 1906. East Battersea 28 85 .36 1.13 North-West Battersea 15 49 .30 .98 South-West Battersea 4 !5 .07 .27 The deaths registered in each of the four quarterly periods in 1906 and 1907 were as follows:— 1907. 1906. First quarter 6 8 Second quarter 5 9 Third quarter 16 117 Fourth quarter 20 15 In July the Health Committee authorised the publication of a leaflet, drawn up by the Medical Officer of Health, on the subject of summer diarrhoea, and its prevention. A copy of this leaflet was, by order of the Committee, distributed to every house in the Borough. The year 1907 was very unfavourable for epidemic diarrhoea. In the County of London the deaths from diarrhoea during the year were less than half the corrected average number. The highest incidence from epidemic diarrhoea occurs in the third quarter, but in 1907 this was not the case in Battersea, the highest number occurring in the fourth quarter, as will be seen by contrasting the deaths registered in each of the four quarters in 1906 and 1907. The number of deaths from diarrhoea, 47, was the lowest ever recorded in the Old Parish or Borough,- being no less than 98 below the average for the ten years. The same remarkable decrease was evident all over the country. In London the death-rate from diarrhoea varied from .09 per 1,000 in Hamp- 106 stead, to .64 in Shoreditch. Diarrhœa is looked upon as a disease of bacterial origin. The factors favouring its development are a high atmospheric temperature and deficient rainfall, the contamination of food, especially milk, from dust, and the unhealthy conditions prevailing in crowded cities. The exact relationship existing between these various factors is not however yet fully known. The effect of season upon the incidence of the disease depends upon dryness and heat. A hot, dry summer, such as that which prevailed in 1906, favours the disease. A cold, wet summer, on the other hand, is unfavourable. In 1907 the summer was the very reverse of that which was experienced the previous year, and the effect of the different meteorological conditions which prevailed is strikingly exemplified in the mortality figures for 1906 and 1907 respectively. In 1906 the 4-foot earth thermometer reached 56 degrees F. on 14th June, or much earlier than in 1907. Fifty-six degrees F. is what is known as the critical earth temperature for diarrhœa, i.e., the temperature at which the germ which gives rise to this particular disease begins to multiply. In 1907 the 4-foot earth thermometer reached the critical temperature at a much later date, while the atmospheric temperature remained abnormally low, hence the unfavourable effect on the growth and multiplication of the organism. It will be interesting to give the meteorological conditions prevailing in the summer of 1907. The 4 foot earth thermometer registered 56° F. in South London on 29th June, rising to a maximum of 60° F. on 15th August, shrinking again to 56° on 13th October. Further, the mean monthly air temperatures were, June 57.8°, July 60°, August 61.6°, September 58.9°, October, 51.1°. While it is clear that the meteorological conditions are by far the most important in their bearing on the incidence and mortality from epidemic diarrhœa, the insanitary conditions prevailing in large towns and cities are amongst the contributing causes. It is a remarkable fact that breast-fed babies rarely suffer, while on the other hand artificially-fed children fall easy victims. This is not difficult to understand 107 when it is remembered that cows' milk or tinned milk are the most common substitutes for mother's milk. The risks from contamination which cows' milk undergoes (and to a lesser extent, perhaps, tinned milk) in its passage from the farm to the home, are innumerable. Milk is an excellent pabulum for the growth of pathogenic organisms, hence the great importance of protecting it from pollution. Other factors contributing to a high incidence and mortality from diarrhoea are overcrowding and poverty, employment of the mother away from home, and last, but unfortunately by no means least, ignorance. The influence of environment is very marked on the mortality from diarrhoea, as is apparent in the death-rate in East and North-West Battersea as compared with South-West Battersea. The preventive methods employed in Battersea aim at the removal of the conditions which are favourable to the disease. First and foremost, the importance of breast-feeding cannot be over-estimated. By visiting the homes where births occur, the Health Visitor endeavours to induce the mothers to feed the baby on the breast. Should this be impossible, then on pure, modified cows' milk. Instruction in the right methods of rearing children. General methods of sanitation, such as the proper cleansing of streets, courts, and alleys, and the maintenance of cleanliness and good sanitary conditions in houses and tenements are not overlooked. The paving of side streets with impervious material, which the Council started in 1905, has, in my opinion, proved most useful, and might with advantage be considerably extended. Lastly, there are the Infants' Milk Depot and the Weighing Room or Milk Clinic, which are dealt with in another part of this Report. Tuberculosis During 1907 304 deaths from Tuberculosis were registered in the Borough of Battersea. Of this number 219 (72 per cent.) were due to phthisis (tuberculosis of the lungs), 35 to 108 tubercular meningitis, 11 to tubercular peritonitis, 31 to general tuberculosis, 1 to tubercular disease of the larynx, and 7 to other forms of the disease. In 1906 the total number of deaths from tuberculosis was 308, and in 1905 323. The following table shows the death-rate from phthisis and other tubercular diseases per 100,000 persons in each year since 1892:— Year Deaths from Phthisis per 100,000 persons. Deaths from other Tubercular Diseases per 100,000 persons. 1892 135 18 1893 143 82 1894 137 53 1895 151 65 1896 146 79 1897 151 62 1898 154 71 1899 162 56 1900 155 53 1901 146 60 1902 129 44 1903 128 51 1904 139 41 1905 132 50 1906 122 48 1907 120 46 The above table exhibits a distinct decline in the deaths from tubercular disease. Taking the ten years 1892-1901, the average death-rate from these diseases is 18 per cent, higher than in 1907. The number of deaths from phthisis and other tubercular diseases, and the death-rate per 1,000 in each of the subdistricts and the Borough is set out in the following table:— 109 District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 117 1.54 48 0.63 165 2.17 Nth.-West Battersea 54 1.09 22 0.44 76 1.53 Sth.-West Battersea 48 0.84 15 0.26 63 1.11 The Borough 219 1.20 85 0.46 304 1.67 The deaths from tuberculosis were 12.6 per cent, of the total deaths; and the disease caused a higher mortality than all the other zymotic diseases put together. It should be noted, however, that the death-rate from phthisis (the most common form of tuberculous disease) was in 1907 1.20, or .02 lower than in 1906, and .09 lower than in 1905. Tuberculosis is essentially a preventable disease; and, although improved methods of sanitary administration have done much in recent years to check the spread of this insidious disease, which has been well termed the white plague, there is still much to be done to limit its activity. In Battersea no special measures, outside of general sanitary administrative methods, have been adopted, other than visiting the houses from which cases have been notified by philanthropic bodies or notices of deaths from tuberculosis sent to the Medical Officer of Health by the district Registrars. In these instances the houses are visited and inspected and disinfection carried out where permitted. The great drawback in dealing with these cases is the absence of some form of notification. Compulsory notification has been urged by sanitarians for some years, but so far without effect. 110 By means of a Local Act, compulsory notification has been in force in Sheffield for the past few years, and Glasgow and Edinburgh have since had compulsory notification in force. Whilst visiting Sheffield last year, 1 took the opportunity of seeing Dr. Scurfield, the Medical Officer of Health, on the results which had been obtained. I was informed that it was too early yet to speak with any degree of certainty, but so far as his experience went, the results obtained were distinctly encouraging. A Conference of Representatives of the City and Metropolitan Borough Councils, convened by the Paddington Borough Council, "on the question of taking measures to limit the spread of Pulmonary Tuberculosis (Consumption)" was held at the Town Hall, Paddington, on the 6th June, 1907. Twenty-six Metropolitan Sanitary Authorities out of 29 were represented. The Mayor of Paddington presided. The resolutions passed were (substantially) as follows:— That it is desirable that the notification of pulmonary tuberculosis (consumption) should be compulsory. That application be made to the Local Government Board for an Order to be made: (i.) To include pulmonary tuberculosis (consumption) among the diseases to be notified under Section 55 of the Public Health (London) Act, 1891. (ii.) To extend the provisions of the following sections of the above Act to pulmonary tuberculosis (consumption): Section 60—Cleansing and disinfection of premises. Section 61—Disinfection of bedding, &c. Section 62—Infectious rubbish thrown into ashpits, &c., to be disinfected. Section 63—Penalty on letting houses in which infected persons have been lodging. 111 Section 64—Penalty on persons letting houses making false statements as to infectious disease. Section 65—Penalty on ceasing to occupy a house without disinfection or notice to owner, or making false answer. That it is desirable, in order to limit the spread of tuberculosis, that provision should be made for public inspection and control, at its several sources, of the milk supply of England; and to ask the Local Government Board to take steps to secure the efficient administration of the Dairies, Cowsheds, and Milkshops Order, 1885, and Orders amending the same. That application be made to the Local Government Board for an Order to extend the provisions of Section 69 of the Public Health (London) Act, 1891, to pulmonary tuberculosis, in so far as it relates to the milking of cows and to the sale and distribution of milk. That the provisions conferred by Section 7 (1) of the Factory and Workshops Act, 1901, namely, that in every room in any factory or workshop sufficient means of ventilation shall be provided, and sufficient ventilation maintained, be rigidly enforced, and a similar provision extended to all places where people are assembled together for any lengthened period, with a view to restricting the spread of pulmonary tuberculosis. That a sanatorium is needed for the open-air treatment of poor persons suffering from pulmonary consumption, in the early stages of the disease, and should be provided by a central authority acting for the Metropolis as a whole. That the Managers of the Metropolitan Asylums Board, by reason of their practical experience in the management of hospitals for infectious disease, being 112 eminently qualified for the position of such authority, the Local Government Board be requested to confer on, or, if necessary, to obtain for the said managers, power to act in that capacity. That the Managers of the Metropolitan Asylums Board should also be empowered to use for sanatorium purposes the "Southern Hospital," recently erected by them at Carshalton, in the County of Surrey. That the Government be asked to provide a sum of money annually for the erection and maintenance of suitable sanatoria for the treatment of early cases of consumption. Voluntary notification is in operation in Manchester, Brighton, and many other large towns, as well as in some of the Metropolitan Boroughs, and a fair amount of success has attended its working. I am strongly of opinion that this would prove of assistance in Battersea in checking the disease. At the present time we begin at the wrong end of the stick in dealing with the disease, and much better results would be obtained if notification were in operation. This would enable the Health Department to adopt such measures of precaution as may be required, both in the interest of the patient, and for the protection of others who may be in contact with him. During 1907 the Second Interim Report of the Royal Commission on Tuberculosis was issued, and is a most important document. The Report definitely and clearly proved the interchangeability of human and bovine tuberculosis, which was so sensationally denied by Dr. Koch at the British Congress on Tuberculosis in July, 1901. The Commission sum up the bearing of the results at which they have already arrived as follows:— "There can be no doubt but that in a certain number of "cases the tuberculosis occurring in the human subject, especi"ally in children, is the direct result of the introduction into 113 "the human body of the bacillus of bovine tuberculosis. And "there also can be no doubt that in the majority at least of "cases the bacillus is introduced through cows' milk. Cows' "milk containing bovine tubercle bacilli is clearly a cause of " tuberculosis, and of fatal tuberculosis, in man." "Of the sixty cases of human tuberculosis investigated by "us, fourteen of the viruses belonged to Group I., that is to "say, contained the bovine bacillus. If, instead of taking all "these sixty cases, we confine ourselves to cases of tuberculosis "in which the bacilli were apparently introduced into the body "by way of the alimentary canal, the proportion of Group I. "becomes very much larger. Of the total sixty cases investi"gated by us, twenty-eight possessed clinical histories indic"ating that in these the bacillus was introduced into the body "by way of the alimentary canal. Of these thirteen belonged "to Group I. Of the nine cases in which cervical glands were "studied by us, three, and of the nineteen cases in which the "lesions of abdominal tuberculosis were studied by us, ten, "belong to Group I. "These facts indicate that a very large proportion of "tuberculosis contracted by ingestion is due to tubercle bacilli "of bovine source. "A very considerable amount of disease and loss of life, "especially among the young, must be attributed to the con"sumption of cows' milk containing tubercle bacilli. The "presence of tubercle bacilli in cows' milk can be detected, "though with some difficulty, if the proper means be adopted, "and such milk ought never to be used as food. There is far "less difficulty in recognising clinically that a cow is distinctly "suffering from tuberculosis, in which case she may be yielding "tuberculous milk. The milk coming from such a cow ought "not to form part of human food, and, indeed, ought not to be "used as food at all. "Our results cleatly point to the necessity of measures "more stringent than those at present enforced, being taken to "prevent the sale or the consumption of such milk." 114 The importance of these results cannot be over-estimated, and should be followed by legislative measures giving greater powers to sanitary authorities to enable them to enforce the precautions recommended by the Commission. This has been to some extent accomplished, so far as London is concerned, by the passage of the London County Council (General Powers) Act, 1907, relating to tuberculous milk. Much more remains to be done, however, if the disease is to be stamped out, and this can only be successfully accomplished, in my opinion, by the introduction of some method of compulsory notification, without which it will be difficult, if not impossible, to adopt preventive measures almost equally as important as those referred to by the Commission with regard to tuberculous milk. During 1907 133 houses where deaths had occurred from pulmonary tuberculosis were disinfected, representing 84 per cent, of the fatal cases occurring in private houses. By arrangements with the district Registrars, information of the deaths of patients from phthisis are immediately sent to the Medical Officer of Health, and steps are at once taken to have the houses in which patients died disinfected. During 1907 67 samples of sputum were examined bacteriologically, 19 of which were found to give a positive and 48 a negative result. Cancer. The number of deaths from cancer registered in the Borough during 1907 was 153, as compared with 172 in 1906, and 171 in 1905. In the subjoined table will be found the number of deaths and the death-rate per 100,000 of the population since 1893:— 115 Year. Deaths. Deaths per 100,000 persons. 1893 85 54 1894 110 62 1895 114 70 1896 105 63 1897 104 62 1898 122 73 1899 113 67 1900 130 77 1901 117 69 1902 151 88 I903 141 81 1904 164 93 I905 171 96 1906 172 95 1907 153 84 Taking the average number of deaths for the ten years 1897-1906, viz., 138.5, as compared with 153 deaths during 1907, there would appear to be an increase in the mortality from this disease during the decennium. This may, to some extent at least be due to improved methods of diagnosis and certification. In the following table the anatomical distribution of the disease in both sexes is shown :— 116 Situation. Males. Females. Total. Mouth and Jaw 6 1 7 Tongue 6 — 6 Stomach and (Esophagus 21 14 35 Liver 3 14 17 Bowels 3 7 10 Rectum 5 4 9 Breast — 14 14 Chest 4 1 5 Uterus — 19 19 Ovary — 2 2 Abdomen 6 6 12 Other situations 12 5 17 Totals 66 87 153 Alcoholism. During- the year 1907 in the Borough of Battersea, 8 deaths were registered from acute and chronic alcoholism (males 3, females 5). In addition to these, 19 deaths were registered from cirrhosis of the liver (males 9, females 10), a disease which is, in the vast majority of cases, due to alcohol. The total number of deaths therefore to be ascribed to alcohol is 27, as compared with 20 in 1906 and 30 in 1905. This shows a slight increase in the number of deaths from this cause registered during the year under report. Unfortunately, there are reasons for believing- that many deaths really due to 117 the excessive use of alcohol are registered under less invidious heading's, and it is consequently impossible with any degree of certainty to record the mortality due to this cairse from the death returns. There is evidence, however, so far as Battersea is concerned, pointing to a distinct improvement in the habits of the people as regards the use of intoxicants. Bacteriological Examination. By arrangement with the Clinical Research Association, medical practitioners practising in the Borough of Battersea are afforded facilities for the bacteriological examination of specimens from suspected cases of diphtheria, enteric fever and phthisis. The cost of the examinations are borne by the Council. Practitioners may also, by arrangement with the Medical Officer of Health, submit to the Association specimens from patients suspected to be suffering from diseases other than the three mentioned above. There can be no doubt that this procedure has been of great assistance in the diagnosis of doubtful cases of these dangerous infectious diseases. It has been largely availed of by the medical men of the district during 1907, the total number of specimens examined being 508 as compared with 348 in 1906. The following table gives particulars as to the examinations made during the year 1907. Suspected disease. Positive Results. Negative Results. Total. Diphtheria 116 270 386 Enteric Fever 8 41 49 Tuberculosis 19 48 67 Cerebro-spinal fever — 5 5 Glanders 1 — 1 Total 144 364 508 General Sanitary Administration. 121 General Sanitary Administration. The following table gives a summary of the work of the sanitary inspectors, so far as the work admits of tabulation. Summary of Sanitary Operations for the Year 1907. Total Sanitary Operations 84127 Dust receptacles provided 652 Number of house inspections 44450 Leaky house-roofs and gutters repaired 728 Bakehouse inspections 232 Bakehouse nuisances abated 78 Houses supplied with water, and fittings repaired 285 Urinals—inspections 425 Do. altered, repaired, or water laid on 124 Water closets supplied with water or supply disconnected from drinking water cisterns 783 Intimations served under Sec. 3 5794 Notices served under Sec. 4, &c. 1506 Cisterns covered, cleansed and repaired 904 Notices served under Sec 62 & 65 2698 Complaints received & attended to 3903 Keeping of animals in unfit state discontinued 88 Number of houses disinfected 2908 Houses supplied with disinfectants 6133 Smoke observations 205 House drains flushed with disinfectants after infectious disease 2987 Certificates of disinfection granted 3123 Houses inspected and certificates granted (Sec. 48) 31 Overcrowding abated 129 Proceedings Ordered by Council and Health Committee 5158 Premises cleansed and repaired 2515 Drains tested ... By smoke 1213 Summonses issued 194 ,, water 4688 Magisterial Orders obtained and enforced 107 Drains cleansed and repaired 422 Drains relaid 534 Factories, Workshops,&c.,inspections 4429 Frontage drains constructed or re-constructed 79 Sanitary conveniences provided or improvements effected in Factories & Workshops (Sec. 38) 335 Soil-pipes and drains ventilated 449 Sink and rain water pipes disconnected or repaired 453 Water Closets cleansed & repaired 880 Underground sleeping rooms disused 91 Cesspools abolished — Mews & Stables drained & paved 11 Gipsy van inspections 224 Yards and forecourts paved 828 Drains laid to new houses and tenements 3 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 116 Samples taken under the Sale of Food and Drugs Acts 1000 122 The Sanitation of House Property. The sanitary supervision of existing houses is one of the most important duties of sanitary authorities, intimately bound up as it is, with the housing question. The difficulties associated with the housing question in London to-day are largely due to the imperfect sanitary supervision which in the past appears to have been exercised in this direction. A good deal of attention has in recent years been devoted to this important subject in Battersea, and while it has not been possible to repair the evil due to neglect of effective supervision in the earlier years of its history, much good work has been done owing to the activity displayed, especially during the past five or six years. Systematic house-to-house inspection is the only satisfactory way to carry out this sanitary supervision, and it is a duty put upon sanitary authorities by Section 1. of the Public Health (London) Act, 1891, and by Section 30 of the Housing of the Working Classes Act, 1890. Sanitary supervision of existing houses to be effective should be two-fold in its application, that is, it must deal with house structure and sanitary maintenance, including the absence of overcrowding. The past year's work in this direction has shown a distinct improvement on that of 1006, and will bear favourable comparison with previous years The total number of houses inspected in house-to-house inspection during 1907 was 4,101. This is a considerable increase over the figures for 1906, and has only been exceeded in one year, viz., 1905, when the highest number of houseto-house inspections in any one year, since the formation of 123 the Borough, was carried out. The following figures show the number of houses inspected in each year since 1900. 1900 3,009 1901 3,116 1902 1,740 1903 2,670 1904 3,020 1905 4,503 1906 3,609 Average for 7 years, 1900-1906 = 3,095 1907 4,101 The prevalence of infectious disease in certain parts of the Borough (in common with the rest of London) during- 1907 took up a good deal of the time of the Inspectors. Notwithstanding this, however, the fact that about 1,000 more inspections over the average 1900-1906 must be considered a highly satisfactory record. House-to-house Inspection. The following table gives particulars as to the number of houses inspected in house-to-house inspections during 1907. 124 House-to-House Inspection. east battersea. north-west battersea. south-west battersea. Name of Road. No. of houses inspected. No. of houses in which defects existed Name of Road No. of houses inspected. No. of houses in which defects existed Name of Road No. of houses inspected. No. of houses In which defects existed Acanthus Road 23 10 Abercrombie Street 63 49 Abyssinia Road 18 10 Arliss Road 50 21 Barmore Street 21 19 Aliwal Road 53 44 Arthur Street 12 11 Benfield Street 39 39 Amner Road 31 8 Beaufoy Road 1 1 Bolingbroke Road 45 32 Auckland Road 32 17 Belfour Street 37 33 Cabul Road 71 53 Battersea Rise 45 24 Berkeley Street 16 14 Candahar Road 59 51 Beauchamp Road 49 40 Blondel Street 88 66 Church Lane 33 25 Boutflower Road 17 16 Bramwell Street 17 15 Cottage Place 21 17 Bramfield Road 53 23 Brougham Street 55 34 Duffield Street 45 40 Broom wood Road 190 58 Carlton Grove 10 7 Falcon Grove 45 27 Burland Road 13 9 Cupar Road Currie Street 20 13 Falcon Terrace 41 25 Cairns Road 1 — 47 36 Fords Place 60 50 Chatto Road 36 17 Dickens Street 18 10 Freeland Street 20 17 Dents Road 19 4 Eland Road 83 23 Grant Road 106 75 Dulka Road 22 7 Everett Street 39 38 Harley Street 27 16 Freke Road 23 18 Landseer Street 65 46 Hyde Lane 24 14 Garfield Road 54 46 Lavender Hill 83 38 Kerrison Road 45 34 Gorst Road 47 17 Longhedge Street 73 63 Lavender Terrace 34 26 Gowrie Road 29 22 Lurline Gardens 66 30 Little Europa Place 37 37 Grandison Road 64 33 Macduff Road 10 6 Lombard Road 13 5 Hillier Road 49 17 Ponton Road 30 24 Lothair Street 9 8 Ilminster Gardens 31 23 Ponton Street 15 15 Newman Street 26 18 Keildon Road 36 25 Prairie Street 57 33 Parkham Street 39 24 Kyrle Road 1 — Roundell Street 18 16 Fearson Street 21 14 Lavender Hill 45 16 Sabine Road 158 86 Randall Street 38 22 Leathwaite Road 30 17 St. James Grove 13 9 Speke Road 84 54 Limburg Road 23 19 Savona Street 36 25 Stanmer Street 48 30 Mallinson Road 65 35 Shellwood Road 16 10 Wayford Street 28 24 Marney Road 82 55 Silverthorne Road 65 29 Winstanley Road 54 37 Nansen Road 61 55 Theatre Street 72 66 Rush Hill Mews 9 9 Tipthorpe Road 29 9 Rush Hill Road 30 24 Trollope Street 36 15 Shelgate Road 54 45 Wellington Road 6 6 Stormont Road 7 7 Wickersley Road 152 102 Strathblaine Road 3 3 William Street 29 27 Woodgate Street 32 32 Wycliffe Road 6 6 Totals 1,583 1,025 Totals 1,196 882 Totals 1,322 763 125 In addition to the above, special areas were dealt with by the Medical Officer of Health personally. These areas were situated in No. 1, No. 3 and No. 4 sanitary districts. Special attention was given to particular streets in those areas owing to the dilapidated and insanitary condition of many of the houses. In No. 1 district the following were the streets which called for attention:— Belfour Street Woodgate Street Ponton Street Ponton Road Everett Street Bramwell Street The condition of many of the houses in these streets was very bad—dirty, damp, dilapidated and verminous. With regard to the worst of these houses I had an interview with the agent, who promised to carry out the Council's requirements. As a result, a very considerable improvement was effected in the condition of these houses. In some houses in Bramwell Street, as a result of several cases of infectious disease having occurred therein, I visited and inspected the houses, which I found to be in a very insanitary condition. The sanitary convenience in 5 of these houses was situate in the scullery, and practically ventilated into the kitchen. In addition to this unsatisfactory and dangerous state of things, the houses were, for the most part, dirty, dilapidated and verminous. I had an interview with the owner, who arranged, at my suggestion, to remove the w.c.'s to the yard and to thoroughly cleanse and repair the houses throughout, and the premises are now in a satisfactory condition. In No. 3 district a personal house-to-house inspection was carried out in Ford's Place and Little Eurapa Place. The condition of several of the houses in the latter street was so bad as to appear to me to be impossible to deal with satisfactorily under the Public Health (London) Act, 1891. I made a special report to the Committee, and applied for notices to be served under Part II., Section 32, of the Housing of the Working Classes Act, 1890. The amount of structural 126 requirements necessary in many of these houses to put them into a satisfactory condition of repair induced me to advise the Committee that action should be taken under this Act in preference to the Public Health Act. The powers under the former Act had not, however, been previously used in this Borough, and the Committee gave instructions to serve the usual notices under the Public Health Act and reported their action to the Council. The Council called for a joint report from the Solicitor and the Medical Officer as to the best method of dealing with similar nuisances in the future. The joint report will be found on pages 245 to 253 in the Appendix. Considerable difficulty, as was anticipated by me, was experienced in getting the notices under the Public Health Act complied with. The Health Committee, in consequence of the delay in carrying out the Council's requirements, visited the premises, and instructed me to write to the owner informing him that unless the Public Health Act Statutory Notices were complied with within a reasonable time proceedings would be taken against him. Notwithstanding this, the work was still carried out in a dilatory and unsatisfactory manner, and the Solicitor was accordingly instructed to take proceedings. The notices are now practically complied with, but the work has not been done satisfactorily, and is not likely to prove of a permanent character, so that the property will, I have little doubt, be before long in as bad a condition as before. It was for this reason I had advised the Committee to proceed under the Housing Act, as an order under that Act is not to be withdrawn until the premises concerned have been put into proper order and condition to the satisfaction of the Borough Council. I am glad to report that the Council decided to make use of the powers conferred on them under Part II., Section 32, of the Housing of the Working Classes Act, 1890, in the future in similar cases as may from time to time be brought to the notice of the Health Committee by the Medical Officer of Health. On the whole, the work done during the year in connection with insanitary property, has been of a satisfactory 127 character. In the more crowded and insanitary areas of the Borough, the necessity of more frequent inspection of house property is urgent, to level up all houses to a fair sanitary standard as well as to check overcrowding. Property has its rights as well as its duties, and it is my practice in dealing with insanitary houses to write to the owners concerned to meet me on the property and to discuss the measures necessary to be taken to put the premises into a satisfactory condition of repair. Every opportunity is given for the Council's reasonable requirements to be complied with, and it is understood that unless these are carried out it will be my duty to advise the Council to take the necessary steps to enforce them. In this way every opportunity is given the owner or owners concerned to carry out their duties. It was found necessary to apply for closing orders under the Public Health (London) Act, 1891, in respect of Nos. 7, 9 and 11 Livingstone Road, the premises being unfit for human habitation. Closing orders were obtained and enforced where necessary. Houses Let in Lodgings. In the Borough of Battersea there are a number of houses, more especially in North-West Battersea, let in lodgings under circumstances and conditions which render it desirable in the interests of personal and public health that they should be registered and inspected at frequent intervals. By the end of 1907, 123 premises were on the Register, and no additional houses were placed on the Register during the year. The bye-laws were revised in 1904, and having been duly sanctioned by the Local Government Board, are now in force in the Borough in 1905. Provisions exist in the bye-laws (a) For fixing the number of persons who may occupy a house, or part of a house, which is let in lodgings or occupied by members of more than one family. (b) For the registration of houses so let or occupied. (c) For the inspection of such houses. 128 (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses. (e) For the cleansing and limewashing, at stated times, of the premises. (f) For the taking of precautions in case of infectious disease. The two main objects of the bye-laws are the maintenance of sanitation and cleanliness and the prevention of overcrowding. The former is attained by a variety of bye-laws (9-17) and the latter by bye-laws 3 and 4, which lay down the following standard:— 3. A lodger in a lodging-house and, subject to the provisions of these bye-laws the keeper of the lodging-house or, where there is no keeper and the landlord resides on the premises, the landlord of the lodging-house shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred and fifty cubic feet of free air space for each person of an age exceeding ten years, and of one hundred and seventy-five cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which in the case of the lodger has been let to such lodger. 4. A lodger in a lodging-house and, subject to the provisions of these bye-laws the keeper of the lodging-house or, where there is no keeper and the landlord resides on the premises, the landlord of the lodging-house shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred and fifty cubic feet of free air space for each person of an age exceeding ten years, and of two hundred and twenty-five cubic feet of free air space for each person of an age not exceeding ten years to occupy, at one time, as a sleeping apartment, a room which is not used exclusively for that purpose and which in the case of the lodger has been let to that lodger. 129 Paving of Yards and Forecourts. The following table shows the number of back-yards and forecourts wholly or partly paved during 1907:— Ward. Back-yards Paved. Forecourts Paved. Wholly paved. Partly Paved. Wholly paved. Partly paved. As far as 12 ft. or more from back addition. For a lesser distance than 12 ft. 1 20 25 54 14 1 2 21 — 29 5 4 3 31 61 183 1 — 4 30 — 119 — — 5 35 7 117 — — 6 40 29 100 15 22 7 2 — — — 1 8 14 1 4 15 10 9 4 1 12 1 3 Totals 197 124 618 51 41 The above table does not include yards or forecourts the paving of which was merely repaired, nor does it include the work in connection with new buildings. No attempt was made to enforce the paving of any yard or forecourt which was being really cultivated as a garden. The yards and forecourts which were paved were those which, owing to their dirty and untidy condition, were a danger to the health of the occupants of the houses to which they were attached. The importance of the paving with impervious 130 material of the ground adjoining dwelling-houses, more particularly in the poorer and more crowded districts of the Borough, in connection with the prevention of dangerous infectious disease, is too well recognised by sanitarians to be any longer a matter for controversy. Block Dwellings. The following- is a list of the artizans' dwellings of the "block" type in the Borough of Battersea, with the number of tenements in each:— Name of Buildings. Situation. Owner. No. of tenements. Battersea Bridge Buildings Bridge Road London County Council 69 Durham Buildings York Road ,, 108 Victoria Dwellings Battersea Park Road Victoria Dwellings Asso., Ltd. 189 Lombard Dwellings Lombard Road Exors. of Francis Ravenscroft 36 Shaftesbury Chambers Ashbury Road Artizans, &c., Dwellings Co. 22 These dwellings are frequently inspected and any insanitary conditions found are remedied. It is satisfactory to be able to record the fact that very few cases of infectious disease have been notified during 1907 from these dwellings, the total number of cases notified for the year being 9 as compared with 16 in 1906. Common Lodging Houses. The following table gives a list of the Common Lodging Houses in the Borough:— 131 Premises. Authorised Number of Lodgers. Whether Males or Females. Date registered. 75 Falcon Road 78 Males March, 1900 5 Sheepcote Lane 11 Males July, 1901 7 „ „ 10 Males „ „ 53 Surrey Lane 39 Females May, 1885 55 „ „ 36 Females „ „ 57 „ „ 22 Males and Females July, 1895 59 „ „ 24 Males and Females June, 1903 89 „ „ 28 Males August, 1885 91 „ „ 30 Males Nov., 1887 6 Orville Road 18 Males June, 1902 Under the Common Lodging Houses Act, 1853-5, the London County Council has control over all the Common Lodging Houses situated within the Metropolis. All Common Lodging Houses must be licensed by the London County Council annually, in accordance with the provisions of the London County Council (General Powers) Act, 1902, Part IX., Sec. 46. The Common Lodging Houses in the Borough are visited from time to time in connection with drainage defects, cases of infectious disease, &c. Van Dwellings. The number of these dwellings in Battersea in 1907 was 81 as compared with 74 in 1906. In the following table are set out the situation and number of occupants :— 132 Situation of Vans. No. of Vans No. of Occupants. Males. Females. Mill's Yard, 88 Sheepcote Lane „ 80 „ Gurling's Yard, High Street Manley's Yard, Falcon Road „ Cabul Road Donovan's Ground, Cabul Road Mill's Yard, Culvert Road "Gray's Fair," Lavender Hill Total 5 4 10 3 26 16 12 5 81 7 4 25 4 25 24 21 5 115 7 3 !5 3 36 25 26 9 124 These vans are frequently inspected by night as well as day. Twenty-five vans were found to be overcrowded, and various structural defects in the vans or in the yards in which they stand were dealt with. The new bye-laws relating to tents, vans and sheds, which were confirmed by the Local Government Board in 1904, gave powers to the Council to have the yards in which these vans are situate adequately paved. This has been extensively carried out, and the general condition of these places has been improved. Constant attention has to be paid to them, however, to prevent nuisances arising. Only 2 cases of infectious disease were notified from van dwellings during the year. Sewer Ventilation. During the year 21 ventilating shafts were erected, one of which was erected by the London County Council, for 133 the purpose of ventilating the London County Council's sewer in Battersea Park Road. The remaining 20 were erected by the Borough Council, to ventilate their sewers, situate as follows:— Albert Bridge Road. Battersea Square. Boutflower Road. Castle Street. Clapham Common West Side. Clapham Common North Side (2). Emma Street (3). Harroway Road. Juer Street. Knowsley Road. Queens Road. St. John's Hill (2). St. James' Road. Wilson Street. Wandsworth Common (2). During the year complaints were occasionally received of the nuisance arising from sewer ventilators on the surface of the roadway. These complaints were in every case enquired into, and ventilating columns were erected to mitigate the nuisance in the localities which gave cause for complaint. During 1906 19 of these shafts had been erected, making a total of 40 during the past two years. It is to be hoped that the efforts which the Council have made to prevent nuisances arising from sewer emanations will meet with success. The problem of sewer ventilation is a troublesome one, and a good deal of controversy has taken place as to the best method of dealing with the subject. All sanitarians are, however, agreed that the more efficiently the sewers are ventilated, the less likelihood is there of a nuisance arising. In well laid, well built, properly ventilated and frequently flushed sewers sewer gas is very rarely given off. The provision of a greater number of open ventilating grids in the 134 middle of the roadways, except in the cases of narrow streets or courts, would in my opinion, greatly tend to minimise the nuisance which occasionally is complained of in the Borough. The erection of upcast ventilating shafts cannot, in my opinion, take the place of the surface grid for ventilating purposes. The former may form a useful combination with the latter, but of themselves upcast shafts, owing to friction due to bends in the pipes, &c., are of necessity incapable of fulfilling the object intended. The danger to health from open surface ventilating grids, especially in wide thoroughfares, is not, I think, a matter for serious consideration. The occasional nuisance which undoubtedly does arise from their presence is compensated for by the knowledge that sewer emanations must necessarily be less harmful in the open air, where they rapidly become diluted and innocuous, than when accumulating in the sewers. Under such circumstances the gases may become at times, especially in foul and badly ventilated sewers, sufficiently concentrated to force the intercepting traps of the house drains. Just as pollution of the room air is prevented by efficient ventilation, so will sewers be prevented from becoming a nuisance or a danger to health when they are provided with an adequate supply of air inlets and outlets, to ensure a free flow of fresh air through them. Putrefaction of their contents is in this way prevented, and while at times, owing to the operation of well known physical laws, fresh air inlets may become outlets, less nuisance is likely to arise, and certainly little or no risk to health. Hygienic Street Paving. A good deal of attention has been given by the Council to the subject of the impervious paving of the side streets of the Borough. On the recommendation of the Health Committee, the Highways Committee, in 1904, decided to make a beginning, and 14 streets, for the most part in the more crowded and insanitary parts of the Borough, were paved with 135 impervious materials. During 1905 21 more streets, with a total area of 33,134 square yards, were dealt with in this manner. On the completion of these streets, the Council decided to suspend the use of impervious paving (tarred slag macadam, which gives a smooth impervious surface, and has the additional advantage of being cheaper than asphalt, being the material used) for a period of twelve months, in order to test its utility. There is no doubt that the action of the Council has proved of great service from the public health standpoint. In my report for 1906, I drew attention to the fact that in North-West Battersea—the part of the Borough in which most of this paving material was employed—less fatal diarrhoea of infants and a lower infantile mortality had occurred than had ever previously been recorded in that district. This district of the Borough had always enjoyed the unenviable notoriety of possessing the highest infantile and general death-rates of the three registration districts into which Battersea is divided. The fact was the more significant, because the summer of 1906 was one of the driest, hottest and most prolonged experienced in my recollection, and it is well known that climatic conditions such as these are highly favourable to a high incidence from summer diarrhoea and to a high infant death-rate. The climatic conditions prevailing during 1907, being the very reverse of those in 1906, do not permit of the same deductions being drawn as regards these conditions. I am still convinced, however, that the paving of side streets in the more crowded and insanitary districts of Battersea is a most salutary measure, and one which I can confidently recommend to the Council. During 1907, after a period of 18 months in which no further paving of this character was carried out, the following additional streets were dealt with:— 136  Square yards. Belfour Street 907 Ponton Road 735 Ponton Street 193 Didcot Street 583 Latchmere Grove 2,520 Lithgow Street 315 Radstock Street 1,053 Thibet Street 230 Wayford Street 1,540 Winstead Street 1,351 Eccles Road 2,534 Spencer Road 1,645 Sisters Avenue 2,286 Total 15,892 square yards It is to be hoped that the Council will continue to carry out this useful work. Forming as they do the playgrounds for the children who live in them, the side streets in the poorer quarters of the Borough are a danger, saturated as they must become with polluted matter when not imperviously paved. During the warm weather the dust, impregnated with germs of various kinds, is blown in the open doors and windows of the houses, contaminating milk and other foods which may happen to be stored therein. Owing to its impervious nature, streets paved with this material are much less likely to retain any polluted matter than the ordinary macadam roadway. The rain washes off impurities from the surface, instead of retaining them to a considerable extent, as in the pervious roadway, and there is consequently much less risk of infection, even when the weather becomes dry, from the fact that less dust is formed on the surface; and, in addition, they are much more readily scavenged. I am of opinion therefore—although the Council's experiment in this direction is in its infancy, so to speak— 137 that, even so far as it has gone, there is proof that it has been successful. The summer of 1906 was a severe test; and although 1907, from the meteorological point of view, has been an extraordinary year as regards its effect on the infantile death-rate, it is in the nature of things improbable that such favourable climatic conditions as those which exercised such a remarkable influence on the death-rate from summer diarrhœa during the year can occur very often. Nor from other points of view is it desirable that they should do so. Some experiments were also conducted by the Council with the object of allaying dust nuisance, a matter of considerable importance from the public health standpoint. Various dustlaying processes were tried, and apparently with more or less satisfactory results. The summer of 1907 was, owing to the heavy rainfall, not a favourable year for these tests, and it may perhaps be as well to withhold any further comment until further and more definite proof is available of the value of these methods of dust prevention. Customs and Inland Revenue Acts. During 1907 certificates under the Customs and Inland Revenue Act, 1903, in connection with tenements (or dwellings) so constructed as to afford suitable accommodation for such of the families inhabiting the same, have been applied for, and, after inspection by the Medical Officer of Health, 8 have been granted and 35 have been refused. The Act provides that the owners of dwellings of a certain class may claim exemption from inhabited house duty on producing a certificate from the Medical Officer of Health that the dwellings afford proper and suitable sanitary conditions for the inhabitants of these dwellings. On receipt of an application a detailed inspection is made, and if found not to be satisfactory, a list of requirements is drawn up and sent to the owner. Should these requirements be carried out, the necessary certificate is then granted. 138 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:— Year. No. of Certificates Granted. Year. No. of Certificates Granted. 1890 243 1899 68 1891 113 1900 93 1892 165 1901 32 1893 201 1902 28 1894 91 1903 97 1895 91 1904 232 1896 120 1905 61 1897 27 1906 11 1898 82 1907 8 The number of tenements inspected by the Medical Officer of Health during 1907 was 43. The certificate was refused in 35 instances, and in the remainder it was granted after structural and other alterations had been carried out to improve the sanitary condition of the dwellings. Water Supply. No samples were examined during 1907. Smoke Nuisance. Emissions of black smoke were reported on 75 occasions. Fifty-one reports were made by the Council's inspectors, 15 by the Coal Smoke Abatement Society, and 9 by the London County Council. Sixty-eight intimations and 12 statutory notices were served, and 16 summonses were taken out, the fines and costs amounting to £17 is. Frequent reports are made of emission of black smoke for periods varying from one to three minutes. These, while they are undoubtedly infringements of the Act, are usually due to stoking and are not sufficiently serious to take legal action. Cautionary letters are however sent, and these in the majority of instances are followed by an improvement. 139 With respect to the above proceedings, the summonses against a firm in Church Road, which were issued for causing a nuisance from the emission of black smoke on seven specified occasions, came on for hearing before Mr. De Grey, on 10th April, 24th April, and 8th May. The learned magistrate dismissed six of the cases on the ground that he was not satisfied that black smoke had been emitted in such volume as to be a nuisance. In the seventh case he was however satisfied that a nuisance had arisen, and the defendants were fined 20s. and 23s. costs. Four of these cases had been reported by the Council's Inspector, and three by the Coal Smoke Abatement Society's officer. The case in which a conviction was obtained was one of three reported by the Society's representative, who in his evidence stated that on the date mentioned in the summons he observed black smoke emitted from the chimney shaft in sufficient quantity as to beat down into Church Road and settle upon the ground. The Council's Inspector was unable to go so far in his evidence as this, although the nuisances observed by him were of considerable duration. Counsel for the defendant firm contended that it was not sufficient for the Sanitary Authority to be satisfied upon the evidence of their officers that black smoke had been emitted in such quantity as to be a nuisance, but that the magistrate was the person to be satisfied. This view was upheld by the magistrate, with the results mentioned. The question of what really constitutes a nuisance from the emission of black smoke is the subject of varying decisions by magistrates, and unless the sanitary authority is prepared to produce evidence to satisfy a magistrate of the existence of a nuisance of a very serious character, the probability of obtaining a conviction is remote. The recent cases of the Chelsea Borough Council against the Central London Generating Station, which were dismissed by the magistrate, with 300 guineas costs against the Council, emphasise the need for the adoption of some uniform standard. The constant pollution of the atmosphere 140 from this cause is, from the health standpoint, of great importance, and the conflicting views held by magistrates as to what degree of black smoke constitutes a nuisance under Section 24, Public Health (London) Act, 1891, will act as a deterrent to Sanitary Authorities from taking cases into court, unless the nuisance is to such a degree as to satisfy even the legal mind. It is satisfactory to learn that the London County Council intend to apply for powers for Sanitary Authorities in their General Powers Bill for 1909 to amend the law in this direction, and it is to be hoped that in the interest of the public health they will be successful. Disinfecting Department. The work carried out during the year 1907 in connection with this important department has been very satisfactory. The continued prevalence during 1907 of infectious disease in the Borough, in common with the Metropolis generally, imposed a heavy strain on the Superintendent (Mr. Woodhouse) and his staff; and it is satisfactory to be able to record that, notwithstanding this heavy pressure of work, no cause for complaint has arisen, and no claim for damage has been sustained against the Council for injury to any article whilst undergoing disinfection. During the year 5,085 infected rooms and 66,181 infected articles have been disinfected, as compared with 2,848 rooms and 66,934 articles in 1906. The large increase in the number of rooms disinfected was due to the greater prevalence of measles during 1907, it being the practice to disinfect rooms in connection with this disease, but the bedding, &c., is not removed for stoving, as is the routine practice in the case of other infectious diseases. The disinfectant employed for disinfecting rooms was, in the majority of instances, formaldehyde, applied either by means of the Schering Alformant lamp, or in solution as "formalin" by means of a spray. Verminous rooms were 141 fumigated with sulphur dioxide, and bedding, wearing apparel, &c., from infected rooms were subjected to steam disinfection in the Equifex disinfecting machine at the Council's Disinfecting Station. Infected articles, such as boots, feathers, &c., which, if subjected to steam disinfection, would have been irretrievably damaged, were disinfected in the specially-constructed chamber by means of formaldehyde. A total number of 1,463 cases of notifiable diseases were reported during the year 1907, but in addition to these a large amount of disinfection was carried out in connection with measles, tuberculosis, cancer, verminous houses, &c. Of the compulsorily notifiable diseases, 1,463 have been dealt with; and 34 schools (public and private) have been disinfected in connection with outbreaks of infectious disease. The following table shows the number of premises and rooms disinfected during each month of 1907:— 142 Month. Scarlet Fever. Diphtheria Enteric Fever. Erysipelas. Puerperal Fever. Phthisis. Measles. Other Diseases. Total. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. Premises. Rooms. January 71 152 28 59 1 1 13 13 2 3 19 22 15 17 3 3 152 270 February 67 110 42 62 4 5 9 9 3 4 25 27 17 18 9 11 176 246 March 72 134 29 46 5 5 8 8 1 1 18 19 56 60 7 18 196 291 April 113 359 36 92 2 8 12 15 1 1 10 11 50 56 13 25 237 567 May 97 185 44 56 ... ... 9 9 1 1 12 15 236 255 14 16 413 537 June 88 189 14 21 1 1 11 14 1 1 12 14 254 282 5 13 386 535 July 114 437 22 36 ... ... 9 10 1 1 14 16 300 338 13 37 473 875 August 63 197 20 29 9 12 18 18 ... ... 10 14 93 119 15 22 228 411 September 69 142 26 46 5 8 9 11 ... ... 10 12 13 18 18 38 150 275 October 102 239 29 48 8 13 15 16 2 2 11 11 23 25 8 14 198 368 November 104 216 36 56 2 2 15 18 1 1 12 14 38 43 10 19 218 369 December 70 202 28 61 2 2 14 14 1 1 12 15 30 32 11 14 168 341 Totals 1,030 2,562 354 612 39 57 142 155 14 16 165 190 1,125 1,263 126 230 2,995 5,085 143 The following table shows the number of articles removed and disinfected by steam at the Disinfecting Station:— Articles. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total for year 1907. Beds 408 430 422 498 1,758 Blankets 1,026 950 817 1,151 3,944 Bolsters 351 353 330 406 1,440 Carpets 398 442 381 498 1,719 Cushions 357 385 350 493 1,585 Mattresses 345 377 308 378 1,408 Palliasses 302 360 340 367 1,369 Pillows 1,023 1,025 944 1,090 4,082 Quilts 702 733 627 915 2,977 Sheets 906 934 804 1,030 3,674 Wearing Apparel, &c. 10,145 10,521 8,546 13,013 42,225 Totals 15,963 16,510 13,869 19,839 66,181 The following is a list of the articles removed and destroyed at the request of the owners:— Beds 34 Blankets 34 Bolsters 15 Carpets 20 Cushions 42 Mattresses 35 Palliasses 66 Pillows 44 Quilts 10 Sheets 17 Articles of wearing apparel 767 Total 1,084 144 During 1907 the new Laundry which the Council decided to erect at the Disinfecting Station was completed and opened for use on 2nd April. It is now possible to return soiled articles, after being disinfected, laundered, to their owners. The Laundry has of course increased the cost of disinfection, but this is compensated for by the added usefulness of the Station. The Council can congratulate themselves on now possessing one of the most complete and efficient Disinfecting Stations in the County of London. The following is a list of articles which, after previous disinfection, have been washed in the Laundry:— Curtains 204 Blankets 430 Bolster Cases 162 Bed Covers 197 Pillow Cases 583 Quilts 256 Sheets 1,144 Towels 1,267 Table Cloths, &c. 256 Wearing Apparel 4,026 Total 8,525 The total weight of articles removed for disinfection during the year 1907 was 160 tons 11 cwt. 21 lbs. The actual cost of this weight of articles at 15s. per cwt., which was the price charged by the contractor formerly employed by the Council to do the work would have amounted to £2,408 6s. od. The actual cost is set out below:— 145 £. s. d. Wages Hire of Council's horses Fuel Electric light Rates and Taxes Insurance Stores and tradesmen's accounts Interest of loan Repairs Depreciation— 718 5 0 200 15 0 53 3 2 6 8 1 85 10 7 17 15 0 70 6 1 125 16 11 39 19 7 Buildings (at 3 p.c.) 82 6 0 Machinery (at 10 p.c.) 63 12 0 Vans (at 10 p.c.) ... 12 18 0 155 16 0 £1,1476 15 5 The Council have, by providing an efficient Disinfecting Station, and doing away with the services of a contractor, saved the ratepayers during the year £931 10s. 7d. This is a gratifying fact to be able to report; and the value of the work done is enhanced by the additional advantage of having this important duty carried out by the Council's own officers. The Station has been in existence now for six years, and it is interesting to show the saving in the cost of disinfection which, has been accomplished in each year since its establishment:— £. s. d. 1902 1903 1904 1905 1906 1907 980 0 0 540 0 5 252 18 9 976 12 3 1,120 13 4 931 10 7 £4,801 15 4 146 The original cost of the Station and machines was £3,200. It will be seen, therefore, that a saving of £4,801 15s. 4d., a sum that is considerably above the original cost of the Station, has been effected by carrying out the work without the intervention of a contractor (apart from the other advantages of such a procedure). In addition to the work set out in the above tables, the bedding belonging to the Council was on 278 occasions lent out to persons whose bedding had been removed for disinfection. As soon as this has been effected it is returned, and the Council's bedding is collected and brought back to the Disinfecting Station, where, after being disinfected, it is returned to the store-room, on the "clean" side of the building. In this way the maximum results of disinfection are attained with a minimum of inconvenience to the owners of articles requiring disinfection, &c. A great deal of additional work is performed by the staff in this connection, which does not appear in the preceding tables. Temporary Shelter or House Accommodation. The Public Health (London) Act, 1891 (Section 60, Subsection 4) imposes an obligation on Sanitary Authorities to provide accommodation for persons who have been compelled to leave their dwellings on account of disinfection being carried on therein. The Reception Shelter in Sheepcote Lane was completed in 1904. In 1905 it was occupied by 33, in 1906 by 31 persons, and during 1907 by 33 persons, whose homes were undergoing disinfection after infectious disease. During 1907, in addition, 7 midwives and 12 nurses, who had been in attendance on cases of puerperal fever, or in contact with cases of scarlet fever, diphtheria, measles, and erysipelas, had the use of one of the tenements for the purposes of personal disinfection. One hundred and eighty-two persons, including laundry workers, dressmakers, milk vendors, &c., whose occupation 147 rendered it desirable, attended for personal disinfection at the Reception Shelter, on account of exposure to infectious disease. Cleansing of Persons Act, 1897. Personal Cleansing Station. The Personal Cleansing Station, which was opened in July, 1906, under the provisions of the Cleansing of Persons Act, 1897, has been largely availed of during the year by persons requiring the facilities therein provided by the Council. During the year 621 persons who were infested with vermin attended at the Station, and were cleansed, and had their clothing disinfected in the Disinfecting Station adjoining. In the following table are set out the numbers of adult persons of each sex, and of children, who took advantage of this useful provision during each month of 1907:— 148 Table showing the number of adult persons of each sex, and of children cleansed, &c., during the year 1907, at the Personal Cleansing Station:— Jan. Feb. Mar. Apr. May June July August Sept. Oct. Nov. Dec. Totals. Men 31 34 29 26 25 22 40 35 50 67 67 74 500 Women ... ... ... 2 ... 1 ... ... ... ... ... 1 4 School Children ... ... 1 2 8 24 17 5 27 8 8 17 117 149 Of the total numbers who were cleansed it will be noted that 500 were men, 4 only women, and 117 children, the latter coming mainly from the public Elementary Schools. In connection with the cleansing of these 617 persons, 7,614 articles of clothing belonging to them were submitted to steam disinfection at the Disinfecting Station. These are not included in the tables of articles disinfected on page 143. The Personal Cleansing Station, as will be seen from the above figures, has been very largely availed of, and has proved a great boon to those unfortunate persons who, owing to their destitute condition, are unable to provide themselves with a bath and clean clothing. Some of these persons succeeded in getting employment after they had taken advantage of the facilities provided by the Council, which in their previous condition it would have been an impossibility for them to have obtained. It should be stated that in carrying out this useful hygienic work, the Council is performing a purely voluntary duty. The Act is not in any sense compulsory: a Local Authority is not under a statutory obligation to administer the Act, nor, should the Authority so decide, is there any power to compel any person to avail himself of its provisions. From Dr. Wanklyn's Report to the London County Council in 1905, on the administration of the Act in the Metropolis, it would appear that comparatively few Sanitary Authorities have made any considerable use of the provisions of the Act. In Marylebone the Sanitary Authority began to administer the Act in March, 1898, and from that time up to November, 1904, the number of persons cleansed was 32,500. In St. Pancras the Sanitary Authority availed themselves of the provisions of the Act in 1904, and in the first six months about 1,400 persons were cleansed, of whom 600 were women and children. These are the only two Sanitary Authorities which had up to that time made much use of the provisions of this useful Act; and in many districts the administration of the Act had been left in the hands of the Boards of Guardians. 150 It is scarcely necessary to point out the desirability of extending this really useful sanitary work. The resources of the present station are strained to the utmost to cope with the numbers of applicants requiring to be cleansed. Under the provisions of the Act, Local Authorities may expend any reasonable sum on buildings, appliances and attendants, that may be required for the carrying out of this Act, and any expenses for these purposes may be defrayed out of any rate or fund applicable by the Authority for general sanitary purposes or for the relief of the poor." The present Station, in addition to the accommodation being inadequate to deal with the number of applicants, is unsuitable in many respects for the purpose; and I would suggest that the piece of waste ground adjoining the Reception Shelter, and belonging to the Council, might be utilised for the purpose of building more commodious and suitable premises for carrying out the provisions of the Act. Hitherto little attention has been paid by Sanitary Authorities to matters of personal hygiene, and personal cleanliness is the foundation of personal hygiene. The success which has attended the Council's initial, and so far inexpensive, attempt to develop this useful measure of sanitary administrative reform amongst the less fortunate members of the community, will, I have little doubt, encourage them to extend the existing facilities in the direction indicated. The Midwives' Act, 1902. This Act, which contains important provisions dealing with the prevention of disease is administered in London by the London County Council, who are the local Supervising Authority; but the important duty of disinfection devolves upon the Borough Councils, in accordance with Rule V. of the Rules framed by the Central Midwives Board, and which is as follows:— "Whenever a midwife has been in attendance upon a patient suffering from puerperal fever, or from any other illness 151 supposed to be infectious, she must disinfect herself and all her instruments and other appliances, to the satisfaction of the Local Sanitary Authority, and must have her clothing thoroughly disinfected before going to another labour. Unless otherwise directed by the local Supervising Authority, all washable clothing should be boiled, and other clothing should be sent to be stoved (by the Local Sanitary Authority) and then exposed to the open air for several days." In Battersea one of the three tenements in the Reception Shelter is used for the disinfection of midwives and monthly nurses who have been in attendance on patients suffering from puerperal fever and other infectious cases. The nurse has a disinfectant bath, while at the same time her clothing, bag, instruments, and other appliances are disinfected at the Disinfecting Station, which adjoins the Shelter. During 1907 2 midwives and 9 nurses attended at the Reception Shelter for purposes of disinfection. Mortuary. The number of bodies removed to the Mortuary in Sheepcote Lane during 1907 was 302, as compared with 244 in 1906, and an annual average for the Parish of Battersea for the five years 1896-1900 of 288. On 288 of these bodies inquests were held, and 14 were removed for sanitary reasons from crowded houses. The following table gives the number of bodies removed to the Mortuary in each week during the year:— 152 Week ending. No. of bodies removed. Week ending. No. of bodies removed. Jan. 5 6 July 6 5 „ 12 6 „ 13 2 „ 19 6 „ 20 6 „ 26 4 „ 27 9 Feb. 2 6 aug. 3 1 „ 9 7 „ 10 4 „ 16 7 „ 17 3 „ 23 8 „ 24 7 mar. 2 10 „ 31 1 „ 9 8 sep. 7 9 „ 16 8 „ 14 10 „ 23 2 „ 21 5 30 8 „ 28 2 april 6 9 oct. 5 5 „ 13 9 „ 12 5 „ 20 10 „ 19 10 „ 27 7 „ 26 3 may 4 2 nov. 2 8 ,, 11 5 „ 9 1 „ 18 11 „ 16 8 „ 25 10 „ 23 2 June 1 7 „ 30 7 „ 8 4 dec. 7 4 „ 15 4 „ 14 4 „ 22 5 „ 21 4 „ 29 3 „ 28 5 153 The following table gives the number of bodies removed to the Mortuary in each year since 1892:— Year. 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. 1892 193 163 187 1893 243 200 237 1894 224 197 208 1895 259 210 232 1896 293 242 278 1897 289 246 273 1898 294 238 267 1899 274 221 260 1900 291 234 273 1901 321 271 304 1902 239 198 224 I903 223 207 213 1904 221 161 204 I905 253 176 236 1906 244 167 239 1907 302 204 288 Inquests. During the year 1907 inquests were held in 288 cases, with the following results:— Natural Causes 182 Open Verdict— Found dead 6 Found drowned 1 Accidental Causes— 7 Burns and Scalds 16 Drowning 1 Run over (in street and on railway) 14 Falls, &c. 29 Suffocation 3 Other injuries 8 71 Carried forward 260 154 Brought forward Suicide— 260 Cut throat 2 Drowning 7 Hanging and strangulation 2 On railway 1 Poison 15 Homicide— 27 Fractured skull 1 1 Total 288 Ambulances. The Council have for some years past provided a wheeled ambulance at each of the following six points in the Borough:— Queens Road (at Queens Circus). Clapham Junction (at Junction of Falcon Road and Lavender Hill). Bridge Road (at junction of Cambridge Road and Bridge Road). York Road (at junction of York Road and Plough Road). Battersea Park Road (outside Christ Church). Nightingale Lane (Wandsworth Common End). These ambulances are freely accessible to the public. They are frequently availed of by the police, and have been found most serviceable for the speedy and humane removal to hospital of persons meeting with accident or illness in the street. Each ambulance is provided with the necessary surgical appliances and dressings for rendering "first aid" to the injured. Protection of the Food Supply. 157 Protection of the Food Supply. During the year 1907 the protection of the food supply has occupied the attention of the Health Department to a considerable extent. The work has comprised meat inspection and seizure, registration and systematic inspection of the milk shops, dairies and cowsheds, and the administration of the Sale of Food and Drugs Acts. A good deal of time has also been devoted to the sanitation of bakehouses (vide section dealing with the administration of the Factory and Workshops Act) and to premises wherein food is prepared as potted meat, and for sausage manufacture. Other premises in which the sale and preparation of food in various ways is carried on have claimed the attention of the Department, such as ice-cream shops, milk shops, butcher shops, restaurant kitchens, &c.; all of these premises being frequently and systematically inspected by the Council's officers. Unsound Food. During the year under review the following seizures of unsound food were made:— Unsound meat 5 Unsound fruit and vegetables 4 Total 9 Proceedings were taken in all cases, and in one case the summons was dismissed. In the remainder fines and costs amounting to £21 16s. were imposed. The case which was dismissed referred to the seizure by the Medical Officer of Health of the carcase of an ox in an advanced stage of generalised tuberculosis, in a private slaughterhouse in York Road. The case, which was decided on a point of law, was heard at the South-Western Police Court, on the 30th January, before Mr. Paul Taylor. The learned 158 magistrate, though accepting the diseased condition of the carcase as a fact, dismissed the case, with ten guineas costs against the Council, on the ground that the defendant did not have an opportunity of inspecting the carcase prior to seizure. In view of the decision of the learned magistrate, it may be interesting to recall the circumstances surrounding the seizure. In October, 1906, while engaged in inspecting my district, in company with Inspector Benjamin, I inspected a private slaughterhouse at York Road. The premises were rarely used, the owner, who had a butcher's shop adjoining, seldom killing his own meat. I was surprised to find, therefore, that two oxen had been slaughtered, one of them being already dressed and hung, the carcase being very thin and emaciated. The other carcase was being flayed when I arrived, being apparently in much better condition than the one already dressed. After making a careful examination of the dressed carcase and offal without being able to find any definite evidence of disease, I waited until the other carcase was dressed. On inspection of that I was of opinion that it was affected with generalised tuberculosis. On asking for the owner of the slaughterhouse, I was informed that he was absent, but a man named Greenwood, a butcher, who has a butcher's shop a short distance away, in the Borough of Wandsworth, was present, and stated that he sold the beasts to the owner of the slaughterhouse, a statement which he later denied in writing. I pointed out that the carcase was unfit for human food, and that it should be destroyed. To this course he demurred, and asked for time to consult his trade organisation. I agreed to this, and later two officials of the trade organisation arrived, both of whom protested at the decision at which I had arrived, and that the offal only was affected, and that it was a case of localised tuberculosis, the carcase in their opinion being perfectly sound. I informed them that unless the carcase was given up to me, I would seize it, and, seeing that I had made up my mind to this course, they asked that they should be allowed to call in an expert on their behalf. I agreed to this, and later Professor Pemberthy, of the Royal Veterinary 159 College, arrived, and, having examined the carcase and offal, gave it as his opinion that the carcase was sound and fit for human food. I did not agree with this gentleman's opinion, and, notwithstanding the protests of the owner and the trade officials, I seized it, as well as the offal, and had them removed to the Council's premises at Lombard Road, whence next day they were taken to the South-Western Police Court, and inspected and condemned by the magistrate, Mr. de Grey. The facts were fully reported to the Health Committee, as well as the subsequent inquiries which were made by Inspector Chuter into the sale of the animals to Greenwood. From these inquiries it was reported that the two beasts had been purchased by a peripatetic dealer named Howard for £8 from the steward of an estate near London (who admitted that he sold the ox in question because it had "not done as well as the others"), and resold to Greenwood for £10, though the latter stated he gave £13 for the two beasts. The trade officials asked for an interview with the Health Committee, which was granted. After giving the case careful consideration, the Committee ordered proceedings to be taken, with the result already mentioned. The Committee decided to instruct the Council's Solicitor to get the magistrate to state a case, but later the Solicitor informed the Committee that he had been in communication with the solicitors for the defendant, who offered to forego the costs which had been given against the Council, if the Council took no further action. The Committee accepted this offer, and reported their action to the Council. The extract from the Minutes of the Council dated 13th March, 1907, reads as follows:— "The Solicitor has reported that he has been in communication with Messrs. W. T. Ricketts and Son, the solicitors to the defendant in the proceedings recently taken by the Council in respect of the seizure of the carcase of an ox from No. 49 York Road, as to the payment of the costs given against the 160 Council, and he has now received a letter from them, stating they have received instructions from their client that if further proceedings are stayed, he will consent to forego such costs. "We have authorised the Solicitor to accept the suggestion referred to." It is the practice in cases when the retail vendor has unknowingly purchased articles of food unfit for human consumption, and has made no attempt to sell the articles, when the latter are brought to the Health Department for inspection and destruction, to grant a certificate which enables the retailer to claim the return of the money paid for the articles to the wholesale dealer. The food is destroyed at the Council's destructor. During 1907 certificates were granted in respect to the following articles of food, all of which were first covered with disinfectant, and then taken to the destructor and destroyed:— i6i Food. Quantity. Where purchased. Apples 1 barrel Borough Market Bananas 7 crates Covent Garden Market „ 4 stalks „ „ „ ,, 1 crate „ „ Bloaters 4 boxes Billingsgate Market Brined Cauliflower 1 hogshead 27 Eldon Street, E.C. Cherries 12 crates Borough Market Cod 1 trunk Billingsgate Market Crabs 1 barrel ,, ,, Dabs 1 box „ ,, Hake 1 ,, ,, ,, Herrings 1 case ,, ,, ,, 1 box ,, ,, ,, i case ,, ,, ,, 2 half barrels „ „ ,, 2 boxes ,, ,, Kippers 4 „ „ „ ,, 1 ,, ,, ,, Mackerel 1 ,, „ ,, ,, ½ ,, ,, ,, ,, 1 ,, ,, ,, ,, 1 ,, ,, ,, Magnums 1 „ „ „ Megrims 1 „ „ „ Plaice 1 „ „ ,, Rabbits 24 ,, ,, Rock Salmon 1 box ,, ,, Skate 2 barrels „ „ SkateWings 1 box „ ,, ,, 1 ,, ,, 2 stone ,, ,, Soles 1 kit „ „ Tomatoes 2 boxes Borough Market ,, 12 ,, ,, ,, ,, 11 ,, ,, ,, ,, 4 „ Spitalfields Market Onions 2 bags Borough Market ,, 2 ,, ,, ,, Winkles 1 bag Billingsgate Market 162 Slaughterhouses. The following are the 5 slaughterhouses situated in the Borough of Battersea:— 205 St. John's Hill. 351 York Road. 345 Battersea Park Road. 235 Battersea Park Road. 96 Falcon Road. The slaughterhouse situated at 49 York Road has been discontinued during the year, the owner not having applied for the renewal of his license at the Annual Licensing Sessions in October. These slaughterhouses have been frequently inspected. The premises are comparatively small, and are, generally speaking, not well situated. They are, however, usually kept clean, and the paving and drainage is satisfactory. These premises are licensed annually by the Licensing Authority, viz., the London County Council, but the duty of inspection, which was formerly carried out by this body, has been transferred to the Borough Councils by the London Government Act, 1899. This is a very important duty, consisting as it does of the enforcement of the bye-laws and regulations made for the sanitation of these premises. Cowhouses. There are only three licensed cowsheds in the Borough of Battersea, situated as follows:— 14 Belle Vue Road. 122 Usk Road. 17 Wiseton Road. These premises are licensed by the London County Council annually, but the duty of enforcement of the regulations and bye-laws made under the Dairies, Cowsheds and Milkshops 163 Orders in connection with these premises devolves on the Borough Councils, which, prior to the passing of the London Government Act of 1899, was carried out by the London County Council. In Battersea they are frequently inspected, and any insanitary conditions found are remedied. Ice Cream. During the year 1907 there were 110 registered premises, as compared with 104 in 1906, from which ice-cream was sold in the Borough. Systematic supervision is exercised over these premises by Inspector Benjamin, and during the period under review 18 defects under the Public Health Act, in connection with the premises, were discovered and remedied. In addition, 5 cautionary letters for breaches of the Regulations made by the London County Council under the General Powers (London County Council) Act, 1902, were sent. Nine of the premises wherein ice-cream is manufactured are occupied by Italians, and 25 barrows are in use by them in the Borough for the sale of their commodity. The trade in ice-cream is carried on by the Italians all the year round, while in the English shops it is confined mainly to the summer months. During 1907, owing to the comparative coolness of the summer, many of the latter gave up manufacturing ice-cream. There has been a considerable improvement in the premises in which this article is manufactured. Persistent efforts have been specially made to compel the Italians to carry out the Regulations. During the year 284 inspections of ice-cream premises have been made. Restaurants and Eating-houses. The annual inspection of these premises was systematically commenced in 1902, and since then a general sanitary supervision has been exercised over them by Inspector Benjamin. The total number on the register at the end of 1907 was 93. Eleven were newly opened and 2 were discontinued during the 164 year. In 6 of these premises the kitchen was underground. During the year it was found necessary to take action in connection with sanitary defects in 55 instances. In the majority of cases these defects were not of a very serious nature, and there is evidence that the strict sanitary supervision that is being carried out has effected a considerable improvement. The chief defects were dirty floors, walls and ceilings, unclean or defectively-paved yards or areas, where food was being prepared. In a number of instances there was an absence of proper and sufficient dust-bin accommodation, and in several the sanitary conveniences were defective. In four cases the sanitary convenience was found to ventilate into the room where food was being prepared, contrary to the bye-law of the London County Council, which states that no sanitary convenience shall directly communicate with a room in which food is being prepared. In three of these premises the nuisance has been abated, and in the fourth the work in connection with the abatement is being carried out. In many of these premises the proprietors conduct their business in a satisfactory manner as regards cleanliness and freedom from contamination in the preparation of food. Some of them, however, require a constant reminder of their duty in this respect, and it is not always the small and cheaper restaurant proprietors that are the defaulters, many of the more pretentious premises requiring a frequent visit from the inspector. The following is a list of the restaurants and eating-houses in the Borough at the end of the year 1907:— 165 Restaurant Kitchens. Premises. Premises. 4 Abercrombie Street 64 New Road 16 Battersea Park Road 10 Nine Elms Lane 24 ,, ,, 71 ,, ,, 34 ,, ,, 93 ,, ,, 35 ,, ,, 4 Northcote Road 126 „ „ 8 „ „ 141C „ „ 14 „ „ 160 „ „ 35 „ „ 178 „ „ 63 „ „ 183 „ „ I51 „ „ 262 „ „ 13 Park Road 335 „ „ 96 Plough Road 431 „ „ 138 „ „ 49 „ „ 35 Queens Road 503 „ „ 174 „ „ 575 „ „ 218 „ „ 583 35 St. Andrew's Street 35 Battersea Rise IC St. John's Hill 64 „ „ 2 „ „ 91 „ „ 4 „ „ 94 „ „ 17 „ „ 21 Bridge Road 18 „ „ 41 „ „ 26 „ „ 42 „ „ 39 „ „ 68 „ „ 64B „ „ 70 Chatham Road 85 „ „ 89 Church Road 93 „ „ 114 Culvert Road 146 „ „ 29 Falcon Road 45 St. John's Road 101 „ „ 62 „ „ 125 „ „ 73 Stewarts Road 135 „ „ 45 Webbs Road 166 ,, ,, 24 Winstanley Road 184 ,, ,, 10 York Road 19 High Street 25 „ „ 22 „ „ 45 „ „ 86 „ „ 76 „ „ 130 „ „ 139 „ „ 150 „ ,, 159 „ „ 87 Lavender Hill 167 „ „ 173 „ „ 183 „ „ 190 „ „ 201 „ „ 233 „ „ 204 „ „ 235 „ „ 216 „ „ 266 „ „ 329A „ „ 291 „ „ 357 „ „ 23 New Road 166 Milk Supply. The milk supply of Battersea has been carefully supervised during 1907, and the milk-shops in the Borough have been systematically visited and inspected. The necessity for exercising a vigilant supervision over this article of food, bearing in mind its susceptibility to contaminating influences and its importance as the staple diet of infants, is apparent, and has been fully recognised by the Health Department. It has been the practice, therefore, in Battersea to devote a good deal of care and attention to premises where milk is sold, with a view to ensuring, as far as it is practicable to do under the existing law, precautions against contamination. The number of registered milk-shops in Battersea at the end of 1906 was 264. During 1907 55 new milk-shops were added and 65 discontinued, the total number at the end of the year being 254. In only 76 of these premises was dairy produce alone sold. Of the remaining premises wherein milk was sold, 157 were general shops, 13 were confectioners, and in 8 instances the milk was sold from a dwelling-house. As showing, the number of hands through which the milk passes before it reaches the consumer, of the 254 registered milk vendors, 129 obtain their supply through milk contractors, 99 vendors are supplied from retail shops in the Borough, and 10 from retail shops outside the Borough. In only 16 instances does the milk vendor obtain his supply direct from the farmer. The quantity of milk sold per day by these 254 milk vendors is as follows:— 106 (i.e., 41.7 per cent.) sell less than one gallon. 59 (i.e., 23.2 per cent.) sell from one to ten gallons. 89 (i.e., 35.1 percent.) sell over ten gallons. A register in the form of a card index system, is kept of all dairies and milk-shops in the Borough, containing particulars as to sanitary conditions, &c. 167 The necessity of exercising a constant and systematic supervision over milk-shops, to prevent breaches of the law, will be apparent from a perusal of the following tabulated statement relating to 72 defects under the Public Health Act, and 160 breaches of the Regulations of the London County Council. In no case was it found necessary to take proceedings, all the notices served being complied with, and the cautionary letters attended to, on re-visiting the premises. Intimations served under the Public Health (London) Act. Cautionary letters for breaches of the Regulations made under the Dairies, Cowsheds and Milkshops Order. Dirty Premises 24 Defective Paving 22 Defective Dustbin 9 Accumulation of refuse 6 Dirty w.c. 3 Dirty drinking water cistern 3 Defective w.c. 1 Other defects 4 Want of covers for utensils 102 Dirty premises 3 Exposing milk to contamination 8 For not being registered 44 Dirty utensils 1 No name or address on barrow 2 Total 72 Total 160 In the above list the defects and breaches of the Regulations were chiefly those relating to want of cleanliness and the neglect of precautions against contamination of milk by dust, flies, &c. In 102 instances it was necessary to send cautionary letters for failing to have the vessel in which the milk was stored protected from dust and flies by means of a suitable cover. In many of these cases the cover was provided, but was not being used or was not kept clean at the time the inspector made his inspection. On the whole, it may be said that there is a distinct improvement in the condition of the premises in which 168 milk is sold in Battersea. This satisfactory state of affairs has only been attained by constant effort of the Council's officers to rigidly enforce the Regulations of the London County Council and the provisions of the Public Health Act. Much more requires to be done before the conditions under which milk is sold in the Borough can be said to be satisfactory. The new sanitary powers which are sought in the London County Council (General Powers) Bill, 1908, in which a clause is provided to enable sanitary authorities "to refuse to register, or to remove from the register," milk vendors, will be of great assistance in controlling the conditions under which milk is sold in London. This is a most important advance, and, while I am of opinion that the annual licensing of milk vendors would have been more useful, the new clause, which, it is to hoped, will soon become law, must be considered a step in the right direction. The problem of the milk supply of the Metropolis can never, however, be considered satisfactory until sanitary authorities can control the source of the supply. Most of the milk supply of London comes from long distances, Wiltshire, Dorsetshire, Somersetshire, Derbyshire, Staffordshire, Leicestershire, Warwickshire contributing the greater portion of the supply. This means that the milk does not reach the milk-shop from the farm until twelve hours or more have elapsed. Before it reaches the consumer it passes through the hands of the contractor to the retail milk vendor, and he in turn frequently supplies small general shops, wherein all sorts of commodities are sold, such as pickles, kippers, soaps, candles, &c., as well as milk. The conditions under which the milk trade of the country is carried on require careful consideration by the Legislature. In England and Wales it is computed that the milk trade represents a sum of over £15,000,000 annually. It is, therefore, a very important industry, and, apart from its importance from the public health standpoint, it should receive greater attention than it seems to do as a commercial asset of the country. It is, however, with the public health aspect of the 169 question that sanitary authorities are most concerned, and in this respect the necessity for some more adequate control over the sources of the milk supply will be at once apparent, when the various sources of contamination to which milk is exposed in its passage from the farm to the consumer, and that the sanitary authority has no control over it until its arrival in their district, are remembered. Contamination of milk may take place 1. At the farm. 2. In transit. 3. After arrival at the milk-shop. 4. In the house of the consumer. The conditions under which milk is produced at the farm are notoriously unsatisfactory. These have reference to diseases of the cow (e.g., tuberculosis: 7 per cent. of the milk supply of London is said to contain the tubercle bacilli), want of grooming of the cows, insanitary, badly lighted and illventilated cowsheds, uncleanly methods of milking, and diseased or dirty milkers. From personal observation I can testify as to the insanitary conditions of cowsheds in various parts of England. Very little attempt is in many districts made to enforce the provisions of the Dairies, Cowsheds and Milkshops Order in relation to farms where milk is produced. A more general levelling up to a fair sanitary standard is urgently called for, and this can only be accomplished by strengthening the present law, and forcing local authorities in rural districts to make use of the powers they already possess, but which they fail to do. Milk is subject to contamination in transit to the milkshop owing to the long time it has to remain in the train, very often in unsuitable vans, or lying on dusty platforms. Railway companies ought to be compelled to provide refrigerator vans lor the conveyance of milk. In milk, unless kept cool, bacteria rapidly develop, hence it is important to keep the temperature down to about 40° F. The condition in which milk arrives at its destination, after being eight or ten hours on rail in an 170 unsuitable van, especially in warm weather, is calculated to increase its liability to further rapid contamination when it reaches the milk-shop. The need for the use of preservatives in milk would be to a considerable extent unnecessary were proper conditions observed in transporting milk long distances, but unfortunately these conditions are not carried out, and the milk contractor is obliged, for this and other reasons, to resort to boracic acid or other preservatives in order to protect his pocket. Milk, when it arrives at the milk-shop, is stored usually either in the shop or in the yard at the rear of the premises, where it remains for a variable period. Usually, in the case of the larger milk-shops, it is kept in the churn in which it arrives until the bulk is transferred to the barrow churn for delivery, the remainder being kept for sale in the shop, in cases where milk is sold both on and off the premises. In 145 (i.e., 57 per cent.) of the milk-shops in the Borough of Battersea milk is sold on the premises only, and the milk on arrival is at once poured into the counter pan in the shop. These pans hold from one to four or five gallons of milk, and the milk in them is constantly exposed to contamination every time a customer has to be served. In every instance a cover for this receptacle is suggested in Battersea, but it is not uncommon to find its use " more honoured in the breach than the observance," and, as will be seen from the tabulated statement of defects, 102 cautionary letters had to be sent for neglect of this precaution in 1907. It is exceedingly difficult to ensure that the covers are being used, and it is to be feared that they are more frequently off than on the receptacle. The stock of milk in these vessels constitutes the day's supply, and the length of time it is exposed more or less to contamination from the dust of the roadway, flies, &c., is dependent on the amount of trade done and the use that is made of the cover. That the condition of the milk, especially in the small general shops to which allusion has already been made, becomes seriously contaminated there can be little doubt, and it is little cause for surprise that in the poorer districts where these small 171 general shops abound the summer diarrhoea of infants, which is so fatal during the third quarter of the year, is so prevalent. The remedy for this state of things is to prevent the sale of milk in premises which are considered unsuitable by the sanitary authority for any reason. The fourth source of pollution to which milk is exposed is in the house of the consumer. The extent to which this occurs is largely a matter for conjecture, but that it does occur, especially in the homes of the poorer classes of the community, to a considerable extent there is little doubt. It should be remembered, however, in this connection, that the milk, when it is purchased, is frequently in a condition to become rapidly contaminated when kept in crowded or dirty rooms. The proper storage and prevention from contamination of milk in the home is largely a matter of opportunity and education; and the Council's health visitor has devoted a good deal of attention to the instruction of the mothers in the best methods of protecting food from contamination, and there is evidence that this has been attended with considerable success. Owing to the lack of proper food cupboards, it is not always an easy matter to carry out the instruction that is given. The London County Council (General Powers) Act, 1907, contains provisions for the prevention of tuberculous milk entering the Metropolis. These only aim at this aspect of the problem, but constitute a distinct advance in the efforts that are being made for the protection of the milk supply of London. It is to be hoped that Parliament will deal with the entire question, as has been promised, during 1908. Until this is done it will be hopeless to expect that sanitary authorities in the Metropolis can adequately safeguard this most important article of food from deleterious influences, which, to a large extent, arise before its arrival in their districts. Fish Shops. There are 67 of these premises in Battersea. In 47 of 172 these places fried fish only is sold; in 16, wet and dried fish only is sold ; and 4 shops sell wet, dried and fried fish. These premises are frequently inspected, and during the year notices were served in 8 instances for various insanitary conditions, all of which were complied with. Butchers' Shops. There are 92 butchers' shops in Battersea, all of which are systematically inspected by Inspector Chuter. On 56 of these premises sausage-making or meat-chopping is carried on, the work being done by hand in 42 cases, and by machinery in 14 cases. Ninety of the shops are provided with ice-safes. The trade refuse is removed as follows:— \ Once a week 3 shops Twice a week 70 shops Three times a week 15 shops Four times a week 2 shops Daily 5 shops The premises generally are well kept and are on the whole in a satisfactory condition. During the year 958 inspections of butchers' shops were made. Sale of Food and Drugs Act. The following table shows the number of samples taken during 1907, and the number found to be genuine or otherwise:— 173 Description of Article. Total No. of Samples taken. Genuine. Adulterated. Inferior. Arrowroot 4 4 - - Brandy 1 i — - Butter 106 86 17 3 Coffee 11 9 2 - Coffee & Chicory 1 1 - - Gin 1 1 - - Milk 799 728 71 - ,, (pasteurised skimmed) 4 2 2 — ,, (separated) 39 30 9 — ,, (skimmed) 11 8 3 — Mustard 4 4 — — Pepper (white) 4 4 — — Preserved Fish 3 3 — — „ Meat 2 2 — — Rum 1 1 — — Vinegar 6 4 1 1 Whisky 3 3 - - Totals 1,000 891 105 4 The adulterated samples formed 10.9 per cent. of the total number of samples taken. The percentage of adulteration during the years 1900 to 1907 are shown in the following table:— 174 Year. Number of Samples taken. Adulterated. Percentage of Adulteration. 1900 514 46 8.9 1901 474 35 7.4 1902 500 52 10.4 1903 500 67 13.4 1904 700 107 15.3 1905 700 90 12.8 1906 925 129 13.9 1907 1000 105 10.9 *Since 1904 a new system has been adopted, a special inspector being appointed to carry out the duties under the Sale of Food and Drugs A cts instead of, as formerly, several of the district inspectors doing this work. It will be noted that the percentage of adulteration during 1907 is considerably less than in 1906. There are two inferences which may be drawn from this fact. One is that less activity is being displayed, or, on the other hand, that the rigid administration of the Sale of Food and Drugs Acts which has been carried out in the Borough during the past five or six years is now bearing fruit. I am satisfied that the latter, however, is the correct inference to be drawn. The steady increase in the number of samples taken, under the instructions of the Council, has contributed, in my opinion, to the increased efficiency of administration. For the past two years the number of samples taken has reached the large total of 1,000 in each year. During 1907, 85 per cent. of the total number were milk samples. The importance of taking a large proportion of milk samples is obvious, as this article of food is by far the most frequently adulterated, and, forming as it does the staple diet of infants and invalids, the need for 175 protecting the public against fraud is, from the public health standpoint, most pressing. There is evidence, therefore, in my opinion, that the activity displayed in regard to milk sampling has been very effective in putting a stop to much of the fraud which, owing to the inadequate powers which sanitary authorities in the Metropolis possess, and to the leniency which magistrates at times exhibit in dealing with milk vendors who have even been convicted for adulteration, has been carried on in the Borough. In my report for 1906 I drew attention to the case of a milk vendor in the Borough, who, by registering his men as milk vendors in their own names (although he was the employer, and reaped the profits), was for a long time able to evade the consequenoes of his fraud. Altogether this individual employed a dozen men, who, when convicted, as nearly all of them were at different times, were fined small penalties. The amount of attention devoted to this gang, however, has at length been successful in driving them, including the principal, from the Borough. Of the total number of samples taken during the year under review, 862 were taken on week days and 138 on Sundays. Samples were taken on 23 Sundays in the year, all of which were milk. Of the 862 week day samples 82, or 9.51 per cent., were adulterated, while out of the 138 samples taken on Sundays, 21, or 15.2 per cent., were adulterated. The need for continuing the practice of sampling on Sundays is still evident from these figures, though the adulteration of Sunday samples shows a decrease as compared with former years. The Health Committee, in July, 1906, gave instructions that samples which it had not been the practice to take heretofore during August should be taken during that month. Ninety samples were taken—79 of milk and 11 of butter. Of these 90 samples, 36 were taken by Inspector Chuter, and 54 by Inspector Lawrence, who acted as Food Inspector during the absence of the former on his annual leave. 176 Samples taken by Inspector Chuter:— Milk: 31 samples. Genuine, 29. Adulterated, 2. Butter: 5 samples. Genuine, all. Adulterated, nil. Samples taken by Inspector Lawrence:— Milk: 48 samples. Genuine, 41. Adulterated, 7. Butter: 6 samples. Genuine, all. Adulterated, nil. In only three of the cases of adulterated samples taken by Inspector Lawrence were proceedings taken. Of the remaining four, in two cases the amount of adulteration certified by the Analyst was small, and it was not considered advisable to take proceedings, and in the other two a disclosure was made at the time of purchase that the article was "skimmed milk" Two of the prosecutions for adulteration in connection with these cases were for the addition of boric acid. A warranty defence was relied on in five cases, and in two of these proved successful, and the summonses were dismissed. In the remaining three cases the warranty was held by the magistrate not to be valid. In one of these, heard before Mr. Plowden, the learned magistrate said that the warranty was not in order, but at the same time he did not think the defendant had tampered with the milk, and simply ordered him to pay the costs, amounting to 12s. 6d. In the two other cases, one relating to a sample of butter and the other to a sample of milk, taken in the same shop, a warranty was relied on for the defence in each case. With respect to the butter sample, the magistrate (Mr. Garrett) was "not satisfied that the sample was not served from the same bulk as that stated in the warranty invoice." With respect to the milk sample, it was shown that there were two deliveries, the first at 5 a.m., and the second at 12 noon. The carman's book was signed for both deliveries at the midday delivery. The sample which was the subject of the proceeding was taken from the morning delivery. The Council's Solicitor pointed out to the Court that there was nothing to connect the early delivery, from which the sample was taken, with the contract. The learned magistrate upheld this view of the case, and the 177 defendant was convicted and fined £2 and 14s. 6d. costs in respect of each sample, butter and milk. Summary of Result of Proceedings. The results of the proceedings relating to 103 cases of adulteration under the Sale of Food and Drugs Acts were as follows:— Convictions 74 No proceedings 20 Dismissed (warranty defence) 2 Defendants absconded 3 *Withdrawn after issue of summons 4 Total 103 *These 4 cases were withdrawn for the followingreasons:—(a) Owing to difference between analysts as to results of analysis obtained, withdrawn, on defendant agreeing to pay £2 2s. costs; (b) withdrawn by order of the Health Committee, defendant having written to the Committee that the milk had been tampered with in transit; (c and d) small amount of boric acid in Pasteurised skimmed milk—summonses withdrawn on defendants agreeing to pay in each case 12s. 6d. costs. In the 20 cases in connection with which no proceedings were taken, the adulteration varied from 1 to 3 per cent. of extraneous water, or 2 to 5 per cent. devoid of fat. The amount of adulteration in all of these cases was not considered sufficiently serious to take into Court. A case which appears to show the inadequacy of the fines imposed by the magistrates in connection with convictions obtained against defendants for adulteration under the Sale of Food and Drugs Acts, may be cited as a good example. The difficulty of capturing these evildoers is, further, well brought 178 out in this case. The defendant was proprietor of one of the best dairy businesses in the Borough. Some months previously this man had a sample of milk taken and it was found to be deficient in fat to a small extent. He addressed a letter to the Health Committee, pointing out that he had been in the Borough for very many years, and that he had never been brought up on a charge before, and suggesting that the milk must have been tampered with in transit. The Committee, on consideration, agreed to accept his statement, and ordered that no proceedings were to be taken. The Food Inspector had suspicions as to the quality of the articles sold in the shop, although milk sampled on the rounds was invariably found to be within the limits allowed by the Board of Agriculture and Fisheries. He laid his plans accordingly, and, with the aid of an agent, he obtained a sample each of milk and butter. The former was found on analysis to be deficient in fat and badly adulterated with water, and the latter was simply margarine. Both samples were served by a girl who was said to act as servant to the manager's family, who lived on the premises. The Inspector received information that this would be put forward as an excuse, and that the girl had no authority to serve in the shop. A week later, by the aid of a different agent, the Inspector again obtained two samples of butter, at 1s. 2d. and 1s. per pound respectively. Both samples on this occasion were served by the manager's wife, who constantly serves in the shop, and were also found on analysis to be margarine. The first two cases came on for hearing on the 25th June, and a fine of £2 and 14s. 6d. costs in respect of the butter sample, and 20s. and 14s. 6d. costs for the milk sample, were imposed. The two latter cases were heard a fortnight later, and notwithstanding that the circumstances associated with the former convictions were mentioned to the magistrate, the defendant was only fined £2 and 14s. 6d. costs in respect of each sample. During 1907 6 cases of adulteration with chemical preservatives were reported by the Analyst, boric acid being the 179 ative in each instance. The decrease in the number of samples adulterated with preservatives is probably, in part at least, accounted for by the climatic conditions which prevailed in the summer of 1907 rendering it unnecessary to resort so frequently to their use. All of the six samples related to milk. The amount of adulteration ranged from roo6 to 22.4 grains per pint. Proceedings were taken and convictions obtained in 3 cases, fines and costs being inflicted. In 2 of the remaining cases, owing to the small quantity of adulteration reported by the Analyst—less than two grains to the pint—the summonses were withdrawn on payment of costs. In the remaining case, for a similar reason no proceedings were taken. A circular letter was issued to local authorities in 1906 by the Local Government Board, in which the Board suggested that milk vendors should be advised by the District Councils that proceedings would be taken under the Acts in instances in which preservatives are reported in milk, and that in cases where a declaration is made with the object of escaping liability, the Board suggested that frequent samples should be taken to ascertain the condition of such milk in regard to preservatives; and in cases in which preservatives are reported in milk then sold, the question would arise whether, in view of the nature and quantity of the preservative added, it can be considered that the article has been rendered injurious to health to an extent sufficient to justify proceedings. The Board state in this circular letter that they are advised that the presence in milk of formalin to an amount ascertained by examination within three days of collecting the sample to exceed 1 part in 40,000 (1 part in 1,000 of formaldehyde), and in the case of boron preservative, to an amount exceeding 57 parts of boric acid per 100,000, or 40 grains to the gallon, raises a strong presumption that the article has been rendered injurious to health. As pointed out in my Annual Report for 1906, it was to be feared that use would be made as a defence of the Board's circular letter, in cases where a disclosure is made, in reference to proceedings where no disclosure is made when the quantity 180 of preservative reported by the Analyst is small. This has been borne out by our experience during 1907, and in cases where the amount of adulteration was small it has been considered advisable to withdraw the summons. This is to be regretted, in view of the recommendation of the Departmental Committee:—"That the use of any preservative or colouring matter whatever in milk offered for sale in the United Kingdom be constituted an offence under the Sale of Food and Drugs Acts." Factory and Workshop Act, 1901. 183 Factory and Workshop Act, 1901. Factory and Workshop Act, 1901. The Factory and Workshop Act, 1901, came into force at the beginning of 1902, and in consequence, a number of additional duties devolved on the local authority. Section 132 of the Act lays down that the Medical Officer of Health of every district council shall every year report specifically on the administration of the Act in workshops and workplaces in the district under his supervision, and transmit a copy to the Secretary of State for the Home Department. In this portion of the Annual Report will be found everything' which has concerned the Health Department in relation to workshops and workplaces. The only exceptions are milk-shops and restaurant kitchens, which are more appropriately included in the section dealing with the protection of the food supply. In the following table is shown a summary of the various premises in the Borough where work is done which are now registered in the Health Department:— Workshops and workplaces 823 Factories 152 Bakehouses 86 Restaurant Kitchens, &c. 93 Ice Cream Premises 110 Home Workers 217 Stables 589 Total 2,070 Factories. The Factory Act contains a sanitary code which is administered by the Factory Inspectors. The duties of the Sanitary Authorities in relation to factories are therefore not 184 very extensive, and are mainly those connected with drainage and the provision of proper and sufficient sanitary accommodation for factory employees, under the provision of the Public Health (London) Act. There is no statutory obligation upon the sanitary authority to register factories, but for purposes of convenience the undermentioned register of all factory premises in the Borough is kept in the Department. The following table shows the various trades and occupations carried on in factories in the Borough of Battersea, which are now on the factory register in the Health Department:— Trade. Number of Factories on the Register Persons Employed. Males. Females. Adults Young Persons Adults Young Persons     Barge builder 2 34 1 Baker 6 127 28 41 43 Bootmaker 4 10 1 — — Builder 5 75 9 — — Butter blender 3 58 31 — Carpenter 2 29 3 Chemical work 3 121 10 14 13 Chaff cutter 6 115 — — — Cycle 2 4 3 — — Dyer 2 39 — 22 — Engineer 8 373 31 — — Flour mill 2 155 10 — — Firewood 4 36 — 28 — Founder 4 87 6 — — Lift maker 2 79 18 — — Mason 11 185 4 — — Mineral water 3 39 1 17 — Printer 14 88 17 3 4 Steam Laundry 30 150 22 738 137 Other trades 39 4,963 141 441 207 Totals 152 6,767 336 1,304 404 185 The following is a list of the defects discovered and remedied in factories during 1907:—  Defects in sanitary conveniences:—    Defective w.c. apparatus 12 Want of proper flush in urinals — Dirty condition of w.c.'s and urinals 24 Defective condition of urinals 2 Want of doors to w.c.'s — „ screens to w.c.'s — „ fastenings to w.c.'s — „ separate accommodation for two sexes 1 „ proper and sufficient number of w.c.'s — W.C.'s opening direct into factories 4 Stoppage of drains 9 Defects in drains — Want of drainage of wet floors 2 Defective condition of roof — Accumulations of refuse 4 Defective condition of yard paving 5 Dilapidations 4 Dirty drinking-water cistern 2 Other defects remedied 14 Workshops. The Workshops in Battersea are under the supervision of the two Workshops' Inspectors—one male and one female Inspector. The former deals with Workshops where men only are employed. The latter with Workshops where female labour is utilised. Workshops in which both male and female labour is employed are supervised by both Inspectors. The following is a list of the workshops on the register at the end of 1907:— 186  Trade. No. of Workshops on Register. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons.     Baker 80 82 182 5 — — Billiard Table Maker 1 1 10 — — — Blindmaker 2 3 7 — — — Bootmaker 65 66 131 17 3 — Carpenter 6 9 19 2 — — Coach Builder 15 26 72 5 — — Coffin Maker 2 2 3 — — — Cycle Maker 17 17 29 8 — — Dressmaker 129 151 — — 389 136 Embroiderer 4 9 5 — 127 1 Farrier and Smith 13 13 38 5 — — Firewood Cutter 7 7 21 1 5 Florist 3 3 — — 6 2 Ironmonger 2 2 3 1 — — Jeweller 4 4 8 — — — Laundry 34 82 4 — 193 — Mason 2 2 11 1 — — Milliner 20 23 — — 75 15 Musical Instrument Maker 2 3 20 — — — Photographer 3 4 1 — 4 — Picture Frame Maker 3 3 .5 1 — — Plumber 4 5 12 — — — Rag Sorter 9 9 24 2 3 — Saddler 5 5 10 — — — Sculptor 1 1 2 — — — Tailor Trunk and Hat-case 42 59 70 7 68 19 Maker 2 6 11 — 2 1 Underclothing Maker 4 5 — — 13 6 Upholsterer 4 8 21 1 5 — Other Trades 39 51 103 12 63 13 Totals 524 661 822 68 956 193 At the beginning of 1907 the number of workshops on the register was 559. During the year the occupation of 187 87 of these premises was discontinued, while 54 new workshops were registered, so that at the end of 1907 the number of workshops on the register was 526, in which were employed 2,041 persons: 892 males and 1,149 females. Section 133 of the Act provides that "when any woman, young person or child is employed in a workshop in which no abstract of the Act is affixed, as by this Act required, and the Medical Officer of Health becomes aware thereof, he shall forthwith give written notice thereof to the Inspector for the district." This section is important, providing as it does the procedure by which most workshops become known to the factory Inspectors, who upon receipt of the notice enter the workshop in the Home Office register and send an abstract of the Act to the occupier. The following table shows the workshops notified to H.M. Inspector during 1907, in pursuance of Section 133 of the Factory and Workshop Act, 1901:— Trade Number of Workshops. Protected Persons employed. Women Young Persons Children. Total. Balloon-making 1 1 — 1 Blind-making 1 1 — 1 Boot-making 4 — 4 — 4 Cab-painting 1 — 2 — 2 Cabinet making 1 — 1 — 1 Carriage work 1 — 1 — 1 Confectionery 1 — 1 — 1 Dressmaking 14 39 9 — 48 Firewood 2 — 2 — 2 Metal-working 1 — 1 — 1 Millinery 1 2 — — 2 Motor body works 1 — 3 — 3 Printing 1 — 1 — 1 Rag-sorting 1 2 — — 2 Tailoring 5 5 4 — 9 Totals 36 49 30 — 79 188 In addition to the above, a domestic workshop was notified to H.M. Inspector in 1907. A domestic workshop, it may be explained, is one in which the persons employed are members of the same family dwelling there. Such workshops (unless the work carried on is one that has been certified by the Secretary of State as dangerous) are exempted from the special provisions as to means of ventilation, &c., but are otherwise, so far as sanitary conditions are concerned, to be treated as workshops. It should be noted that the above table does not include all the workshops newly registered in 1907, but only those in which women, young persons or children were employed, and in which no abstract of the Factory Act was affixed in accordance with the Act. Section 131 of the Act places the Statutory obligation on the Local Authority to keep a register of all workshops situated within its district. This register is kept in the form of a card-register, which has been found more convenient than a book-register. Such workshop has a special card with all particulars recorded thereon. Sanitary Condition of Workshops. The Local Authority is the authority responsible for the sanitary condition of the workshops and workplaces in its district. Sanitary conditions include (a) cleanliness, (b) air space, (c) ventilation, (d) drainage of floors, and (e) provision of sanitary accommodation. For these purposes the provisions of the Public Health Act relating to nuisances apply to all workshops and workplaces, supplemented by certain additional provisions in the Factory Act. (a) Cleanliness.—Every workshop and workplace must be kept in a cleanly state and free from effluvia. Speaking generally, the condition of the workshops in Battersea as regards cleanliness may be said to be satisfactory. In more than 25 per cent. of the workshops in the Borough dressmaking or millinery is the work carried on, and cleanliness 189 is a necessary condition for the carrying on of this industry. In a good many of the other industries, however, the nature of the work does not lend itself to the same necessity and in some cases the work itself is such as to make it a matter of difficulty to secure cleanliness. During the year it was found necessary to serve 114 notices for the cleansing of workshops. (b) Air Space.—Workshops and workplaces must not be so overcrowded while work is being carried on so as to be dangerous or injurious to the health of the persons employed. Section 3 of the Act lays down a standard of 250 cubic feet per head and 400 cubic feet during overtime. This standard is rarely contravened in the workshops in Battersea, and during the year only 5 complaints of overcrowding have been reported and dealt with. In the majority of the workshops in the Borough the air space is above the standard. (c) Ventilation (Section 7).—In every room in the factory or workshop sufficient means of ventilation must be provided and maintained. This requirement, so far as the provision of sufficient means of ventilation is concerned, is in the majority of the workshops in the Borough fulfilled. The "maintenance of sufficient ventilation" is not, however, so freely observed, and it is not uncommon to find the windows and sometimes the other means of securing and maintaining ventilation closed, for fear of draughts. During 1907 it has only been necessary to serve notice in one instance for defective ventilation in a workshop, and on the whole the condition of the workshops as regards this important requirement has been very satisfactory. (d) Drainage of floors in workshops when wet processes are carried on.—Section 8 provides that "in every factory and workshop where the floors are liable to be wet, sufficient means for drainage must be provided." The class of workshop to which this Section of the Factory Act mainly applies, so far as the Borough of Battersea is concerned, is the laundry class. There are at present 34 workshops laundries registered in the Borough. 190 (e) Provision of Sanitary Accommodation.—Section 9 of the Factory and Workshop Act, 1901, states that "Every factory and workshop must be provided with a sufficient number of sanitary conveniences, with separate accommodation for persons of each sex.'' The Section does not apply to London: the powers of the Metropolitan Sanitary Authorities in this respect being granted 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 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." This important requirement has been enforced in every instance in Battersea, though at times difficulty has been experienced. In the larger premises in which many hands are employed, there is usually ample accommodation provided, but in the smaller workshops the sanitary convenience is usually a secondary consideration, and is in many cases badly constructed and inconveniently situated. Part of this difficulty arises from the fact that the sanitary accommodation provided is that which existed for the use of the family residing in the dwelling which has later been utilised as a workshop. Many of the workshops in the Borough are situate in private houses, and the accommodation for the requirements of the inmates which at one time was sufficient is now inadequate or unsuitable in other respects. It is not always easy to overcome this difficulty, even when the occupier is prepared to meet the requirements of the Act, owing to perhaps structural or other unsuitability. The "standard of accommodation" in Battersea is that fixed by the Home Office Order of 1903. The provisions of the Order are as follows:— 191 STATUTORY RULES AND ORDERS, 1903. No. 89. FACTORY AND WORKSHOP. Sanitary Accommodation. The Sanitary Accommodation Order of 4th February, 1903. In pursuance of Section 9 of the Factory and Workshop Act, 1901, I hereby determine that the accommodation in the way of sanitary conveniences provided in a factory or workshop shall be deemed to be sufficient and suitable within the meaning of the said Section if the following conditions are complied with and not otherwise:— 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; (i) 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. 192 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 workroom except through the open air or through an intervening ventilated space: provided that in workrooms in use prior to 1st January, 1903, and mechanically ventilated in such a manner that air cannot be drawn into the workroom 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. A. Akers Douglas, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 4th February, 1903. During the year 4 cases of insufficient sanitary accommodation in relation to factories, workshops and workplaces, and two cases where separate accommodation for persons of each sex was not provided have been remedied. In addition, in 116 instances in which the sanitary conveniences were found 193 to be in a dirty or defective condition these were cleansed and repaired. The following is a summary of the year's work carried out in connection with the sanitary condition of workshops, &c. During the year 3,917 visits of inspection to factories and workshops and workplaces, exclusive of home workers visits, have been made by the workshops Inspectors. In addition, the district Sanitary Inspectors in the ordinary course of their duties, have made 512 inspections of factories, workshops and workplaces, principally in connection with drainage defects. Paving.—47 Intimation notices have been served for defective paving of floors, yards, &c., of premises used as factories, workshops and workplaces, as follows:— Factories 4 Workshops and Workplaces 43 In 45 of these cases the notices have been complied with, and in connection with the remainder the work is in hand. The following is a tabulated statement of the work carried out in connection with workshop inspection during the year, so far as it admits of tabulation:— 194 Workshops inspections and re-inspections 1,558 Workrooms measured 54 Workshops notified to H.M. Inspector 36 Cards distributed showing number of persons legally employed in workrooms 22 Written intimations issued 192 Statutory notices served 65 Defects discovered in Workshops and remedied:— Workrooms in a dirty condition 4 ,, overcrowded 5 „ badly ventilated 1 ,, with defective walls or ceilings 20 „ with defective floors 2 Workshops with defective yard paving 14 „ with defective drains 2 ,, with blocked drains 5 „ without proper dustbins 17 ,, with defective w.c. apparatus 23 ,, with sanitary conveniences insufficient in number or absent 4 ,, with sanitary conveniences opening into workrooms 1 ,, with sanitary conveniences without proper doors or fastenings — ,, with sanitary conveniences in dirty condition 18 Coal bins provided in bakehouses — Accumulations of refuse removed 10 Other defects remedied 16 195 The following notices of defects were received from H.M. Inspectors of Factories. In each case a notice was served on the person responsible, and the defects remedied:— Premises. Trade. Nature of Complaint.     220 Queens Road Embroidery All walls and ceilings are in a dirty state and require cleansing. 86 St. John's Road Millinery Requires limewashing. 211 Lavender Hill Dressmaking Requires cleansing. A1 Biscuit Co., Queens Road Biscuit making Effluvia from water closets. Underground Workrooms. Excluding the underground bakehouses there are 32 underground workshops and workplaces in Battersea, and the number in each trade is given below:— Workshop. Laundries 2 Picture frame making 2 Cycle making 3 Tailoring 1 Workplaces. Restaurant kitchens 6 Meat chopping 6 Small exempted laundries 12 Bakehouses. Bakehouses are either factories or workshops within the meaning of the Act according as mechanical power is or is not used in aid of the processes carried on. They are therefore subject to the provisions of the Act, and although in the main the factory bakehouses in the Borough are supervised by the 196 Factory Inspectors, by far the greater part of the work connected with the supervision of bakehouses in Battersea devolves on the Council as the Sanitary Authority. In the Borough of Battersea during 1907, there were registered 86 bakehouses, 6 of which were factory bakehouses, with regard to which the duties of the Council are few, and 80 were workshop bakehouses. Of the latter, 49 are above ground and 31 underground, according to the definition given in the Factory Act. A list of the workshop bakehouses is given below:— 49 Above Ground. Address. Address.     25 Battersea Park Road 48 New Road 257 „ „ „ 89 „ „ 292 „ „ „ 148 „ „ 343 „ „ „ 205 „ „ 1 Battersea Rise 10 Northcote Road 78 „ „ „ 23 „ „ 31 Bridge Road 64 „ „ 84 „ „ „ 94 „ „ 64 Castle Street 62 Plough Road 45 Culvert Road 76 „ „ 83 „ „ „ 112 „ „ 139 Chatham Road 41 Queens Road 47 Este Road 121 „ „ 29 Falcon Road 88 Grayshott Road 38 Rowena Crescent 93 Stewarts Road 45 Harroway Road 29 Stockdale Road 11 Hanbury Road 90 St. John's Hill 49 High Street Sugden Road 80 „ „ 32 Tyneham Road 173 „ „ 102 Usk Road 137 Lavender Hill 46 York Road 313 „ „ 70 „ „ 64 Latchmere Road 198 „ „ 93 „ „ 287 „ „ 29 Meyrick Road 197 31 Underground. Address. Address. 163 Battersea Park Road 103 Falcon Road 189 „ „ „ 46 Frances Street 200 „ „ „ 30 Lavender Hill 219 „ „ „ 123 Maysoule Road 265 „ „ „ 36 Orkney Street 310 „ „ „ 23 Plough Road 373 „ „ „ 34 „ „ 501 „ „ „ 109 Salcott Road 525 „ „ „ 140 St. John's Hill 48 Broomwood Road 8 Tyneham Road 2 Burland Road 23 Webbs Road 35 Castle Street 47 Winstanley Road 83 Chatham Road 79 „ „ 83 Church Road 6 York Road 4 Currie Street 345 „ „ 43 Falcon Road Before the Factory and Workshop Act, 1901, came into force, there were in Battersea 49 underground bakehouses. Owing to the action taken by the Local Authority, 18 of these premises have since been closed, leaving 31 now in use. These have been greatly improved to meet the requirements of the Sanitary Authority, and certificates have been granted as to their suitability. The sanitary regulation of bakehouses is a matter of great importance, and a good deal of attention has been given to the inspection of these premises during the year. On the whole, the condition of the bakehouses, both above ground and under ground, have been satisfactory, and very few complaints of a serious character have been reported. The underground bakehouses have decreased by one during the year. Underground bakehouses can never, of course, be considered as satisfactory, as it is a difficult matter to secure in them efficient lighting and ventilation, in addition to the other drawbacks 198 associated with their use. What has been possible to attain in regard to making these places as sanitary as under the circumstances can be expected has been done. Under the systematic supervision exercised by Inspector Benjamin, both the above ground and underground bakehouses have been kept up to a fair standard as regards the requirements of the Act. Only one serious contravention of the Act occurred during the year. This had reference to the temporary use of a disused underground bakehouse. The occupier of an aboveground bakehouse in Northcote Road, owing to pressure of work just before Christmas, had used an old underground bakehouse in the same premises for the purpose of baking cakes. On the matter being reported to me by Inspector Benjamin, I visited the premises. The occupier, on his attention being drawn to the breach of the law, expressed his regret, and immediately discontinued the offence. He was cautioned as to his future action. The following is a list of the 6 factory bakehouses in the Borough:— Altenburg Gardens Bread and Confectionery. Park Road „ „ „ Broughton Street Biscuits only. 37 Grayshott Road Bread. 465 Battersea Park Road „ 465 Battersea Park Road „ The following summary of the work done during the year in connection with the supervision of the bakehouses in the Borough of Battersea may, for convenience of reference, be set down here. It should of course be remembered that these are all included in the tables giving the results of general factory and workshops inspection. Above ground bakehouses.—55 intimation notices were served for various defects, and in 11 cases it was found necessary to serve statutory notices. All of these notices were complied with. 199 Underground bakehouses.—23 intimation notices were served for various defects, and in 4 cases it was found necessary to serve statutory notices, all of which were complied with. The defects for which these notices were served had reference to want of cleanliness, defective sanitary fittings, paving, &c. In the case of one of these premises in which there was evidence of effluvia nuisance in the bakehouse, the drains were tested and found defective. The necessary repairs were carried out and the drains were found on retesting with water to be satisfactory. The half-yearly cleansing and lime-washing required under the provisions of the Factory and Workshop Act have, on re-inspection, been found to have been in every case complied with. Homework. This term has reference to persons who carry on certain classes of work in their own homes. Under the Factory and Workshop Act, 1901, very important powers are given to District Councils for controlling the conditions under which the work is done. The powers conferred by the Act of 1901 aim at the prevention of home-work being done (1) in dwellings which are injurious to the health of the workers themselves, e.g., through overcrowding, want of ventilation or other insanitary defects; (2) in premises where there is dangerous infectious disease. The home-workers residing in Battersea are employed both by firms established in the Borough and by firms belonging to other Boroughs. The list of trades specified by the Home Secretary, to which Sections 107, 108 and 110 apply, are set out in the Home Work Order of the 23rd May, 1907, which reads as follows:— 200 STATUTORY RULES AND ORDERS, 1907. No. 408. FACTORY AND WORKSHOP. Home Work. The Home Work Order of 23rd May, 1907. In pursuance of Sections 107, 108, and 110 of the Factory and Workshop Act, 1901, I hereby make the following Order:— I. Section 107 (relating to lists of out-workers) and Section 108 (relating to employment in unwholesome premises) shall apply to the following classes of Work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel; The making, ornamenting, mending, 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; The making or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; The making of nets other than wire nets; The making of tents; The making or repairing of sacks; The covering of racket or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; The making of brushes; Pea picking; Feather sorting; The carding, boxing, or packeting of buttons, hooks, and eyes, pins, and hair pins; The making of stuffed toys; The making of baskets; And any processes incidental to the above. 201 II. Section no (relating to the prohibition of home work in places where there is infectious disease) shall apply to the following classes of work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto (as in the said section specified); The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Upholstery work; Fur-pulling; The making or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; The making of nets other than wire nets; The making of tents; The making or repairing of sacks; The covering of racket or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; The making of brushes; Pea picking; Feather sorting; The carding, boxing, or packeting of buttons, hooks and eyes, pins, and hair pins; The making of stuffed toys; The making of baskets; And any processes incidental to the above. 2. The lists of out-workers required to be kept by Section 107 and the copies thereof shall be kept and made in the form and manner and with the particulars shown in the Schedule hereto. 3. This Order may be referred to as the Home Work Order of the 23rd May, 1907. 4. The Home Work Order of the 15th August, 1905, is hereby revoked. H. J. Gladstone, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 23rd May, 1907. 202 SCHEDULE. List of Out-workers. A correct list of out-workers employed in the following classes of work:— (a) the making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel; (b) The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; (c) cabinet and furniture making and upholstery work; (d) the making of electro-plate; (e) the making of files; (f) fur-pulling; (g) the making of iron and steel cables and chains; (h) the making of iron and steel anchors and grapnels; (i) the making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; (j) the making of locks, latches, and keys; (k) the making or repairing of umbrellas, sunshades, parasols, or parts thereof; (l) the making of artificial flowers; (m) the making of nets other than wire nets; (n) the making of tents; (o) the making or repairing of sacks; (p) the covering of racket or tennis balls; (q) the making of paper bags; (r) the making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; (s) the making of brushes; (t) pea picking; (u) feather sorting; (v) the carding, boxing, or packeting of buttons, hooks, and eyes, pins, and hair pins; (w) the making of stuffed toys; (x) the making of baskets; (y) and any processes incidental to the above; must be kept in the form and with the particulars specified below in the factory or workshop or place from which the work is given out, and must be open to inspection by H.M. Inspectors and the officers of the local authority; and a copy of the list signed and dated and corrected up to that date must be forwarded to the local authority of the district on or before the first day of February and on the first day of August in each year. 203 In order that the list may be correct, the name of any person newly taken into employment shall be immediately entered, and the name of any person ceasing to be employed should be immediately struck out. Factory, Workshop or Place from which the work is given out Full Postal Address Business Name of Occupier (а) Give name of employer. (b) Say whether the occupier or a contractor employed by the occupier. List of Persons directly employed by (a) (b) in the business of, but outside, the above Factory, Workshop, or Place, in the classes of work specified above. Name in full. Whether employed as Workman (W) or Contractor (C). Class of work. (Specify by means of index letters as above.) Place of Employment i.e. place where the work is actually done. Address [No entry need be made in this column if the entry in column (4) is a sufficient address. (1) (2) (3) (4) (5) The subject of home-work in Battersea was fully dealt with by me in a report to the Health Committee contained in my Annual Report for 1906, as the result of a circular letter received by the Council in October, 1905, from the Secretary of State for the Home Department, drawing the attention of district councils to their powers under the Act and the little use made in many districts of these powers. During 1907, special attention was devoted to outworkers. The results of the work accomplished will be found set out in the following tables. Systematic inspection is carried out by Inspector Benjamin and Miss Fairbairn. The former deals with male outworkers and the latter with females. In addition, the lists kept by firms established in Battersea of outworkers are regularly inspected, and care taken that these lists 204 are kept in the manner and form prescribed by Section 107 of the Factory and Workshop Act. The names and addresses of 787 outworkers as compared with 520 in 1906, were received during the year. Lists were sent in by employers, and by the Medical Officers of Health of the following Metropolitan Boroughs:— Borough. No. of Lists. Borough. No. of Lists. Camberwell 6 Kensington 9 Chelsea 5 Lambeth 6 City of London 12 St. Marylebone 2 Finsbury 8 Shoreditch 1 Fulham 1 South wark 4 Hammersmith 2 Wandsworth 36 Holborn 2 Westminster 9 The names and addresses of 191 outworkers which were sent in by employers were found to refer to other districts, and were accordingly forwarded to the Medical Officers of Health of these districts. The premises occupied by the outworkers are registered and regularly inspected, and any insanitary conditions found remedied. The premises generally were in a very fair condition, and comparatively few notices were required. The following table shows the number of such places which have been registered, together with the trades and the number of persons employed:— 205 Trade. Number on Register. Persons Employed. Premises Rooms Males. Females. Art needlework 4 4 Blouse makers 7 7 — 11 Bootmakers 29 29 32 1 Dressmakers 11 11 — 11 Embroiderers 35 35 — 38 Glove makers 34 36 — 40 Hosiers 2 2 — 2 Tailors 63 63 38 43 Underclothing makers 18 18 — 22 Upholsterers 1 1 — 3 Other trades 13 13 3 11 Totals 217 219 73 186 During the year 751 inspections were made, and 57 written notices were served in connection with home-work inspection. The following defects relating to male outworkers' premises were discovered and remedied as the result of the visits paid by Inspector Benjamin Dirty premises 9 Defective paving 2 Defective w.c. fittings 5 Defective walls, floors and ceilings 6 Defective dust bins 5 Miscellaneous 5 Owing to the continual movements taking place amongst outworkers, it is very difficult to trace them. Every effort is 206 made in each case where a removal is reported to trace the new address of the outworker. Owing to the resignation of Miss Dawson, part of whose duty was to look after, and the delay in filling the vacancy, the work was, during the latter part of the year considerably hampered. The new lady Inspector, Miss Fairbairn, is rapidly overtaking the arrears of work in connection with workshops and home-work inspection. A satisfactory fact to be able to record in connection with home-work provisions of the Factory and Workshop Act, 1901, is the great improvement which has taken place with regard to the keeping of lists of outworkers by employers and the avoidance of delay in sending in the half-yearly lists to the Health Department. This has greatly facilitated the more rapid inspection of these premises, and has led to less difficulty in tracing the movements of outworkers who have changed their addresses. 251 visits were made to the premises of 46 employers, and the printed form, No. 44, was on examination found to be correctly kept in each case. Workplaces. Workplace is not defined in the Factory and Workshop Act, but the term is used in the Public Health Acts, and in a case under Section 38 of the Public Health (London) Act, 1891, where the phrase "Factory, Workshop and Workplace" occurs, it was held that the term "Workplace" includes "any place where work is done permanently, and where people assemble together to do work permanently of some kind or other." The term has therefore, a much wider significance than the word "Workshop," and it has been held that a stable and stable-yard where men are employed as ostlers and cabcleaners is a "Workplace." In addition to the supervision of restaurants and kitchens, ice cream shops and milk shops, which will be found on page 163 in the part of the Report dealing with the protection of the food supply, marine store dealers and wharves were inspected during the period under report. 132 Intimation Notices and 26 Statutory Notices were served for various nuisances under the Public Health (London) Act and remedied. Legal Proceedings. 209 Legal Proceedings. Summary of Legal Proceedings. The facts relating to the legal proceedings instituted by the Council in connection with the work of the Health Department are set out on pages 210 to 225, and are summarised below:— No. of Prosecutions. No. of Convictions. Fines. Costs. £ s. d. £ s. d. Sale of Food and Drugs Acts 138 74 154 5 0 55 12 6 Smoke nuisances 16 10 15 0 0 2 1 0 Unsound Food 10 5 20 14 0 1 2 0 Contravention of ByeLaws 13 5 2 10 0 2 16 0 Other proceedings 17 13 12 5 0 4 12 0 Total 194 107 204 14 0 66 3 6 Note.—In two cases the defendants went to prison in default. 210 Legal Proceedings under the Public Health (London) Act, 1891, and Metropolis Management Act, 1855. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 1906. Nov. 7 & Dec. 5 1907. Jan. 16 Mr. Paul Taylor Miss J., 3 Livingstone Road Non-compliance with closing order relating to No. 3 Livingstone Road Fined £4 10s. and 2s. costs Jan. 2 & 30 ,, E. J. G., 276 York Road, Wandsworth Depositing unsound ox for preparation for sale at No. 49 York Road, Battersea Summons against defendant, E. J. G., dismissed with ten guineas costs, and summons against defendant, J. T. B., withdrawn ,, ,, J. T. B., 49 York Road ,, ,, 16 ,, Mr. G., 14 Boundaries Road, Balham Neglecting to deposit plans of reconstruction of drains at No. 122 Balham Park Road Plans having been deposited, defendant ordered to pay 5s. costs Feb. 13 & 27 Mr. Francis F. N., Hope Dairy, Hope Street Nuisances at Nos. 6 and 8 Mendip Road Fined 10s. and 2s. costs on each of 3 summonses and 2S. costs on two summonses, making total fines and costs £2 ,, ,, Mr. B., Winchester House, 50 Old Broad Street, E.C. Nuisance at No. 27 Winstanley Road Order for abatement within 7 days and 5s. costs Feb. 13 & 27, Mar.13 & April 10 & 18 ,, W. B., Winchester House, 50 Old Broad Street, E.C. Nuisance at No. 27 Winstanley Road Fined 10s. with £2 2s. costs April 10 & 24 & May 8 Mr. de Grey M. M., Ltd., Flour Mills, Church Road Black smoke nuisances (seven offences) Fined £1 and £1 3s. costs for offence on 2nd November, and summonses for other offences dismissed, the magistrate not being satisfied there was a nuisance May 8 ,, J. W., 29 Ascalon Street Fixing new trap at No. 134 Taybridge Road without giving notice to Sanitary Authority Fined 10s. and 2s. costs 211 Legal Proceedings under the Public Health (London) Act, 1891, and Metropolis Management Act, 1855—(continued). Date Heard. Before Whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 1907. May 8 Mr. de Grey H. C. U., 41 Harbut Road Fixing a soil pipe and flushing apparatus at No. 78 Harbut Road without giving notice to Sanitary Authority Fined 10s. and 2s. costs ,, ,, Do. Neglecting to make joints of cast iron soil with molten lead Fined 10s. and 2s. costs Mar. 13, Apr. 24 & May 8 & 22 Mr. Garrett M. & B., Ltd., The Chemical Works, Church Road Black smoke nuisances (4 offences) Fined £1 and 2s. costs in each case. £4 8s. in all Apr. 24 & May 8 & 22 ,, R. Bros., 72 St. John's Hill Black smoke nuisances (5 offences) Fined £2 and 2s. costs in each case £10 10s. in all May22& June 19 ,, T. W., 25 Gonsalva Road Exposing unsound beef and mutton for sale Fined £10 and 4s. costs July 3 ,, S. E., 55 Sarsfeld Road No proper water supply at No. 55 Sarsfeld Road Closing Order made but not to be drawn up for 7 days, and ordered to pay 5s. costs ,, ,, A. A., 176 Garratt Lane, Earlsfield (a) Exposing unsound meat for sale at No. 67 High Street, Battersea Fined £10 and 4s. costs on first summons, and ordered to pay 4s. costs on the second summons and 2s. costs on third (b) Depositing unsound meat for sale at No. 67 High Street, Battersea (c) Depositing unsound meat for sale at No. 85 High Street, Battersea ,, 17 Mr. de Grey Miss J., 3 Livingstone Road Nuisance at No. 7 Livingtone Road Order made to abate same in 28 days and ordered to pay 5s. costs ,, ,, Do. Nuisance at No. 9 Livingstone Road Closing order made and ordered to pay 5s. costs 212 Legal Proceedings under the Public Health (London) Act, 1891, and Metropolis Management Act, 1855—(continued). Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 1907. July 17 Mr. de Grey Miss J., 3 Livingstone Road Nuisance at No. 11 Livingstone Road Closing order made and ordered to pay 5s. costs 1906. Dec. 19 1907. Jan. 16, Feb. 13, Mar. 13 & July 17 ,, Mrs. W., 36 Bolingbroke Road Non-compliance with bye-law as to paving of yards and open spaces at Nos. 2, 4 and 6 Somerset Street Work done and nuisance abated and summonses withdrawn on payment of £1 1s. costs ,, ,, Do. Nuisance at No. 2 Somerset Street July 31& Sept.25 ,, Mr. S., 170 High Street, Clapham Nuisance at No. 283 Battersea Park Road and no dustbin Work having been done, dustbin provided, and 6s. costs paid, summonses withdrawn Sept. 25 ,, Miss J., 3 Livingstone Road Non-compliance with notice to abate nuisance at No. 7 Livingstone Road Fined £5 and 2s. costs ,, ,, Do. Non-compliance with notices to abate nuisance and pave yard at Nos. 9 and 11 Livingstone Road Closing orders having been made summonses adjourned sine die. ,, ,, W. G., 126 Old Kent Road, S.E. Non- deposit of plans of drainage at Palace Wharf, Nine Elms Lane Fined £1 and 2s. costs ,, ,, Do. Constructing a water closet there without notice Ordered to pay 2s. costs Oct. 9 ,, A. D., 30 Britannia Place Exposing unsound fruit for sale Fined 10s. and 4s. costs ,, ,, W. H., 15 Livingstone Road Do. Fined 2s. and 2s. costs ,, ,, J. M., 1 Tritton Street, Plough Road Do. Fined 2s. and 2s. costs ,, 23 Mr. Garrett J. W., 91 Durham Buildings, York Road Exposing unsound fruit for sale Summons withdrawn on directions of Health Committee 213 Legal Proceedings under the Public Health (London) Act, 1891, and Metropolis Management Act, 1855—(continued). Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 1907. Oct.23& Nov. 6 Mr. Plowden E. B., 24 Laburnum Street, N. Non-deposit of plans of drainage at No. 54 Battersea Rise Summons withdrawn, plans having been deposited and 10s. 6d. costs paid Dec. 4 Mr. Francis J.M., 53 Strathblaine Road Exposing himself while suffering from scarlet fever Fined 15s. and 7s. costs „ 4 & 18 Mr. Mead D. M., 48 Arthur Street Non-deposit of plans of drainage Summons withdrawn, plans having been deposited and 7s. 6d. costs paid 214 Legal Proceedings under Sale of Food and Drugs and Margarine Acts. No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 657 1907. Jan. 2 Mr. Paul Taylor J. T., 46 New Road Selling butter containing 80 per cent. of foreign fat Fined £5 and 12s. 6d. costs 663 ,, ,, Do. Exposing margarine for sale without a label Ordered to pay 2s. costs 647 ,, ,, S. B, 38 Clyston Street, Wandsworth Road Selling separated milk containing less than 9 per cent. of milk solids Fined £1 and 12s. 6d. costs or one month in default 649 ,, ,, E. O., 38 Clyston Street, Wandsworth Road Do. Fined 10s. and 12s. 6d. costs 517 1906. Nov. 7 and Dec. 5 1907. Jan. 2 ,, J. J., 109 Larkhall Lane, Clapham Selling milk containing 10 per cent. of extraneous water Summons against R. A. withdrawn on J. J. taking responsibility and he having required the third sample to be sent to Government Analysts, they reported they could not give a definite opinion owing to the state of decomposition which had set in, and the summons was thereupon, on the Magistrate's suggestion, withdrawn R. A., 41 Portslade Road Do. — ,, ,, J. J., 109 Larkhall Lane, Clapham No name on barrow Fined 10s. and 2s. costs 476 1906. Nov. 7, Dec. 5 and 19 1907. Jan. 2 and 30 ,, F. C., 56 Grayshott Road Selling milk containing 0.035 Per cent. of boron trioxide F. C. fined £2 10s. and 12s. 6d. costs, and, on his taking responsibility, summons against W. C. T. was withdrawn W. C. T., 25 Ashbury Road 215 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 487 1906. Nov. 7, Dec. 5 and 19. 1907. Jan. 3. 10 & 17 Mr. Garrett G. D., 221B Eversleigh Road Selling milk containing 00425 per cent. of boron trioxide Defendant pleaded warranty. The Magistrate held that the contract of warranty, which was dated 20th March, 1906, was sufficient, but held, though with hesitation, that the writing on which the defendant relied to connect such warranty with the consignment of milk from which the sample was taken was not a sufficient identification within the recent case of Watts v. Stevens, 70 J. P., 418. He, however, thought it would be a hardship on the defendant to convict him, and therefore dismissed the summons on payment by the defendant of 12s. 6d. costs 659 Jan. 2 and 30 Mr. Paul Taylor W. J., 46 St. Andrews Street Selling milk containing 22 per cent. of extraneous water Fined £5 and 12s. 6d. costs 673 ,, 16 ,, C. R., sen., Culverhouse, Motcombe, Dorset Selling milk from which 12.6 per cent. of the original fat had been abstracted without disclosure. Sample taken in course of delivery Fined £10 and 12s.6d. costs 672 ,, ,, Do. Selling milk containing 3 per cent. of extraneous water and 16.4 per cent. devoid of fat. Sample taken in course of delivery. Fined £10 and 12s. 6d. costs 216 Legal Proceedings under Sale of Food and Drugs and Margarine Acts —(continued). No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 666 1907. Jan. 16 Mr. Paul Taylor S. B., 2 Tennyson Street Selling milk containing 8 per cent. of extraneous water S. B. fined £1 and 12s. 6d. costs, and, on his taking responsibility. summons against E. B. withdrawn — ,, ,, E. B., 2 Tennyson Street 744 Feb.13 ,, C. R., 28 Crichton Street Selling milk from which 6 per cent. of the original fat had been abstracted without disclosure Fined £2 and 12s. 6d. costs 726 ,, ,, J. C. G., 65 Grant Road Selling milk containing 5 per cent. of extraneous water J. C. G. fined 5s. and 14s. 6d. costs, and, on his taking responsibility, summons against A. H. withdrawn — ,, ,, A. H., 65 Grant Road 669 Jan. 16 and Feb.13 ,, H.S.,30 Totteridge Road Selling milk from which 12 percent. of the original fat had been abstracted without disclosure H. S. fined £3 and 14s. 6d. costs, and, on his taking responsibility, summons against J. B. withdrawn — ,, ,, J. B., 6 Simpson Street 746 Feb.13 ,, J.T., 46 New Road Selling milk containing 11 per cent. of extraneous water Summons adjourned sine die, defendant J. T. having left the neighbourhood — ,, ,, J. J. T., 46 New Road 729 ,, ,, E. G., 93 Stainforth Road Selling butter containing 81 per cent. of foreign fat Fined £2 and 12s. 6d. costs 784 ,, 27 Mr. Francis J. W. Y., 22 Oldridge Road, Balham Selling milk containing 5 per cent. of extraneous water Summons against J. W. Y. dismissed, he proving warranty, and summons against G. S. withdrawn — ,, ,, G. S., 29 Oldridge Road, Balham 767 ,, ,, E. H., Cannon Court Farm, Milbourne Port, Wilts Selling milk from which 33 per cent. of the original fat had been abstracted without disclosure. Sample taken in course of delivery Fined £1 and 14s. 6d. costs 217 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 796 1907. Feb. 27 Mr. Francis T. R., 21 Pearson Street Selling butter containing 37 per cent. of foreign fat J R., who took responsibility, fined £1 and 12s. 6d. costs, and summons against T. R. withdrawn — ,, ,, J. R. , 21 Pearson Street 797 ,, ,, T. R. , 21 Pearson Street Exposing margarine for sale by retail without a label J. R., who took responsibility, fined £1 and 12s. 6d. costs, and summons against T. R. withdrawn — ,, ,, J. R., 21 Pearson Street 480 1906. Nov. 7 and Dec. 5. 1907. Mar. 13 Mr. Paul Taylor The W. U. D., Ltd., Pans Lane, Devizes, Wilts Selling cream containing 0.40776 per cent. of boron trioxide. Sample taken in course of delivery Summons withdrawn by order of the Health Committee. The third sample was at defendants' request sent to the Government Analysts 779 Feb, 27 and Mar. 13 ,, J. V. E., 99 Northcote Road Selling milk containing 4 per cent. of extraneous water J. V. E. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against D. E. withdrawn — ,, ,, D. E., 99 Northcote Road 747 ,, ,, W. T., 572 Garratt Lane, Tooting Selling skimmed milk containing at least 8 per cent. of extraneous water and less than 9 per cent. of milk solids Fined £5 and costs amounting to £1 17s. 6d., or one month 808 ,, ,, Do. Selling skimmed milk containing less than 1 per cent. of fat 809 ,, ,, Do. Selling skimmed milk containing less than 1 per cent. of fat 822 ,, ,, J. F., 61 Bridge Road Selling milk from which 5 per cent. of the original fat had been abstracted without disclosure Summonses withdrawn by order of the Health Committee on payment by J. F. of 14s. 6d. costs — ,, ,, T. E., 61 Bridge Road 218 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 790 1907. Feb. 27 and Mar. 13 Mr. Paul Taylor F.D., 30 Totteridge Road Selling milk containing 12 per cent. of extran. eous water F. D. fined £5 and 14s 6d. costs, and, on his taking responsibility, summons against J. B. withdrawn — ,, ,, J. B., 6 Stimpson Street 858 Mar. 13 ,, W. P., 51 Gwynne Road Selling butter containing 50 per cent of foreign fat Summonses dismissed on defendants paying 14s. 6d. costs — ,, ,, K. P., 51 Gwynne Road 837 ,, 27 Mr. Curtis Bennett W. J., 4 Sandall Street, Waterloo Road, S.E. Selling separated milk containing at least 4.4 per cent. of extraneous water and less than 9 per cent. of milk solids Fined £1 and 12s 6d. costs 911 Apr. 10 ,, A. M., 140 Meyrick Road Selling milk containing 5 per cent. of extraneous water A. M. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against E.M. withdrawn — ,, ,, E. M., 140 Meyrick Road 913 ,, ,, F. C., 54 Winstead Street Selling milk containing 6 per cent. of extraneous water Fined £2 and 12s 6d. costs 949 ,, 24 ,, E. B., 147 High Street Selling milk containing 21 per cent. of extraneous water Fined £2 and 12s. 6d. costs 939 ,, ,, F. J., 3 Cabul Road Selling milk containing 3 per cent. of extraneous water and 7 per cent. of milk devoid of fat Fined 10s. and 12s. 6d. costs 938 ,, ,, H. J., 121 Maysoule Road Selling milk containing 6 per cent. of extraneous water Fined £1 and 12s. 6d. costs 973 ,, ,, A. E. H., 34 Savona Street Selling milk from which 31 per cent. of the original fat had been abstracted without disclosure A. E. H. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against A.H. withdrawn — ,, ,, A. H., 34 Savona Street 219 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 934 1907. Apr. 24 Mr. Curtis Bennett F. H., 15 Plough Road Selling butter containing 30 per cent. of foreign fat F. H. fined £3 and 14s. 6d. costs, and, on his taking responsibility, summons against E.H. withdrawn — ,, ,, E. H., 15 Plough Road 935 ,, ,, F. H., 15 Plough Road Exposing margarine for sale without a label F. H. fined £2 and 14s 6d. costs, and, on his taking responsibility, summons against E.H. withdrawn — ,, ,, E. H., 15 Plough Road 990 May 8 Mr. de Grey D. M., 123 York Road Selling butter containing 78 per cent. of foreign fat H. A. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against D.M. withdrawn — ,, ,, H A., 123 York Road 19 ,, 8 and 22 Mr. Garrett F.D., 30 Totteridge Road Selling separated milk containing less than 9 per cent. of milk solids and at least 10.47 per cent. of extraneous water F. M. ordered to pay 12s. 6d. costs, and summons against F. D. withdrawn — ,, ,, F. M., 58A Aslett Street, Wandsworth — ,, ,, F.D., 30 Totteridge Road Having no name or address inscribed on barrow F. M. ordered to pay 2s. costs, and summons against F. D. withdrawn — ,, ,, F. M., 58a Aslett Street, Wandsworth — ,, ,, F. D., 30 Totteridge Road Do. (2nd offence) F. M. ordered to pay 2s. costs, and summons against F.D. withdrawn — ,, ,, F. M., 58a Aslett Street, Wandsworth 30 ,, 22 ,, F.J.C., 131 Sugden Road Selling butter containing 43 per cent. of foreign fat F. J. C. fined £2 and 14s. 6d. costs, and, on his taking responsibility, summons against K.C. withdrawn. Warranty defence — ,, ,, K. C., 131 Sugden Road 220 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 31 1907. May 22 Mr. Garrett F.J.C., 131 Sugden Road Selling milk containing 16 per cent. of extraneous water F. J. C. fined £2 and 14s. 6d. costs, and, on his taking responsibility. summons against K. C. withdrawn. Warranty defence — ,, ,, K. C., 131 Sugden Road 75 June 5 ,, E. D., 27 Etruria Street Selling milk from which 13 per cent. of the original fat had been abstracted without disclosure Ordered to pay 12s. 6d. costs 68 ,, ,, H. P., 10 Jew's Row. Wandsworth Selling separated milk containing at least 11.77 per cent. of extraneous water and less than 9 per cent. of milk solids Fined £2 and 12s. 6d. costs 69 ,, ,, J. B., 17 Heaver Road Selling milk containing 3 per cent. of extraneous water J. B. fined £4 and 14s. 6d. costs, and, on his taking responsibility, summons against E. B. withdrawn — ,, ,, E. B., 17 Heaver Road 113 ,, 19 ,, A. K., 90 Grayshott Road Selling milk from which 14 percent. of the original fat had been abstracted without disclosure Fined £1 and 12s. 6d. costs 119 ,, ,, T. C., 81 Grant Road Selling milk from which 6 per cent. of the original fat had been abstracted without disclosure T. C. fined £1 and 12s. 6d. costs, and, on his taking responsibility, summons against C. C. withdrawn — ,, ,, C. C., 81 Grant Road 101 ,, ,, J. M. K., Didswell Manor, West Clandon, Guildford Selling milk from which 18 per cent. of the original fat had been abstracted without disclosure. Sample taken in course of delivery Fined £2 and 12s. 6d. costs 221 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 98 1907. June 19 Mr. Garrett J. M. K., Didswell Manor, West Clandon, Guildford Selling milk from which 17 per cent. of the original fat had been abstracted without disclosure. Sample taken in course of delivery Fined £1 and 28s. costs 100 ,, ,, Do. Selling milk from which 14 per cent. of the original fat had been abstracted without disclosure. Sample taken in course of delivery 27 May 22 and June 19 ,, W. F., 30 Totteridge Road Selling milk from which 18 per cent. of the original fat had been abstracted without disclosure Fined £3 and 12s. 6d. costs 44 ,, ,, L. E., 24 St. George's Street Selling milk containing at least 14.67 per cent. of extraneous water and less than 9 per cent. of milk solids Fined £5 and 12s. 6d. costs 41 ,, ,, T. W., 25 Gonsalva Road Selling milk containing 11 percent. of extraneous water Fined £2 and 12s. 6d. costs 154 July 3 ,, W. J. M., 35 Hanbury Road Selling milk containing less than 9 per cent. of milk solids and at least 8.95 per cent. of extraneous water W. J. M., fined £1 and 14s. 6d. costs, and on his taking responsibility, summons against T. B. withdrawn — ,, ,, T. B., 5 Nursery Street, Wandsworth Road 800 Feb. 27 Mar. 27 Apr. 24 May 8 and July 17 Mr. de Grey L. E. and J. H., 212 Battersea Park Road Selling milk from which 10 percent. of the original fat had been abstracted without disclosure Summons withdrawn by order of the Health Committee on payment of £2 2s. costs 222 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 162 1907. July 17 Mr. de Grey W. W., 10 Lubeck Street Selling milk containing 5 per cent. of extraneous water J. W. fined £1 and 14s. 6d. costs, and, on her taking responsibility. summons against W. W. withdrawn — ,, ,, J. W., 10 Lubeck Street 259 ,, 31 ,, J. F., 61 Bridge Road Selling butter containing 77 per cent. of foreign fat J. F. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against R. E. withdrawn — ,, ,, R. E., 61 Bridge Road 261 ,, ,, J. F., 61 Bridge Road Selling butter containing 78 per cent. of foreign fat J. F. fined £2 and 14s. 6d. costs, and, on his taking responsibility, summons against R.E. withdrawn — ,, ,, R. E„ 61 Bridge Road 232 ,, ,, J. F., 61 Bridge Road Selling butter containing 78 per cent. of foreign fat J. F. fined £2 and 14s. 6d. costs, and, on his taking responsibility. summons against L. P. withdrawn — ,, ,, L. P., 61 Bridge Road 237 ,, ,, J. F., 61 Bridge Road Selling milk containing 10 per cent. of extraneous water with 19.4 per cent. devoid of fat J. F., who relied on a warranty, fined £1 and 14s. 6d. costs, and, on his taking responsibility. summons against L. P. with drawn — ,, ,, L. P., 61 Bridge Road 214 ,, ,, J. W. P., 104 Salcot Road Selling milk containing 7 per cent. of extraneous water Fined £1 and 12s. 6d. costs 201 ,, ,, C. S., 301 York Road Selling separated milk containing at least 11.5 per cent. of extraneous water and less than 9 per cent. of milk solids C. S. fined £2 and 14s. 6d. costs, and, on his taking responsibility, summons against M. A. S. withdrawn — ,, ,, M. A. S., 301 York Road — ,, ,, A. M., 18 Lockington Road Obstructing Inspector Chuter Fined £3 and 2s. costs, and in default 1 month 223 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample. Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 239 1907. July 31 Mr. de Grey M. M., 56 Bridge Road Selling coffee containing 33 per cent. of chicory m. m. fined £1 and 14s. 6d. costs, and, on her taking responsibility, summons against S. C. withdrawn — ,, ,, S. C., 56 Bridge Road 317 Sept. 25 ,, D. J. E., 21 New Road Selling butter containing 84 per cent. of foreign fat Fined £5 and 12s. 6d. costs 336 ,, ,, L .H. T., 1 Tennyson Street Selling milk containing 5 per cent. of extraneous water L. H. T. fined £1 and 22s. 6d. costs, and, on his taking responsibility, summons against F. T. withdrawn — ,, ,, F. T. 1 Tennyson Street 377 ,, ,, G. D., 127 Lavender Hill Selling milk containing 7 per cent. of extraneous water G. D. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against W. C. withdrawn — ,, ,, W. C., 24 Morrison Street 307 ,, ,, F. J., 3 Cabul Road Selling milk containing 10 per cent. of extraneous water F. J. fined £2 and 14s. 6d. costs, and, on his taking responsibility, summons against E. J. withdrawn — ,, ,, E. J., 3 Cabul Road 299 ,, ,, J. B., 33 High Street Selling milk containing 8 per cent. of extraneous water J. B. ordered to pay 14s. 6d. costs and summons against C. H. withdrawn — ,, ,, C. H., 163 Church Road 383 ,, ,, W. C., 56 Bridge Road West Selling milk containing 0.021 per cent of boron trioxide W. C. fined 10s. and 14s. 6d. costs, and, on his taking responsibility, summons against J. F. withdrawn — ,, ,, J. F., 11 Freeland Street 343 ,, ,, F. G. H., 15 Plough Road Selling coffee containing 55 per cent. of chicory F. G. H. fined £2 and 14s. 6d. costs and F. H. fined £2 — ,, ,, F. H., 35 Tyneham Road 224 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 368 1907. Sept. 25 Mr. de Grey L. G. & N. H. D. Co., Ltd., Canterbury Road, Brixton Selling milk containing 0.0123 per cent. of boron trioxide L. G. & N. H. D. Co., Ltd., fined 10s. and 16s. 6d. costs, and on their taking responsibility, summonses against H. B. and L. P. withdrawn — ,, ,, H. B., 2a Bridport House, Wandsworth Road — ,, ,, L. P., 27 Alford Road, Clapham 433 Oct. 9 ,, L. H. T., 1 Tennyson Street Selling milk containing 0.143 Per cent. of boron trioxide L. H. T. fined £3 and 14s. 6d. costs, and, on his taking responsibility, summons against F. T. withdrawn — ,, ,, F. T., 1 Tennyson Street 432 ,, ,, J. E., 1 Arden Street Selling milk containing 14 per cent. of extraneous water J. E. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against K. E. withdrawn — ,, ,, K. E., 1 Arden Street 478 ,, 23 Mr. Garrett H. A., 131 Lavender Road Selling vinegar containing 90 per cent. of vinegar of the lowest strength and 10 per cent. of extraneous water Fined 10s. and 12s. 6d. costs 438 ,, ,, W. P., 14 Candahar Road Selling milk containing 6 per cent. of extraneous water W. P. fined £1 and 14s. 6d. costs, and, on his taking responsibility, summons against S. P. withdrawn — ,, ,, S. P., 14 Candahar Road 471 ,, ,, G. A. B., 185 New Road Selling milk containing 15 per cent. of extraneous water Fined £3 and 12s. 6d. costs 484 Nov. 6 Mr. Plowden I. R., 63 Ascalon Street Selling milk containing 6 per cent. of extraneous water I. R. fined 10s. and 14s. 6d. costs, and, on his taking responsibility, summons against A. R. withdrawn — ,, ,, A. R., 63 Ascalon Street 225 Legal Proceedings under Sale of Food and Drugs and Margarine Acts—(continued). No. of Sample Date Heard. Before whom. Initials and Address of Defendant. Nature of Offence. Result of Proceedings. 493 1907. Nov. 6 Mr. Plowden W. H., 18 Plough Road Selling milk from which 9 per cent. of the original fat had been abstracted Defendant who pleaded warranty defence ordered to pay 12s. 6d. costs 528 Nov. 20, Dec. 4 and 18 Mr. Mead F. C. C., 27 Gambetta Street Selling butter containing 72 per cent. of foreign fat Fined £6 and 23s. costs 502 ,, ,, M. M., 14 Leopold Street, Vauxhall Selling pasteurised skimmed milk containing boracic acid Summons withdrawn on defendant paying 12s. 6d. costs 548 Nov. 20 and Dec. 18 ,, F. J. C., 131 Sugden Road Selling milk containing 6 per cent. of extraneous water F. J. C., who pleaded warranty, fined £5 and 23s. costs, and, on his taking responsibility, summons against G. V. withdrawn — ,, ,, G. V., 131 Sugden Road 581 Dec. 18 ,, A. G., 38 Orkney Street Selling milk containing 10 per cent. of extraneous water Fined £2 and 23s. costs 600 ,, ,, A. B., 355 York Road Selling milk containing 13.5 per cent. of extraneous water A. B. fined £1 and 12s. 6d. costs, and, on her taking responsibility, summons against H. W. withdrawn — ,, ,, H. W., 355 York Road 564 ,, ,, W. J., 99 Church Road Selling milk containing 9 per cent. of extraneous water W. J. fined £2 and 12s. 6d. costs, and, on his taking responsibility, summons against E. C. withdrawn — ,, ,, E. C., 99 Church Road 585 ,, ,, M. M., 56 Bridge Road Selling butter containing 56 per cent. of foreign fat M M. fined £6 and 23s. costs, and, on her taking responsibility, summons against G. W. withdrawn — ,, ,, G. W., 56 Bridge Road — ,, ,, J. J., 109 Larkhall Lane, Clapham Having no name on barrow Fined £2 and 12s. 6d. costs Appendix. REPORTS AND TABLES. TABLE I. (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 1907 and Previous Years. Year Population estimated to middle of each year. Births. total deaths registered in the district Total Deaths in Public Institutions in the District. Deaths of NonResidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Under 1 Year of Age. At all Ages. Number. Rate* Number. Rate per 1,000 Births registered. Number. Rate* Number. Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 16.1 603 311 348 2,766 16.3 1902 171,401 4,844 28.2 654 135 2.451 14.2 601 298 428 2.581 15.0 1903 173,422 4,973 28.6 688 138 2,425 13.9 622 299 350 2,476 14.2 1904 175,465 4,849 27.5 706 146 2,517 14.3 725 372 398 2.543 14.4 1905 177,532 4,843 27.3 550 114 2,542 14.3 741 399 418 2,561 14.4 1906 179,622 4,654 25.9 611 13l 2,425 13.5 786 444 4°3 2,384 13.2 Averages for years 1897-06. 171,632 4.995 29.1 738 148 2,628 15.3 622 324 379 2,682 15.5 1907 181,736 4,552 25.0 534 116.7 2,431 13.4 817 446 421 2,406 13.2 229 * Kates 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 or infirmity, and dying in public institutions there; and by the term " residents " is meant persons who have been taken out of the Borough on 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. 230 TABLE II. (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 1907 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. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 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 441 49,747 1744 1017 311 45.125 989 475 103 1899 167,570 5179 2905 837 72,020 2424 1412 437 49,719 1791 954 299 45,831 964 539 101 1900 168,339 5161 2978 822 72,119 2418 1370 411 49,691 1749 1044 314 46,529 994 564 97 1901 169,100 5025 2766 821 72,226 2357 1271 407 49,663 1658 932 296 47,211 1010 563 118 1902 171,401 4844 2581 657 72,797 2208 1133 312 49,631 1643 911 270 48,973 993 537 75 1903 173.422 4973 2476 671 73.310 2298 1101 316 49,593 1692 851 268 50,5i9 983 524 87 1904 175,465 4849 2543 715 73,931 2249 1159 365 49,564 1584 845 248 51,970 1016 539 102 1905 177,532 4843 2561 636 74,589 2278 1159 305 49,536 1622 873 256 53,407 943 529 72 1906 179,622 4654 2384 588 75,169 2150 1100 316 49,520 1570 759 198 54,933 934 525 74 Averages of years 1897 to 1906 i7i,632 4995 2682 745 72,995 2323 1237 372 49,644 1687 919 279 48,893 983 526 94 1907 181,736 4574 2406 526 75,740 2139 1125 257 49,481 1552 793 211 56,515 883 488 58 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 deaeased. 231 TABLE III. (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 1907. 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. S.-West Battersea East Battersea. N. West Battersea S.-West Battersea. Under 1. I to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria 310 2 131 154 15 8 ... 138 103 69 132 101 62 Membranous croup 5 ... 4 I ... ... ... 3 I I 2 ... I Erysipelas 173 11 9 14 12 112 15 78 72 23 18 16 5 Scarlet fever 922 7 223 592 72 28 ... 348 378 196 344 374 170 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 36 ... 5 9 11 11 ... 14 13 9 12 12 6 Relapsing fever ... ... ... ... ... ... ... ... ... ... Continued fever 1 ... ... 1 ... ... ... ... 1 ... ... ... Puerperal fever 13 ... ... ... 2 11 ... 7 i 5 6 1 ... Plague ... ... ... ... ... ... ... ... ... Cerebro-spinal fever 3 1 1 1 ... ... 2 i ... 2 1 ... Totals 1,463 21 372 772 113 170 15 590 569 304 516 505 244 232 TABLE IV. (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 1907. 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. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 65 years. 65 years and upwards. East Battersea. North-West Battersea. South-West Battersea. Small-pox ... ... ... ... ... ... ... ... ... ... ... Measles 72 15 54 3 ... ... ... 36 27 9 28 Scarlet Fever 20 1 15 3 1 ... ... 8 4 8 ... Whooping Cough 62 23 39 ... ... ... 29 21 12 25 Diphtheria and Membranous Croup 38 ... 28 10 ... ... ... 11 19 8 ... Croup 1 ... 1 ... ... ... ... ... 1 ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... Fever Enteric 4 ... 1 ... ... 3 ... 3 1 ... 1 Other Continued 4 1 3 ... ... ... ... ... 4 ... ... Epidemic Influenza 22 1 ... ... ... 20 1 9 10 3 2 Cholera ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 47 36 9 ... ... 2 ... 28 15 4 ... Enteritis 43 30 8 ... ... 2 3 16 20 7 23 Puerperal Fever 7 ... ... ... 1 6 ... 4 2 / 1 9 Erysipelas 5 1 1 ... ... 1 2 4 1 1 Other Septic Diseases 14 2 1 2 ... 9 ... 5 4 5 5 Phthisis 219 2 5 12 40 153 7 117 ... 48 92 Other Tubercular Diseases 85 13 30 18 9 15 ... 48 22 1 15 24 Cancer, Malignant Disease 153 1 2 2 2 93 53 53 58 42 76 Bronchitis 281 72 23 1 1 74 110 133 104 44 66 Pneumonia 185 43 49 6 8 58 21 99 66 20 50 Pleurisy 3 ... ... 1 ... 2 ... 1 1 I 1 Other Diseases of Respiratory Organs 17 ... ... 2 ... 7 8 10 3 4 2 Alcoholism Cirrhosis of Liver 27 ... 1 ... ... 23 3 8 7 12 7 Venereal Diseases 13 8 ... ... 5 ... 7 5 1 10 Premature Birth 120 120 ... ... ... ... ... 62 37 21 2 Diseases and Accidents of Parturition 7 ... ... ... 1 6 ... 1 3 3 1 Heart Diseases 108 ... 1 7 12 54 34 42 31 35 59 Accidents 66 9 8 9 7 25 8 33 24 9 43 Suicides 23 ... ... ... 5 17 1 9 7 7 7 All other causes 760 148 34 30 26 263 259 349 / 242 / 169 283 All causes 2406 526 313 106 113 838 510 1125 793 488 817 233 TABLE V.-Required by the Local Government Board to be used in the Annual Reports of the Medical Officer of Health. Borough of Battersea. Infantile Mortality during the Year 1907. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes.—Certified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 526 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 4 1 5 3 15 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 3 ... 1 1 3 3 2 2 4 3 23 Diarrhœal Diseases. Diarrhoea, all forms ... ... ... 1 1 3 3 3 5 4 5 5 2 3 ... 1 36 Enteritis Muco 1 ... 2 1 4 3 2 3 4 2 2 1 1 2 5 1 30 Gastro Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Wasting Diseases. Premature Birth 83 12 8 5 108 9 2 1 ... ... ... ... ... ... ... ... 120 Congenital Defects 11 4 3 1 19 2 ... ... ... 1 2 ... 1 ... 1 ... 26 Injury at Birth 3 1 ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 Want of Breast-milk ... ... ... ... ... ... ... 1 2 2 ... ... ... ... ... ... 5 Atrophy, Debility, Marasmus 4 4 2 1 11 2 3 9 4 2 2 ... ... 2 1 1 37 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 ... ... 1 2 ... 2 7 Tuberculous Peritonitis : Tabes Mesenterica ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 ... 4 Other Tuberculous Diseases ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... 4 Other Causes. Erysipelas ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Syphilis ... 1 ... 1 2 2 2 1 ... ... ... ... ... ... ... ... 8 Rickets ... ... ... ... ... ... ... ... ... ... ... 1 1 1 2 ... 7 Meningitis (not Tuberculous) ... ... ... ... ... 2 ... 2 1 1 ... 1 ... ... 1 1 7 Convulsions ... 2 1 2 5 4 1 ... ... ... ... ... ... ... 1 ... 11 Bronchitis ... 2 3 6 11 14 13 6 4 ... 6 ... 2 5 1 2 72 Laryngitis ... ... ... ... ... ... ... ... ... 4 ... 3 ... ... 2 ... ... Pneumonia ... ... ... 1 1 4 9 5 3 a 5 ... 2 4 ... 3 43 Suffocation, overlaying ... ... ... ... ... ... ... ... ... J ... 1 ... ... 3 ... ... Other Causes 22 5 6 3 36 8 5 5 3 1 ... 2 1 1 2 ... 64 124 31 25 22 202 54 47 37 28 22 27 20 20 23 29 17 526 Borough of Battersea. Population (estimated to middle of 1907).—181,736. Deaths in the year of Legitimate Infants, 481; Illegitimate Infants,45. Births in the year:—Legitimate, 4,406; Illegitimate, 114. Deaths from all Causes at all Ages—2,406. 234 TABLE V.—(continued) East Battersea. Infantile Mortality during the Year 1907. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5*6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months 11-12 Months. Total Deaths under One Year All Causes.—Certified. 56 11 17 11 95 29 25 16 17 9 12 12 10 7 16 9 257 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 3 2 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... ... ... 3 1 1 1 1 8 Diarrhoeal Diseases. Diarrhœa, all forms ... ... ... ... ... 2 2 1 5 3 3 3 1 1 ... ... 21 Enteritis Muco Gastro ... ... ... ... ... 1 1 2 ... 1 1 ... 1 2 2 ... 11 Gastritis Gastrointestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Premature Birth 40 4 7 2 53 7 1 1 ... ... ... ... ... ... ... ... 62 Wasting Diseases. Congenital Defects 7 1 3 1 12 1 ... ... ... 1 2 ... 1 ... ... ... 17 Injury at Birth ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus 1 2 2 1 6 1 2 3 2 1 ... ... ... ... 1 1 17 Tuberculous Diseases. Tuberculous Meningitis) ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 ... 1 4 Tuberculous Peri- tonitis: Tabes Mesenterica ... ... ... ... ... ... 1 ... ... ... 1 .... 1 ... 1 ... 4 Other Tuberculous Diseases ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... 4 Erysipelas ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Syphilis ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 3 Other Causes. Rickets ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... 2 ... 5 Meningitis (not Tuberculous) ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 1 ... 4 Convulsions ... 1 1 1 3 1 1 ... ... ... ... ... ... ... ... ... 5 Bronchitis ... ... 2 3 5 8 5 4 4 1 4 2 1 1 1 1 37 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 1 1 2 6 ... 2 ... 1 ... ... ... ... 3 17 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 8 1 2 2 13 4 2 1 2 ... ... 2 1 ... 1 ... 26 56 11 17 11 95 29 25 16 17 9 12 12 10 7 16 9 257 Sub-division of East Battersea. Population (estimated to middle ot 1907).—75,740. Births in the year: Legitimate, Illegitimate, 44. Deaths in the year of Legitimate Infants, 236; Illegitimate Infants, 21. Deaths from all Causes at all Ages. 1,125 235 TABLE V.—(continued). North-West Battersea. Infantile Mortality during: the Year 1907. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year  All Causes.—Certified. 48 14 6 8 76 20 17 19 11 IO 13 7 7 14 10 7 211 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 2 1 8 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 ... 1 ... 2 ... ... 1 ... 1 7 Diarrhoeal Diseases. Diarrhoea, all forms ... ... ... 1 1 1 1 2 ... 1 2 2 1 1 ... 1 13 Enteritis Muco Gastro 1 ... ... ... 1 1 ... 1 4 1 1 1 ... ... 3 1 14 Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 28 4 1 2 35 1 1 ... ... ... ... ... ... ... ... ... 37 Congenital Defects 3 2 ... ... 5 1 ... ... ... ... ... ... ... ... 1 ... 7 Injury at Birth 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Want of Breast-milk ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus 3 2 ... ... 5 1 1 5 2 1 2 ... ... 2 ... ... 19 T uberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 Tuberculous tonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... 1 1 2 1 ... ... ... ... 1 ... ... ... ... 5 Other Causes. Rickets . ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Meningitis | (not Tuberculous) ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 3 Convulsions ... 1 ... ... 1 2 • •• ... ... ... ... ... ... ... 1 ... 4 Bronchitis ... 2 ... 3 6 6 7 2 ... 2 2 1 ... 4 1 1 32 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 1 3 5 1 3 3 1 2 3 1 ... 23 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 10 3 4 1 18 3 1 4 1 ... ... ... ... 1 1 ... 29 48 14 6 8 76 20 17 19 11 1O 13 7 7 14 10 7 211 Sub-division of North-Wesi Battersea Population (estimated to the middle of 1907).—49,481. Births in the year.—Legitimate, 1,503 ; Illegitimate, 49.1 Deaths in the year of Legitimate Infants, 192 ; Illegitimate Infants, 19. Deaths from all Causes at all Ages—793. 236 TABLE V.—(continued). South-West Battersea. Infantile Mortality during the Year 1907. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 1 Months. 2-3 1 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. io-11 Months. 11-12 Months. Total Deaths under One Year All Causes.—Certified. 20 6 2 3 31 5 5 2 3 2 i 3 2 3 1 58 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 3 1 8 Diarrhoeal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Enteritis Muco Gastro ... ... 2 1 3 1 1 ... ... ... ... ... ... ... ... ... 5 Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 15 4 ... 1 20 1 ... ... ... ... ... ... ... ... ... ... 21 Wasting Diseases. Congenital Defects 1 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Ereast-milk ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Atrophy, Debility, Marasmus ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes. Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 Bronchitis ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 3 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 4 1 ... ... 5 1 2 ... ... 1 ... ... ... ... ... ... 9 20 6 2 3 31 5 5 2 ... 3 2 i 3 2 3 1 58 SUb-division of Socth-West Battersea. Population (estimated to middle of 1907).— 56,515. Births in the year—Legitimate, 862; Illegitimate, 21. Deaths in the year of Legitimate Infants, 53 ; Illegitimate Infants, 5. Deaths from all Causes at all Ages, 488. 237 The Tables on pages 237 to 240 have been drawn up by the Home Secretary "for the guidance of Medical Officers of Health in preparing that part of their Annual Report which relates to factories, workshops, workplaces and homework." They are intended to provide for uniformity in the presentation of such particulars as lend themselves to statistical treatment. Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices Proseoutions. Factories (including Factory Laundries) 621 73 ... Workshops (including Workshop Laundries) 1.558 258 ... Workplaces 1.738 158 ... Homeworkers' Premises 751 57 ... Total 4,668 546 ... 238 2.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions Nuisances under the Public Health Acts:— Nil. Want of Cleanliness 184 184 — Want of Ventilation 3 3 — Overcrowding 5 5 — Want of drainage of floors 3 2 1 Other Nuisances 220 220 — Insufficient 4 4 — Sanitary accommodation Unsuitable or defective 116 116 — Not Separate for Sexes 2 2 — Offences under the Factory and Workshop Act:— Illegal Occupation of Underground Bakehouse (sec. 101) 1 1 — Breach of Special Sanitary Requirements for Bakehouses (secs. 97 to 100) 53 53 — Other Offences (excluding Offences relating to Outwork which are included in Part 3 of this Report) — — — Total 519 590 1 — 239 3.—Home Work. nature of work. outworkers' LiSTS, section 107. Outwork im Unwholesome Pkemisks, Section 108. Lists received from Employers.* Numbers of Addresses of Outworkers received from other Councils.* Numbers of Addresses of Outworkers forwarded to other Councils.* Number of Inspections of Outworkers' premises. Instances. Notices served. Twice in the year. Once in the year. Lists. Outworkers. Lists. Outworkers. Wearing Apparel— Making, &c. 88 4IO — — 316 182 688 57 57 Lace, lace curtains and nets — — 1 1 1 1 2 — — Furniture and Upholstery 4 7 — — 2 2 4 — — Paper Bags and Boxes — — — — 5 1 8 — — Brush making — — — — 1 — 1 — — Stuffed Toys — — — — — — — — — Other trades — — 1 1 43 5 48 — — Total 92 417 2 2 368 191 75i 57 57 •For these figures the February and August lists are added together. 240 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of 1907:— Bakehouses 80 Bootmakers 65 Dressmakers 129 Laundries 34 Milliners 20 Tailors 42 Other Trades j56 524 Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 37 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5):— Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 31 Proceedings during 1907. (The following tables are suggested by the Medical Officer of Health to the County of London in order to secure uniformity of tabulation in the annual reports of the Medical Officers of Health of the Metropolitan Boroughs). 241 Premises. Number of Places. No. of Inspections, 1907. No. of Intimation Notices. 1907. No. of Prosecutions, 1907. On Register at end of 1906. Added in 1907. Removed in 1907. On Register at end of 1907. Milk premises 264 55 65 254 710 72 — Cowsheds 3 — — 3 14 — — Slaughterhouses 6 — 1 5 80 — — Other offensive trade premises 2 — — 2 29 2 — Ice-cream premises 104 16 10 110 284 18 — Registered houses let in lodgings 123 — — 123 * 102 — * These premises are subject to frequent inspection. Total number of intimation notices served for all purposes 5.794 Overcrowding-— Number of dwelling-rooms overcrowded 129 Number remedied 129 Number of prosecutions — Underground rooms— Illegal occupation dealt with during the year 91 Number of rooms closed 91 Insanitary houses— Number closed under the Public Health (London) Act 3 Number closed under the Housing of the Working Classes Act — Number of verminous premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 — 242 Shelters provided under Section 60 (4) of the Public Health (London) Act— Number of persons accommodated during the year . 33 Revenue Acts— Number of houses for which applications were received during- year 15 Number of tenements comprised therein 43 Number of tenements for which certificates were:—(a) Granted 43 (b) Refused 8 (c) Deferred 35 Number of prosecutions under bye-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. — (c) For prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, &c., of dwelling houses 5 (e) In connection with the removal of offensive matter, &c — (/) As to cesspools and privies, removal and disposal of refuse, &c — (g) For securing the cleanliness of tanks, cisterns, &c — (h) With respect to water-closets, &c. 3 (») With respect to sufficiency of water supply to water-closets — (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) 1 (fe) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (Bye-laws) Act, 1899) 4 Mortuary—• Total number of bodies removed 302 Total number of infectious bodies removed 14 243 NOTIFICATION OF BIRTHS ACT, 1907. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor and Gentlemen,— Acting upon the instructions of the Council I beg to report as follows:— The Notification of Births Act, 1907, received the Royal Assent on 24th August, 1907. This Act is the outcome of Battersea's and other Councils' representations to Government Departments for the purpose of minimising the present appalling infantile death-rate. The Battersea and other Councils have again and again pointed out the difficulty of dealing with the question of infantile mortality, on account of the necessary information through registration of births being obtained only after an interval of 42 days. Endeavours have frequently been made to limit this period as e.g. in Scotland to 21 days, or, still better as in France, to 3 days. I welcome, as the Borough Council will, the action of the Legislature in having succeeded in passing a Notification of Births Act which makes it compulsory upon those concerned to notifiy all births and still-births within a period of 36 hours. Primarily, the "duty" of notifying a birth to the Medical Officer of Health devolves upon the father of the child, and, in his absence, then upon "any person in attendance upon the mother at the time of, or within 6 hours after the birth." The notice must be " given by posting a prepaid letter or postcard within 36 hours of the birth " or by delivery of a "written notice of the birth (in either case) at the office or residence of the Medical Officer of Health within the same time." The Local Authority are required to supply without charge addressed and stamped post-cards containing the form of notice to any medical practitioner or midwife practising or residing in their area who applies for the same. The notification is, "in addition to, and not in substitution 244 for, the requirements "of the Act" relating to the registration of Births" and it applies to any child born after the twenty-eighth week of pregnancy, whether alive or dead." Liability to a penalty not exceeding twenty shillings is incurred by any person who fails to give notice of a birth. The necessary resolution will, I am sure, be readily passed in view of the previous action of the Borough Council as far as the Borough of Battersea is concerned. The Council have already given the required Statutory Notice of not less than one calendar month. All sanitarians are agreed that this early information will be of the greatest value in helping Sanitary Authorities to deal with the question of Infantile Mortality. It will materially increase the present success which has attended the Council's efforts in connection with their Infants' Milk Dep6t. The Council have already adopted the report of the Health Committee suggesting the appointment of a Health Visitor, whose work will be connected with, and entirely depend upon, this early information of'births obtainable under the Notification of Births Act, 1907, and in this connection it is satisfactory to note that the London County Council propose to include a clause in their General Powers Bill for the Session of 1908 to enable the Council to repay to the Metropolitan Borough Councils a moiety of the salaries of Health Visitorsas they now repay half the salaries of Sanitary Inspectors. In the opinion of some it is perhaps to be regretted that the suggested provision exempting medical men was, at the last moment, dropped by the promoters of the Bill, but I am of opinion that the Act will not be in any way irksome or derogatory to the medical practitioners throughout the Borough, who are at all times anxious to assist the Borough Council and its Officers to protect the public health. (Signed) G. Quin Lennane, Medical Officer of Health. 245 INSANITARY PROPERTY. To the Health Committee. Mr. Chairman and Gentlemen,— In accordance with the instructions of the Council, I beg to submit my report as Medical Officer of Health on the question of dealing with insanitary property in the Borough of Battersea under the Housing of the Working Classes Act, 1890. I propose restricting my report to the advantages of the Housing Act, and the desirability of putting its provisions into force as occasion may require, together with the reasons for so doing. The Solicitor will deal with the legal aspects of the Act, as to procedure, &c. My attention has been much engaged for some considerable time with this subject of insanitary houses, and the difficulty at times encountered in dealing therewith, e.g., in getting owners of such houses to put them into proper order and condition, and so render them fit for human habitation, under the powers vested in Sanitary Authorities under the Public Health Acts. Such difficulties will be realised when I remind the Council that over twelve months ago a Closing Order, under the Public Health Act, was obtained from the Magistrate in connection with certain premises within the Borough, and that up to date such order has not been enforced, owing to the practical difficulties met with. As Medical Officer of Health, therefore, I advise the Council to take advantage of the powers conferred on them under Part 2 of the Housing of the Working Classes Act, 1890. These powers, so far as I can ascertain, have never been exercised by the Sanitary Authority of Battersea, though it would appear that other Metropolitan Sanitary Authorities have used them with advantage. The Annual Reports of the London County Council from 1890-1905 show that nearly 5,000 246 houses have been dealt with under the Housing Act, Part 2, dealing with unhealthy dwellings within the Metropolitan area. In recently recommending that notices should be served under Section 32 of the 1890 Housing Act, with respect to houses in Europa Place, I was of opinion, after careful consideration, that more satisfactory results would accrue from proceedings under the Housing Act than under the Public Health Act, as the state of the premises (more especially as pointed out in my report, Nos. 21-27) was such as to render it practically impossible to state specifically all the defects or nuisances as required under the Public Health Act. My opinion is being justified, having regard to the fact that difficulties are already being experienced in getting the work carried out under the Statutory Notices under the Public Health Act, served by the Chief Sanitary Inspector, who has even found it necessary to write in his official capacity to the London County Council as the Building Authority, drawing their attention to the state of the property in so far as it contravenes the Building Acts in addition to the Public Health and Housing Acts. The Housing of the Working Classes Act, 1890, consists of 7 parts, and these will, doubtless, be dealt with by the Solicitor in his report. Suffice it to say that the general experience of Medical Officers of Health is that Part 1 of the ^ct is cumbersome in procedure, officially and legally dilatory, costly to the ratepayers and otherwise unsatisfactory, while good results are obtainable under Part 2 of the Act dealing with unheaJthy dwelling houses. Under this Part 2 it is the duty of the Medical Officer of Health (he has no option in the matter) under Section 32 to "represent to his Authority any dwelling house which appears to him to be in a state so dangerous or injurious to health as to be unfit for human habitation," so that notices may be served calling upon the owners concerned to do certain work, so as to put the premises into proper order and condition or to have the premises closed. The advantages of this procedure under the Housing Act over the procedure under the Public Health Act are worthy of 247 the Council's consideration, experience in other Metropolitan Districts shewing that insanitary property can be more effectually dealt with under the former Act in cases where the conditions are sufficiently bad as to call for its application. Speaking generally, the premises represented by the Medical Officer of Health are put into proper order and condition to the satisfaction of the Sanitary Authority and any financial cost involved falls upon the owners. In this way owners are compelled to put their own insanitary property in order—a most desirable condition of things. Further, the "owner" under the Housing Act, is practically the freeholder, being the person having more than 21 years' interest in the property, and such a person is not anxious to have his property closed, preferring rather to have it put into proper habitable repair. For purposes of comparison, I herewith summarise reasons for action being taken under the Housing Act, 1890, rather than under the Public Health Act, 1891, it being understood that the more stringent powers of the Housing Act are only required in my opinion, in exceptional instances, such as Nos. 21 to 27 Europa Place, the powers under the Public Health Act sufficing in the majority of cases:— 1. In consequence of the Local Government Board as a Central Authority having drawn the attention of Local Authorities to the powers which they already possess under the Housing of the Working Classes Act, but which have not been used in the past as the Legislature expected, and calling upon such Authorities to use such powers as may be found necessary in the future. 2. Where the premises are in such a condition as to require a lot of structural and other work to be done, the Closing Order (under the Housing Act) not being withdrawn until the Sanitary Authority certifies to the Magistrate that they are satisfied with the improved condition of the premises. 248 3. Where it is advisable to serve a notice upon the holder or person or persons having a long interest in the property, it being unfair in my opinion to saddle a short leaseholder with the responsibilities of practically rebuilding or reconstructing premises. 4. When the Public Health Act is used the notices must state specific defects, and when these are remedied the notices are complied with, thus limiting, under certain circumstances the works that are necessary to put the premises into proper order and condition; some of such work not coming within the nuisance clauses of the Public Health Act. 5. When the Public Health (London) Act, 1891, is used a Closing Order in practice is difficult to enforce, more especially when some of the nuisances mentioned in the notices have been abated, as shown by an actual case in Battersea mentioned in this report. In conclusion, I am firmly convinced that it would greatly facilitate the object which the Council have so warmly at heart, i.e., the proper housing of the Working Classes, if they would adopt these powers under the Housing Act in such special cases as may from time to time be brought by the Medical Officer of Health to their notice. In this way the work of the Public Health Department will be made easier, whilst the intrinsic value of the powers conferred will exert a powerful influence upon such owners as may prove recalcitrant from any cause. Systematic house-to-house inspections, which have been SO effectively carried out, especially for the past five years, in the Borough (vide Annual Reports of the Medical Officer of Health), are most desirable, with the object of levelling up all houses to a fair and proper standard. Any individual houses which may be found in the course of such house-tohouse inspections to be sanitarily unfit, can be dealt with 249 under the Public Health or Housing Acts, as may be required, with a view to their being put into proper order and condition, and so rendered fit for human habitation. 1 thank the Council for giving me an opportunity of laying my official views before them on the important subject of dealing with insanitary property throughout the Borough. I need hardly say that my only desire is to do the best for the Borough of which I have the honour of being the Medical Officer of Health. I am, Gentlemen, Your obedient Servant, (Signed) G. Quin Lennane. 250 LITTLE EUROPA PLACE. To the Health Committee. Gentlemen, In accordance with the Council's instructions I beg to report to you as to the best course to adopt to abate nuisances at certain dwelling-houses in the above street. I understand the nuisances complained of arise from the fact that the houses are in a bad state of repair, and are not fit for human habitation while in such a state of dis-repair, but that they are capable of being put into a habitable condition. The case is similar to many cases which the Council have had before, and in which cases they have found, by the adoption of the procedure laid down by the Public Health (London) Act, they have been able to get the nuisance abated and the premises restored to habitable condition. The procedure under that Act, shortly, is as follows:—A notice is served by the Health Committee, to whom the Council's powers have been delegated in these matters, requiring the owner of the property to abate the nuisance within a specified time, and then, in default of his doing so, to issue in the Police Court a summons for what is known as a Closing Order, that is, an order prohibiting the premises from being used for human habitation. Where there has been a proper case for such an order, I have never known any difficulty in obtaining it, but it has been generally found in practice that the Council have been able to get the nuisance abated by obtaining the order but not having it drawn up for a certain number of days sufficient to give the owner an opportunity of making the premises fit for human habitation. The Act enforces compliance with the order by imposing a daily penalty not exceeding 40s. a day, so long as it remains uncomplied with, while on the other hand it gives the Court power, on being satisfied that the premises have been made fit for human habitation, to cancel the order, the onus of showing 251 the premises having been made so fit being of course on theowner. The Court has also the power, in making a closing order, of inflicting a fine not exceeding £20, and both this fine and the daily fine of 40s. go to the Council towards their expenses of executing the Act. Instead of going under the Public Health Act, the Council could, if they choose, take proceedings for a closing order under the Housing of the Working Classes Acts. With certain exceptions to be mentioned, the procedure is similar to that under the Public Health Act. These exceptions concern special circumstances which do not appear to apply to the present case. If, for instance, the Council are of opinion that the premises are not reasonably capable of being made fit for human habitation, or are in such a state that the occupation of them should be immediately discontinued, it is not necessary if proceeding under these Acts for a closing order, to first serve a notice on the owner to abate the nuisance, but the Council may at once issue a summons for an order. These Acts also make special provisions for the ejection of occupying tenants where an order has been made. With regard to these exceptions, as I have before stated, it does not appear in this case that the premises are not reasonably capable of being made fit for human habitation, nor does there seem to be any urgent reason why the statutory notice should not precede the summons, because such notice can specify the time in which the premises are to be put in order, and such time can be made as short as the Council deem requisite to meet the case, and as to getting rid of any tenant, it has never been found in practice that there is any difficulty about this, and if the premises are so bad as to be unfit for human habitation, the tenants, as a rule, are easily persuaded to vacate them. What has been stated above affects the procedure down to the making and enforcing of the closing order. I should add 252 that a fine of £20 can also be inflicted as in proceeding's under the Public Health Act, but it is doubtful whether the Court has power to inflict a daily penalty in the event of the order not being complied with, and it is important to notice that it does not appear to be at all clear that either the £20 or the daily penalty, if there is power to inflict this, would go to the Council in the same way as it would under the provisions of the Public Health Act. So far, then, it would appear there is good reason, having regard to the past experience of the Council in these cases, for not departing in the present case from their previous practice of taking proceedings under the Public Health Act. It might be urged that there is one great advantage in taking proceedings under the Housing of the Working Classes Acts, and that is, the Council would have under these Acts power to order the demolition of the property. Admitting that there might be cases in which it was desirable to put this power in force, there does not seem to be any ground for saying that if the proceedings were taken under these Acts in the present case the Council could exercise any such power, because the conditions on which the power depends does not appear to exist. Under these Acts the Council can order the demolition of buildings unfit for human habitation, for the following reasons only : that is to say, where a closing order has not been cancelled, and the Council are of opinion that the premises have not been rendered fit for human habitation, that the necessary steps are not being taken with due diligence to render them so fit, and that the premises or any part of them are dangerous or injurious to the health of the public or the inhabitants of neighbouring houses. All these conditions must exist, and the failure of one of them would imply that the Council could not exercise the power in question. This power appears to have been intended to meet the case of buildings so dilapidated as to be a source of danger to passers by in any thoroughfare adjoining them, or to the inhabitants of 253 neighbouring houses, that is to say, this provision goes one step further than the closing order. A closing order is intended to protect those who might otherwise have been inmates, while this power is intended to protect outsiders who might be passing by or standing near premises in a dilapidated and dangerous condition. It does not appear, however, that such a condition of things exists in the present case. There may be cases, as I have said before, where it would be advisable to proceed under the Housing of the Working Classes Acts, but so far as my information goes, the present does not appear to be such a case. I therefore in this case recommend the Council to proceed as before, namely, under the Public Health Act. In conclusion, I would point out that the cases under which dwelling-houses may be closed are more numerous under the Public Health Act than under the Housing of the Working Classes Acts. Under the latter Acts dwelling-houses can only be closed if their state or condition is so dangerous or injurious as to be unfit for human habitation. This would not appear to include, among other things, cases of overcrowding, absence of water fittings, or absence of water supply, whereas under the Public Health Act, closing orders may be obtained in all these cases. I am, Gentlemen, Your obedient servant, Paul Caudwell. TABLE VI. Causes of, and Ages at Death, during the Year 1907. (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) Causes of Death. Ages. All Ages. Sub-Districts. 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. 75 and under 85. 85 and under upwards. Males. Female Total East Batterse Nth West Battersea Sth. West Battersea Measles 15 54 3 ... ... ... ... ... ... ... ... ... ... 32 40 72 36 27 9 Scarlet Fever 1 15 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 8 4 8 Epidemic Influenza 1 ... ... ... ... ... 4 3 6 7 1 ... ... 10 12 22 9 10 3 Whooping Cough 2 3 39 ... ... ...• ... ... ... ... ... ... •... ... 28 34 62 29 21 12 Diphtheria ... 28 10 ... ... ... ... ... ... ... ... ... ... 22 16 38 11 19 8 Enteric Fever ... 1 ... ... ... ... 2 1 ... ... ... ... ... 2 2 1 3 1 ... Diarrhoea, Dysentery 22 6 ... ... '... ... ... 1 ... 1 ... ... ... 20 10 T- 1 3n j IQ 7 4 Epidemic Enteritis 14 3 ... c l Ay 1 / g 1 " Other Allied Diseases ... 7 I 0 9 J7 9 5 Glanders ... ... ... 3 ... I ... 2 x 2 4 1 4 x Tetanus Syphilis *8 I I 2 I 8 3 1 11 5 1 5 1 Gonorrhoea ... I I 2 2 2 Erysipelas 1 1 ... I I I 2 3 5 4 1 Puerperal Fever... I 4 2 ... ... 7 7 4 2 1 Pyaemia 1 x x 2 x i / c 5 » a x 2 Infective Endocarditis ... I •• T 1 2 5 2 3 I 1 Other Allied Diseases 2 ... I 2 1 c x 6 x 3 1 2 Rheumatic Fever ... 2 4 I 2 x 2 x 3 ... j 8 8 16 j a Rheumatism of Heart 1 ^ 1 x J 1 X<i 4 * Tuberculosis of Brain 7 18 7 2 I 16 Tuberculosis of Larynx / J4 35 12 7 Phthisis ... ... 2 t Q ... £ 1 1 1 . Q Abdominal Tuberculosis ... 4 5 3 7 2 5 10 x 22 x 5° 29 41 33 0 I 120 93 219 11 117 54 48 General Tuberculosis 2 7 6 3 2 3 4 a 1 9 IQ 2 12 21 9 20 g 3 Other forms Tuberculosis ... 2 1 I j 1 2 j I 3 4 O1 7 a J 4 Acute Alcoholism x 2 2 T / J 7 2 Chronic Alcoholism ... I I 2 1 x 3 c 1 x x a Chronic Industrial Poisoning I 1 4 J, I 1 0 Osteo-arthritis ... ... ... ... 1 2 2 a 2 c 3 1 I Gout... 3 x 0 e J j Cancer 1 2 1 I x x 3 IS 31 j 41 38 13 2 5 66 87 5 t53 2 *8 Diabetes Mellitus I j 2 J x 2 ' ■3 ju 2 5 07 oj 53 ft Haemophilia 2 ..: J 5 2 2 u x x 3 Anaemia 1 1 x 2 x 2 x x 6 Premature Birth i20 ... 5 5Q 5 61 120 62 37 21 Injury at Birth ... 4 J / Debility at Birth 26 ... ... 2 2 4 I 3 Atelectasis 8 ... ... x5 5 11 2D 8 12 T3 1 x Congenital Defects 26 x x ... ... 2 4 3 Want of Breast Milk 5 *3 c x5 20 c l7 7 4 x Atrophy, Debility, Marasmus 37 1 0 2 3 t c D 38 17 20 1 Dentition 1 2 J I 2 O 3 A / 2 1 Rickets 7 6 8 "1 Old Age, Senile Decay I 15 48 24 10 3"? 3 q6 !3 88 38 4 18 32 Convulsions ... ... 11 2 4j T 6 t 3 c c j1" a Meningitis 7 6 I x x 7 A A J 16 D J 5 j x Encephalitis 2 I 10 2 u x 3 9 x x I Apoplexy ... ... ... x 6 8 3 I 10 0 to 12 3 Softening of Brain j 9 f. 4 j Hemiplegia x I I 2 2 3 2 c 3 0 9 4 1 - 5 4 General Paralysis of Insane 2 8 A x 7 2 5 3 12 3 15 18 4 10 6 5 2 Other forms of Insanity T x *5 0 1 Cerebral Tumour ... ... Epilepsy 1 1 1 2 1 2 3 x 3 ... 2 2 3 8 5 t 3 3 10 1 2 1 x Laryngismus Stidulus 1 J 5 x 1J I 1 Locomotor Ataxy * T * * * Paraplegia 1 2 2 2 Other forms. Brain Diseases 1 3 1 i 3 2 1 2 2 5 2 a 3 10 10 13 14 7 3 3 Q 3 2 Otitis 1 i j D *r A 7 J y Pericarditis Endocarditis 1 1 g 1 4 3 10 3 4 1 4 2 2 Hypetrophy of Heart 5 0 3 x *4 9 23 *7 2 12 x 1 4° 61 ioi 39 28 34 Angina Pectoris ... 1 2 2 4 2 1 1 Aneurism ... ... 1 2 a 1 2 i 7 2 2 9 6 x 2 2 Senile Gangrene... j i / i 1 1 Embolism, Thrombosis ... i x 2 "2 Other Diseases, Heart and Vessels ... 1 1 0 x A ? 6 T A 18 9£* 4 28 ... 2 68 7 87 y 3 62 4 Laryngitis J 2 4 j 1 I4 JJ 3° 1 2 07 x r55 a 2 ! 57 30 x Croup 1 j x Acute Bronchitis 72 23 1 2 4 ii 20 6 2 7/1 68 t/1 2 73 1 C.A t e Chronic Bronchitis 1 4 6 I5 31 41 34 7 /4 66 i3q / 3 60 j4 so J 29 Lobar Pneumonia 3 i 3 2 1 6 *t i j7 / 12 / J 1 J? 17 io c 2 Lobular Pneumonia 35 3i 3 1 3 i i 39 j 36 A / 75 37 3 34 4 Pneumonia ... ... ... 8 i5 1 2 x ■3 10 8 t 7 1 a t 3 2 06 Emphysema, Asthma ... J A / i A J i 57 x 3U x 93 2 52 1 2 27 J4 Pleurisy 1 1 1 1 2 3 1 : 1 1 Other Diseases, Respiratory System ... ... 1 i 3 ... 4 j. 8 12 6 ; 3 3 Diseases of Mouth and Annexa 1 2 j 3 0 Diseases of CEsophagus ... ... ... ... i 2 3 2 1 Ulcer of Stomach and Duodenum ... 1 ... 1 1 i Other Diseases of Stomach... 1 ... 1 3 2 i 3 6 1 3 1 9 2 4 1 2 3 x Enteritis 30 8 2 x 2 /i a t 6 20 Appendicitis 2 i 0 20 23 4J 7 Obstruction of Intestine 2 2 1 3 J 2 A x x 7 5 9 17 2 8 3 6 4 a Cirrhosis of Liver 1 1 3 8 3 4 3 9 10 1 / x9 6 6 j 7 Other Diseases of Liver 1 4 1 1 X 3 8 2 2 / j. Peritonitis 1 1 i 1 2 ... 5 j. 0 1 5 1 3 ti Diseases, Lymphatic System and Glands 1 1 x 1 t- 5 Acute Nephritis ... ... ... 2 3 3 5 1 ... Bright's Disease... 1 1 ... Q 1 • •• 2 1 3 1 2 Diseases of Bladder and Prostate 1 i 4 O I3 1 x4 *5 2 3 A 33 20 59 7 3° 2 x3 2 10 a Other Diseases, Urinary System " t ... 7 / 0 j Diseases of Ovaries 2 4 1 2 j 0 1 3 4 i Diseases of Uterus and Appendages ... j 1 1 Abortion, Miscarriage x 1 1 3 5 3 1 Puerperal Convulsions 1 1 1 ... Placenta Prsevia, Flooding... i 2 ... 1 2 1 2 ... 1 x X Other Diseases, Pregnancy & Childbirth Arthritis, Ostitis, Periostitis 1 2 3 3 1 2 Ulcer, Bedsore ... 1 x 1 x 1 t 2 2 3 o 1 2 2 x Pemphigus 2 j Other Diseases, Integumentary System i ... i i 2 I Accidents and Negligence. In Vehicular Traffic x 2 2 1 x 2 On Railways 1 ... i i 1 12 5 4 3 In Building Operations ... i X 1 2 3 3 2 1 1 By Machinery ... 3 3 2 By Weapons and Implements I i ... 2 ... 4 4 3 1 Burns and Scalds 2 ... i i ... 1 1 2 1 fi 1 Poisons, Poisonous Vapours 4 1 i ... ... i 1 I x 4 7 11 3 0 2 Surgical Narcosis 1 x 1 ... ... 1 t J 2 2 2 ... 1 Drowning ... 2 t ... ... 1 Suffocation ... ... i 2 3 1 2 Falls not specified 4 1 x 2 ... ... ... x ... 5 5 1 3 1 Otherwise, not stated ... i 4 2 2 i 7 7 • J4 9 5 ■.. Homicide ... i 1 1 3 1 2 1 5 2 4 2 1 yoTCSttitS; By Poison ... By Hanging and Strangulation 2 i 3 3 1 3 ... 4 9 13 7 3 3 By Drowning ... i 1 ... 2 2 2 By Cut or Stab ... 1 2 1 ... 4 4 1 1 2 By other and unspecified methods ... 2 ... 2 2 1 1 Ill-defined and unspecified causes •• i 1 ... ... ... 2 2 1 1 Found Drowned 1 i 1 2 I ... ... i 3 4 7 4 2 1 Found Dead 3 1 ... 1 ... ... ... 1 2 1 4 1 2 1 1 Totals 526 3i 3 74 32 63 *4 5 175 238 280 50 269 189 52 1 225 1181 2406 ii25 793 488