BAT 15 Metropolitan Borough of Battersea. REPORT on the H EALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1909. by G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. 3 Health Committee. Chairman. Councillor J. J. Taylor. HIS WORSHIP THE MAYOR (Councillor P. P. Haythornthwaite, J.P.) Alderman A. BRIDGE. Councillor Miss E. BROWN. Councillor Dr. S. H. CURRY. Councillor Dr. J. M. EHRHARDT. Councillor G. T. KF.TTLEY. Councillor Dr. L. S. McMANUS. Councillor C. MAY. Councillor R. W. MOFFREY. Councillor W. RAYMOND. Councillor J. B. TAYLOR. Councillor J. J. TAYLOR. Alderman W. WATTS. 4 Staff of the Public Health Departmant. Chief Sanitary Inspectors. i. Young, m.k.s.i. Lady Sanitary Inspectors. Miss A. E. Moss, San. Insp. Board's Cert. Miss L. M. Fairbaikn ,, Lady Health Visitor. Miss E C. Peacock. Food Inspector. A Chuter, Cert. an. 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. Purnei.l, Cert. San. Inst. „ 5 „ ..J. t. Baxter „ „ „ 6 „ .. H. Marrarle ,, „ 7 „ .. A. Odell, Cert. San. Inst. and Meat Insp.Cert. „ 8 ,. .. H. H. May, Cert. San. Inst. Clerks. Second Class Clerks {B. W. Sears {F.H.Preston, Cert. San. Inst. Third Class Clerks {E. Cole. {J. H. Lloyd, San. Insp. Board's Cert. Office Youth .. B. Hayman. Manageress of Milk DepÔt. Miss A. Lowe. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper. G. Streat. 5 To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Battersea. I have the honour to submit the Annual Report on the Health and Sanitary Conditions of the Borough of Battersea for the year 1909. It is satisfactory to be able to record, as will be seen from a perusal of the statistical information contained in this Report, that the Borough has maintained the high position in Sanitation which has been so marked during the past few years. I have again to acknowledge my indebtedness to the Health Committee for the support and assistance extended to me during the year. G. Quin LENNANE. Public Health Department, Town Hall, Lavender Hill, S.W. 6 CONTENTS. Births, Marriages and Deaths. page Births 9 Deaths 11 Deaths in Public Institutions 14 Home Office Enquiry 17 Infantile Mortality 14 Marriages 11 Notification of Births Act 18 Population 9 Senile Mortality 22 Infectious and other Diseases. Alcoholism 45 Bacteriological Examinations 45 Cancer 45 Diarrhoea 39 Diphtheria 31 Enteric Fever 33 Epidemic Cerebro-spinal Fever 38 Erysipelas 37 Measles 38 Notifiable Infectious Diseases 28 Puerperal Fever 37 Scarlet Fever 30 Small Pox 29 Tuberculosis 41 Whooping Cough 39 Zymotic Diseases 24 General Sanitary Administration. Ambulances 65 Block Dwellings 57 Cleansing of Persons Act, 1897 63 Common Lodging Houses 57 Customs and Inland Revenue Act 58 Disinfection 60 House-to-house Inspection 50 Houses Let in Lodgings 53 7 General .Sanitary Administration (Continued). page Housing and Town Planning Act 51 Housing of the Working Classes Act 52 Hygienic Street Paving 54 Midwives Act 63 Mortuary 64 Paving of Back yards and Forecourts 54 Sanitation of House Property 47 Sewer Ventilation 55 Shelter, Temporary 62 Smoke Nuisances 53 Van Dwellings 56 Water Supply 58 Protection of the Food Supply. Butchers'Shops 71 Cow-houses 68 Fish Shops 71 Ice Cream 68 Milkshops 69 Restaurants, &c. 69 Sale of Food and Drugs Acts 72 Slaughter-houses 67 Unsound Food 66 Factory and Workshop Act, 1901. Bakehouses 82 Factories 77 Homework 84 Underground Workrooms 81 Workshops 78 Legal Proceedings 87 Infants' Milk Depot 20 Appendices. Legal Proceedings 89 Tables 95 Reports 108 8 Summary of Vital Statistics for 1909. Area of Borough (excluding water) 2,139.9 acres Population (Census 1901) 168,907 „ Estimated to middle of 1909 186,036 Density 86 9 persons per acre Inhabited Houses (Census 1901) 23,462 Marriages 1,307 Births 4,450 Birth-rate 23.9 Deaths 2,417 Death-rate 12.9 Infantile Mortality 107 per 1,000 births 9 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 1909 was 186,036, made up as follows :— East Battersea 77,469 North-West Battersea 49,417 South-West Battersea 59,150 186,036 The estimate of the Registrar-General is based on the assumptionthat 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) were 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 35,816 16,150 82,247 12,889 1,458 Births. The total number of births belonging to the Borough of Battersea during 1909 was 4,450. Of the total births 2,289 were males and 2,161 females, showing an excess of 128 males. The number of births showed a decrease of 179, as compared with the total for 1908, and was 423 below the decennial average 18991908, and 825 less than the number in 1884, when the population was only 121,299. The births in the sub-districts were as follows :— 10 Males. Females. Total. East Battersea 1,057 994 2,051 North-West Battersea 814 764 1,578 South-West Battersea 418 403 821 Borough 2,289 2,161 4,450 The birth-rate, i.e., the number of births per 1,000 of the population was 23.9, the lowest birth-rate ever recorded in Battersea, and is 4.0 per 1,000 below the average for the previous ten years. Thus the birth-rate which appeared to have been checked in 1908, or at least stationary (the rate for 1908 being exactly equal to that for 1907, i.e., 25.1) has again shown a considerable decrease. The fall in the birth-rate in Battersea, in common with that of the rest of the country, is, as has been pointed out in previous annual reports, a matter for serious concern. As the declining birth-rate is accompanied by a decreasing deathrate, the natural increase in the population (i.e., excess of births over deaths) is not therefore affected, but the time will come when the effect of the falling birth-rate must result in a decline in the population. 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 1908 26.5 25.2 25.1 1909 25.6 24.2 23.9 The next table shows the birth-rate in the Borough, and in each of the sub-districts, during the ten years 1899-1908, and in 1909. 11 Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1899 30.9 33.6 36.0 210 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 1907 25.1 28.2 31.3 15.6 1908 25.1 27.3 32.8 15.8 Average 1899-1908 27.9 30.6 33.2 18.9 1909 23.9 26.5 31.9 13.9 Marriages. The marriages registered in Battersea during 1909 number 1,307 or 105 less than the decennial average. The marriage-rate i.e., the number of persons married per 1,000 of the population was 14.0, or 2.1 below the decennial average. Deaths. The total number of deaths registered in the Borough of Battersea during the year 1909 was 2,445, as compared with 2,265 during 1908, and a yearly average of 3,049 in the old Parish of Battersea for the deeennium 1891-1900. Of the total deaths, 1,235 were males and 1,210 females, showing an excess of 25 males. The death-rate for Battersea is, therefore, 13.14 per 1,000 inhabitants, as compared with 14.75 for London. This rate is, however, uncorrected, and on analysing the 2,445 deaths registered in the Borough of Battersea it is found that 502 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted; but on the other hand there are 474 deaths registered outside the Borough, of Battersea residents, and these must be added, giving a corrected number of deaths for Battersea during 1909 of 2,417 (1,213 males and 1,204 females), an excess of nine males, and a corrected 12 death-rate of 12.99, as compared with 14.0 for London (the total corrected number of London deaths being 67,632). A further correction can be made according to age and sex distribution. This is a more reliable method for ascertaining the healthiness of a district. The death-rate of a district will vary according to the character of its population, e.g., a district containing a large number of very young or very old people will have a higher death-rate than a district where there is a large proportion of people of middle age. The Registrar-General has provided a factor by means of which the death-rate of each of the Metropolitan Boroughs in the County of London can be thus corrected and compared. The factor for Battersea is 1.0728, and the death-rate corrected by this factor is 12.99× 1.0728 = 13.93 per 1,000. Sub-dividing the death-rate amongst the three registration sub-districts, it will be noted that in South-West Battersea a decrease has been recorded, while in East and North-West Batter sea an increase, most marked in the first mentioned district, has taken place. At the same time it is satisfactory to note that the increase has been slight, and there has been, as pointed out in the Annual Report for 1908, a steady improvement in the rates recorded for these two districts, which are mainly inhabited by the less properous class of the inhabitants of the Borough. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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 1907 13.2 14.8 16.0 8.6 1908 12.3 13.0 15.1 9.1 Average 1899-1908 14.8 16.0 17.5 10.4 1909 13.0 14.0 16.5 8.7 13 In the following table is shown the number of deaths, and the death-rate, in the nine Wards into which the Borough is divided:— Ward. Population Estimated to middle of 1909. Number of Deaths. Death Rates. Nine Elms 31,882 469 14.7 Park 20,069 315 15.6 Latchmere 22,704 286 12.6 Shaftesbury 17,703 208 11.7 Church 21,579 308 14.3 Winstanley 22,709 343 15.1 St. John 9,131 98 10.7 Bolingbroke 20,651 209 10.1 Broomwood 19,608 181 9.2 In the above table it will be seen that Park and Winstanley Wards have the highest, and Broom wood Ward has the lowest general death-rates. In fact all the lower Wards with the exception of Shaftesbury, in which the death-rate is practically the same as during 1908, show an increase in the rate, as compared with the previous year, while on the other hand, the three upper Wards exhibit a decrease. The cause of the slight increase in the general death-rate in Battersea during 1909, as compared with the previous year, is undoubtedly due to the severity of the weather at the beginning of the year. A glance at the table on page 14 will at once show this. Thus in the first quarter of the year the number of deaths was 30 per cent. in excess of the number during the last quarter, and no less than 15 per cent. higher than the corresponding quarter for 1908. Were it not for this, the death-rate for Battersea for 1909 would have established another record. On the whole the results exhibit the satisfactory conclusion that the Borough has maintained the improvement which has been such a marked characteristic of its mortality statistics during recent years. It is interesting to note the place that the Borough takes during 1909 in the Registrar-General's corrected returns amongst the twenty-nine Metropolitan Boroughs. There are nineteen Boroughs with a higher general death-rate, ten with a higher zymotic death-rate, and twelve with a higher infantile mortality rate. Taking the ten South Metropolitan Boroughs, Lewisham has the lowest general death-rate, viz., 10.3, and Bermondsey the highest, viz., 18.8 : Only four of the ten southern Boroughs having a lower death-rate than Battersea. 14 London as a whole has a birth-rate of 24.2, a corrected deathrate of 14.0, a corrected zymotic (death) rate of 1.31 per 1,000 population, and an infantile mortality (corrected) rate of 108 per 1,000 births. For England and Wales the figures are : birthrate, 25.6; death-rate, 14.49; infantile mortality, 109. 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 402 419 821 Second quarter 280 275 555 Third quarter 229 220 449 Fourth quarter 302 290 592 Deaths in Public Institutions. During the year 1909 the deaths of Battersea residents occurring in public institutions numbered 874, as compared with 747 in 1908. Of this number 400 occurred within and 474 outside the Borough. Four hundred and seventy occurred in workhouses or union infirmaries, as against 383 in 1908, and 444 in 1907. 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. Infant mortality varies widely in different districts, being as low as 80 per 1,000 in some, and as high as 160 in others. In recent years, owing to the attention devoted to this subject, there has been a general improvement throughout the country, the infant mortality for England and Wales showing a record decrease during 1909. Compared with the average for the ten years 1899-1908, there has been a decline of 29 per 1,000 births. Infant Mortality in Battersea in 1909. During the year 1909, 478 deaths of infants were registered in the Borough of Battersea. The total number of births recorded during the year was 4,450, and the infant mortality rate was 107 per 1,000 births. This rate was exactly equal to the rate for 1908, which was the lowest infant death-rate ever previously recorded in Battersea. CHART showing the Infantile Mortality in the Borough of Battersea during the last ten years. 15 Since the formation of the Borough, and for the previous decennium, the infantile mortality in Battersea and in London 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 1908 113 107 1909 108 107 In the above table, while the average rate in Battersea for the quinquennium 1901-1905 was 142.4 per 1,000, the average for the four subsequent years had fallen to 114 per 1,000. In the County of London during 1909, there was a total of 12,582 infant deaths, giving an infantile mortality rate of 108 per 1,000, which is a record, the previous lowest rate was (during 1908) 113 per 1,000. In the next table is shown the distribution of the 478 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 231 112.6 North-West Battersea 191 127.4 South-West Battersea 56 68.2 The Borough 478 107 In the next table is shown the incidence of mortality from the chief diseases of infancy in the first and second trimesters and the last six months of the first year respectively:— 16 Certified Causes of Death. Months. 0-3. Months. 3-6. Months. 6-12. Total. Diarrhœa 29 28 29 86 Prematurity 88 1 — 89 Marasmus and debility 19 10 6 35 Developmental disease 18 1 1 20 Bronchitis 28 10 13 51 Pneumonia 8 16 26 50 Convulsions 10 1 3 14 Suffocation 2 — — 2 Measles 1 — 13 14 Whooping cough 5 4 17 26 Tuberculosis 2 4 10 16 Meningitis — 2 3 5 Miscellaneous 44 10 16 70 254 87 137 478 A glance at the above tables shows (a) that the mortality is heaviest in the first three months of life, more than half the deaths occurring during that age period ; (b) that three groups of diseases between them account for 331 (or 69.2 per cent.) of the total deaths of infants during 1909, viz., prematurity, respiratory diseases and diarrhoea. Looking more in detail into these figures, it will be seen that of the 478 deaths of infants 144 (or 30 per cent.) were due to congenital or developmental diseases (which include prematurity, marasmus, atrophy, debility, etc.), such infants not having the necessary vitality to survive. The diarrhoeal group of diseases show a decrease in infantile mortality, as compared with 1908, probably, to some extent at least, the result of the (favourable) meteorological conditions prevailing during the summer season, viz., wet and cold. The respiratory group shows a slight increase as compared with 1908. The causes responsible for these 478 infant deaths were inquired into by the Health Department. The preventive measures for dealing with this important subject have been fully described in past annual reports, so that it will be unnecessary to do more than briefly recapitulate them. These measures may be summarised as 1. Notification of Births Act. 2. Health Visitors. 3. Milk Depôt. 17 During 1909 an additional Health Visitor (Miss Peacock) was appointed, whose ties are entirely devoted to this work. The Notification of Birtns Act, which was adopted by the Council, and came into force in March, 1908, rendered it necessary to appoint an additional Health Visitor. Prior to this, part of the time of one of the female Sanitary Inspectors (Miss Moss) was allocated to this work. As a result much good work has been accomplished, and the rate of progress which began with the initiation of the Council's attempts to grapple with the problem of infant mortality in has been maintained. The efforts of the Council have in this cornection been assisted by the Battersea Voluntary Health Society, and the other philanthropic Societies working in cooperation engaged in social work in the district. Home Office Enquiry. In connection with the industrial employment of married women, and its effects on infant mortality, a Conference of Medical Officers of Health was held at the Home Office in 1907. The object of the Conference was to arrange for the holding of a systematic enquiry in a number of industrial centres throughout the kingdom, to assist the Secretary of State to ascertain by means of the information thus obtained the need for further legislation regulating the employment of married women. Forms were provided by the Home Office, which, after being filled up, were to be returned. The area selected for the enquiry in Battersea was situate mainly in the East and North-West registration sub-districts. The enquiry started early in 1908, and was to relate to children born in that year, and for the first twelve months of their lives, hence it could not be completed until the end of 1909. One hundred and thirty births were enquired into in Battersea in connection with this investigation, and, while the information which was obtained was interesting, and may, when taken with the mass of similar material obtained throughout the kingdom, prove useful to the Home Office, the figures are too small to draw any particular deduction therefrom. A few of the more important points ascertained in this enquiry are briefly summarised as follows:— The occupations of the mothers of these 130 children were laundresses 32, charwomen and hawkers 33, domestic servants 19, miscellaneous 33. The remaining 13 mothers did not go out to work, but were at home engaged in domestic duties. As regards the feeding of these 130 infants, 47 were breast fed, 58 partly breast fed, and 25 were artificially fed. 18 Twenty-five of the 130 infants died during their first year of life (i.e, 19.2 per cent.), showing a high rate of mortality. The largest number of deaths occurred amongst the children of laundresses, viz., 12, nearly 50 per cent. of the total deaths. The nature of the diseases which caused the deaths of these 25 infants was in 11 cases diarrhæa, wasting diseases 8, other diseases 6. The average income of the families worked out at £1 2s. 6d. weekly. In 90 per cent. of the cases the homes were found to be clean or fairly clean. As already stated, it would be practically useless to draw any conclusions from the result of this enquiry in Battersea, but the report of the Home Office on the investigation conducted throughout the country will be awaited with interest, having regard to the importance of the subject from the social and economic standpoint. Notification of Births Act. This useful Act was passed with the object of removing the delay which, under the Registration (of Births) Acts, arose through late registration of births. The Act, which was adopted by the Council in 1907, came into force in March, 1908. The Act requires that the birth of every child shall be notified to the Medical Officer of Health within thirty-six hours. The notification is "in addition to and not in substitution for the requirements of any Act relating to the registration of births," and applies to any child born " after the expiration of the twenty-eighth week of pregnancy, whether alive or dead." In default of notification a penalty of 20s. is provided. The Act has now been in force in the Borough for nearly two years, and the results so far appear to have fully justified its adoption. During 1909, 2,933 notifications of birth were received, 1,046 births (i.e., 35 per cent.) were notified by medical practitioners, 914 (i.e., 31 per cent.) by midwives, and 973 (i.e., 33 per cent.) by other persons. The number of births notified from each of the registration sub-districts of the Borough was as follows:— Eas Battersea 1,415 North-Wes Battersea 1,030 South-West Battersea 488 The number of births registered during the same period in Battersea was 4,253. The proportion of notified to registered births was, therefore, 69 per cent. These results are on the whole satisfactory. Some little time must necessarily elapse to permit of a new Act being sufficiently known, but little difficulty has, so far, been experienced in connection with the administration of its provisions in Battersea. 19 Of the total number (2933) of births notified during the year 1909, 1,110 have been visited by the Council's Health Visitors. In addition 874 revisits have been made, and the Visitors of the Health Society have in addition paid a considerable number of revisits to births previously visited by the Council's Officers. The districts in which these births have occurred have been specially selected, and the following summary of the results of the enquiries made into these 1,110 births are set out below. The enquiries made had reference— (a) As to the mothers: to health and occupation of; character of the labour, whether a doctor or midwife in attendance; condition of the house, and number of rooms occupied. (b) As to the child: condition of health at birth, and nature of food given. (a) As to the mothers:— In 187 cases the character of the labour was described as "difficult." In 526 instances a doctor was in attendance at the birth; in 483 cases the woman was attended by a midwife; in 65 cases an uncertified nurse or person was in attendance. No. of previous Children in family. 1 2 3 4 5 6 7 8 9 10 ll 12 13 14 15 16 17 188 160 137 112 106 87 59 44 40 29 10 16 5 3 1 1 1 No. of previous Deaths of Children in Family. 1 1 3 4 5 6 177 93 51 27 8 7 No. of Rooms occupied by Family. 1 2 3 4 5 6 Caravans. 121 283 442 149 41 5 6 20 Sanitary conditions of homes:— 71 of the 1,110 homes were very dirty. 314 „ ,, „ dirty. In 385 (i.e., 35 per cent.), therefore, of the homes there was evidence, more or less, of neglect of cleanly habits. (b) As to the child: health at birth:— Of the 1,110 infants visited at their homes the conditions as regards health were ascertained to be as follows:— 311 were at the time they were visited more or less seriously ill. Of these 1,110 infants, information as to the feeding was obtained with regard to 1,066. Breast fed only 894 Infants' Milk Dep6t 102 Cows Milk 18 Breast and other food 52 Two hundred and sixteen of the mothers of these 1,110 children had had previous history of accidents at birth, and 116 of them had "gone out to work" before confinement. A very large number of revisits were paid to the homes of these infants both by the Council's Health Visitors and the Visitors of the Battersea Voluntary Health Society. Infants' Milk Depot. During the year 1909, the number of infants fed from the Milk Depot was 567, as compared with 632 in 1908. Of this number 527 were resident in Battersea and the remaining 40 in neighbouring districts. Of the 567 infants fed, 204 were already on the books of the Milk Dep6t at the beginning of the year, so that the number of children who were admitted during the year was 363. The length of time during which these children were fed from the Depot up to the end of December, 1909, is shown in the following table:— 21 AGE STARTED AND PERIOD FED. Period Fed. Age Started. Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. 1-2 mos. 2-3 mos. 3-4 mos. 4-5 mos. 5-6 mos. 6-7 mos. 7-8 mos. 8-9 mos. 9-10 mos. 10-11 mos. 11-12 mos. Over 1 year. Totals. Under 1 wk 1 1 1 2 5 5 5 2 3 3 .. 5 4 4 3 5 49 1-2 wks. 3 3 .. 1 4 3 .. 1 .. 3 2 1 2 1 2 6 32 2-3 „ .. 1 .. 3 4 6 3 .. .. 1 .. 1 .. 1 1 7 28 3-4 „ 3 1 1 .. 4 5 .. .. 1 1 2 .. .. 1 2 5 26 1-2 mos. 6 .. 6 3 21 16 12 6 3 6 3 7 .. 2 5 32 128 2-3 „ 5 4 1 6 10 15 10 8 10 5 3 4 4 2 1 8 96 3-4 „ 2 2 1 2 6 5 4 2 5 5 2 5 5 1 1 8 56 4-5 „ 3 .. .. 2 5 7 5 4 2 1 1 2 .. 1 3 1 37 5-6 „ 1 7 .. .. 5 5 1 .. 1 3 2 .. 1 .. 1 1 28 6-7 „ 3 1 1 .. 4 5 3 .. 2 1 2 .. .. 1 .. 1 24 7-8 „ .. .. .. 1 2 4 1 3 .. 2 2 .. .. 1 .. .. 16 8-9 „ 1 .. .. .. 1 3 .. 1 1 .. .. .. 1 1 .. .. 9 9-10 „ .. .. .. 1 .. 1 .. .. 1 .. .. .. .. .. .. 1 4 10-11 „ 1 1 .. 1 2 3 .. 1 .. 2 .. .. .. 2 .. 1 14 11-12 „ .. .. .. .. 1 1 1 .. .. .. .. 1 .. .. .. 1 5 Over 1 year. 1 1 1 2 4 2 1 2 .. .. .. .. .. .. .. 1 15 Totals 30 22 12 24 78 86 46 30 29 33 19 26 17 18 19 78 567 22 It should be noted that as some of the children fed commenced taking the milk towards the end of the previous year, the periods shown in the above table are somewhat understated. Of the 567 infants fed from the Milk Depot, 363 were admitted during 1909, and 274 of these were admitted on the recommendation of medical practitioners, and the remainder by hospitals, midwives, or the Council's Health Visitors, etc.; 255 of the 363 children admitted during the year were more or less seriously ill on admission, the nature of the illnesses comprising almost all the diseases of infancy, congenital and wasting disease contributing the largest quota. The total number of deaths amongst the children fed from the Milk Dep6t was 34, and the death-rate was, therefore, 59.9 per 1,000, as compared with 107, the general infantile mortality rate for the Borough. In connection with the Infants' Milk Dep6t, a large percentage of the babies were brought to the weighing room weekly or fortnightly to be weighed. This practice enables the Medical Officer of Health to exercise supervision over the majority of the infants on the Depot Register. Of the 567 infants admitted to the Depot, 369 were brought to the weighing room to be weighed periodically during the year, and 2,775 weights were recorded. In addition 509 weights were taken of babies not fed on the Borough Council Milk. As in past years this work has been most ably superintended by Miss Moss, who is most successful in her efforts to get a large number of mothers to attend regularly for this useful purpose. The following is a summary of the work carried out in connection with Infants' Milk Depot during 1909:— Visits paid by Health Visitor to homes of infants admitted to Milk Depot 919 Attendances of Health Visitor at weighing room 105 Number of infants attending weighing room 369 Weights registered 2,775 Number of infants under observation at home 104 Senile Mortality. During the year 1909, in the Borough of Battersea, 630 deaths of persons aged 65 years and upwards were registered. The age distribution of these deaths in the sub-districts is set out in the following table: — 23 District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. East Battersea 153 93 13 259 North-West Battersea 101 57 12 170 South-West Battersea 90 77 34 201 Borough of Battersea 344 227 59 630 The 630 deaths over 65 were equivalent to 26.1 per cent, of the deaths at all ages. The deaths over 65 in each year during the seven years 19031909 are:— 1903 404 1904 508 1905 537 1906 495 1907 510 1908 564 1909 630 It will be noted that there was a marked increase in the senile mortality for Battersea during the year 1909. This, as has already been pointed out, was probably due to the severe weather during part of the first quarter of the year, causing a high mortality, especially amongst the very old and very young. 24 Infectious and other Diseases. Zymotic Diseases. The principal zymotic diseases are seven in number, viz., small-pox, scarlet fever, diphtheria (including membranous croup), whooping cough,"fever" (including typhus, enteric or typhoid, and simple or continued), and diarrhoea. 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 will be found to show on the whole a very satisfactory record, as compared with former years. In the Borough of Battersea during 1909 there were registered from the principal zymotic diseases 237 deaths, giving a corrected zymotic death-rate of 1.27 per 1,000, the corrected rate for the County of London being 1.31, varying in the different Metropolitan Boroughs from .52 in Hampstead to 2.74 in Bermondsey. The zymotic death-rates vary considerably for the three sub-districts into which, for registration purposes, the Borough is divided. Thus in the East district the rate was 1.94, in the North-West district, 1.47, while in South-West Battersea the rate was only .22 per 1,000. As in past years, the less sanitary areas of the Borough show a much higher death-rate, accounted for by the crowding and absence of home isolation in the two first-named districts, as compared with the latter, in which the housing accommodation and general standard of living is on the whole much superior. Similar conclusions are to be drawn from a comparison of the death-rates from the chief zymotic diseases in the different Wards of the Borough, as shown in the table on page 25. The number of deaths registered from the chief zymotic diseases during 1909 was 113 fewer than the average for the ten years 1899-1908. 25 The following table gives the death-rate from each of the chief zymotic diseases compared with the mean death-rate for the decennium 1899-1908, the gain or loss in each case being also shown:— Diseases. Mean Deathrate per 1,000 1899-1908. Death-rate per 1,000 1909. Gain in 1909. Loss in 1909. Small-pox 0.01 0.00 0.01 .. Measles 0.48 0.46 0.02 .. Erysipelas 0.06 0.02 0.04 .. Scarlet Fever 0.09 0.04 0.05 .. Diphtheria 0.14 0.12 0.02 .. Enteric Fever 0.08 0.03 0.05 .. Puerperal Fever 0.03 0.03 .. .. Whooping Cough 0.37 0.32 0.05 .. Diarrhœa 0.73 0.28 0.45 .. The great improvement which has taken place in this respect will be seen by an inspection of the table. In the next table is shown the death-rate from the chief zymotic diseases aranged in Wards:— 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. All chief Zymotic diseases. 1. Nine Elms 31,882 .00 .65 .03 .06 .12 .15 .00 .53 .59 2.16 2. Park 20,069 .00 .84 .04 .14 .39 .00 .04 .34 .39 2.24 3. Latchmere 22,704 .00 .44 .48 .04 .22 .04 .08 .22 .26 1.80 4. Shaftesbury 17,703 .00 .39 .00 .00 .05 .00 .00 .67 .11 1.24 5. Church 21,579 .00 .23 .00 .00 .13 .00 .00 .32 .50 1.20 6. Winstanley 22,709 .00 .96 .00 .08 .00 .04 .13 .44 .13 1.80 7. St. John 9,131 .00 .10 .00 .00 .00 .00 .00 .10 .00 .21 8. Bolingbroke 20,651 .00 .14 .00 .00 .00 .00 .00 .04 .14 .33 9. Broom wood. 19,608 .00 .00 .00 .00 .10 .00 .05 .00 .05 .20 The seasonal mortality from the different important zymotic diseases is well shown by arranging the deaths quarterly, thus:— 26 Quarter No. Small-pox. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Fever. Diarrhœa. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1 — 39 27 3 9 — 2 — 4 1 3 — 22 110 2 — 34 17 1 6 — 1 1 6 1 — — 5 72 3 — 10 9 2 4 — 2 — 27 — 1 — — 55 4 — 3 7 2 4 — 2 1 16 2 3 — 6 46 Year — 86 60 8 23 — 7 2 53 4 7 — 33 283 Drains and sanitary fittings are tested as a routine in all infected houses in cases of diphtheria, enteric and puerperal fevers, and in the case of other diseases in such instances as may be found necessary. It should, of course, be remembered in this connection, that where defects are found it does not follow that these are necessarily the cause of the disease. Indirectly, however, they may be so. The tests employed are the ordinary smoke test and chemical test (Kingzett's). The following table gives the drainage defects, etc., in houses in which cases of infectious disease were notified during 1909:— 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. Diphtheria 235 17 46 63 26 74 Erysipelas 152 1 15 16 10 90 Scarlet Fever 551 12 53 65 11 89 Typhoid 34 8 5 13 38 62 Puerperal Fever 14 — — — — 100 Cer.-Sp. Fever 4 — — — — 100 Total 990 38 119 157 16 84 27 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. 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 — — 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 1908 0.00 0.00 0.82 0.02 1.84 0.11 5.97 0.13 0.19 0.03 0.03 0.02 0.01 0.01 Average 1899-1908 0.15 0.01 0.94 0.06 1.72 0.14 4.20 0.09 0.47 0.08 0.05 0.03 — — 1909 0.00 0.00 0.83 0.02 1.42 0.12 3.77 0.04 0.25 0.03 0.07 0.03 0.02 0.01 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." 28 Notifiable Infectious Diseases. During 1909, under the Notification Clauses of the Public Health (London) Act, 1891, 1,189 cases of infectious diseases have been reported, and of this number 1,020 (i.e., 85.7 per cent.) were removed to hospitals of the Metropolitan Asylums Board or to other hospitals, and 169 (i.e., 14.3 per cent.) remained under treatment at their homes. It is satisfactory to note the continued high percentage of cases of infectious disease removed to isolation hospitals, a matter of great importance in a district such as Battersea, where, owing to the density of the population and the absence of means of adequate isolation, the difficulty of checking the spread of epidemics is considerable. Examining the removals to hospitals more in detail (e.g., nature of disease) it is seen that during 1909, in the Borough of Battersea, the following are the percentages:— Scarlet fever 97.0 Diphtheria and membranous croup 94.7 Enteric fever 87.5 Erysipelas 21.1 Puerperal fever 64.2 The number of cases notified in the three sub-districts of the Borough and the proportion per 1,000 of the population are as follows:— Total number of cases certified. Notification per 1,000 of the population. The Borough 1,189 6.3 East Battersea 585 7.5 North-West Battersea 348 7.0 South-West Battersea 256 4.3 The total number of cases of notifiable infectious diseases reported during 1909 shows a considerable decrease, as compared with 1908, being no less than 446 fewer in number. No case of small-pox was notified during 1909 in Battersea. The total amount paid to medical practitioners as fees for notification of infectious diseases in Battersea during 1909 was £177 17s. 0d. This amount includes fees paid for notification of cases of phthisis both for voluntary notification and notification under the Public Health (Tuberculosis) Regulations. There was a decrease in the number of notifications of scarlet fever during 1909, viz., 36 per cent., as compared with 1908, and 28 per cent, below the average for the ten years 1891-1900. The 702 cases occurred in 551 houses, and in 65 of these sanitary defects were found. 29 A decrease has also to be recorded in the number of notifications of diphtheria received during 1909 as compared with 1908. The notifications were 46 per cent. below the average for the ten years 1891-1900. The 265 diphtheria cases occurred in 235 houses, and in only 17 of these were the drains on testing found defective. The enteric fever or typhoid notifications received were 62 per cent. below the average for the decennium 1891-1900. The 48 enteric fever cases occurred in 34 houses, in eight of which the drains, on testing, were found to be defective. On the 23rd March, 1909, an Order was made making Glanders, Anthrax and Hydrophobia notifiable diseases in the County of London. The following Table shews the 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) 31,882 2.00 0.90 3.63 0.46 0.03 0.03 7.08 „ 2 (Park) 20,069 2.04 1.09 4.48 0.49 0.14 0.09 8.37 „ 3 (Latchmere) 22,704 1.23 1.05 4.58 0.26 0.08 0.00 7.22 „ 4 (Shaftesbury) 17,703 1.29 0.90 5.08 0.16 0.00 0.00 7.45 „ 5 (Church) 21,579 1.15 1.11 2.13 0.18 0.00 0.04 5.09 „ 6 (Winstanley) 22,709 1.18 0.96 3.96 0.26 0.22 0.00 6.60 „ 7 (St. John) 9,131 0.54 0.54 1.97 0.00 0.00 0.00 3.06 „ 8 (Bolingbroke) 20,651 1.15 0.53 3.68 0.00 0.09 0.00 5.47 „ 9 (Broomwood) 19,608 1.42 0.15 316 0.20 0.05 0.00 4.99 Small-pox. Again it is satisfactory to record that no case of small-pox was notified in Battersea in 1909. One suspected case was referred to me by a medical practitioner, which, on investigation, proved not to be small-pox. In the County of London, twenty-one cases occurred during the year. Contacts were watched on arrival within the Borough during 1909 in connection with small-pox cases that had occurred on 30 board vessels arriving from abroad. All these were kept under observation for a period of sixteen days, and no case of small-pox arose. Scarlet Fever. There was a considerable decrease in the number of cases of scarlet fever reported in Battersea during 1909, 702 cases being notified and eight deaths registered from the disease, giving a case mortality of 1.1 per cent. In 1908, 1,099 cases were notified and twenty-four deaths registered, i.e., a case mortality of 2.1 per cent. The death-rate for 1,000 population (0.04) from scarlet fever in Battersea was the lowest rate recorded in the County of London during 1909. The following table shows the distribution of the disease and the case mortality and death-rate per 1,000 of the population in the Borough and the sub-districts during 1909:— Sub Registration Districts. East Battersea. Nth.-West Battersea. Sth. -West Battersea. Borough. No. of Cases 336 197 169 702 Case-rate per 1,000 population 4.33 3.98 2.85 3.77 No. of Deaths 6 2 — 8 Death-rate per 1,000 population .08 .04 .00 .04 Case-mortality per cent. 1.78 1.01 .00 l.11 Of the 702 cases of scarlet fever notified 437 (i.e., 62 per cent.) were of children of school age. Of the eight deaths registered from the disease during 1909, six were of children under five years of age. In 104 of the 551 houses invaded by the disease, multiple cases occurred. In a number of instances it was found that the source of infection was traceable to a mild unrecognised case, or to some suspicious illness from which one or more members of the family or families residing in the house was suffering. CHART showing the number of cases of Scarlet fever notified during each week of the year 1909. 31 So-called "return cases" were again more numerous in 1909. In all such cases special enquiries were made, with results more or less suggestive of the recently discharged patient having been responsible for the infection in the new case. Milk as a factor in the spread of infection did not arise during 1909. 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 1908 1,099 52 4.73 1909 702 45 6.41 The number of cases sent back from hospitals notified as scarlet fever, and in which the diagnosis was found to be erroneous, was 31, or 4.2 per cent., as compared with 4.9 per cent, in 1908. Diphtheria. The number of diphtheria notifications received during 1909 (including membranous croup) in the Borough of Battersea was 265, a marked decrease as compared with 1908, when the figure was 340. The distribution of the disease in the three registration subdistricts of the Borough, together with the number of deaths among both hospital and home-treated patients during 1909 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 137 4 133 — 15 15 10.9 1.7 North-West Battersea 69 2 67 1 5 6 8.7 1.3 South-West Battersea 59 8 51 — 2 2 3.4 0.9 It will be noted that diphtheria has been fairly uniformly distributed over the Borough, though on the whole East Battersea and North-West Battersea have suffered more than the other 32 registration district of the Borough. This is in accordance with the rule, that generally speaking, the incidence of the disease is heavier in the poorer and more congested parts of the district. Two hundred and fifty-two of the cases notified were removed to hospital, or 94.7 per cent. In 1908 the percentage of cases removed to hospital was 86.7 per cent., and in 1907, 94.6. In the sub-districts the percentages of cases removed to hospital were as follows: East Battersea, 97.0; North-West Battersea, 97.1; South-West Battersea, 86.4. Twenty-two deaths occurred in hospital, and one at home. The following table gives the age distribution of the cases notified, and of the fatal cases:— Age Periods—Years. Boro. Under 11 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 65— No. of Cases 6 19 27 23 34 90 33 10 23 .. 265 No. of Deaths 2 5 6 4 3 3 .. .. .. .. 23 Case Mortality per cent. 33.3 26.3 22.2 17.3 8.8 3.3 0.0 0.0 0.0 0.0 8.6 The total number of houses invaded by diphtheria was 235. In 17 houses (i.e., 7.2 per cent.) the drainage was found defective, and in 46 (i.e., 19.4 per cent.) insanitary conditions other than drainage defects were discovered. The source of infection in the majority of cases was merely conjectural. In 23 instances there was evidence pointing to personal contact, in three to schools, eight were post-scarlatinal cases, which developed in hospital while the patients were recovering from scarlet fever. In nine instances the patients were infected outside the Borough. There were three "return" and four "relapse" cases. During the year 24 cases (i.e., 8.3 per cent.) notified as diphtheria and removed to hospital were found not to be suffering from the disease and were discharged to their homes. Six hundred and twenty-eight bacteriological examinations were made during 1909, as compared with 2,319 in 1908, and 386 in 1907. In 147 a positive, and in 481 a negative result was obtained. CHART showing the number of cases of Diphtheria notified during each week of the year 1909. 33 Enteric Fever. During 1909, 48 cases of enteric fever were notified in the Borough of Battersea, as compared with 36 in 1908, and 37 in 1907, and seven deaths were registered, giving a case-mortality of 14.5 per cent. The slight increase during 1909 in the number of cases was due to a small local outbreak. There was, however, no increase in the death-rate from the disease, which was exactly the same as in 1908, viz., .03 per 1,000 population. The incidence and death-rate from this disease has shown a steady decline both in London and Battersea during the past ten years. The age distribution of the cases was as follows: — Ages. Under 5. 5-15. 15-30. Above 30. Totals. Males 2 7 4 11 24 Females — 8 10 6 24 Totals 2 15 14 17 48 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 0.40 0.07 19.3 North-West Battersea 0.26 0.02 7.6 South-West Battersea 0.06 0.00 0.0 The Borough 0.25 0.03 14.5 In the County of London the case-rate was 0.21 and the death-rate 0.03 per 1,000. Of the 34 typhoid-infected houses 13 (i.e., 38 per cent.) showed on inspection defective traps, fittings or appliances. In eight of the houses the drains themselves were found to be defective. The source of infection in 16 cases was probably due to personal infection, or to a so-called "carrier" case. In nine cases it was ascertained that fried fish had been partaken of during the critical period and may have been the cause of the disease, and in four cases shell-fish was suspected as a probable cause of origin. 34 A somewhat remarkable outbreak was that which occurred in a street in the Nine Elms Ward, during the late summer and autumn months. The outbreak began on the 19th August. Between that date and the 27th October I received the following notifications:— Date of Notification. Name. Age. Address. Date of onset of Feve Aug. 19th. George S. 46 16, L Street 18th July „ 20th. William E. 28 24, „ ,, 11th August „ 24th. Kate M. 30 16, „ „ 16th „ „ 24th. Rose M. 8 6, „ „ 16th „ „ 24th. Alice M. 16 16, „ „ 16th ,, Sept. 23rd. George M. 5 16, „ „ 6th Sept. „ 27th. Eliza R. 51 39, A Street 27th August Oct. 7th. Eliza A. 27 13, L Street 24th Sept. „ 11th. Lena A. 8 13, „ „ 20th „ „ 11th. Ernest A. 34 13, „ „ 29th „ „ 11th. Ernest A. 6 13, „ „ 20th „ „ 11th. Margaret C. 14 13, „ „ 2nd Oct. „ 19th. Joseph C. 9 13, „ „ 13th „ „ 27th. George A. 38 47, „ „ 18th Sept. The history of the outbreak was as follows: George S. was admitted to the Wandsworth Infirmary on the 14th August, suffering from what was thought ''heat prostration." On the 19th he was notified as suffering from enteric fever. It was ascertained on enquiry at his home that he had been in ill-health for some five or six weeks. He was employed as a coal carman, his occupation taking him to various coal depots in London, and he had consequently to have his meals casually, when away from home. No further information could be obtained as to how he may have contracted the disease. It is probable, however, that he was the first person attacked and that he had been suffering from the disease for some time prior to his admission to the Infirmary. One of his children was removed on the same day (14th August) to the Infirmary. The symptoms of this child's illness appear to have given rise to suspicion, but the bacteriological examination for Widal's reaction proved negative in her case. The case appears, therefore, to have been probably one of tuberculosis, judging from the result of the bacteriological examination. William E. was notified on the 30th August as suffering from typhoid. He also was a coal carman, but it is said, did not know George S. He occupied, with his wife and three children,, the upper part of No. 24, L—— Street, the lower being occupied by another family, but no case of illness occurred amongst the latter. The onset of his illness was said to be the 11th August, so that he was lying ill at home for about ten days. While lying ill at home Eliza R., his mother-in-law, who resided at A—— Street, some considerable distance away, helped her daughter to nurse her husband. She subsequently contracted the disease (typhoid). 35 On the 24th August, Kate M. and two of her children, Rose and Alice were notified as suffering from enteric fever, the onset of the fever being given as about a week previous. She is said, however, to have been out of sorts for some time longer than this. and, with her husband and family, occupied the lower floor of No. 16. She is a sister-in-law of the patient William E., and there was constant intercourse between the two families. It is probable, therefore, that she was the connecting link between the illness of the patient George S., who occupied the upper floor of the same house, and William E., and also Eliza R., her mother. On the 21st September, another child, George M., was notified, the onset of his illness dating from the 6th September. This child had been sent to an address in Kensington when his mother was removed to hospital, and the Medical Officer of Health of that district, who was advised of the fact, reported that on enquiries being made it was found that the child was an inpatient at St. George's Hospital. The case was subsequently notified by the Hospital Authorities as typhoid fever. On the 7th October, Eliza A. was notified from No. 13, L- Street, nearly opposite Nos. 16 and 24. This patient occupied, with her husband and five children, the lower part of the house, the upper portion being in the occupation of the C family. This patient had been lying ill at home for some thirteen days prior to her removal to hospital. On visiting the house I found that two of the children appeared to show signs of recent illness, and I was informed that the father, who was at the time away at work, was also ill. The medical attendant was communicated with, and two of the children and the father were notified subsequently and removed to hospital. The three remaining children were removed to the Workhouse, and the Medical Officer of Health for Wandsworth advised of the history of the outbreak. Specimens of blood were obtained from these children for bacteriological examination, the result being found to be positive in each case. There being no clinical symptom present, however, it was not considered necessary to notify these children, though from the history and the bacteriological test there would appear to be little doubt that they had suffered from enteric fever. Margaret C. was notified on the 11th October. This patient lived, with her family consisting of father, mother, sister and brother, in the upper portion of No. 13, and had looked after Eliza A. and her children during her (Eliza A.'s) illness. It is thus most probable that she was infected from the A. family. Subsequently her brother Joseph C. was notified and removed to hospital. Enquiries were made into the probable source of infection in the case of these two families, and it was ascertained that the 36 children of the A. family had played with those of Kate M. One of the children of the A. family removed to the Workhouse was said to have been ill from about the end of August, and his statement was subsequently confirmed by the mother. It is probable, therefore, that the disease may have been contracted from the M. family in the first instance. The last case notified was that of George A., of 47, L- Street, on the 27th October. He occupied, with his family of ten persons, the lower part of No. 47, the upper rooms being occupied by a married couple without children. Not a single case of illness of a suspicious nature occurred amongst the other occupants of this house, and there appeared to be no connection either direct or indirect between any of the other cases in the same street. It is, therefore, probable that his case may have been only a coincidence. The history of the outbreak appears to point to the disease having been spread by personal contact or by so-called "carrier" cases. It is clear that the disease started at No. 16, and that probably George S. was the first case infected. How he mayhave contracted the disease it was impossible to ascertain. The subsequent spread of the disease to the family living in the lower rooms of the same house, and the intercourse that existed between the other persons attached appears to furnish a strong case in favour of the personal contact theory as the cause of the spread of the disease. The probable presence of an unrecognised "carrier " case must be remembered. The drains in each of the houses invaded were tested and found not to be defective. Cleansing and disinfection of rooms, clothing and bedding was carried out in every case. The measures taken proved successful in preventing a further spread of infection after the nature of disease was brought to light. Forty-four samples of blood were submitted for bacteriological examination for the Widal reaction for typhoid, and in 12 (i.e., 27 per cent.) a positive result was obtained. At the suggestion of the Local Government Board, arrangements were made for the bacteriological examination of specimens of the stools and urine of persons discharged from fever hospitals after typhoid fever in connection with an investigation into the question of "carrier" cases—that is, cases of persons capable of conveying infection to others though not themselves suffering from clinical manifestation of the disease but in whose blood or excretions the typhoid germ is found on bacteriological examination to be present, as a cause of the spread of infection in typhoid fever. Samples were obtained in several cases and forwarded to the laboratories for bacteriological examination. CHART showing the number of cases of Enteric fever notified during each week of the year 1909. 37 Puerperal Fever. During 1909, in the Borough of Battersea, fourteen cases of puerperal fever were notified, and seven deaths were registered, giving a case-mortality of 50 per cent. The case-rate was .07, or .02 above the mean case-rate for the preceding ten years. The death-rate was .03 per 1,000, and was equal to the decennial average. The death-rate for London was 0.3. Five deaths occurred in North-West Battersea and one each in East and SouthWest Battersea. In 1908, seven cases of puerperal fever were notified, and five deaths were registered, giving a case-mortality of 71.4 per cent, and a death-rate of .02 per 1,000. Puerperal fever is a preventable disease, and is caused by want of care by those in attendance on the lying-in woman. During 1909, 4,450 births were registered in or belonging to Battersea. The mortality statistics for this disease cannot, therefore, be considered unsatisfactory. Enquiries were made in every case notified, and the midwives in attendance 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 bath and her clothing, instruments, etc., sterilised by steam 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, however, devolves on the Borough Council as the Local Sanitary Authority. Seven 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 1909, in the Borough of Battersea, 156 cases of erysipelas were notified, and four deaths were registered, as compared with 151 cases and five deaths in 1908. The case-mortality was 2.56 per cent., as compared with 3.3 per cent, in 1908, and 2.89 per cent, in 1907. The case-rate was .83, and the death-rate .02, or .11 and .04 below the decennial average respectively. Thirty-three cases were removed to hospital, the majority going to Union Infirmaries, and the remainder to general hospitals. In London during 1909, 4192 cases of erysipelas were notified, and 176 deaths registered from the disease, giving a case-mortality of 4.2 per cent. 38 Epidemic Cerebro-spinal Meningitis. During 1909, four cases of epidemic cerebro-spinal meningitis were notified, as compared with two cases in 1908. There were three deaths registered from the disease. In the County of London, 111 cases of cpidemic cerebro-spinal meningitis were notified during the year 1909. Measles. During 1909, 86 deaths were registered within the Borough of Battersea from measles, a number which was about equal to the average for the ten years 1899-1908. In 1908, 47 deaths, and in 1907, 72 deaths were registered in Battersea from the disease. The death-rate was .46 per 1,000 population, as compared with .48, the mean death-rate fc. the preceding ten years. The death-rate in East Battersea was .64, North-West Battersea, .62; South-West Battersea, .08. The London death-rate for measles was .48 per 1,000, there being 2,324 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 sequelæ of measles. Measles and whooping cough, between them, caused many more deaths in Battersea during 1909 than all other notifiable diseases put together, the figures being: measles and whooping cough, 146; all other notifiable diseases, 49. The number of deaths registered in each of the registration sub-districts in 1907, 1908 and 1909, is as follows:— 1909. 1908. 1907. East Battersea 50 22 36 North-West Battersea 31 21 27 South-West Battersea 5 4 9 The influence of environment is strikingly exhibited in the above-mentioned figures, the two first-named districts containing in the main a less prosperous class of inhabitant than the latter. Fourteen deaths were of infants under one year, and 66 of children aged one to five years. Only six of the deaths occurred amongst children over five years of age. 39 The deaths in each of the four quarters of the year were as follows: — First quarter 39 Second quarter 34 Third quarter 10 Fourth quarter 3 Measles not being a notifiable disease we are dependent mainly on the School Authorities for information of cases occurring. When cases are brought to the notice of he Health Department the homes of the patients are visited and leaflets calling attention to the dangerous nature of the disease and the precautions to be taken are left at the homes. Disinfection of the rooms is carried out when the patient has recovered. Whooping Cough During 1909, in the Borough of Battersea, 60 deaths from this disease, as compared with 39 in 1908. The deaths were seven below the average for the preceding ten years, and were equivalent to a death-rate of .32 per 1,000, as compared with .37, the mean death-rate for the previous ten years. In the sub-districts the number of deaths and the death-rate per 1,000 of the population were as follows:— No. of deaths. Death-rate per 1,000 of the population. East Battersea 41 .52 North-West Battersea 17 .34 South-West Battersea 2 .03 In this disease, as in measles, the influence of environment is well shown in the above figures. East Battersea suffered most, and South-West Battersea least, from the disease. The death-rate under one year of age was 43.3 per cent., and from one to five years 55 per cent., the total percentage of deaths under five years of age being 98.3. The deaths in each of the four quarters of the year were as follows:— First quarter 27 Second quarter 17 Third quarter 9 Fourth quarter 7 Diarrhœa. During 1909 the number of deaths from diarrhœa registered in the Borough of Battersea was 53, as compared with 89 in 1908. 40 Fifteen of these deaths were registered as being due to epidemic or zymotic enteritis. The death-rate was .28 per 1,000, or .45 below the decennial average, .73. Of the 53 deaths, 51 (i.e., 96 per cent.) were of children under five years of age, and 42 (i.e., 79 per cent.) of infants under one year of age. During 1908, 89 deaths from diarrhœa were registered, of which 72 (i.e., 80 per cent.) were of infants under one year. The number of deaths and the death-rate in the sub-districts in 1907, 1908 and 1909 were as follows:— Registration Sub-District. No. of Deaths. Death-rate per 1,000 population. 1909. 1908. 1907. 1909. 1908. 1907. East Battersea 33 39 28 ·42 ·51 ·36 North-West Battersea 16 40 15 ·32 ·80 ·30 South-West Battersea 4 10 4 ·06 ·17 ·07 In the next table are set out the deaths registered in each of the four quarterly periods in 1907, 1908 and 1909 :— 1909. 1908. 1907. First quarter 4 12 6 Second quarter 6 7 5 Third quarter 27 53 16 Fourth quarter 16 17 20 Of the 42 deaths of infants under one year from diarrhœa or epidemic enteritis, 22 occurred in the third quarter of the year, distributed as follows in the three sub-districts: East Battersea, 17; North-West Battersea, 8; South-West Battersea, 2. The following table gives the age periods at which these 42 infants died during 1909:— Deaths of Infants under 1 year of age from Zymotic Diarrhœa and Epidemic Enteritis. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total. 13 12 12 5 42 41 A glance at the above table shows that of the total number of infant deaths from this cause, 24 (i.e., 57 per cent.) were between three and nine months old. Only five of the 42 infants were entirely breast fed. Tuberculosis. During 1909, 289 deaths from tuberculosis were registered in the Borough of Battersea. Of this number 217 (i.e., 75 per cent.) were due to phthisis (tuberculosis of the lungs), 33 to tubercular meningitis, 17 to general tuberculosis, 2 to tubercular disease of the larynx, 8 to tuberculosis of the intestines, and 12 to other forms of the disease. In 1908 the total number of deaths from tuberculosis was 306; in 1907, 304. The following table shows the death-rate from phthisis and other tubercular diseases per 100,000 persons in each year since 1900:— Year. Deaths from Phthisis per 100,000 persons. - Deaths from other Tubercular Diseases per 100,000 persons. 1900 155 53 1901 146 60 1902 129 44 1903 128 51 1904 139 41 1905 132 50 1906 122 48 1907 120 46 1908 119 46 1909 116 38 The number of deaths from phthisis and other tubercular diseases, and the death-rate per 1,000 of the population in each of the sub-districts and the Borough, is set out in the following table:— District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 97 1·25 37 0·47 134 1·72 Nth.-West Battersea 72 1·45 22 0·44 94 1·90 Sth.-West Battersea 48 0·81 13 0·21 61 1·03 The Borough 217 1·16 72 0·38 289 1·55 The highest rates were, it will be noted, in North-West and East Battersea. These two districts are inhabited by a large number of the poorer classes, whose circumstances render them more vulnerable to attack than those more fortunately situate. The deaths from tuberculosis were 11.9 of the total deaths. It will be seen, however, that the death-rate from phthisis (the most common form of tubercular disease) was in 1909 1.16, or .03 lower than in 1908, and .04 lower than in 1907. PREVENTIVE MEASURES. Public Health (Tuberculosis) Regulations. At the beginning of 1909 the Public Health (Tuberculosis) Regulations came into force. The Regulations provide for the compulsory notification (within 48 hours) to the Medical Officer of Health of cases of phthisis occurring amongst Poor Law patients. Prior to the issue of these regulations there was no satisfactory means of knowing when cases of phthisis occurred, the first intimation usually reaching the Health Department in the death returns. The Regulations have now been in force for a year and have provided a valuable aid to Sanitary Authorities in connection with the preventive measures carried out in dealing with this insidious disease. During 1909, 491 notifications have been received referring to 257 cases. 42 43 Table shewing the number of notifications received under the Public Health (Tuberculosis) Regulations, 1908. Class. 1st Notifications. Duplicates. Total. a 145 126 271 B 90 44 134 C 22 63 85 D — 1 1 Total 257 234 491 Early in May, 1909, on the recommendation of the Health Committee the Council resolved to adopt a system of voluntary notification of the disease in Battersea, and a few notifications have been received from Brompton Hospital through the Medical Officer of the London County Council. During the year voluntary notification certificates of 130 cases of phthisis in Battersea were received. In the following table are set out particulars as regards age periods and distribution in the sub-districts and Wards, of the notifications, both voluntary and compulsory, of pulmonary phthisis during 1909 :— Age Periods—Years. Notified under Under 1 1 2 3 4 5-10 10-15 15-25 25-65 65 Total P.H. (T.) R.,'08 1 3 4 - 2 15 11 37 172 12 257 Voluntary 2 1 — 1 2 9 4 28 81 2 130 Total 3 4 4 1 4 24 15 65 253 14 387 Arranged in Wards. Notified under 1 2 3 4 6 6 7 8 9 Total. P.H. (T.) R., 1908 56 43 26 17 30 40 35 5 5 257 Voluntary 18 22 13 15 20 22 8 8 4 130 Total 74 65 39 32 50 62 43 13 9 387 Immediately on receipt of a notification the home of the patient is visited by one of the Inspectors or Health Visitors, and 44 enquiries are made into the history of the case. Advice, both oral and printed, is given as to the precautions to be taken by the patient and those in contact, and sputum vessels are provided free. The sanitary condition of the home is noted and any defects found dealt with. Disinfection of the rooms, clothing, etc., of the patient is arranged for, and disinfectants supplied. The patient, if being treated at home, is kept under observation and periodically visited, and in cases where removal to hospital or the infirmary is necessary, assistance where possible is rendered by the Health Department. In addition assistance is rendered by the Health Society and philanthropic bodies working in the Borough. Many of the cases after being visited by one of the Council's Officers are handed over to the Health Society, which arranges for the revisiting of the patients and other material assistance through the appropriate channel. To sum up, therefore, the preventive measures at present in operation in Battersea for dealing with pulmonary tuberculosis are as follows: — 1. Voluntary notification. 2. Compulsory notification of Poor Law cases. 3. Facilities for the free bacteriological examination of sputum in suspected cases. 4. Visiting of patients at their homes, by Health Visitors, for the purposes of giving advice, oral and printed, and for securing, where possible, isolation and the disinfection of rooms, clothing, etc., and the removal of insanitary conditions. During the year some useful work has been accomplished in this direction, but there still remains a good deal to be done before it can be claimed that a proper and sufficient provision is made for dealing with this terrible disease. The great drawback at the present time is the absence of free sanatorium accommodation for the treatment of suitable cases. It is surely time when some adequate provision should be made to supply this want for London. Numerous examples might be cited as a result of the enquiries made into notified cases of the disease in the poorer quarters of the Borough during the year. Thus, for example, of 22 cases notified amongst children, in ten the condition of the families of these patients was described by the Health Visitor as being practically destitute, and in the case of four others poor. In 18 of the 22 cases there was a previous history of phthisis, and in only three 45 instances was the patient provided with separate sleeping accommodation. It will be at once apparent, therefore, that it is only by the provision of adequate sanatorium accommodation that the most satisfactory progress will be made in stamping out the disease. Cancer. The number of deaths from cancer registered of persons belonging to Battersea during the year 1909 was 180 (males 67, females 113), as compared with 156 in 1908 and 153 in 1907. Taking the average annual number of deaths for the ten years 1899-1908, viz., 146.8, as compared with 180 deaths during 1909, there would appear to be an increase in the mortality from this disease. This may be due, to some extent at least, to improved methods of diagnosis and certification. Alcoholism. During 1909, in the Borough of Battersea, three deaths were registered from acute and chronic alcoholism (males 0, females 3). In addition to these, 22 deaths were registered from cirrhosis of the liver (males 12, females 10), a disease mainly due to alcohol. The total number of deaths, therefore, to be ascribed to alcohol is 25, as compared with 25 in 1908 and 27 in 1907. Bacteriological Examinations. Since 1903 the Council have provided for the use of medical practitioners practising in the Borough, facilities for the bacteriological examination of specimens from suspected cases of diphtheria, enteric fever, and pulmonary tuberculosis. The cost of these examinations is borne by the Council. Practitioners may also, bv arrangement with the Medical Officer of Health, submit for examination specimens from patients suffering from diseases other than those mentioned. During the year 1909, 825 examinations have been made at the Clinical Research Association Laboratories, as set out in the following table, at a cost of £134 3s. 4d. 46 The number of examinations in previous years were: 1903, 189; 1904, 351; 1905, 264; 1906, 348; 1907, 508; 1908,* 2,486. The following table gives particulars as to the examinations made during 1909:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 147 481 628 Enteric fever 12 32 44 Tuberculosis 34 117 151 Cerebro-spinal fever — 2 2 Total 193 632 825 * N.B.—The large number of diphtheria specimens examined during 1908 was occasioned by the outbreaks of Diphtheria at the Infirmary and Royal Masonic Institute for Girls. There is no doubt that the procedure has proved most useful in the diagnosis of doubtful cases of these dangerous infectious diseases. The facilities provided by the Council have been largely availed of by the medical practitioners of the district during 1909, the total number of specimens examined showing a progressive increase in each year, excluding the exceptional year of 1908. The Council might with advantage provide a Bacteriological Laboratory for the sole use of the Borough. 47 General Sanitary Administration. The following table gives a summary of the work of the Sanitary Inspectors as far as the work admits of tabulation:— Summary of Sanitary Operations for the Year 1909. Total Sanitary Operations 79,356 Dust receptacles provided 616 Number of house inspections 12,340 Leaky house-roofs and gutters repaired 807 Bakehouse inspections 226 Bakehouse nuisances abated . . 66 Houses supplied with water, and fittings repaired 308 Urinals—inspections 207 Do. altered, repaired or water laid on 80 Water closets supplied with water or supply disconnected from drinking water cisterns 409 Intimations served under Sec. 3 4,318 Notices served under Sec. 4, &c. 1,253 Cisterns covered, cleansed and repaired 521 Notices served under Sec. 62 &65 2,228 Complaints received &attended to 3,741 Keeping of animals in unfit state discontinued 59 Number of houses disinfected . . 2,656 Houses supplied with disinfectants House drains flushed with 5,791 Smoke observations 31 Certificates of disinfectiongranted 2,532 fectants after infectious disease 2,656 Houses inspected and certificates granted (Sec. 48) 98 Overcrowding abated 86 Premises cleansed and repaired . 3,780 Proceedings ordered by Council and Health Committee 4,720 Drains tested . . By smoke. 721 ,, water. 3,521 Summonses issued. . 133 Drains cleansed and repaired 630 Magisterial Orders obtained and enforced 78 Drains relaid Frontage drains constructed or 469 Factories, Workshops,&c.,inspections 4,673 re-constructed 71 Soil-pipes and drains ventilated 182 Sanitary conveniences provided or improvements effected in Factories&Workshops (Sec. 38) 400 Sink and rain water pipes disconnected or repaired 433 Water Closets cleansed&repaired 733 Cesspools abolished 2 Underground sleeping rooms disused 26 Mews & Stables drained & paved 15 Yards and forecourts paved and repaired 742 Gipsy van inspections 113 Drains laid to new houses and tenements 98 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 135 Samples taken under the Sale of Food and Drugs Acts 1,000 Miscellaneous 639 Sanitation of House Property. As in past years a good deal of attention has been devoted to this important subject, The need for constant and systematic supervision by means of house-to-house inspection is, in a district such as Battersea, most imperative. The work in connection with the inspection and supervision of insanitary houses in the Borough is carried out by eight district Inspectors, each of whom has a district assigned to him, and a large part of their time is taken up with this class of work, 48 ing as it does not only inspection and the service of notices, but of revisits to see that the notices served under the Public Health Act are complied with. Difficulty is at times experienced in getting some owners to carry out the work for which notices have been served upon them in a satisfactory manner, so as to put the property into a fair state of sanitary repair. In many respects the Public Health (London) Act is, in my opinion, unsatisfactory for this purpose as I have pointed out in previous Annual Reports (vide Annual Report of Medical Officer of Health for 1907), and it is to be hoped that in the new Housing and Town Planning Act, which is now the law of the land, will be found more effective machinery for inducing owners to realise their obligation in regard to keeping their property in a reasonably healthy and habitable condition, thereby supplementing the powers under the Housing Act. The importance of the question cannot be overlooked as will be gathered from a perusal of the vital and morbidity statistics of this report. It will be found that it is in those districts where the housing accommodation is most unsatisfactory that a high deathrate and a high mortality-rate prevails, and that most requires the attention of the outdoor sanitary staff. During the year 1909 the total number of houses inspected in house-to-house inspection was 3,218. This number is a decrease on that for 1908, and is accounted for by the fact that the time of some of the district inspectors was taken up in other directions. It will be seen, moreover, that the number of houses inspected has, during 1909, decreased to some extent, as compared with the four preceding years. The largest number of houses inspected was during 1905 (i.e., 4,503). The great prevalence of scarlet fever (and to a less extent of diphtheria) which began to rise in that year, took up a great deal of time of the inspectors in making enquiries, securing removals to hospitals and tracing contacts, etc. Notwithstanding, however, a fair amount of work in this connection has been carried out, as a glance at the undermentioned figures showing the number of house inspected in each year since 1900, and the average for the nine years 1900-1908:— 1900 3,009 1901 3,116 1902 1,740 1903 2,670 1904 3,020 1905 4,503 1906 3,609 1907 4,101 1908 3,609 Average for nine years 1900-1908 = 3,264 1909 3,218 It will be seen from the above figures that the decrease in the numbers of houses inspected during the year took place in Nos. 6, 7 and 8 districts. The reason for this was that the time of the Inspectors for Nos. 7 and 8 districts was largely taken up with supervising the drainage work on the new estate at Clapham Common and the new Infirmary respectively, while the. time of the Inspector for No. 6 district was a good deal occupied in supervising the drainage work at the Royal Masonic Institute for girls. The percentage of houses in which sanitary defects were found was 68.5, as compared with 69 per cent. in 1908, and varied from 37.2 per cent. in No. 5 district (Shaftesbury Estate) to 73.7 per cent. in No. 3 district. Preliminary and statutory notices were served to remedy these 1,949 defects. The following table gives particulars as to the number of houses inspected during 1909:— 49 The average for the nine years was 3,264, and the number of houses inspected during 1909 was about equal to the average. For administrative purposes the nine Wards of the Borough are divided into eight sanitary districts, to each of which a sanitary inspector is attached. The sanitary districts are not, therefore, coterminous with the Wards, but for practical purposes may be considered so, as one of the Wards is comparatively very small both in area and population, and is included with portions of two other Wards in No. 6 district. The following is the number of houses inspected and the num ber of defects found in each of the sanitary districts:— Number of houses inspected. Number in which defects found. No. 1 District 435 250 No. 2 502 353 No. 3 442 326 No. 4 492 332 No. 5 607 226 No. 6 261 172 No. 7 201 144 No. 8 278 146 Total 3,218 1,949 50 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 Beaufoy Road 156 58 Atherton Street 32 24 Almeric Road 42 34 Chalmers Street 28 18 Bourne's Place 14 10 Blenkarne Road 18 5 Chesney Street 49 34 Britannia Place 39 25 Chatham Road 113 67 Corunna Place 11 7 Canterbury Place 14 13 Darley Road 57 44 Corunna Road 63 32 Church Lane 12 12 Didcot Street 28 22 Corunna Terrace 16 12 Church Road 148 82 Estcourt Road 18 7 Gaines Cottages 12 7 Creek Street 27 18 Fontarabia Road 54 42 Gideon Road 38 17 Ford's Place 62 56 Granard Road 23 8 Gladstone Street 49 34 Frere Street 23 14 Latchmere Road 35 3 Gladstone Terrace 41 33 Garden Cottages 10 7 Lindore Road 38 28 Glycena Road 59 23 Green Lane 6 6 Morella Road 26 9 Gonsalva Road 58 36 Hyde Lane 34 20 Northcote Road 31 25 Haines Street 22 16 Ingrave Street 156 108 Rusham Road 11 2 H anbury Road 18 5 Kambala Road 91 54 Rushill Mews 8 5 I.atchmere Road 129 20 Latchmere Road 12 11 Sisters Avenue 28 10 Linford Street 64 42 Lithgow Street 19 15 Stonells Road 12 4 Motlev Street 45 23 Little Europa Place 74 74 Usk Road 74 44 Palmerston Street 44 20 Livingstone Road 3 2 Ponton Road 30 22 Lothair Street 9 7 Portslade Road 28 18 Maysoule Road 44 27 Rollo Street 53 37 Meyrick Road 26 19 Russell Street 60 42 Orville Road 37 37 St. George's Street 25 20 Randall Street 38 17 Sheepcote Lane 76 66 Spicer Street 17 12 Stanley Street 70 24 Thibet Street 11 9 Stewart's Lane West 29 16 Totteridge Road 33 22 Tyneham Road 33 14 Union Terrace 7 6 Warriner Mews 9 6 Urswick Road 44 32 Wycliffe Road 127 75 Usk Road 36 21 Verona Street 47 30 Winstanlev Road 8 5 Yelverton Road 27 18 Totals 1,442 777 Totals 1,160 813 Totals 616 359 51 Housing- and Town Planning Act. This new Act contains many important provisions for dealing with the sanitation of house property. It is in dealing with insanitary property that its application will perhaps be found most useful. Some of the points to which attention may be drawn are as follows:— Section 14 extends the application of section 75 of the Housing of the Working Classes Act, 1890, to the effect that in any contract for the letting of houses for the working classes it is to be an implied contract that the house is to be at the beginning of the tenancy in all respects reasonably fit for human habitation from houses not exceeding a rental of £20 per annum to houses at a rent not exceeding £40. Further (section 15), the implied condition as to fitness includes not only that the house at the beginning of the tenancy was fit for human habitation, but that it shall be maintained so during occupation. Under the same section the Sanitary Authority are empowered to do the work necessary to render the house fit for human habitation and to recover the cost from the landlord, or alternatively to make a Closing Order under sections 17 and 18. In connection with closing and demolition orders, such orders may, under the new Act, be made by the Sanitary Authority instead of having to apply to a Court of Summary Jurisdiction, as laid down in previous Acts. Further, an appeal was provided in the latter to the Quarter Sessions. Under the provisions of the Town Planning Act the appeal against a Closing or Demolition Order will lie to the Local Government Board. Amongst other matters dealt with in this Act of special interest to Sanitary 52 Authorities are:(a) Underground rooms, (b) By-laws with respect to tenement houses, (c) Back-to-back houses. (a) Section 17 prohibits the use of underground rooms for sleeping purposes unless conforming to certain requirements, and is an advance on section 96 of the Public Health (London) Act. The defect in the latter Act in this connection is due to the fact that an underground room, if used in conjunction with another room in the same house not underground, does not come under the section, and this section is amended by the Housing and Town Planning Act, 1909. This section comes into force on the 1st July, 1910. (b) Section 16 imposes on the owner, as defined under the Public Health (London) Act, the duty of complying with the By-laws made under section 94 of the Public Health (London) Act with regard to the carrying out of work. In default of the owner carrying out the work required within three weeks of the service of notice, the Authority may do the work themselves and recover the cost from the owner. It may be necessary, therefore, to revise the existing by-laws as to houses let in lodgings. (c) Section 43 prohibits the erection of back-to-back houses, and also applies to the case of tenement houses where the tenements are placed back to back—unless it can be certified by the Medical Officer of Health that they are so constructed and arranged as to secure effective ventilation of all habitable rooms in every tenement. Under section 17 the Local Government Board may make regulations and prescribe the records relating to the dwelling houses in each district. The regulations have not yet been issued, but the Board have issued a circular letter in which is foreshadowed the importance attached by them to this matter. Housing of the Working- Classes Act. 16-29, Didcot Street. During 1909, on the representation of the Medical Officer of Health, notices, under the Housing of the Working Classes Act, 1890, Part II., Sec. 32, were ordered on the 9th June by the Council to be served on the Owner in respect of certain insanitary houses in Didcot Street. The notices were duly served by the Town Clerk on the 24th July. 53 Houses let in Lodgings. In the Borough of Battersea there are a number of houses let in lodgings under circumstances which render it desirable in the interest of public health that they should be registered and inspected at regular intervals. By the end of 1908, 123 premises were on the register, and no additional houses were registered during the year. The sanitary supervision of these premises is governed by bye-laws which were revised in 1904, and having been duly approved by the Local Government Board, are now in force in the Borough. Smoke Nuisance. Emissions of black smoke were reported on 33 occasions during 1909. Twenty-four were reported by the Coal Smoke Abatement Society, seven by the Council's Inspectors, and two by the London County Council's. Seventeen preliminary and two statutory notices were served, but no legal proceedings were taken during the year. A Conference took place between the London County Council (Public Control Committee) and the Borough Councils. At the Conference the Council was represented by Councillor Raymond and the Medical Officer of Health. After discussion the following proposals were adopted:— (a) That Sec. 24 (6) of the Public Health (London) Act, 1891, which provides that "Any chimney-pot, being the chimney of a private dwellinghouse, sending forth black smoke in such quantity as to be a nuisance shall be a nuisance liable to be dealt with summarily under the Act," should be amended by the deletion of the word " black.'' (b) That the word "chimney" in Section 24 (6) should be deemed to include:— (i.) Openings through which smoke is emitted from buildings or places in which processes of trade or manufacture are carried on, and the chimneys of any building or place where furnaces are used in operations carried on under statutory powers. (ii.) The chimneys of Government workshops or factories. (c) That in special cases of nuisance arising under Sections 23 and 24 of the Act, the proceedings in respect of any nuisance may, at the request of and by agreement with the Sanitary Authority, be taken by the London County Council in such special cases. 54 The following proposal was rejected by a small majority:— That the power of the Council to take proceedings in respect of a nuisance created by Sanitary Authorities under Section 22 of the Act should be extended to apply to smoke nuisances from electricity or other industrial works, or from premises used for the treatment or disposal of refuse, or for disinfecting purposes, or from baths or washhouses, or other buildings or wharves owned by Sanitary Authorities in which furnaces are used; and that as regards such proceedings the Council should be relieved of the restriction imposed by Section 117 of the Act, that a proceeding under the Act should not be undertaken by the London County Council against a Sanitary Authority save with the sanction of the Local Government Board, unless such proceeding is for the recovery of expenses or of money due from the Sanitary Authority to the Council. Paving of Yards and Forecourts. The following table shows the number of back-yards and forecourts wholly or partly paved during 1909:— Sanitary District. Backyards. Forecourts. Wholly paved. Partly paved. Wholly paved. Partly paved. 12 ft. or more from back addition. Less than 12 ft. from hack addition. 1 14 - 56 35 39 2 28 1 53 7 7 3 - - 91 10 55 4 1 1 3 — — 5 1 - 200 1 6 6 5 - 5 1 7 7 8 - - 7 - 8 - 20 - - - Totals 57 22 408 61 114 Street Paving. This important and useful hygienic work has been fully dealt with in past annual reports, and it is satisfactory to be able to report that the practice of paving with impermeable material the side streets in the Borough was continued during 1909. 55 The following is a list of the streets paved during 1909:— Square yards. Aegis Grove 716 Afghan Road 1,075 Anerley Street 1,090 Carpenter Street 2,194 Chatham Street (part) 869 Corunna Place 400 Falcon Terrace 1,405 Foots Row 200 Tidbury Street 666 Freeland Street 586 Henley Street 2,444 Lavender Terrace 1,042 Lothair Street 299 Nepaul Road 538 Pagden Street 526 Raywood Street 668 Seldon Street 427 Tidgmore Street 1,333 A total of 16,478 square yards. Sewer Ventilation. During the year 1909, thirteen ventilating columns were erected, one of which was erected by the London County Council for the purpose of ventilating the London County Council's sewer in Bridge Road. The remaining twelve were erected by the Borough Council to ventilate their sewers, as folows:— Beauchamp Road. Bridge Road West. Clapham Common West Side. Eckstein Road. Lavender Sweep (2). Longbeach Road. Nansen Road. Park Road, St. Johns Hill. St. Johns Hill. Shellwood Road. Stormont Road. During the year complaints were fairly frequent as to the nuisance arising from sewer ventilators on the surface of the roadway. These complaints were in every case inquired into and ventilating columns were erected to mitigate the nuisance in the localities which gave cause for complaint. 56 During the past four years a good deal of attention has been devoted to this subject by the Health Committee, and in that period sixty-five ventilating shafts have been erected by the Council in various parts of the Borough. The problem of the ventilation of sewers is, however, a difficult one and has been dealt with by me in past annual reports. Van Dwelling's. The number of these dwellings in Battersea in 1909 was 71, as compared with 73 in 1908. In the following table are set out the situation and number of occupants:— Situation of Vans. No. of Vans. No. of Occupants. Males. Females. Mill's Yard, 88 Sheepcote Lane 5* 6 6 „ 80 „ 4* 4 3 Gurling's Yard, High Street 7 10 9 Manley's Yard, Falcon Road 5 8 3 Yard, Cabul Road 19† 17 21 Donovan's Ground, Cabul Road 16† 29 20 Mill's Yard, Culvert Road 11* 16 24 ''Gray's Fair," Lavender Hill 4 5 8 Total 71 95 94 * Including one shed. †Including one cottage. There is also a structure at the rear of 55 Cabul Road, occupied by a Mr. Sprat. These vans are frequently inspected by night as well as day. Twenty vans were found to be overcrowded during the year, and notices were served where necessary. Only two cases of infectious disease were notified from van dwellings during the year. 57 Common Lodging Houses. The following table gives a list of the Common Lodging Houses in the Borough:— Premises. Authorised Number of Lodgers. Whether Males or Females Date registered. 75 Falcon Road 78 Males March, 1900 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 of all the Common Lodging Houses situate within the Metropolis. All Common Lodging Houses must be licensed annually by the London County Council (General Powers) Act, 1902, Part IX., Sec 46. The Common Lodging Houses in Battersea are visited from time to time by the Borough Council's Officers in connection with drainage defects, infectious disease, etc. Block Dwellings. The following is a list of the artisans' 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 Dwelings Asso., Ltd. 189 Lombard Dwellings Lombard Road Exors. of Francis Ravenscroft 36 Shaftesbury Chambers Ashbury Road Artizans, &c., Dwellings Co. 22 58 These dwellings are frequently inspected and any insanitary conditions found are remedied. It is satisfactory to be able to record the fact that few cases of infectious disease have been notified from these dwellings during 1909. The total number of cases notified for the year being seven, as compared with nine in 1908, and 18 in 1907. Customs and Inland Revenue Act, 1903. During 1909, three applications were received in respect of 21 tenements for the certificate of the Medical Officer of Health, under the provisions of the Revenue Act, 1903, in connection with tenements (or dwellings) so constructed as to afford suitable accommodation for such of the families inhabiting the same, and, after inspection by the Medical Officer of Health, five certificates were granted for five tenements, the remainder having been either refused or postponed. The object which the legislature had in view, in connection with these certificates, was to induce owners of tenement property to provide a higher standard of accommodation for tenants of this class of property by offering in such cases an abatement in the inhabited house duty, as were certified as suitable. In the new Housing and Town Planning Act a further extension has been made by exempting from inhabited house duty any house occupied for the sole purpose of letting lodgings to persons of the working class at a charge not exceeding 6d. a night for each person, if certified by the Medical Officer of Health to have due provision made for the sanitary requirements of the lodgers using such lodging houses. Water Supply. During the year 1909, 98 applications were received for certificates of water supply, and granted in each instance. Thirtyseven notices of withdrawal of supply for various reasons were received from the Metropolitan Water Board, and in connection with one of these it was necessary to take legal action to obtain a Closing Order. Additional supplies to the upper floors of tenement houses were provided in 55 instances, and in connection with the latter it was found necessary in eight instances to take legal proceedings to enforce the notices served under the provisions of the London County Council (General Powers) Act, 1907. In connection with the proceedings against the owner of a tenement house in Meyrick Road, the following report was submitted to the Health Committee:— 59 Public Health Department, Municipal Buildings, Battersea, S.W., 20th July, 1909. To the Health Committee. Mr. Chairman and Gentlemen,— I have to draw the attention of the Committee to the recent proceedings at the South-Western Police Court against Mr. Barnes, who was summoned for failure to comply with the Council's notices served under the provisions of Section 78 of the London County Council (General Powers) Act, 1907, for an additional supply of water to be provided on one of the other storeys of a tenement house situate at 146, Meyrick Road. The magistrate, after hearing evidence that the provision of an additional water supply was in the interest of the health of the persons living in the house, and was a reasonable requirement, made an order to that effect so far as that house was concerned, but expressed his opinion very definitely that the section referred to did not give power to the Sanitary Authority to require that a supply should be provided for more than one storey, or, in other words, more than one water supply to the house, irrespective of the number of tenements therein. It will be in the recollection of the Committee that when the Act came into force, I pointed out that the wording of the section was ambiguous, and that difficulty would probably be experienced in enforcing its provisions. The opinion expressed by the Magistrate in the above-mentioned case will render it advisable for the Committee to reconsider their position as regards their powers under this section. There are several other cases pending, and should an adverse decision be given in connection with any of these cases, whether they are prepared to advise the Council to carry the matter to a Higher Court. There can, of course, be no question as to the advantage from the sanitary standpoint of the provision of a water supply on each of the floors of tenements occupied by separate families, and I gave evidence to that effect in the case just decided. As, however, the Magistrate has held that the section under which the proceedings were taken does not confer on the Sanitary Authority the power to enforce a supply to more than one floor, it is useless to issue notices unless the Council are prepared to carry the case to a higher tribunal to decide the point. The opinion just given would seem to indicate that Section 78 of the L.C.C. (General Powers) Act, 1907, does not confer any powers on Sanitary Authorities in excess of those given them under Section 48 of the Public Health (London) Act, 1891. Under the latter Act, there was some doubt as to whether Section 48 (1) did not empower Sanitary Authorities to require a separate supply to each tenement. A decision given in 1905 by one of the Metropolitan Magistrates settled, so far as these Courts are concerned, the matter, the learned Magistrate holding that the words "proper and sufficient" in the section referred to the source of supply and not to the provision of taps within a house. The object of the promoters of the L.C.C. (General Powers) Bill, 1907, which came into force as an Act of Parliament at the beginning of 1907, was apparently to remove the difficulty set up by conflicting decisions of Magistrates as to the interpretation to be placed on the wording of Section 48 of the Public Health (London) Act in regard to such premises. The wording of Section 78 of the General Powers Act is as follows:— "For the purposes of Section 48 (provisions as to house without proper water supply) of the Public Health (London) Act, 1891, a tenement hot 60 shall be deemed to be a house without a proper and sufficient supply of water, unless there shall be provided on the storey or one of the storeys in which the rooms or lodgings in the separate occupation of each family occupying such house are situate a sufficient provision for the supply of water for domestic purposes." It is provided, however, that this section shall not apply to "any tenement house in respect of which it can be shown that any such provision for the supply of water as aforesaid is not reasonably necessary." The Committee will gather from the wording of the section that its meaning is not very clear. I ask for your instructions as to the course to be followed with regard to future action in this connection. I have the honour to be, Mr. Chairman and Gentlemen, Your obedient Servant, G. QUIN LENNANE. Upon consideration of the above the Committee resolved: "That proceedings be taken in similar cases and that in the event of a case being dismissed, the Solicitor be authorised to ask the magistrate to state a case for the decision of a Superior Court, if he should consider it advisable." No. applications for new water supply 98 No. of notices re withdrawal (from W. B.) 37 No. of instances where supply has been reinstated under notice 4 No. of additional supplies to tenement houses 55 No. legal proceedings re same 8 Disinfecting Department. During the year 1909, 4,192 rooms and 58,474 infected articles were disinfected, as compared with 4,583 rooms and 85,117 infected articles in 1908. A total number of 1,189 cases of notifiable infectious diseases were reported during the year, but in addition to these a large amount of disinfection was carried out in connection with measles, tuberculosis, cancer, verminous houses, etc. Eighty-four schools were dealt with in connection with outbreaks of infectious disease. The following table gives particulars of the work carried out at the Disinfecting Station since it was opened in 1902:— 61  1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Premises 1,161 1,187 1,215 2,589 1,991 2,995 2,418 2,656 Rooms 1,771 1,616 1,637 3,308 2,848 5,085 4,583 4,192 Articles disinfected 92,368 67,001 54,626 64,052 72,531 72,220 85,117 58,474 Articles destroyed 984 847 1,288 929 1,244 1,084 778 607 Books disinfected — 271 215 332 337 399 387 331 Persons admitted to shelter — - — 33 31 33 28 4 62 The new Laundry which was added to the Station, and opened in 1907, has proved of great utility. During 1909, 18,760 articles were, after previous disinfection, laundered before being returned to their owners. The total weight of articles removed during the year for disinfection was 137 tons 9 cwts. 0 qrs. 17 lbs. In addition to the work carried out in the disinfection of rooms, clothing, etc., bedding belonging to the Council was lent out during 1909 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 Station, when after being disinfected it is returned to the store room. The total weight of bedding belonging to the Council dealt with in this way, and not included in the table, amounted to 6 tons 5 cwts. 3 qrs. 16 lbs. Verminous clothing belonging to persons who attended the Personal Cleansing Station adjoining, weighing 6 tons 19 cwts. 0 qrs. 6 lbs., was disinfected at the Disinfecting Station, and is not included in the returns shown in the table. The question of the disinfecting and cleansing work of a Northern Metropolitan Borough being carried on by a Battersea contractor within the Borough of Battersea came up for consideration during 1909, by the Council on September 29th. The goods for disinfection are collected from infected houses in the Northern Borough and removed to Battersea Borough in ordinary tarpaulin-covered vans, and the Council expressed the opinion that such an arrangement was unsatisfactory, being in the opinion of the Council dangerous to public health. The attention of the Local Government Board was consequently drawn to the matter. Since this action of the Council the infected articles are brought by the Battersea contractor in a suitable conveyance instead of the ordinary type of tarpaulin-covered vans previously in use. Temporary Shelter or House Accommodation. During 1905 the Reception Shelter at Sheepcote Lane was occupied by four persons whose homes were undergoing disinfection after infectious disease. In addition, three midwives and thirteen nurses who had been in attendance on cases of puerperal fever or in contact with other forms of dangerous infectious disease, had the use of one of the tenements at the Shelter for purposes of personal disinfection. 63 Three hundred and eighty-nine person, including laundry workers, milk vendors, dressmakers, etc., whose occupation rendered it desirable, attended for personal disinfection at the Shelter on account of exposure to infectious disease. Cleansing: of Persons Act, 1897. The use of the Personal Cleansing Station has been largely availed of during the year 1909 by persons requiring the facilities therein provided by the Council, and 1,694 persons who were infected with vermin attended the Station, and were cleansed and had their clothing disinfected at the disinfecting station adjoining. Of the total number who were cleansed 1,332 were men, 41 women, and 321 children, the latter coming mainly from the public elementary schools. In connection with the cleansing of these 1,694 persons, 16,380 articles of clothing, weighing over 6 tons, were removed for disinfection to the Disinfecting Station. In connection with the cleansing of verminous school children, the London County Council are in negotiation with the Borough Council for the use of their Cleansing Station for the purpose of carrying out the duty which devolves upon them of cleansing these verminous school children, under the London County Council (General Powers) Act, 1908. Under the provisions of the Children Act, the County Council are empowered to make use of the apparatus, etc., of the Local Sanitary Authority on terms to be agreed upon, and have approached the Borough Council on the subject, but the negotiations are still pending. Much good work has been done at the Personal Cleansing Station during the year, and the popularity of the Station continues to grow. During 1909 there was an increase of nearly 400 adults cleansed as compared with 1908. As pointed out in previous annual reports, the accommodation provided for the purpose is inadequate to meet the demand, and in other respects the present arrangements are unsuitable for the work. The Midwives Act, 1902. The only duty cast upon the Borough Council in connection with the above-mentioned Act is the important one of disinfection. With this exception the Act in London is administered by the London County Council as the Local Supervising Authority. Rule V. of the rules framed by the Central Midwives Board states:— "Whenever a midwife has been in attendance upon a patient suffering from puerperal fever, or from any other illness 64 supposed to be infectious, she must disinfect herself and all her instruments and other appliances to the satisfaction of the Local 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 Authority) and then exposed to the open air for several days." In Battersea one of the tenements at 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, and her clothing, bag, instruments and other appliances are disinfected at the Disinfecting Station which adjoins the Shelter. During 1909, three midwives and thirteen nurses attended at the Reception Shelter for purposes of disinfection. Mortuary. The total number of bodies received at the Mortuary in Sheepcote Lane during 1909 was 269, as compared with 259 in 1908, and an annual average for the Parish of Battersea for the five years 1896-1900 of 288. On 258 of these bodies inquests were held, and eleven were received for sanitary or other reasons. The following table gives the number of bodies received at the Mortuary in each year since 1900:— Year. Number of bodies received in the Mortuary. Number of bodies upon which postmortem examinations were held. Number of bodies upon which Coroners' Inquests were held. 1900 291 234 273 1901 321 271 304 1902 239 198 224 1903 223 207 213 1904 221 161 204 1905 253 176 236 1906 244 167 239 1907 302 204 288 1908 259 174 247 1909 269 170 258 65 Inquests. During the year 1909, inquests were held in 258 cases, with the following results:- Natural Causes 161 Open Verdict— Found dead 7 Found drowned 4 11 Accidental Causes— Burns and Scalds 11 Poisoning 2 Falls, etc. 25 Run over (in street and on railway) 12 Suffocation 3 Other injuries 11 64 Suicide— Cut throat 5 Drowning 3 Hanging and strangulation 4 Poison 6 Other methods 1 19 Homicide— Exposure 3 3 Total 258 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 proved of much service in connection with street accidents, etc. Each ambulance is provided with the necessary surgical appliances and dressings for rendering "first aid" to the injured. 66 Protection of the Food Supply. During the year 1909, as in past years, a good deal of attention was devoted to the protection of the food supply. The work has comprised meat inspection and seizure, registration and strict supervision of milk shops, dairies and cowsheds. Attention has also been given to the sanitation of bakehouses (vide section dealing with administration of Factory and Workshops Act) and to premises wherein food is prepared, e.g., sausage manufacturers, potted meats, etc. Other premises in which the sale of, and preparation of food in various ways is carried on, such as icecream shops, butchers' shops, restaurant kitchens, etc., have been visited and inspected systematically by the Council's Officers. Unsound Food. During the year 1909 the following seizure was made:— Unsound meat 1 Legal proceedings were taken and the defendants, a large firm of provision dealers in the Borough and other districts of London, were fined £25 and 4s. costs. The following table gives particulars of the quantities and nature of the unsound food brought to the Health Department for inspection and destruction during 1909:— 67 Food. Quantity. Where purchased. Apples 1¾ barrels Covent Garden Market Bananas 150 Borough Market Bloaters 1 box Billingsgate Market Carrots 40 bags G. W. Docks, Plymouth Dabs 1 box Billingsgate Market Fillets 7 lbs. " " Grapes 770 lbs. Spitalfields Market Haddock 2 boxes Billingsgate Market Hake 13 „ „ „ Herrings 1 box „ „ „ „ 1 kit „ „ Mackerel 1 box „ „ Peas (Green) 1 bag Borough Market „ „ 2 bags „ „ Plaice 2 boxes Billingsgate Market „ „ 1 box „ „ Plums 17 boxes — Skate Wings 1 box Billingsgate Market Sweets 8 lbs. — Tomatoes 2 bundles Covent Garden Market „ „ 5 „ Borough Market „ „ 3 „ Covent Garden Market „ „ 16 boxes Borough Market „ „ 23 „ Neal Street, Long Acre In relation to the above-mentioned articles of food, it is the practice in cases where the retail vendor has unknowingly purchased articles which are unfit for human food, and where he has made no attempt to sell them, to grant a certificate which enables him to claim the return of his money. The food is destroyed under the supervision of the Council's Officers. During 1909, twenty-four certificates were granted in respect of the articles shown in the table. Slaughterhouses. There are now only five slaughterhouses in the Borough, in only three of which is any regular business done. One of the latter is licensed for the slaughter of small animals only. These premises have been systematically inspected during the year. The premises are, comparatively speaking, small, and 68 generally may be said to be not well situated. They are, however, usually kept clean, and the paving and drainage are satisfactory. The annual inspection of their premises is carried out prior to the Annual Licensing Session, held by the County Council, who are the licensing authority. The duty of inspection, which was formerly carried out by the County Council, 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 by-laws and regulations made for the sanitation of these premises. During 1909, 78 special inspections of these premises were made in connection with the inspection of food. Cowhouses. There are only three licensed cowsheds remaining in the Borough of Battersea. Very few cows are kept in these cowsheds, which appear to be kept more for advertisement purposes, or with the object of retaining the licence. These premises are licensed annually by the London County Council, the enforcement of the bye-laws and regulations devolving on the Borough Council as the Sanitary Authority, since the passing of the London Government Act of 1899. The premises were systematically inspected during the year. Ice Cream. During the year 1909 the number of premises in which this article is manufactured or sold considerably increased, 156 premises being registered, as compared with 108 premises in 1908. Systematic supervision and inspection is exercised over these premises by Inspector Benjamin. Of the 156 registered premises, nine are occupied by Italians who employ 25 barrows in the sale of this article. Although, owing to the strict supervision exercised over the premises by the Council's Officers, the conditions under which ice-cream is manufactured and sold in Battersea has greatly improved in recent years, the need for continuing this important duty is, however, pressing. It was found necessary during the year to take proceedings for an infringement of the regulations made under the London County Council (General Powers) Act, 1902, against an ice-cream 69 dealer living at Wayford Street, as to want of cleanliness of premises and utensils. In this case the defendant was convicted and fined £1 10s. and £2 6s. costs (two offences). That this prosecution has resulted in a salutary effect is shown by the fact that only eight defects were reported during the year, as compared with 54 in 1908, and that only seven intimation and four statutory notices were served to remedy these defects, as compared with 86 and 10 respectively during 1908. The defects enumerated had reference mainly to dirty condition of premises, defective sanitary fittings, etc. 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 1909 was 95, as compared with 90 in 1908. During the year it was found necessary to serve 26 preliminary and nine statutory notices in connection with sanitary defects. In the majority of instances these defects were not of a serious nature, and had reference to dirty condition of premises (walls, floors and ceilings), defective sanitary appliances, etc. On the whole there is evidence that the regular and frequent inspection of these premises has resulted in an improvement in the sanitary conditions under which food is prepared and sold in eating houses in Battersea as compared with past years. Milk Shops. The milk supply of Battersea has, as in past years, been carefully supervised during 1909, and the additional powers which have been given to the Council by the London County Council (General Powers) Act, 1908, have proved of considerable service in dealing with premises which were in many respects sanitarily unsuitable for carrying on the sale of this important article of food. The necessity of effectually controlling the conditions under which milk is produced and sold is, having regard to its importance as the maim diet of infants and invalids and its susceptibility to be injuriously affected by exposure to insanitary conditions, a matter of vital importance. The number of registered milk shops in Battersea at the end of 1908 was 241. During 1909, 50 new milk shops were added and 113 removed from the register. The total number on the register at the end of 1909 being 178. 70 The character of the business carried on in premises in which milk is sold in Battersea during 1909, as compared with 1908, was as follows:— 1908 1909 Dairy produce only 70 72 General shops 131 78 Confectioners 13 11 Dwelling houses 22 14 Wholesale 5 3 241 178 It will be noted that there has been a considerable decrease in the number of general shops and dwelling houses. This has been effected as the result of the Council's action in availing themselves of the new powers conferred upon them under the General Powers Act. Accordingly the Medical Officer of Health was instructed to revise the register, and with that object a special inspection of all premises in the Borough wherein milk was sold was carried out. Special attention was devoted to premises which, owing to the varied character of the business carried on therein, could not be considered sanitarily suitable for the sale of milk, such for example as general shops, dwelling houses, etc. The owners of these premises were asked to comply with the Council's requirements in such circumstances, to limit the risk of exposure of the milk to contamination. In a large number of cases, as this part of the business was of an insignificant character, rather than incur the expense involved in taking measures for as far as possible safeguarding their milk from injury, it was decided to discontinue its sale and application was made by the owners to have their registration cancelled. In a fewcases some difficulty was experienced in getting some of these persons to comply with the minimum requirements, but eventually the revision of the register was satisfactorily completed. The number of general shops in which the sale of milk was carried on has, therefore, been considerably reduced. Those premises in which milk was continued to be sold were rendered sanitarily more suitable, or rather less objectionable. The measures taken in such cases to protect the milk from contamination were to require that articles likely to affect the milk injuriously were not to be sold, at least in that part of the premises in which the milk was exposed for sale, and that as an additional safeguard a specially constructed safe was to be provided for holding the counterpan in which the milk was contained. It was further decided by the Health Committee that the owners of new general shops were not in future to be placed on the register. 71 The action of the Health Committee cannot fail to be productive of satisfactory results in regard to the conditions under which the sale of milk has, in the past, been carried on in Battersea. The sale of milk in premises in which a general assortment of merchandise is sold, the nature of many articles of which is likely to injuriously affect it, cannot be defended, and in curtailing the long list of such premises (nearly half the total premises registered in the Borough) by such a considerable percentage, the conditions under which milk is now sold in the Borough are, in this respect, greatly improved. Moreover, these premises (general shop) which are still retained on the register have been rendered sanitarily much more suitable, and the owners given to understand that the requirements of the Council as to the protection of this article of food will have to be maintained if their names are to remain on the register. During the year 1909 the Milk Bill introduced by the Government had to be withdrawn owing to lack of time for dealing with it. It is to be regretted that the Bill which presented many admirable features did not receive the sanction of Parliament. The need for powers for effectually controlling the milk supply at its source is a pressing one, and it is to be hoped that the legislature will deal with the milk supply of the country as a whole at the earliest possible moment. Fish Shops. There are 75 of these premises in Battersea, an increase of seven, as compared with 1908. In 53 of these places fried fish is sold; in 18, wet and dried fish is sold; and four shops sell wet, dried and fried fish. These premises are frequently inspected, and during the year notices were served in 28 instances for various insanitary conditions, all of which were complied with. In addition 75 inspections were made by the Food Inspector at these premises. Butchers' Shops. There are 91 butchers' shops in Battersea, all of which are regularly and frequently inspected by Inspector Chuter. In 54 of these premises sausage-making or meat-chopping is carried on, the work being done by hand in 39 cases and by machinery in 15 cases. Ninety of the shops are provided with ice-safes. The trade refuse is, in the majority of instances, moved biweekly or oftener from these premises, and they are well-kept and are on the whole in a satisfactory condition. During 1909, 1,017 inspections of butchers' shops were made. 72 Sale of Food and Drugs Acts. The object of these Acts is two-fold in character (a) to protect the honest trader from fraudulent competition, and (b) to safeguard the public from fraud, imposition and dangers to health in regard to food and drugs. During the year 1909, 1,000 samples were purchased within the Borough of Battersea and submitted to the Public Analyst for analysis. Of the 1,000 samples 91 (i.e., 9.1 per cent.) were reported by the Analyst to be adulterated, and in addition 22 were reported by him to be inferior. The following table gives the details of the number of samples purchased during the year, and the number found to be genuine or otherwise:— Description of Article. Total No. of Samples taken. Genuine. Adulterated. Inferior. Arrowroot 4 4 .. .. Bread 6 6 .. .. Butter 164 138 10 16 Cheese 11 10 1 .. Cocoa 17 15 1 .. Coffee 39 34 5 .. Cream 5 1 4 .. Gin 2 2 .. .. Lard 5 5 .. .. Margarine 10 9 1 .. Milk 672 612 60 .. Mustard 5 4 .. .. Oatmeal 4 4 .. .. Olive Oil 5 5 .. .. Pepper 4 4 .. .. Rum 2 2 .. .. Sausages 15 8 7 .. Tea 5 5 Tinned Meats, &c. 6 5 1 .. Vinegar 11 6 1 4 Whisky 8 8 •• •• Totals 1,000 887 91 22 The next table shows the percentage of adulteration during the years 1900-1909:— 73 Year. No. 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 1,000 105 10·5 1908 1,000 115 11·5 1909 1,000 91 9·1 * 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 Act, instead of, as formerly, several of the district inspectors doing this work. It will be noted that the percentage of adulteration (9.1) is lower than in 1908, and is the lowest since 1900 and 1901. These years do not bear comparison however, as the number of samples now taken annually is double that taken in those years. The results are relatively, therefore, of greater significance in 1909, and would appear to suggest that the increased activity displayed by the Council in the administration of these important Acts has resulted in a satisfactory decline in the percentage of adulteration. Of the total number of samples purchased during 1909, 672 (i.e., 67.2 per cent.) were milk samples. Of this number 60 (i.e., 8.9 per cent.) were reported by the Analyst to be adulterated. During 1908, 693 of the total samples purchased referred to milk, 74 (i.e., 10.7 percent.) of which were reported to be adulterated. The number of milk samples taken shows a slight decrease as compared with 1908, but owing to the importance of milk as the staple article of diet for infants and invalids, and to the fact that it is by far the most frequently adulterated article of food, not less than two-thirds of the total number of samples taken should be of milk, and this fact has been fully recognised in connection with the administration of the Acts in Battersea. The nature of the adulteration in the 60 adulterated samples of milk was as follows:— 1. Extraneous water (37) varying from a minimum of 1 per cent. to a maximum of 12 per cent., viz., 1, 1, 1, 1.5, 1.5, 1.5, 1.5, 2, 2, 2, 2, 2, 3, 3, 3, 3.5, 4, 4, 5.5, 5.5, 6, 6, 6.5, 7, 7, 7, 7, 8, 8, 8.5, 9, 9, 9.5, 11, 11.5, 12, 12. 74 2. Deficiency in milk fat (11) varying from a minimum of 3 per cent. to a maximum of 52.6 per cent., viz., 3., 5, 6, 6.6, 7, 10, 15, 29, 35, 36, 52.6. 3. Extraneous water and fat deficiency (3), viz., 1.5 and 3.9, 10 and 10, 16 and 13.3. 4. Added preservatives (1), viz., 2.266 grains per pint boric acid. 5. Skimmed milk (14—11 genuine, 3 adulterated), viz., 9, 12 and 17.3 per cent, extraneous water. 6. Separated milk (24—19 genuine, 5 adulterated), viz., 1, 6, 9, 14.2, 18.5 per cent, of extraneous water. Of the total number of milk samples taken during the year under review, 539 were taken on week-days and 133 on Sundays. Samples were taken on 23 Sundays in the year. Of the 539 weekday samples 41 (i.e., 7.6 per cent.) were adulterated, while out of 133 samples taken on Sundays, 19 (i.e., 14.3 per cent.) were adulterated. It will be noted that the percentage of adulteration in the case of the samples taken on Sundays, as compared with those taken on week-days, was double in the case of the first-mentioned. Butter. One hundred and sixty-four samples of butter were taken, and of these 10 (i.e., 6.1 per cent.) were reported by the Analyst to be adulterated, as compared with a percentage of adulteration during 1908 of 12.7. The form of adulteration found to be present in these ten samples was in all ten cases added foreign fat. The added margarine ranged from a minimum of 30 per cent, to a maximum of 84 per cent., viz., 30, 40, 52, 70, 70.5, 73.4, 73.7, 76.5, 82.5, 84. In respect of these ten adulterated samples proceedings were taken, and in each case a conviction was obtained on prosecution. Proceedings were taken in one case in connection with butter sampling for obstructing the Inspector. The Inspector reported that he sent his agent to purchase a sample of butter. After she purchased the sample she laid it down with some other articles she had in her hands for a moment. The wife of the vendor went to the door evidently to watch for the Inspector, and having apparently caught sight of him approaching she called out and the vendor walked round from behind the counter and snatched the butter away, and then served 75 another sample. The Inspector demanded the first sample but the vendor said he did not change it but had only picked it up to put in a bag. His wife had previously stated, however, that the sample was changed because she thought the purchaser had been given "salt" instead of fresh butter. The Inspector pointed out that the vendor had deliberately come round and removed the sample purchased by his agent while in her possession and substituted a different sample. He was prosecuted, and at the hearing of the case the magistrate (Mr. Francis) was not satisfied with the evidence of the Inspector's agent, who suffered from deafness, and dismissed the case. A case in which a conviction was obtained and a fine £4 and 14s. 6d. costs was imposed by the magistrate (Mr. de Grey), was appealed against by the vendor. The sample was purchased by the Inspector's agent, who asked for butter and paid for that article, and was reported by the Analyst to contain 52 per cent. foreign fat. At the first hearing at the Police Court the third portion was referred to the Government Analyst who certified "not less than 53 per cent. foreign fat." The appeal came on for hearing at the Quarter Sessions. The Appellant endeavoured to show that a mistake had probably been made by the Inspector and that the butter had by some means got ruined, as analyst employed by the Appellant certified portion submitted to him as being "pure butter." The Appellant admitted in cross-examination that the Inspector had compared the numbers on each of the three bottles together at time of purchase, and each bore the same number. Each of the three Analysts produced his official bottle, the numbers on each being found to correspond, thus proving that no such error had been made by the Council's Officer. The Chairman, Mr. Loveland-Loveland, K.C., in giving judgment in favour of the Council, ordered the fine and costs to be paid into Court forthwith, and the costs of the appeal were also given in favour of the Council. Sausages. Fifteen samples of sausages were obtained and submitted to the Public Analyst. Of the 15 samples taken 7 (i.e., 47 per cent.) were reported by the Analyst to contain added preservative (i.e. boric acid) in varying proportions, from 8.3 grains per lb. to 22.435 grains per lb. With regard to these samples, proceedings were taken in respect to five of the seven adulterated samples; in the remaining two the adulteration was considered not large enough to warrant proceedings being taken. 76 The result of proceedings in respect of one of these cases was that a conviction was obtained, and a penalty of £4 14s. 6d. inflicted by the magistrate. The remaining cases were adjourned sine die. In connection with the adulteration of sausages by means of added preservatives, an appeal from the decision of the magistrate (Mr. Mead), at Marylebone Police Court, who convicted and fined, under Sec. 6, Sale of Food and Drugs Act, the defendant, a sausage manufacturer, for selling sausages containing 22.4 grains of boric acid, was heard at the Quarter Sessions, and the decision of the magistrate, upheld by Mr. Wallace, K.C., Chairman of the Quarter Session, before whom the appeal was heard, who held that the sausages were sold to the prejudice of the purchaser, that they contained something which was not of the nature, substance and quality demanded by the purchaser, and with regard to the provision in the section as to the addition of matter necessary for preservation, that it was not matter or ingredient that was required for the purpose, and that it was, therefore, prejudicial to the purchaser. The case is important having regard to the action taken by Battersea Borough Council in similar circumstances. Coffee and Cocoa. Thirty-nine samples of coffee were taken and submitted for analysis, five of which were reported to be adulterated, and seventeen samples of cocoa were taken and similarly dealt with, one of which was returned by the Analyst as being adulterated. Other Articles. Lard, 5; arrowroot, 4; olive oil, 5; oatmeal, 4; spirits, 12; cheese, 11 (one of which was deficient in fat—no proceedings); vinegar, 11 (one adulterated, 15 per cent, extraneous water, vendor ordered to pay 14s. 6d. costs); mustard, 5; pepper, 4; tea, 5; tinned meats, etc., 6 (one of which contained 11.13 grains per lb. boric acid, no proceedings taken, amount of adulteration too small); bread, 6; cream, 5 (four adulterated, fines 5s. and costs 14s. 6d. imposed in each case); margarine, 10 (one adulterated, vendor fined £2 and 12s. 6d. costs); making a total of 93. 77 Factory and Workshop Act, 1901. The Factory and Workshop Act 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 directs 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 factories, 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 828 Factories 183 Bakehouses 88 Restaurant Kitchens, &c. 95 Ice Cream Premises 156 Home Workers 271 Stables 548 Total 2,169 Factories. Factories include all places in which mechanical power is used in aid of the manufacturing processes. There are 183 of these premises registered in the Health Department, employing 7,341 persons (males 5,606, females 2,735). 78 The duties of Sanitary Authorities in relation to factories are few and limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. The Factory Act contains a sanitary code which is administered by the Factory Inspectors. There is no statutory obligation upon the Sanitary Authority to register factories, but for purposes of convenience a register of all factory premises is kept in the Public Health Department. During 1909, 72 defects were found on factory premises, mostly relating to sanitary accommodation or to defects in sanitary fittings and appliances; 56 preliminary and seven statutory notices were served to remedy these defects. Workshops. Workshops include any premises (not being factories) in which manual labour is exercised by way of trade or for purposes of gain in or incidental to the making, altering, repairing, finishing or adapting for sale of any article, and to or over which the employer of the persons there has the right of access or control. The workshops in Battersea are under the supervision of the two workshop Inspectors—one male and one female Inspector. The former deals with workshops where men only are employed, the latter with workshops employing female labour. Workshops where 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 1909:— 79 Trade. No. of Workshops on Register. No. of Work rooms. Persons employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 78 110 191 l - - Balloon Maker 3 3 13 l 7 - Billiard Table Maker 2 3 8 2 - - Blind Maker 3 2 21 1 - - Bootmaker 72 78 144 8 4 - Carpenter 6 7 15 - — - Coach Builder 6 13 32 4 - - Coffin Maker 3 3 3 - - - Cycle Maker 13 18 21 7 - Dressmaker 109 145 — — 320 99 Embroiderer 4 9 3 - 82 61 Farrier and Smith 9 9 27 2 - - Firewood Cutter 11 11 17 1 9 1 Florist 4 4 — - 5 4 Ironmonger 2 2 4 1 - - Jeweller 3 4 6 1 - - Laundry 39 98 8 - 165 4 Mason 5 5 55 1 - - Millinery 23 29 — — 60 29 Musical Instrument Maker 1 2 19 - - - Photographer 4 7 11 3 7 7 Picture Frame Maker 4 4 7 - - - Plumber 2 3 8 2 — - Rag Sorter 11 11 32 - 1 - Saddler 8 8 15 2 - - Sculptor 2 2 4 - - - Tailor 37 57 62 5 72 19 Underclothing Maker 4 4 — — 8 3 Upholsterer 4 8 16 - 8 - Other Trades 58 79 195 26 45 20 Totals 530 738 937 68 793 247 At the beginning of 1909 the number of workshops on the register was 510. During the year the occupation of 64 of these premises was discontinued, while on the other hand 84 new workshops were added to the register, so that at the end of 1909 the total of these premises was 530, in which were employed 2,045 persons (1,005 males, and 1,040 females). 80 Of the 84 new workshops added to the register during 1909, 67 were notified to H.M. Inspector in pursuance of Section 133 of the Factory and Workshop Act, 1901, which directs that "when any woman, young person or child is employed in a workshop in which no abstract of the Act is affirmed, 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." The following table gives particulars relating to new workshops in which "protected persons" were employed, notices of which were duly sent to H.M. Inspector during 1909:— Trade. No. of Work shops. Protected Persons employed. Women Young Persons Children. Total. Baker 3 - 3 - 3 Dressmaker 25 33 22 — 55 Florist 3 - 3 - 3 Milliner 3 1 2 - 3 Photographer 3 1 2 - 3 Tailor 10 9 7 - 16 Miscellaneous 20 6 22 — 28 Totals 67 50 61 — 111 Sanitary Condition of Workshops. The Local Authority is the Authority responsible for the sanitary conditions of workshops and workplaces in its district. Sanitary conditions include (a) cleanliness, (b) air space, (c) ventilation, (d) drainage of floors, (e) provision of sanitary accommodation. During the year 1909, 3,864 visits of inspection (2,947 by the male and 917 by the female workshop Inspectors) to factories, workshops and workplaces, exclusive of visits to home workers, have been made by the workshop Inspectors. The following is a tabulated statement of the work carried out in connection with workshop inspection during 1909, so far as it admits of tabulation:— 81 Workshops inspections and re-inspections .. .. 1,951 Workrooms measured .. .. .. .. 136 Workshops notified to H.M. Inspector .. .. 67 Cards distributed showing number of persons legally employed in workrooms .. .. .. 142 Written intimations issued .. .. .. 153 Statutory notices served .. .. .. I Defects discovered in Workshops and remedied :— Workrooms in a dirty condition .. .. 56 „ overcrowded .. .. • • I 2 ,, badly ventilated .. .. .. 3 ,, with defective walls or ceilings .. 31 ,, with defective floors .. .. 4 Workshops with defective yard paving.. .. 18 „ with defective drains .. • • — „ with blocked drains .. .. 1 ,, without proper dustbins .. .. 12 „ with defective w.c. apparatus .. 36 ,, with sanitary conveniences insufficient in number or absent .. .. 9 „ with sanitary conveniences opening into workrooms .. .. .. 4 ,, with sanitary conveniences without proper doors or fastenings .. 1 „ with sanitaiy conveniences in dirty condition .. .. • • 19 Coal bins provided in bakehouses .. .. .. 1 Accumulation of refuse removed .. .. .. 2 Other defects remedied .. .. .. .. 17 The following notice of defects was received from H.M Inspector of Factories during 1909, and received attention:— Premises. Trade. Nature of Complaint. 62 Salcott Rd. Tailor At the time of visit the workroom was overcrowded; it also requires efficient ventilation. Underground Workrooms. Excluding the underground bakehouses there are 37 underground workshops and workplaces in Battersea, as compared with 41 in 1908. The number in each trade is given below:— 82 Workshops. Laundries 9 Picture-frame making 2 Cycle making 3 Tailoring 1 Fitters 2 Workplaces. Restaurant kitchens 7 Meat chopping 6 Small exempted laundries 7 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 factory Inspector, by far the greater part of the work connected with the sanitary supervision of bakehouses in Battersea devolves upon the Council as the Sanitary Authority. In the Borough of Battersea during 1909, there were on the register 86 bakehouses, eight of which were factory bakehouses, with regard to which the duties of the Council are few, and 78 workshop bakehouses. Of the latter, 47 are above ground and 31 underground according to the definition given in the Factory Act. The following is a list of the workshop bakehouses :— 47 Bakehouses Above Ground. Addresses. Addresses. 257 Battersea Park Road 148 New Road 292 „ „ „ 205 „ „ 343 „ „ „ 10 Northcote Road 1 Battersea Rise 23 „ „ 78 „ „ 64 „ „ 31 Bridge Road 94 „ „ 64 Castle Street 175 „ „ 83 Culvert Road 62 Plough Road 139 Chatham Road 76 „ „ 47 Este Road 112 „ „ 29 Falcon Road 41 Queen's Road 88 Grayshott Road 121 „ „ 45 Harroway Road 10 St. Phillip Street 11 Hanbury Road 93 Stewarts Road 49 High Street 29 Stockdale Road 80 „ „ 90 St. John's Hill 173 „ „ 32 Tyneham Road 137 Lavender Hill 47 „ „ 213 „ „ 102 Usk Road 64 Latchmere Road 70 York Road 93 „ „ 187 „ „ 29 Meyrick Road 198 „ „ 48 New Road 287 „ „ 89 „ „ 83 31 Bakehouses Under Ground. Addresses. Addresses. 163 Battersea Park Road 103 Falcon Road 189 „ „ „ 46 Francis 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 The bakehouses in the Borough have been systematically inspected during the year, and on the whole may be said to be in a (sanitorily) satisfactory condition. 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 workshop inspection. Above-ground bakehouses.—26 intimation notices were served, and in four cases it was found necessary to serve a statutory notice, which were duly complied with. Underground bakehouses.—40 intimation notices were served for various defects, but the service of a statutory notice was not necessary in any of these instances. All the defects for which the preliminary notices were served having been complied with. The defects for which these notices were served had reference mainly to want of cleanliness, defective sanitary fittings, paving, etc. Factory Bakehouses. The following is a list of the factory bakehouses in the Borough:— 84 Altenburg Gardens Bread and Confectionery. Park Road „ „ „ 381, Battersea Park Road ,, ,, „ Broughton Street Biscuits only. 37, Grayshott Road Bread. 465, Battersea Park Road ,, 465, Battersea Park Road ,, — Sugden Road ,, Homework. This term has reference to persons who carry on certain classes of work in their own homes. Under the Factory and Workshop Act, very important powers are given to District Councils for controlling the (sanitary) conditions under which the work is done. These powers aim at the prevention of homework being done (1) in dwellings which are injurious to the health of the workers themselves, viz., through overcrowding, want of ventilation, etc.; (2) in premises where there is dangerous infectious disease. The homeworkers residing in Battersea are employed 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 107-110 are set out in Orders made by the Home Secretary (vide previous Annual Reports). During 1909 the names and addresses of 832 outworkers were received, as compared with 814 in 1908, and 787 in 1907. Lists were sent in by employers and by Medical Officers of Health for the following Metropolitan Boroughs:— Lists of Outworkers received from other Boroughs, 1909. District. Lists. Outworkers District. Lists. Outworkers Bethnal Green 1 1 Lambeth 8 25 Bromley 2 2 Lewisham 1 1 Chelsea 7 61 Paddington 1 1 City of London 7 15 St. Marylebone 2 22 Finsbury 5 7 Shoreditch 2 2 Hammersmith 2 2 Southwark 4 10 Holborn 2 2 Wandsworth 25 122 Islington 1 1 Westminster 5 76 Kensington 3 22 Wimbledon 1 1 Totals 79 373 85 The names and addresses of 196 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 outworkers are registered and regularly inspected, and any insanitary conditions found remedied. The premises generally were in 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:— Trade. Number on Register. Persons Employed. Premises Rooms. Males. Females. Art Needlework 3 3 - 3 Blousemakers 10 10 - 12 Bootmakers 34 34 39 1 Dressmakers 2 2 2 Embroiderers 39 39 — 39 Glovemakers 54 54 1 58 Hosiers 1 1 — 1 Milliners 4 4 — 5 Tailors 75 75 42 49 Underclothing Makers 25 26 — 32 Other Trades 24 24 1 27 271 272 83 229 The systematic inspection of outworkers' premises is carried out by the workshop Inspectors (Inspectors Benjamin and Miss Fairbairn). The former deals with male outworkers and the latter with female. In addition, the lists kept of outworkers employed by Battersea firms are regularly inspected and care taken that these lists are properly kept, in accordance with section 107 of the Factory and Workshop Act. The lists are sent in twice yearly, February and August, but difficulty is experienced in getting some employers to comply with their statutory obligation in this respect, and in a few cases it is only on the threat of proceedings that the lists are sent in. During the year 809 inspections were made and 64 notices were served in connection with homework inspection, the results of which are summarised as follows:— 86 Male Outworkers (Inspector Benjamin). Number of male outworkers on register 69 Total number of inspections 180 Number of notices served to remedy 18 defects 16 Nineteen outworkers removed during the year, three of whom removed to other addresses in the Borough, and 37 new outworkers were registered. Female Outworkers (Miss Fairbairn). Number of female outworkers on register 202 Total number of inspections 629 Number of notices served to remedy 94 defects 48 During the year 62 female outworkers had removed or discontinued for various reasons. In all but ten instances these persons were traced to their new addresses. The defects found in outworkers' premises were mainly those referring to want of cleanliness of rooms, defective sanitary fittings, etc. Five cases of scarlet fever occurred in outworkers' homes, one case in each home. The special precautions taken in each instance were successful in preventing the spread of infection. 87 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 in Appendix No. 1, pages 89 to 91, and are summarised below:— No. of Prosecutions. No. of Convictions. Fines. Costs. £ s. d. £ s. d. Sale of Food and Drugs Acts 103 57 91 6 0 39 18 3 Smoke Nuisances — — — - Unsound Food 1 1 25 0 0 0 4 0 Contravention of ByeLaws 3 3 2 0 0 0 6 0 Other proceedings 26 17 3 15 0 11 13 0 Total 133 78 122 1 0 52 1 3 89 APPENDIX No. 1. Legal Proceedings under the Public Health (London) Act, 1891, London County Council (General Powers) Acts, 1902 and 1907, and Metropolis Management Act, 1855. Nature of Offence. Result of Proceedings. Non-deposit of drainage plans Fined £1 and 2s. costs. Overcrowding at 20 Orville Road Fined £1 and 2s. costs. Insufficient water supply at 186, 188, Meyrick road Order for taps on second floors, and £1 costs. Non-deposit of drainage plans Fined 10s. and 2s. costs. Non-deposit of drainage plans Fined 10s. and 2s. costs. Manufacture of ice cream under improper conditions Fined 10s. and £1 3s. costs. The like(second offence) Fined £1 and £1 3s. costs. No water supply at 122 Taybridge Road Closing order, 5s. costs. Non-compliance with closing order Adjourned sine die. Nuisance at 146 Meyrick Road Nuisance abated, summons withdrawn. Depositing unsound meat for sale Fined £25 and 4s. costs. Insufficient water supply at 146 Meyrick Road Supply provided, ordered to pay £2 2s. costs. Non-compliance with notice to provide supply Summons withdrawn. Nuisance at 20 Orville Road Order for abatement, 5s. costs. Non-compliance with notice to abate nuisance Ordered to pay 2s. costs. Overcrowding at 20 Orville Road Fined £1 5s. and 2s. costs. Application for cancellation of closing order Closing order cancelled. Insufficient water supply at 40, 42, 46 Chatham Road Supply provided, summons withdrawn, £1 1s. costs. Nuisance at No. 74 Usk Road Nuisance abated, ordered to pay 10s. 6d. costs. Nuisance at 232 York Road Order for abatement, £1 5s. cost Nuisance at 103 Usk Road Summons withdrawn, work done, 10s. 6d. costs. Insufficient water supply at 46, 48 Wayford Street Order for taps on top floors, and £2 2s. costs. 90 Legal Proceedings under Sale of Food and Drugs and Margarine Acts. Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 654 Irish whisky 31·08 per cent. of water Ordered to pay 12s. 6d. costs. 650 Scotch whisky 26·95 per cent of water Ordered to pay 12s. 6d. costs. 684 Camphorated oil Deficient in camphor Fined £1, and 14s. 6d. costs. 617 Milk 6·5 per cent. added water Fined £3 and £1 3s. costs. 627 „ 4·5 „ „ „ Dismissed (warranty). — ,, Giving false warranty Dismissed. 688 Bread and butter Butter containing 82 per cent. foreign fat Fined £4 and £1 3s. costs. 693 „ „ Butter containing 80 per cent. foreign fat Fined £2 and £1 3s. costs. 739 Milk 6·4 per cent. added water Fined £1 10s. and 12s. 6d. costs. 747 Butter 74·5 per cent. foreign fat Fined £4 and £1 3s. costs. 696 Milk 7·5 per cent. added water Warranty defence, 12s. 6d. costs. — „ Giving false warranty Dismissed. 768 „ 9 per cent. added water Dismissed (warranty). 832 Butter 73·4 per cent. foreign fat Fined £2 and 12s. 6d. costs — „ Selling margarine in a plain wrapper Summons withdrawn. Fined £5 and 12s. 6d. costs. 818 „ 84 per cent. foreign fat — „ Selling margarine in a plain wrapper Summons withdrawn. 795 Milk 5·5 per cent. added water Fined £1 and 12s. 6d. costs. 813 Butter 40 per cent. foreign fat Fined £1 and 12s. 6d. costs. — „ Selling margarine in a plain wrapper Ordered to pay 2s. costs. 796 Milk 11 per cent. added water Fined £2 and 12s. 6d. costs. 797 „ 9 per cent. added water and 33·4 devoid of fat Ordered to pay 2s. costs. 252 „ 12 per cent. of fat abstracted Fined 10s. and 14s. 6d. costs. 856 Butter 82·5 per cent. foreign fat Fined £3 and 14s. 6d. costs. — „ Selling margarine in a plain wrapper Ordered to pay 2s. costs. - Milk Giving false warranty Dismissed. 847 „ 29 per cent. of fat abstracted Fined £2 and 12s. 6d. costs. 805 Skimmed milk 9 per cent. added water Fined 10s. and 12s. 6d. costs. 844 Milk 7 „ „ „ Fined £2 and 12s. 6d. costs. — - Obstructing Inspector Dismissed. 934 Milk 9·5 per cent. added water Dismissed (warranty). 899 Coffee 33 per cent. chicory Fined 10s. and 14s. 6d. costs. 956 Milk 6·5 per cent. added water Fined £1 10s. and 12s. 6d. costs. 969 Vinegar 15 per cent. added water Ordered to pay 12s. 6d. costs. 990 Milk 6 per cent. added water Fined £3 and 14s. 6d. costs. 63 „ 4 „ „ „ Fined £1 and 14s. 6d. costs 64 „ 12 „ „ „ Warranty defence, 14s. 6d. costs. 12 Skimmed milk 12 „ „ „ Fined 10s. and 12s. 6d. costs. 91 Legal Proceedings under Sale of Food and Drugs and Margarine Acts (continued). Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 30 Milk 8 per cent. added water Fined £1 and 14s. 6d. costs. 74 „ 36 per cent. of fat abstracted Fined £2 and 14s. 6d. costs. 80 „ 15 per cent. of fat abstracted Fined £2 and 13s. 6d. costs. 138 „ 5 per cent. of fat abstracted Ordered to pay 14s. 6d. costs. 39 „ 5•5 per cent. added water Dismissed (warranty). 150 Sausages 19•83 grains per lb. boric acid Fined £4 and 14s. 6d. costs. 161 Milk 8•5 per cent. added water Fined £1 5s. and 14s. 6d. costs. 186 „ 6 „ „ „ Withdrawn (warranty). 164 „ 7 „ „ „ Ordered to pay £1 1s. costs. 207 „ 52•6 per cent, of fat abstracted Fined £5 and 12s. 6d. costs. 238 „ 10 per cent. of fat abstracted Withdrawn (warranty). 212 „ 7 per cent. of fat. abstracted Fined 10s. and 12s. 6d. costs. 209 „ 6•6 per cent. of fat abstracted Fined £2 and 12s. 6d. costs. 196 Butter 52 per cent. foreign fat Fined £4 and 14s. 6d. costs. 281 „ 76•5 „ „ „ Fined £1 10s. and 14s. 6d. costs 269 Milk 2•266 grains per pint boric acid Fined 1s. and 14s. 6d. costs. — „ Giving false warranty Dismissed. — „ „ „ „ ,, „ „ „ „ „ 340 Skimmed milk 17•3 per cent. added water Fined £5 and 14s. 6d. costs. 386 Milk 12 „ „ „ Withdrawn, bottle burst 387 „ 10 per cent. added water and 10 per cent. devoid of fat Fined £1 and 14s. 6d. costs. 359 „ 4 per cent. added water Dismissed (warranty). 339 „ 11•5 „ „ „ Fined £1 and 14s. 6d. costs. 428 „ 9 „ „ „ Fined £1 10s. and 14s. 6d. costs. 418 Coffee 65 per cent. chicory Fined 10s. and 14s. 6d. costs 473 Milk 8 per cent. added water Fined £2 and 14s. 6d. costs. 491 Butter 30 per cent. foreign fat and selling margarine in a plain wrapper Fined £5 and 18s. 6d. costs. 528 Margarine Containing more than 10 per cent. of butter fat Fined £2 and 12s. 6d. costs. 539 Coffee 50 per cent. chicory Fined £1 and 14s. 6d. costs. 553 Butter 73•7 per cent. foreign fat, and selling margarine in a plain wrapper Fined £1 and 18s. 6d. costs. 451 Milk 7 per cent. added water Fined £5 and £3 10s. 3d. costs. 627 „ 7 „ „ „ Fined £2 and 14s. 6d. costs. 609 Separated milk 14•2 per cent. extraneous water, and less than 9 per cent. of milk solids Warrant granted on information. 93 Appendix No. 2. REPORTS AND TABLES. 95 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 1909 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 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 2,541 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 25.9 611 131 2,425 13.5 786 444 403 2,384 13.2 1907 181,736 4,574 25.1 534 117 2,431 13.4 817 446 421 2,406 13.2 1908 183,873 4,629 25.1 495 116 2,265 12.4 740 408 415 2,272 12.3 Averages for years 1899-08 174,806 4,873 27.9 673 138 2,568 14.7 683 357 385 2,587 14.8 1909 186,036 4,450 23.9 483 113 2,445 13.1 902 502 474 2,417 13.0 * Rates calculated per 1.000 of estimated population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the Borough. The deaths included in Column 12 are the number in Column 7 corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term “Non-residents" is meant persons brought into the Borough on account of sickness 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. 96 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 1909 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. 1 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. 1899 167,570 5,179 2,905 837 72,020 2,424 1,412 437 49,719 1,791 954 299 45,831 964 539 101 1900 168,339 5,161 2,978 822 72,119 2,418 1,370 411 49,691 1,749 1,044 314 46,529 994 564 97 1901 169,100 5,025 2,766 821 72,226 2,357 1,271 407 49,663 1,658 932 296 47,211 1,010 563 118 1902 171,401 4,844 2,581 657 72,797 2,208 1,133 312 49,631 1,643 911 270 48,973 993 537 75 1903 173,422 4,973 2,476 671 73,310 2,298 1,101 316 49,593 1,692 851 268 50,519 983 524 87 1904 175,465 4,849 2,543 715 73,931 2,249 1,159 365 49,564 1,584 845 248 51,970 1,016 539 102 1905 177,532 4,843 2,561 636 74,589 2,278 1,159 305 49,536 1,622 873 256 53,407 943 529 72 1906 179,622 4,654 2,384 588 75,169 2,150 1,100 316 49,520 1,570 759 198 54,933 934 525 74 1907 181,736 4,574 2,406 526 75,740 2,139 1,125 257 49,481 1,552 793 211 56,515 883 488 58 1908 183,873 4,629 2,272 494 76,321 2,087 993 217 49,453 1,624 748 198 58,099 918 531 79 Averages of years 1899 to 1908 174,806 4,873 2,587 678 73,822 2,261 1,182 334 49,585 1,648 871 256 51,399 964 534 85 1909 186,036 4,450 2,417 478 77,469 2,051 1,088 231 49,417 1,578 815 191 59,150 821 514 56 Note.—Deaths of residents occurring in public institutions, whether within or without the Borough, are allotted to the respective localities according to the addresses of the deceased. 97 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 1909. 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. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 262 6 101 122 10 23 .. 136 67 59 132 65 51 Membranous croup 3 .. 2 1 .. .. .. 1 2 .. 1 2 .. Erysipelas 156 8 5 12 11 103 17 74 61 21 18 13 2 Scarlet fever 702 6 179 437 46 34 .. 336 197 169 333 196 152 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 48 1 1 15 11 20 .. 31 13 4 29 12 1 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 14 .. .. .. 4 10 .. 4 7 3 4 5 .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 4 2 2 .. .. .. .. 3 1 .. 3 1 .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1,189 23 290 587 82 190 17 585 348 256 520 294 206 98 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 1909. 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 86 14 66 6 .. .. .. 50 31 5 41 Scarlet Fever 8 .. 6 2 .. .. .. 6 2 .. .. Whooping Cough 60 26 33 1 .. .. .. 41 17 2 36 Diphtheria and Membranous Croup 23 2 18 3 .. .. .. 15 6 2 .. Croup .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. Enteric 7 .. .. .. 1 6 .. 6 1 .. 1 Other Continued 2 1 1 .. .. .. .. 1 1 .. 1 Epidemic Influenza 33 .. 2 .. 2 17 12 9 11 13 7 Cholera .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 53 42 9 .. .. 2 .. 33 16 4 2 Enteritis 55 40 5 .. 1 .. 9 23 25 7 35 Puerperal Fever 7 .. .. .. 2 5 .. 1 5 1 8 Erysipelas 4 1 .. .. .. 1 2 2 1 1 5 Other Septic Diseases 13 4 .. 1 1 4 3 5 7 1 7 Phthisis 217 1 7 6 35 153 15 97 72 48 107 Other Tubercular Diseases 72 15 27 15 9 6 .. 37 22 13 8 Cancer, Malignant Disease 180 .. .. 1 2 112 65 74 44 62 73 Bronchitis 319 51 22 2 1 92 151 136 111 72 93 Pneumonia 211 50 51 10 9 66 25 107 79 25 61 Pleurisy 10 .. 3 .. 1 1 5 9 1 .. 5 Other Diseases of Respiratory Organs 22 1 .. .. .. 16 5 8 7 7 5 Alcoholism 25 l .. 1 .. 20 3 11 4 10 13 Cirrhosis of Liver Venereal Diseases 9 6 1 .. .. 2 .. 4 3 2 9 Premature Birth 89 89 .. .. .. .. .. 38 36 15 10 Diseases and Accidents of Parturition 7 .. .. .. 1 6 .. 4 2 1 3 Heart Diseases 86 .. 3 3 4 52 24 29 32 25 45 Accidents 46 5 7 7 7 14 6 19 17 10 42 Suicides 14 .. .. .. 2 10 2 7 3 4 9 All other causes 759 129 21 27 23 256 303 316 259 184 276 All causes 2417 478 282 85 101 841 630 1088 815 514 902 99 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 1909. 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 95 24 19 17 155 51 48 28 31 28 31 14 22 18 24 28 478 Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Measles .. .. .. .. .. 1 .. .. .. .. .. .. 1 2 6 4 14 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 2 Whooping Cough .. .. .. .. .. 4 1 2 1 1 2 1 2 4 4 4 26 Diarrhœal Diseases. Diarrhœa, all forms .. .. .. 1 1 7 5 4 4 4 7 2 3 1 .. 4 42 Enteritis Muco- .. 2 .. .. 2 4 8 5 5 4 4 2 1 1 4 • • 40 Gastro- Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. 2 1 .. 1 .. .. .. .. .. .. 4 Wasting Diseases. Premature Birth 56 4 8 6 74 7 7 1 .. .. .. .. .. .. .. .. 89 Congenital Defects 9 3 1 3 16 1 1 .. 1 .. .. .. .. 1 .. .. 20 Injury at Birth 5 .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. 5 Want of Breast Milk 1 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Atrophy, Debility, Marasmus 2 2 2 1 7 5 7 5 4 1 3 1 1 1 .. .. 35 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. 1 .. 1 .. 1 .. 1 4 .. .. 1 9 Tuberculosis Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .... 1 1 2 .. 1 .. .. .. 5 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 2 Erysipelas .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Other Causes Syphilis .. .. .. .. 1 1 1 1 1 .. 1 .. .. .. .. .. 6 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. 2 1 1 .. 1 .. .. 5 Convulsions 3 6 .. .. 9 1 .. .. .. 1 .. 1 .. 1 1 .. 14 Bronchitis 3 3 3 5 14 6 8 3 3 4 4 1 1 1 1 5 51 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Pneumonia .. .. 1 1 2 3 3 2 7 7 4 3 4 3 5 7 50 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes 16 3 3 .. 22 10 4 3 3 .. 2 1 2 2 2 1 52 94 24 19 17 155 51 48 28 31 28 31 14 22 18 24 28 478 Borough of Battersea. Deaths in the year Population (estimated to middle of 1909).—186,036. of Legitimate Infants, 432; Illegitimate Infants, 46. Births in the year :—Legitimate, 4,354 ; Illegitimate, 96. Deaths from all Causes at all Ages—2,417. 100 TABLE V.—(continued). East Battersea. Infantile Mortality during the Year 1909. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Week. 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 40 11 7 7 65 23 25 16 16 11 19 11 13 8 12 12 231 Common Infectious Diseases. Small-pox .. .. .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. 1 2 4 1 8 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 2 Whooping Cough .. .. .. .. .. 3 1 2 1 1 2 1 .. 2 3 2 18 Diarrhœal Diseases. Diarrhœa, all forms .. .. .. 1 1 3 2 2 3 2 7 2 2 .. .. 1 25 Enteritis Muco- .. 1 .. .. 1 3 4 2 1 1 1 1 1 .. 2 .. 17 Gastro- Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 2 Premature Birth 24 1 2 1 28 4 5 1 .. .. .. .. .. .. .. .. 38 Wasting Diseases. Congenital Defects 4 3 .. 1 8 1 .. .. 1 .. .. .. .. 1 .. .. 11 Injury at Birth 4 .. .. .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 Want of Breast Milk 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus 1 1 1 1 4 2 5 2 2 1 1 1 1 .. .. .. 19 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. 3 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Other Causes. Syphilis .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. .. 3 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 2 Convulsions .. 2 .. .. 2 .. .. .. .. 1 .. 1 .. .. 1 .. 5 Bronchitis 2 1 1 2 6 2 5 1 1 .. 2 1 1 .. 1 4 24 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. 1 1 2 3 .. 2 5 4 3 2 3 2 1 3 30 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes 5 1 2 .. 8 .. 2 2 .. .. .. 1 .. 1 .. .. 14 40 11 7 7 65 23 25 16 16 11 19 11 13 8 12 12 231 Sub-Division of East Battersea. Deaths in the year of Population (estimated to middle of 1909)—77,469. Legitimate Infants, 207; Illegitimate Infants, 24. Births in the year—Legitimate, 2,014; Illegitimate, 37. Deaths from all Causes at all ages—1,088. 101 TABLE V.—(continued). North-West Battersea Infantile Mortality during the Year 1909. 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 38 10 8 7 63 21 19 10 11 14 12 1 8 9 10 13 191 Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Measles .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 3 5 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria : Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 .. .. .. .. .. .. 2 2 1 2 8 Diarrhœal Diseases. Diarrhœa, all forms .. .. .. .. .. 2 2 2 1 2 .. .. 1 1 .. 3 14 Enteritis Muco- .. 1 .. .. 1 .. 4 3 2 2 3 1 .. 1 2 .. 19 Gastro- Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases. Premature Birth 22 2 4 5 33 1 2 .... .. .. .. .. .. .. .. .. 36 Congenital Defects 4 .. .. .. 4 .. 1 .. .. .. .. .. .. .. .. .. 5 Injury at Birth 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Want of Breast Milk 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus 1 1 .. .. 2 3 1 3 2 .. 2 .. .. 1 .. .. 14 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 2 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. 3 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes. Syphilis .. .. 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. 2 .. .. .. 1 .. .. 3 Convulsions 2 3 .. .. 5 1 .. .. .. .. .. .. .. 1 .. .. 7 Bronchitis 1 1 2 2 6 3 3 1 2 4 2 .. .. 1 .. 1 23 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. .. 3 .. 2 2 1 .. 1 .. 4 1 14 Suffocation, overlying.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes 6 2 1 .. 9 9 2 1 2 .. 2 .. 2 1 2 1 31 38 10 8 7 63 21 19 10 11 14 12 1 8 9 10 13 191 Sub-Division of North-West Battersea. Deaths in the year of Population (estimated to middle of 1909)—49,417. Legitimate Infants, 174 ; Illegitimate Infants, 17 Births in the year—Legitimate, 1,536; Illegitimate, 42. Deaths from all Causes at all ages-815. 102 TABLE V.—(continued). South-West Battersea. Infantile Mortality during Year 1909. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3—4 Week 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 Y ear. All Causes.—Certified 17 3 4 3 27 7 4 2 4 3 .. 2 1 1 2 3 56 Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœal Diseases. Diarrhœa, all forms .. .. .. .. .. 2 1 .. .. .. .. .. .. .. .. .. 3 Enteritis Muco- .. .. .. .. .. 1 .. .. 2 1 .. .. .. .. .. .. 4 Gastro- Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 2 Wasting Diseases. Premature Birth 10 1 2 .. 13 2 .. .. .. .. .. .. .. .. .. .. 15 Congenital Defects 1 .. 1 2 4 .. .. .. .. .. .. .. .. .. .. .. 4 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast Milk .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus .. .. 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 2 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes. Syphilis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Convulsions 1 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Bronchitis .. 1 .. 1 2 1 .. 1 .. .. .. .. .. .. .. .. 4 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Pneumonia .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. 3 6 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Causes 5 .. .. .. 5 1 .. .. 1 .. .. .. .. .. .. .. 7 17 3 4 3 27 7 4 2 4 3 .. 2 1 1 2 3 56 Sub-Division of South-West Battersea. Deaths in the year of Legitimate Population (estimated to middle of 1909)—59,150. Infants, 51; Illegitimate Infants, 5. Births in the year—Legitimate, 804; Illegitimate, 17. Deaths from all Causes at all ages, 514. 103 Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 677 63 - Workshops (including Workshop Laundries) 1,951 186 - Workplaces 1,236 146 1 Total 3,864 395 1 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. Nuisances under the Public Health Acts:- Want of Cleanliness 103 103 - NIL. Want of Ventilation 7 7 - Overcrowding 2 2 - Want of drainage of floors 6 6 - Other nuisances 179 179 - Sanitary accommodation Insufficient 13 13 - Unsuitable or defective 130 130 — Not separate for sexes — — — Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (Sec. 101) - - - Breach of Special Sanitary Requirements for Bakehouses (Secs. 97 to 100) 14 14 - Other Offences (excluding Offences relating to Outwork which are included in Part 3 of this report) - - - Total 454 454 — 104 3.—Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Inspections of workers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109,110. Lists received from Employers. Addresses of Outworkers. stances. Notices served. stances. Orders made (S. 110) Sending twice in the year. Sending once in the year. Received from other Councils. Forwarded to other Councils. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel- (1) Making, &c. 80 51 352 6 — 19 338 185 800 75 73 5 — (2) Cleaning & washing 8 19 10 — — — 5 22 - - - - - Lace, lace curtains and nets 2 - 2 — — — 14 2 - - - - - Sacks 2 — 2 — — — — 2 — — — — — Furniture and upholstery 2 2 2 - - - - - 4 1 1 — — Fur pulling - - - - - - - - - - - - - Paper bags and boxes - - - - - - 14 4 5 2 2 — — Brush making - - - - - - 2 - - - - - - Total 94 72 368 6 - 19 373 215 809 78 76 5 — 105 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of 1909 :— Bakehouses 78 Bootmakers 72 Dressmakers 109 Laundries 39 Milliners 23 Tailors 37 Other Trades 172 530 5.—Other Matters. Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 67 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 1 Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 31 106 Proceeding's during 1909. (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.) Premises. Number of Places. No. of Inspections, 1909. No. of Intimation Notices 1909. No of Prosecutions, 1909. On Register at end of 1908. Added in 1909. Removed in 1909. On Register at end of 1909. Milk premises 241 50 113 178 852 65 - Cowsheds 3 - — 3 * - - Slaughterhouses 5 - - 5 78 — — Other offensive trade premises 2 - — 2 6 — — Ice-cream premises 108 56 8 156 260 7 — Registered houses let in lodgings 123 - — 123 387 114 9 * These premises are subject to frequent inspection Total number of intimation notices served for all purposes 4,318 Overcrowding— Number of dwelling-rooms overcrowded 86 Number remedied 86 Number of prosecutions 2 Underground rooms— Illegal occupation dealt with during the year 26 Number of rooms closed 26 Insanitary houses— Number closed under the Public Health (London) Act Number closed under the Housing of the ing Classes Act — Number of verminous premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 — 107 Shelters provided under Section 60 (4) of the Public Health (London) Act— Number of persons accommodated during the year 4 Revenue Acts— Number of houses for which applications were received during year 9 Number of tenements comprised therein 21 Number of tenements for which certificates were :—(a) Granted 5 (b) Refused — (c) Deferred 16 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 — (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, terns, &c. — (h) With respect to water-closets, &c. — (i) With respect to sufficiency of water supply to water closets (;') With respect to drainage, &c. (Metropolis Management Act, Section 202) (k) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (Bye-laws) Act, 1899) 3 Mortuary— Total number of bodies removed 269 Total number of infectious bodies removed 11 108 REPORT. Public Health Department, Municipal Buildings, Battersea, S.W. 19th January, 1909. To the Health Committee, Mr. Chairman and Gentlemen,— The London County Council (General Powers) Act, 1908, which came into force on the 1st January of this year, contains important provisions dealing with sanitary matters. Under these provisions, increased powers are given to the Council, as the sanitary authority, in respect to the following matters:— (A) 1—Registration of Milk Vendors. 2—Appointment of Health Visitors. 3—Accommodation for cooking of food in tenement houses. 4—Sanitary regulations for premises used for sale, &c., of food for human consumption ; and to the London County Council, among other matters :— (B) 5—Power to make by-laws with respect to certain businesses. Among the more important of these provisions, those dealing with the registration of milk vendors call for special mention. Under Section 5, Part II. (Sanitary Provisions) power is given to any sanitary authority to refuse to register or to remove from the register kept by them persons from time to time carrying on the trade of dairymen or purveyors of milk upon premises which are, in the opinion of such sanitary authority, for any reason unsuitable for the sale of milk therein. Provided that for the purposes of this section premises shall not be deemed to be unsuitable for the sale of milk therein on any ground inconsistent with the provisions or requirements of any Order or Regulations made under any enactment for the time being in force and applicable to such premises. The section further provides for an appeal to the London County Council by any person who thinks himself aggrieved by the exercise by any sanitary authority of the powers of this section. The section, as will be gathered from its wording, will be of great assistance to the Council in safeguarding the health of the inhabitants of the Borough by preventing milk being 109 sold from insanitary premises. Prior to the passing of this Act, the sanitary authority were compelled to register any person who applied to be registered as a milk vendor, notwithstanding that in many instances the premises from which the milk was sold were on sanitary grounds unsuitable for the purpose. It will now be possible for the Council to exercise a stricter supervision over the sanitary suitability of the premises and thereby to enable them to gradually raise the standard of cleanliness under which this important and sensitive article of food is deposited or exposed for sale. It will be within the knowledge of the Committee that in many instances milk is sold in premises side by side with commodities which are liable to give rise to contamination of the milk ; and notwithstanding the constant supervision exercised by the officers of the Council it has not been possible heretofore, with the limited powers at their disposal, to do more than mitigate the evil which, under such conditions, must prevail. The question, therefore, of enforcing the provisions of the Act in this respect will call for careful consideration, and I am engaged in revising the register with a view to securing reasonable conditions as regards the suitability on sanitary grounds of premises, more especially in the case of general shops, wherein milk is sold. As it may be found necessary from time to time to take legal proceedings to enforce the provisions of the section, I would suggest that it would be desirable for the Council to advertise in the local papers or alternative methods the duty of milk vendors to register in accordance with the provisions of the Dairies, Cowsheds and Milkshops Order, Section 6 (4) of which states:— The Local authority shall from time to time give public notice by advertisement in a newspaper circulating in their district, and, if they think fit, by placards, handbills or otherwise, of registration being required, and of the mode of registration. Otherwise, the legal proceedings which it may be the duty of the Council to take under this section may be vitiated. Under Section 6 (1) any sanitary authority may at any time after the 1st January, 1909, appoint suitable women (to be known as Health Visitors) for the purpose of giving to persons advice as to the proper nurture, care and management of young children, and of promoting cleanliness and discharging such other duties (if any) as may be assigned to them in accordance with the provisions of this section. (2) The Local Government Board may make regulations prescribing the qualifications, mode of appointment, duties, 110 salary and tenure of office of Health Visitors appointed under this section, and no appointment of a Health Visitor shall be made o herwise than in accordance with such regulations. Sub-section (3) provides that it shall be lawful for the London County Council to pay out of the County Fund and charge to th Exchequer Contribution Account any sum or sums by way of contribution towards the salaries of any person so appointed, not exceeding of any such person one-half of her salary. This section is of considerable importance to sanitary authorities as they are now empowered to appoint Health Visitors as such and to have returned to them a portion of the salaries of these officers as in the case of sanitary inspectors. As the Committee are aware, part of the time of one of the lady sanitary inspectors is devoted to Health Visiting, for which the Council receive no return in respect of that portion of her salary which has been allocated for this purpose. The success that has already attended the efforts of the Council in the reduction of the high rate of infant mortality which formerly prevailed in the Borough should encourage them to appoint at least one additional Health Visitor. The Notification of Births Act and, more recently, the Public Health (Tuberculosis) Regulations have added largely to the duties of the Health Department, and the duties in connection with these enactments are most suitably performed by such officers. It will not be possible, in my opinion, to adequately carry out the duties under these powers unless the Council appoint an additional Health Visitor whose duties should be entirely devoted to this important work. Sections 7 and 8 deal with the provision of accommodation for cooking of food in tenement houses and with sanitary regulations for premises used for the sale of food for human consumption, respectively. With regard to Section 7, the powers provided by the Section suffer from the fact of not being retrospective in character. Section 8 should prove of material assistance to sanitary authorities in securing the sanitary condition of premises in which food is prepared, stored and sold for human consumption. Prior to the passing of this Act, a sanitary authority could only deal with these premises under the provisions of the Public Health and Factory and Workshops Acts. The powers of the authority as regards the latter Act are largely confined to workshops, workplaces, &c. In the case of factory premises, the duties of the sanitary authority are of a very limited character. There are a great many premises in the borough in which food is prepared that, by reason of the fact that electric or steam power is used—such. 111 for example as the sausage manufacturers, many of whom use an electric motor or gas engine for the purposes of their business—thereby become technically factories, for the most part under the jurisdiction of the Factory Inspectors. It will be found, I am of opinion, more in the interests of the public health to have, so far as these duties are concerned, such premises under the supervision of the sanitary authority, as provided for in the new Act. Under Section 9 the London County Council are empowered to make by-laws for the conduct of certain businesses, viz., fried fish vendors and rag and bone dealers, and Section 10 imposes on each sanitary authority the duty of enforcing, within their district, this part of the Act and all by-laws made by the London County Council thereunder. I have the honour to be, Mr. Chairman and Gentlemen, Your obedient servant, (Signed) G. Quin LENNANE, Medical Officer of Health.