BAT 17 3 Health Committee. Chairman. Councillor Dr. J. T. RICHARDS. HIS WORSHIP THE MAYOR. (Councillor A. E. Runeckles, J.P.) Councillor P. BROLLY. Miss E. BROWN. A. BUSSELL. Dr. S. H. CURRY. G. D. DEANE. Dr. J. M. EHRHARDT. G. T. KETTLEY. Dr. J. T. RICHARDS. J. B. TAYLOR. J. J. TAYLOR. S. J. THOMAS. Alderman W. WATTS. 4 Staff of the public Health department. Chief Sanitary Inspector. I. Young, m.r.s.i. Women Sanitary Inspectors. Miss A. E. Moss, San. Insp. Board's Cert., Cert. C.M.B. Miss L. M. Fairbairn, San. Insp. Board's Cert. Health Visitor. Miss E. C. Peacock, San. Insp. Board's Cert., Nursing Cert. Food Inspector. A Chuter, Cert. San. Inst, and Meat Insp. Cert. Workshop Inspector. W. E. Benjamin, Cert. San. Inst. District Sanitary Inspectors. No. 1 District .. J. Herrin, Cert. San. Inst, and Meat Insp. Cert. ,, 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. Marrable ,, 7 „ A. Odell, Cert. San. Inst, and Meat Insp.Cert ,, 8 ,, H. H. May, Cert. San. Inst. Clerks. Chief Clerk .. B. W. Sears. Second Class Clerk. F. H. Preston, Cert. San. Inst. | E. Cole. Third Class Clerks J. H. Lloyd, San. Insp. Board's Cert. [ T. F. Davis. Office Youth .. W. Campbell. Manageress of Milk Depot. Miss A. Lowe. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper G. Street. 6 CONTENTS, Births, Marriages and Deaths. page Births . 11 Deaths 13 Deaths in Public Institutions 17 Infantile Mortality 17 Marriages 13 Notification of Births Act 20 Population 10 Senile Mortality 26 Infectious and other Diseases. Acute Polio-Myelitis 56 Alcoholism 75 Bacteriological Examinations 76 Cancer 75 Diarrhoea 60 Diphtheria 50 Enteric Fever 53 Epidemic Cerebro-spinal Fever 55 Erysipelas 55 Measles 56 Notifiable Infectious Diseases 46 Ophthalmia Neonatorum 56 Puerperal Fever 54 Scarlet Fever 48 Small Pox 48 Tuberculosis 66 Whooping Cough 59 Zymotic Diseases 42 General Sanitary Administration. Ambulances 41 Block Dwellings 37 Cleansing of Persons Act, 1897 39 Common Lodging Houses 36 Customs and Inland Revenue Act 37 Disinfection 38 7 General Sanitary Administration (continued). page House-to-house Inspection 29 Houses Let in Lodgings 33 Housing, Town Planning, &c., Act 31 Hygienic Street Paving 35 Midwives Act 40 Mortuary 40 Paving of Back yards and Forecourts 34 Sanitation of House Property 28 Sewer Ventilation 35 Shelter, Temporary 39 Smoke Nuisances 34 Van Dwellings 35 Water Supply 38 Protection of the Food Supply. Butchers' Shops 84 Cow-houses 79 Fish Shops 84 Ice Cream 80 Milkshops 81 Restaurants, &c. 80 Sale of Food and Drugs Acts 85 Slaughter-houses 79 Unsound Food 77 Factory and Workshop Act, 1901. Bakehouses 96 Factories 91 Homework 98 Underground Workrooms 96 Workshops 92 Legal Proceedings 102 Infants' Milk Depot 23 Appendices. Legal Proceedings 103 Tables 106 Reports 118 8 Summary of Vital Statistics for 1911. Area of Borough (excluding water) 2,1399 acres Population (Census 1901) 168,907 ( „ 1911) 167,793 „ Estimated to middle of 1911 167,765 Density 78.4 persons per acre Inhabited Houses (Census 1901) 23,462 Marriages 1,281 Births 4,381 Birth-rate 26.1 Deaths 2,404 Death-rate 14.3 Infantile Mortality 124 per 1,000 births 9 Births, Marriages and Deaths. The Census. The Registrar-General has issued his Preliminary Report on the twelfth Census of the Population of England and Wales, taken on the 3rd April, 1911. The enumeration shows that the population increased since 1901 from 32,527,843 to 36,075,269, an increase of 10-9 per cent. While the population is numerically greater than in any previous decennium, this is the lowest rate of increase on record, the rates for the two previous decennia being 11.65 and 12.17, respectively. The rate of increase of population depends on two factors (1) the balance between births and deaths, and (2) the balance between outward and inward passenger movements. The net gain of population by excess of births over deaths, which had been 15.09, 13.97 and 12.39 per cent, in the three preceding decennia, rose in the period 1901-1911 to 12.44, a result due to the counter-balancing of a great reduction of the birth-rate by a still greater reduction of the death-rate. The loss by the balance of passenger movements was nearly half a million persons as compared with 68,000 in 1891-1901 and over 600,000 in 1881-1891. With regard to the rate of increase or decrease in country areas, the report shows that some of the highest increases occurred in the counties surrounding the Metropolis, viz., Middlesex, Surrey, Essex, and Hertfordshire, in each of which the increase was over 20 per cent. Kent, however, shows an increase of only 8.8 per cent. The Census just taken shows the increasing predominance of the urban over the rural population. In 1901 the urban population of England and Wales was 77 per cent, of the total, and the rural population 23 per cent. In 1911 the figures are 78.1 and 21.9, respectively. The rate of increase in rural districts has, however, risen in the intercensal period from 2.9 to 10.2 per cent, while in urban districts the rate has fallen from 15 .2 to 11.1 per cent. London furnishes the most remarkable instance of decline of population in the central portions of large cities. The process of decentralisation which at first affected the inner districts of London only, has gradually affected a much wider area until in 1901-1911 only nine of the 28 Metropolitan Boroughs showed an increase of population. These Boroughs, which are mainly those farthest removed from the centre, are Hampstead, Hackney, Fulham, Hammersmith, Wandsworth, Camberwell, Greenwich, Lewisham and Woolwich. The Boroughs showing the highest increases are Wandsworth, 34·3 per cent; Lewisham, 26·2 per cent.; and Fulham, 11·7 per cent. Of the 20 Metropolitan Boroughs showing 10 decreases, Battersea shows the lowest, viz., 0·7 per cent, and Holbom and the City of London the highest, viz., 16.9 and 27·0 per cent., respectively. Outside the Administrative County of London the group of sub" urban towns and districts, viz. (the "outer ring"), all with the exception of the urban district of Penge (-0·6) show an increase. The rate of increase during the last intercensal period was less than during the four preceding decennia; it was, however, numerically greater than in any previous period, representing an addition of 684,867 persons. In London the population of the Administrative County was 4,522,961, a decrease of 13,306, as compared with 1901. The population of Greater London (Outer and Inner Rings) was 7,252,963, showing an increase of well over half a million persons since the previous census. The same tendency towards decentralisation of the population is observable from the Census Returns in most of the great towns. One result of the publication of the Census Returns is that, with regard to our death-rates, these are shown to have been seriously understated during recent years, and that while we have been congratulating ourselves upon the results of increased public health administrative activity, we have been somewhat too optimistic. This fact strongly emphasises the need for a Quinquennial Census in the interest of more accurate statistical returns. Population. In 1901 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 fine), was 168,907. By the recent Census of 1911 the population of the Borough was shown to have decreased during the decennium to the extent of 1,164 (—0·7 per cent.). In this report the rates are based on the estimated population for the middle of the year 1911, viz., 167,765. In previous Annual Reports I pointed out that the population of the Borough as estimated by the Registrar-General, was probably over stated. His method of calculation is based upon the assumption that the rate of increase in the population during the last intercensal period was maintained during the subsequent years. The estimated population for each of the sub-districts is as follows:— East Battersea 69,760 North-West Battersea 49,143 South-West Battersea 48,862 11 The natural increase of population by excess of births over deaths during the year amounted to 1,977. Births. The total number of births belonging to the Borough of Battersea during 1911 was 4,381. Of the total births 2,161 were males and 2,220 females showing an excess of 51 females. The births were 108 fewer than in 1910 and 782 below the decennial average 1901-1910. The births in the sub-districts were as follows:— Males. Females. Total. East Battersea 945 976 1,921 North-West Battersea 773 816 1,589 South-West Battersea 443 428 871 Borough 2,161 2,220 4,381 The birth-rate, i.e., the number of births per 1,000 of the population, was 26·1, as compared with 23·7 in 1910. It should be remembered, however, that the rate during that of previous intercensal years was calculated on the estimated population of the Registrar-General, which is now shown to have been high, and that consequently the decline in the birth-rate in the Borough has not been so marked during the past live years, as shown by this method of calculation. There has been, of course, in Battersea as in England and Wales, and, in fact, in almost all civilised countries, a serious decline in the birth-rate during the past three decades. The causes responsible for this unsatisfactory state of things have been referred to in previous Annual Reports. While it is satisfactory to note that the birth-rate in Battersea, as shown in the following table has not declined to the extent that appeared from the method of calculation adopted, it is still sufficiently serious to be a matter for concern. In the sub-districts the birth-rates during 1911 were as follows: East Battersea, 27·5; North-West Battersea, 32·3; South-West Battersea, 17·8. The decline in the birth-rate in Battersea as compared with that in England and Wales is shown in the following table:— 12 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 1910 24·8 27·6 23·7 1911 24.4 24·8 26·1 The next table shows the birth rate in the Borough and in each of the sub.districts during the ten years 1901.1910 and in 1911:— Birth.rate per 1,000 Population. Year. The Borough. East Battersea. North.West Battersea. South.West Battersea. 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 1909 23·9 26·5 31·9 13·9 1910 23·7 26·6 30·5 14·8 Average 1901-1910 26·5 29·2 32·3 17·5 . 1911 26·1 27·5 32·3 17·8 13 Marriages. The marriages registered in Battersea during 1911 number 1281 and are 107 less than the decennial average. The marriagerate, i.e., the number of persons married per 1,000 of the population was 15·2 or 0·3 below the decennial average. Deaths. The total number of deaths registered in the Borough of Battersea during the year 1911 was 2,437 as compared with 2,163 during 1910 and a yearly average of 2,849 in the old Parish of Battersea for the decennium 1891-1900. Of the total deaths registered 1,264 were male and 1,173 females showing an excess of 91 males. The death rate for Battersea is therefore 14·5 per 1,000 inhabitants as compared with 15·0 for London. This rate is, however, uncorrected and on analysing the 2,437 deaths registered in the Borough of Battersea it is found that 506 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted: but on the other hand there are 473 deaths of Battersea residents and these must be added giving a corrected number of deaths for Battersea during 1911 of 2,404 (1,239 males and 1,165 females) an excess of 74 males, and a corrected death-rate of 14·3 as compared with 15·8 for London (the total corrected number of London deaths being 67,826). A further correction can be made according to age and sex distribution. This is a more satisfactory method for ascertaining the healthiness of a district. The death-rate for 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. Sub-dividin the death-rate amongst the three registration sub-districts it will be noted that in all there has been an increase in the death-rate, most marked in the North West district. As in the case of the birth-rate calculation, it should be remembered that the higher death-rate recorded in Battersea during 1911, as compared with 1910 and the previous 4 or 5 years, is calculated on the estimated population as ascertained from the recent census, and to a large extent accounts for the disparity. The following table shows the death rates per 1,000 of the population in the Borough and the sub-districts for the ten years 1901-1911. 14 Death-rate per 1,000 Population. Year. The Borough East Battersea. North-West Battersea. South-West Battersea. 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 1909 13·0 14·0 16·5 8·7 1910 11·3 11·9 13·9 8·3 Average 1901-1910 13·7 14·6 16·6 9·7 1911 14·3 14·9 16·8 10·9 It is apparent from an examination of the above table that the death-rate for the Borough has for the past 3 or 4 years been under stated, and that the actual figures as calculated on the recent census return represent a more normal condition for Battersea. In the following table is shown the number of deaths and the death-rates in the Nine Wards into which the Borough is divided:— Ward. Population Census 1911. Number of Deaths. Death Rates. Nine Elms 27,376 464 16·1 Park 17,592 272 15·4 Latchmere 20,094 273 13·6 Shaftesbury 16,031 207 12·9 Church 19,377 320 16·5 Winstanley 20,247 357 17·6 St. John 8,216 82 9·9 Bolingbroke 18,495 228 12·3 Broomwood 20,315 201 9·9 It is interesting to note the place the Borough takes during 1911, in the Registrar-General's corrected returns, amongst the 15 twenty-nine Metropolitan Boroughs. There are 17 Boroughs with a higher general death-rate and only 8 of the 29 Boroughs have a lower death-rate than Battersea. 15 Boroughs have a higher zymotic death-rate and 15 a higher infantile-mortality rate. Taking the ten south Metropolitan Boroughs, Lewisham has the lowest general death-rate (11.3) and Bermondsey and Southwark the highest (each 18·4): Only three of the ten Southern Boroughs have a lower death-rate than Battersea. London as a whole has a birth-rate of 24·8, a corrected zymotic (death) rate of 2·2 per 1,000 and an infantile mortality (corrected) rate of 129 per 1,000 births. For England and Wales the figures are Birth-rate 24·4, death-rate 14·6, infantile mortality 141, per 1,000 births. The corrected number of deaths of males and females registerd in each quarter of the year is set out as follows :— Males. Females Total. First quarter 358 374 732 Second quarter 269 238 507 Third quarter 326 289 615 Fourth quarter 286 264 550 16 Comparative Statistics of Births, Mortality, &c· Year· Mean population for year· Births· Birth Rate· Deaths, Death Hate· Zymotic Deaths· Natural Increase· 1857 15,970 582 36· 0 343 21·4 46 239 1858 16,872 562 33·3 380 22·5 100 182 1859 17,774 685 38·5 394 22·1 96 292 1860 18,676 680 36·4 399 21·3 62 281 1861 19,582 750 38·3 595 25· 7 112 245 1862 23,108 784 33·9 491 21·2 106 293 1863 26,635 1,042 39·1 522 19·5 86 520 1864 30,161 1,140 37·7 669 22 1 129 471 1865 33,688 1,357 40·2 785 23·3 177 572 1866 37,145 1,386 37·3 1,002 26·9 244 384 1867 40,741 1,734 42·5 870 21 ·3 122 864 1868 44,267 1,975 44·6 1,046 23·6 194 929 1869 47,749 2,096 43·8 1,121 23·4 247 975 1870 51,320 2,170 42·2 1,375 26·7 404 795 1871 54,847 2,220 40·4 1,472 26·8 463 748 1872 60,244 2,349 38·9 1,202 19·9 220 1,147 1873 65,614 2,659 40·5 1,307 19·9 205 1,352 1874 70,984 2,865 40·3 1,387 19·5 238 1,478 1875 76,354 3,080 40·3 1,724 22·5 307 1,356 1876 81,704 3,455 42·2 1,745 21·3 340 1,710 1877 87,094 3,481 39·9 1,725 19·8 280 1,756 1878 92,464 3,748 40·5 1,803 19·4 322 1,945 1879 97,834 4,001 40·8 1,980 20·2 355 2,021 1880 103,204 4,095 39·6 2,040 19·7 383 2,055 1881 108,342 4,452 41·8 2,033 18·7 381 2,419 1882 112,661 4,504 39·9 2,214 19·6 353 2,190 1883 116,980 4,711 40·2 2,344 20·0 369 2,367 1884 121,299 5,275 43·4 2,569 21·1 568 2,706 1885 125,618 5,654 37·0 2,566 20·4 432 2,088 1886 129,937 5,140 36·5 2,477 19·0 398 2,663 1887 134,256 5,186 38·6 2,451 18·2 502 2,735 1888 138,565 5,061 36·5 2,187 15·7 363 2,874 1889 142,884 5,161 36·1 2,240 15·6 366 2,921 1890 147,203 5,105 34·6 2,854 19·3 543 2,251 1891 150,880 5,237 34·7 2,697 17·9 398 2,540 1892 153,778 4,990 32·4 2,782 18·1 439 2,208 1893 156,719 5,225 33·3 2,974 18·9 614 2,251 1894 159,724 5,024 31·4 2,577 16·1 526 2,447 1895 162,787 5,264 32·3 2,961 18·1 460 2,303 1896 165,309 5,358 32·4 2,994 18·1 642 2,364 1897 166,059 5,266 31·7 2,737 16·4 486 2,529 1898 166,814 5,157 30·9 2,892 17·3 531 2,265 1899 167,570 3,179 30·9 2,905 17·3 418 2,274 1900 168,339 5,161 30·6 2,978 17·6 435 2,183 1901 169,100 5,025 29·7 2,766 16·3 491 2,259 1902 171,401 4,844 28·2 2,581 15·0 367 2,263 1903 173,422 4,973 28·6 2,476 14·2 347 2,497 1904 175,465 4,849 27·5 2,543 14·4 353 2,306 1905 177,532 4,843 27·3 2,561 14·4 375 2,282 1906 179,622 4,654 25·9 2,384 13·2 338 2,270 1907 181,736 4,574 25·1 2,406 13·2 255 2,168 1908 183,873 4,629 25·1 2,272 12·3 238 2,357 1909 186,036 4,45(1 23·9 2,417 12·9 283 1,033 1910 188,222 4,489 23·7 2,124 11·3 242 1,365 1911 167,765 4,381 26·1 2,404 14·3 331 1,977 The years marked thus were census years· . 17 Deaths in Public Institutions. During the year 1911 the deaths of Battersea residents occurring in Public Institutions numbered 857 as compared with 735 in 1910. Of this number 384 occurred within and 473 outside the Borough. Four hundred and fifteen occurred in Workhouses or Union Infirmaries as against 370 in 1910 and 470 in 1909. 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 distiicts and has come to be regarded as a sensitive index of the Sanitary condition of a district. In recent years much attention has been devoted to this subject by health authorities and there has in consequence been a marked improvement in the vital statistics of the Country. Last year the lowest infant mortality ever previously recorded was registered throughout England and Wales, and compared with the average for the decennium 1901-1910, there has been a decline of 26 per 1,000. Owing, however, largely to the very hot, dry and prolonged summer, which was experienced during 1911, there was again noticeable a considerable rise in infant mortality: an increase of about 30% over that of the record low rate of 1910. Battersea, in common with the rest of the Metropolis and throughout Kingdom generally, suffered a temporary set back from the satisfactory position which had been gained by years of sound sanitary administrative action in dealing with infant mortality. The causes responsible for this set-back were first and most important, the epidemic of summer diarrhoea which prevailed during the third quarter of the year, and secondly and less serious, the severe outbreak of measles which existed in the early part of year. Notwithstanding, it is satisfactory to note that the infant death-rate in Battersea compares favourably with the figures for the decennium 1901-1910, as will be seen from an inspection of the table on page 18. Infant Mortality in Battersea in 1911. During the year 1911, the deaths of 546 infants were registered in the Borough of Battersea. The total number of births registered during the year was 4,381, a decrease of 108 births from those of 1910, giving an infant mortality rate of 124 per 1,000. This was an increase of 27% over the rate for 1910 which was the lowest ever previously recorded in Battersea, viz., 97 per 1,000. 18 Since the formation of the Borough and for the previous decennium the infant mortality in Battersea and in London has been as follows:— Year· 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 1910 103 97 1911 129 124 In the County of London during 1911 there was a total of 14,440 infant deaths registered, giving an infantile mortality rate of 129 per 1,000 births, as compared with 11,809 deaths giving an infantile mortality rate of 108 per 1,000 births in 1910· The next table is shown the distribution of the 546 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 252 131·1 North-West Battersea 215 135·3 South-West Battersea 79 90·7 The Borough 546 124·6 The next table shows 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 of life respectively:— 19 Certified Causes of Death. Months· 0-3. Months· 3-6. Months. 6-12. Total. Diarrhoea 47 55 84 186 Prematurity 64 — — 64 Marasmus and debility 45 7 10 62 Developmental disease 25 2 2 29 Bronchitis 18 13 14 45 Pneumonia 12 11 30 53 Convulsions 5 2 7 Suffocation — — — Measles 2 2 14 18 Whooping cough 6 5 11 22 Tuberculosis 2 5 9 16 Meningitis 1 1 3 5 Miscellaneous 22 5 12 39 249 108 189 546 From the above table it will be noted (a) that the mortality is heaviest in the first three months of life: (b) that three groups of diseases between them account for 341 (i·e·, 62·6%) of the total deaths of infants during 1911, viz·:—Diarrhoea, prematurity, and respiratory diseases. Looking more in detail into these figures it will be seen that of the 546 infant deaths, 186 (i·e·, 34 per cent·) were due to diarrhoeal disease, the result mainly of the unfavourable climatic conditions prevailing during the summer of 1911. The deaths from Congenital and developmental diseases were somewhat higher (17 per cent·) than in the preceding year. The respiratory group show a slight increase as compared with 1910. Preventive Measures, The causes responsible for these 546 infants' deaths were enquired into by the Health Department' of the Council· The chief preventive measures carried out by the Council in relation to infant mortality may be classified under the following heads. 1· Notification of Births Act. 2· Health Visitors. 3· Milk Depot. 20 Notification of Births Act. This useful Act was passed to provide for early notification of Births to the Medical Officer of Health, and so to avoid the delay which arose through late registration of these births. In this way valuable assistance has been given to health authorities in their efforts to prevent a high death-rate amongst infants. The Act has now been in force in the Borough for the past four years, and provides that the birth of every child shall be notified to the Medical Officer of Health within 36 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." For default in notification a penalty of 20s. is provided. During the year 1911, 2,889 notifications of births were received. Of the number 1,123 (i.e., 39 per cent.) were notified by Medical Practitioners, 755 (i.e., 26 per cent.) by midwives and 1,011 (i.e., 35 per cent.) by other persons. The number of births notified from each of the three sub-districts of the Borough was as follows:— East Battersea 1,241 North West Battersea 1,047 South West Battersea 601 The number of births registered in Battersea, during 1911 was 4,381. The proportion of notified to registered births was therefore 69·5 per cent, as compared with 70 per cent, in 1910 and 69 per cent, in 1909. It will be noted from a comparison of the births registered with the notified births that the requirements of the Notification of Births Act, are still not being fully complied with. The Act has now been sufficiently long in force to permit of its provisions being widely known to the Public. That this is not so, however, notwithstanding the efforts of the Council to bring to the notice of all persons upon whom the duty of notification devolves, their liability under the Act, is evident from the large number of pleas of ignorance of the Act, sent in by many of those whose attention has had to be drawn to their default. During the year steps have been taken to ascertain the cause of the failure to notify in every case and a cautionary letter has been sent to those who are found to have failed to comply with the provisions of the Act. No prosecutions have been made during 1911 for default in Notification. 21 Of the total number (2,889) of births notified during the year 1,025 were visited by the Council's Health Visitors. In addition 770 revisits have been made and the Voluntary workers of the Battersea Voluntary Health Society have also paid a considerable number of visits, mainly revisits to births already visited by the Councils Visitors. It has not been possible during 1911 to pay so many visits to the homes from which births have been notified owing to the resignation of Miss Fairbairn, one of the Council's (female) Workshop Inspectors, rendering necessary rearrangement of the work of the Outdoor Sanitary Staff of the Health Department. The value of the work carried out by the Council's Health Visitors in connection with the Notification of Births Act is from the educational standpoint, inestimable, and is one of the most useful features of the Council's Public Health Work. During the year 1911, attention has been given to those districts of the Borough where from the circumstances and status of the inhabitants the services of the Health Visitors were most likely to be of use. These localities are situate mainly in the most congested areas of North West and East Battersea. The following is a summary of the results of the enquiries made into these 1,025 births:— The enquiries made had reference to the (a) Mothers; to health and occupation of; number of children; whether mother attended in her confinement by a doctor or midwife; condition of the home and number of rooms occupied. (b) Child; condition of health at birth and nature of food given. As regards the mothers of these 1,025 children visited by the Health Visitors in the majority of cases the parents were found to be in good or fair health. In 597 instances a doctor had been in attendance at the birth; in 380 cases the mother was attended by a midwife. In 23 cases an uncertified nurse or midwife was in attendance at the birth as compared with 29 cases in 1910 and 65 cases in 1909 attended by an uncertified person. In the following table will be found particulars relating to the family history of the mothers of these children and their circumstances as regards dwelling house accommodation;— 22 No. of previous Children in family. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 169 123 128 105 110 71 72 60 27 29 18 7 6 4 1 1 No. of previous Deaths of Children in Family. 1 2 3 4 5 6 7 8 9 137 75 35 5 9 4 2 — 2 No. of Rooms occupied by Family. 1 2 3 4 5 6 Caravans. 97 239 393 139 19 11 2 Sanitary Condition of Homes. Forty-one of these 1,025 homes were found to be very dirty and 184 others showed evidence more or less of uncleanliness. On the whole these figures compare favourably with those of previous years (vide previous annual reports) and points to a progressive tendency as regards the advantages of personal cleanliness. As regards the child : health at birth:— Of the 1,025 infants visited at their homes the state of health was ascertained to be as follows:— Two hundred and twenty-five were at the time they were first visited more or less seriously ill. The diseases from which these children suffered embraced the following. Indigestion, Syphilis, Wasting, Bronchitis, Ophthalmia, Naevus, Cleft Palate and Hare-lip, Immaturity, Congenital Debility and Prematurity, Catarrh of Bowels, Thrush, Rickets, Marasmus, Constipation, Rupture, Deformed Foot, Convulsions, Jaundice, Diarrhoea, Intussusception, &c. Of the 1,025 infants information as to the feeding was obtained with the following results. Breast fed only 794 Infants' Milk Depot 78 Cow's milk, Condensed milks, &c. 142 23 Most of these children it will be observed were, when first visited, found to be breast-fed, but it must not be assumed that this desirable state of things continued during the child's first year of life. Generally it is found that on subsequent visitation a very considerable proportion are found to have been for some reason, such as failure of breast milk, going out to work of mothers, &c., wholly or in part deprived of the natural milk supply, and some form of artificial feeding substituted. Cows milk is found to be the most usual form of food substituted, and as pointed out in last year's annual report there is a growing tendency to the use of cows milk in preference to condensed milk, due no doubt, to the persistent efforts of the Council to bring to the notice of the mothers the advantages of the former over the latter as a food for babies unable to be fed on the breast. The visits of the Health Visitors continue to be greatly appreciated by the mothers and have produced excellent results in the reduction of infant mortality in the Borough. Thus Miss Moss in her report to me states "During 1911, 333 notified births have been visited against 290 in 1910, 47 per cent, of the babies were more or less ill as against 53 per cent, in 1910. The death rate for infants under observation (616 including Milk Depot) is 92 per 1,000 births as against 124 per 1,000 for the Borough. Owing to the press of other work it is impossible to visit a very large number and the revisits are not satisfactory in number; ideally each infant should be visited at least 4 times during the first year. Some of the delicate ones needing weekly supervision for at least the first three months, the weighing-room in a measure helps this deficiency." It is satisfactory to note, mainly, there can be little doubt, owing to the educational effect of these visitations, that many of the abuses carried out in the feeding and rearing of infants are gradually disappearing. Thus the long-tube bottle which can only be fitly described as a most unhygienic contrivance has almost disappeared, Miss Peacock who visited 692 births in 1911, finding it being used in only ten instances. In all but two of these, she was able to persuade the mothers to give up using this form of bottle, and in regard to these two, in one case the child was subsequently removed to the Infirmary where it died, and the other child was removed from the district, the mother promising to discontinue the use of this form of bottle. Infants' Milk Depot. During the year 1911, the number of infants fed from the Council's Infant's Milk Depot, was 470 as compared with 492 in 1910. Of this number 431 were resident in Battersea and the remaining 39 in adjoining districts. The age at which these children commenced taking the milk and the length of time fed are shown in the following table:— 24 MILK DEPOT.—Table 2. Age Started. Period Fhd. Totals. 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. Under 1 wk 1 2 1 1 9 3 6 •• 1 •• •• 2 2 1 3 9 41 1-2 wks. •• 2 •• 1 7 3 3 3 •• 2 2 2 1 1 3 5 35 2-3 „ •• •• •• 1 3 4 3 •• •• 1 1 2 2 1 1 4 23 3-4 „ •• •• 1 •• 2 •• 1 2 1 2 2 •• •• 1 2 1 15 1-2 mos. •• 3 6 6 11 12 8 4 2 1 6 5 6 6 3 7 86 2-3 „ •• 3 4 3 8 7 6 6 6 3 2 2 1 5 5 8 69 3-4 „ 1 4 4 3 6 3 7 6 2 4 2 1 5 1 4 9 62 4-5 ,, •• 1 •• 1 4 6 2 2 1 3 •• 1 3 1 5 4 34 5-6 „ •• 1 •• •• 3 2 3 3 •• 5 2 1 •• •• 2 2 27 6-7 „ •• •• •• 1 1 4 4 4 1 1 •• 1 •• 1 •• 3 24 7-8 „ •• •• •• 2 1 2 1 .. •• 1 3 .. .. 1 1 2 14 8-9 „ •• •• •• 2 1 3 1 •• 2 1 •• 2 •• •• •• 1 14 9-10 „ •• 1 •• •• •• 1 1 1 1 •• •• •• •• 2 •• •• 7 10-11 „ •• 2 •• •• •• 2 1 1 •• •• •• •• •• •• •• •• 6 11-12 „ •• 2 .. •• •• •• •• 1 3 .. 1 •• •• •• •• •• 7 Over 1 year. •• •• •• 1 2 •• 2 1 •• •• •• •• •• •• •• •• 6 Totals .. 4 21 18 22 60 52 49 31 20 24 21 19 21 21 29 55 470 25 Of the 470 infants fed from the Milk Depot 347 were admitted during 1911, of the children admitted during the year 346 were more or less seriously ill on admission from various ailments. The state of health on admission of the infants' fed from the Milk Depôt during the year are classified in the Registers as follows:— Good health, 57; immaturity and prematurity, 21; congenital syphilis, 17; indigestion, 28; diarrhoea, 47; malnutrition, 25; sickness, 5; wasting, 41; rickets, 9; congenital debility, 35; bronchitis and pneumonia, 10; tuberculosis, 6; anaemia, 1; teething, 2; constipation, 13; whooping-cough, 3; opthhalmia, 1; epileptic, 1; infantile paralysis, 1; measles, 1; thrush, 3; hare-lip and cleft palate 2; eczema, 2; meningitis, 2; other diseases, 6; no information, 7. The great majority of the children fed from the Milk Depot were not as in past years, it will be seen from the above list, from a normal population. There was a considerable increase in the number of depot fed infants suffering from diarrhœa in 1911 as compared with previous years, owing to the abnormal meteorological conditions prevailing in that year. The total number of deaths amongst the children fed from the milk depot was 56 giving a death-rate of 119 as compared with 124 the general infantile mortality for the Borough. The rate was considerably higher than in 1910, and is accounted for by the very large number of sick children who were admitted during the year. No less than 17 {i.e. 30 per cent.) of the dead children were taking the milk for one week or under, some of them only for a day or two, having as a last resort been given this food. It is of course impossible to regard the infants fed on the Milk Depot as a normal infant population nor on the other hand can the method of calculating the death-rate be considered satisfactory, for reasons pointed out in previous annual reports. The two weighing-rooms which have been provided by the courtesy of the Baths Committee at the Latchmere Road and Nine Elms Baths have proved of much service in connection with the Council's Infants Milk Depôt and the work of the Health Visitors during the year. The weighing-room at the Latchmere Baths which is very centrally situate is open on two afternoons a week, and that at the Nine Elms Baths, one afternoon a week, the hours of attendance being from 3 o'clock to 5. The children are brought by the mothers to be weighed weekly or fortnightly and the practice has proved a very popular feature of the Council's efforts in the prevention of Infant Mortality. By this means a continuous supervision is maintained over the children fed from the Milk Depot, the weight of each child being recorded and its progress noted. The mothers sre also advised by the Health Visitors in such cases as may be found necessary and any serious deviations 26 from the normal progress of the infants are reported to the Medical Officer of Health. Some success is being obtained by the health visitors also in endeavouring to induce mothers to discontinue the use of those useless and dangerous contrivancies known by the name of dummies. It is most gratifying to find that the work of the Official Health Visitors and female Sanitary Inspectors is proving so successful, more especially in connection with child life, and that these Officers' visits are so greatly appreciated bymothers. The following is a summary of the work done by the Health Visitors and female Sanitary Inspectors during 1911:— Visits paid by Health Visitors to homes of infants admitted to Milk Depot 1,226 Attendances of Health Visitors at Weighing-rooms 146 Number of infants attending Weighing-rooms 306 Weights registered 3,903 Number of infants under observation at home 98 Senile Mortality. During the year 1911 in the Borough of Battersea 591 deaths of persons aged 65 years and upwards were registered. The age distribution of these deaths is set out in the following table:— District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. East Battersea 131 86 29 246 North-West Battersea 80 48 21 149 South-West Battersea 106 69 21 196 Borough of Battersea 317 203 71 591 The 591 deaths over 65 were equivalent to 24 per cent, of the deaths at all ages. The deaths over 65 in each year during the nine years 19031911 were:— 1903 404 1904 508 1905 537 1906 495 1907 510 1908 564 1909 630 1910 510 1911 591 27 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 1911. Total Sanitary Operations 77,055 Number of house inspections 45,390 Bakehouse inspections 227 Bakehouse nuisances abated 50 Urinals—inspections 190 Do. altered, repaired or water laid on 60 Intimations served under Sec. 3 4,351 Notices served under Sec. 4, &c. 1.24s Notices served under Sec. 62 &65 2,915 Complaints received &attended to 3,403 Number of houses disinfected 3,394 houses supplied with disinfectants 3,513 House drains flushed with disinfectants after infectious disease 2,515 Overcrowding abated 84 Premises improved, cleansed and repaired 3,383 Drains tested By smoke. 743 „ water. 3,276 Drains cleansed and repaired 434 Drains relaid 546 Frontage drains constructed or re-constructed 79 Soil-pipes and drains ventilated 128 Sink and rain water pipes disconnected or repaired 684 Water Closets cleansed&repaired 566 Cesspools abolished 1 Mews & Stables drained & paved 4 Yards and forecourts paved and repaired 545 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 43 Dust receptacles provided 431 Leaky house-roofs and gutters repaired 458 Houses supplied with water, and fittings repaired 171 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 634 Cisterns covered, cleansed and repaired 752 Additional water supplies to upper floors 148 Keeping of animals in unfit state discontinued 39 Smoke observations 62 Certificates of disinfection granted 1,748 Houses inspected and certificates granted (Sec. 48) 74 Proceedings ordered by Council and Health Committee 3,649 Summonses issued 115 Magisterial Orders obtained and enforced 51 Factories, Workshops,&c.,inspections 3,609 Sanitary conveniences provided or improvements effected in Factories&Workshops (Sec. 38) 262 Underground sleeping rooms disused 19 Gipsy van inspections 95 Drains laid to new houses and tenements 74 Samples taken under the Sale of Food and Drugs Acts 1,000 Miscellaneous 596 28 Sanitation of House Property. The systematic inspection of house property is carried out by eight district inspectors, the Borough for this purpose being divided into eight sanitary districts. During 1911 the total number of houses inspected in house-tohouse inspection was 2,736 as compared with 3,441 in 1910. The following is a summary of the number of houses inspected in each year since 1901:— 1901 3,009 1902 1,740 1903 2,670 1904 3,020 1905 4,503 1906 3609 1907 4,101 1908 3,609 1909 3,218 1910 3,441 Average for the ten years 1901-1910 3,292 1911 2,736 The number of houses inspected it will be seen has varied from year to year. The fluctuations in this important branch of Sanitary administration work are due to the varied nature of the duties of the district Sanitary Inspectors. In years when infectious diseases are unduly prevalent a good deal of their time is taken up with securing the isolation or removal to hospital of patients, disinfection of premises, search for sources of infection, contacts, &c. The supervision of drainage work in connection with new buildings is a duty that takes up a good deal of time and during the last two or three years in two of the sanitary districts, a considerable amount of new drainage has been carried out. During 1911 the number of houses inspected was the lowest since 1903. The loss of the services for 8 or 9 months of one of the most experienced of the district inspectors owing to his having met with a serious accident and the resignation of the female workshop Inspector rendering it necessary to rearrange the work of the outdoor sanitary Staff were additional factors which are responsible for the decrease. The following summary shows the number of houses inspected and the number of defects found in each of the sanitary districts in 1911 29 Summary. House-to-House Inspection. District No. No. of houses inspected. No. of houses in which defects found. 1 379 257 2 478 299 3 284 265 4 293 171 5 256 123 6 259 118 7 293 219 6 494 217 Totals 2,736 1,669 The percentage of houses in which Sanitary defects were, on inspection, found to exist was 61.0 as compared with 53.2 in 1910, and varied from 44.0 per cent, in No. 8 district to 94.0 per cent, in No. 3 district. 30 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 found. Name of Road. No. of houses inspected. No. of houses in which defects found. Name of Road. No. of houses inspected. No of houses in which defectsfound. Ascalon Street 72 36 Benham Street 29 8 Broxash Road 86 35 Austin Road 53 35 Cottage Place 24 15 Craven Mews 3 2 Carpenter Street 80 55 Fords Place 52 52 Culmstock Road 21 12 Ceylon Street 35 26 Grant Road 34 19 Devereux Road 58 20 Cherwell Street 8 8 Green Lane 6 6 Elspeth Road 79 58 Haines Street 30 14 Henry Street 39 29 Forthbridge Road 63 48 Havelock Terrace 38 22 Latchmere Road 18 10 Gayville Road 62 29 Landseer Street 43 24 Lavender Road 93 46 Kyrle Road 18 5 Latchmere Road 17 9 Little Europa Place 72 72 Manchuria Road 96 42 Mundella Road 52 44 Livingstone Road 3 1 Marmion Mews 2 2 Orkney Street 47 26 Meyrick Road 25 15 Northcote Road 42 25 Park Grove 58 35 Newcomen Road 14 10 Roseneath Road 21 10 Parkside Street 71 40 Orville Road 76 76 St. Johns Hill Grove 31 11 Savona Place 40 24 Parkham Street 15 15 Stormont Road 7 7 Seldon Street 17 11 Stainforth Road 90 66 Taybridge Road 139 102 Sterndale Road 76 66 Steelworks Road 17 6 Vardens Road 38 15 Tweed Street 31 18 Wilson Street 65 47 Webbs Road 18 10 Warriner Gardens 23 37 Winders Road 26 10 Winsham Grove 72 38 Warsill Street 30 26 Winstanley Road 8 4 Wickersley Road 122 65 York Road 79 31 William Street 18 10 Wycliffe Road 134 58 Totals 1,095 669 Totals 785 538 Totals 856 462 31 Housing- and Town Planning Act, 1909. This Act imposes upon sanitary authorities duties of a most important character in connection with the sanitation of house property. Under sec. 17 (1) the duty devolves upon the sanitary authority "to cause to be made from time to time inspection of their district with a view to ascertain whether any dwelling-house therein is in a state so dangerous or injurious to health as to be unfit for human habitation and for that purpose it shall be the duty of the local authority and of every Officer of the local authority to comply with such regulations and to keep such records as may be prescribed by the Local Government Board." The Board made an Order dated 2nd September, 1910, prescribing regulations under section 17 (1) of the Act, but the Council deferred action in connection with the Act until 1911. In April, 1911, the Council considered these Regulations and the Medical Officer of Health was instructed on the 10th May, 1911, to submit a report as to the arrangements to be made to comply with the requirements of the Order of the Local Government Board—(vide appendix). The suggestions contained in the report of the Medical Officer of Health were adopted. In October the Medical Officer of Health represented certain houses in Little Europa Place as being unfit for human habitation. The Health Committee inspected the houses in question on the 28th October. As notices under the Public Health (Lond.) Act, 1891 had been served on the owner, it was decided on the advice of the Borough Solicitor to postpone action under the Housing, Town Planning &c., Act, until the notices under the Public Health Acts were " out of time." The Housing, Town Planning &c., Act gives important powers to sanitary authorities in relation to underground rooms. The Act provides that an underground room that is habitually used as a sleeping place must be at least 7ft. in height from floor to ceiling and must comply with such regulations as the sanitary authorities with the consent of the Local Government Board may make. The Public Health Act contained provisions specified in detail in the Act, for preventing the use as sleeping places of underground rooms separately occupied as dwellings, but these provisions were rendered practically useless by the fact that they do not apply if the rooms are at the same time occupied with a room or rooms on an upper floor. The Council have made the following regulations which have been duly approved by the Local Government Board and are now in operation in the Borough. 32 Regulations. Regulations made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea under the Housing, Town Planning, &c., Act, 1909, with respect to Underground Rooms habitually used as sleeping places. Whereas by Section 17 of the Housing, Town Planning, &c.. Act, 1909, it is enacted as follows:— Sub-Section 7.—A room habitually used as a sleeping place, the surface oi the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room shall, for the purposes of this Section, be deemed to be a dwelling house so dangerous or injurious to health as to be unfit for human habitation if the room either— (а) Is not on an average at least seven feet in height from floor to ceiling; or, (б) Does not comply with such regulations as the Local Authority, with the consent of the Local Government Board, may prescribe for securing the proper ventilation and lighting of such rooms and the protection thereof against dampness, effluvia or exhalation. Provided that if the Local Authority, after being required to do so by the Local Government Board, fail to make such regulations or such regulations as the Board approve, the Board may themselves make them, and the regulations so made shall have effect as if they had been made by the Local Authority with the consent of the Board. Provided that a Closing Order made in respect of a room to which this sub-section applies shall not prevent the room being used for purposes other than those of a sleeping place ; and that, if the occupier of the room, after notice of an Order has been served upon him, fails to comply with the Order, an Order to comply therewith may, on summary conviction, be made against him. Now, therefore, we, the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea, being the Local Authority for the said Metropolitan Borough, hereby prescribe the following regulations with which a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply, namely:— (а) Such room shall in every part thereof have at least three feet of its height above the level of the surface of the street or ground adjoining or nearest to such room. Provided that, if the width of the area hereinafter mentioned is not less than the height of the room from the floor to the said surface or is not less than six feet, the height of the room above such surface may be less than three feet, but not in any case less than one foot. (b) Every wall of such room shall be constructed with a proper damp- proof course, and, if in contact with the soil, shall be effectually protected against dampness from that soil by means of a vertical damp-proof course, or otherwise. (c) There shall be outside of and adjoining such room and extending along the entire frontage thereof and open upwards from six inches below the level of the floor thereof an area properly paved and effectually drained and at least four feet wide in every part thereof, provided that the width of such area may not be less in any part than three feet, if the mean width of the area be not less than four feet; provided also, that in the area there may be placed steps necessary for access to the room, and over and across such area there may be 33 steps necessary for access to any buildings above the room, if the steps are so placed in such case as not to be over or across any external window of the room. (d) The space, if any, beneath the floor of such room shall be provided with adequate means of ventilation. (e) Every drain passing under any such room shall be properly structed of a gas and watertight pipe with gas and watertight joints. (/) Such room shall be effectually protected against the rising of any effluvia or exhalation by means of a layer of good cement concrete at least six inches thick laid upon the soil of the site of the entire room, or by some other equally effective means. (g) Every such room which is without a fireplace and a flue properly con- structed and properly connected with such fireplace, shall be provided with special and adequate means of ventilation by a sufficient aperture or air-shaft, which shall provide an unobstructed sectional area of 100 square inches at the least. (h) Such room shall have one or more windows opening directly into the external air, with a total area clear of the sash frames equal to at least one-tenth of the floor area of the room, and so constructed that one-half, at least, of every such window can be opened, and that the opening may in every case extend to the top of the window. A special inspection was begun of. underground rooms in certain streets of the Borough during the autumn of 1911. In Landseer Street a large number of basement rooms were found to be occupied in contravention of the Act. The total number of rooms inspected was 78, of which 35 were found to be illegally occupied. The structural defects and the number of rooms in which defects were found were as follows:— No proper area provided 35 Space beneath floor insufficiently ventilated 35 Site not concreted 35 Other defects 20 In 14 cases the illegal occupation of the rooms was at once discontinued. In the remaining cases the owners were called upon to carry out the necessary structural alterations to make the rooms comply with the Act and the regulations made thereunder within a reasonable time, and were informed that in default of compliance Closing Orders would be made by the Council. Houses Let in Lodgings. In the Borough of Battersea there are a small 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 1910, 123 premises were on the register and no additional house was registered during the year. 34 The sanitary condition of these premises is governed by bylaws which were revised in 1904 and having been duly approved by the Local Government Board are at present in force in the Borough. Owing to the passage of the Housing and Town Planning, &c., Act, 1909, the by-laws will have to be remade so far at least as they relate to houses intended for the working classes. In the case of Arlidge v. Borough of Islington, a by-law was held to be bad under sec. 94 of the Public Health (London) Act, 1891, because it required the landlord who had let the house and has no right of entry to do works in the house to comply with the by-law. Section 16 of the Housing, Town Planning, &c., Act, 1909, reverses that decision. The by-laws are at present under the consideration of the Council. During 1911, frequent inspections of the houses-let-in-lodgings have been carried out. Smoke Nuisance. Emissions of black smoke were reported during the year on 62 occasions. In 54 instances these were reported by the Coal Smoke Abatement Society, in 4 by the Council's Sanitary Inspectors, and in 4 cases by the London County Council. Twentytwo preliminary and 2 statutory notices were served, but no legal proceedings were taken during the year. Paving of Yards and Forecourts. The following table shows the number of backyards and forecourts wholly or partly paved during 1911. Sanitary District. Backyards. Forbcourts. Wholly paved. Partly paved. Wholly paved. Partly paved. 12 ft. or more from back addition. Less than 12 ft. from hack addition. 1 5 - 77 25 7 2 4 4 28 7 1 3 12 - 35 9 6 4 9 2 22 2 15 5 4 - 226 2 2 6 2 - 16 1 — 7 2 1 9 5 2 8 — - 2 1 — Totals 38 7 415 52 33 35 Street Paving-. This important and useful hygienic work has been continued during the year, several additional streets having been paved with impervious material, to the already considerable number thus paved. I am convinced that much benefit has resulted from the adoption of this method of paving of the side streets in the poorer districts of the Borough and I have shown in past annual reports that in the improved position which the Borough has attained in recent years in regards to its vital and morbid statistics is to some extent to be attributed to this hygienic innovation. This is not surprising when it is borne in mind that these streets form the playgrounds of the children who dwell in them, and that, moreover, much less dust is formed and that they are more readily scavenged. During 1911 the following streets were paved with impervious material. Square Yards. Arden Street 850 Ceylon Street 882 Cherwell Street 552 Currie Street 1,562 Everett Street 1,820 Mantua Street) Wye Street ) Parts of 704 Tweed Street 1,118 Woodgate Street 1,692 Total 9,180 sq. yds. Sewer Ventilation. During the year complaints were received on several occasions of nuisance arising from sewer ventilators on the surface of the roadway or from upcast columns. These complaints were in each instance fully enquired into and dealt with by the Council. In two instances it was found necessary to erect upcast ventilating shafts in the following situations:— Heaver Road. Webbs Road. Van Dwellings. The number of van dwellings in Battersea during 1911, was 74 as compared with 78 in 1910. In the following table are set out the situation and number of occupants:— 36 Situation of Vans. No. of Vans. No. of Occupants. Males. Females. Mill's Yard, 88 Sheepcote Lane 5* 7 5 80 4* 4 4 Land rear of 383 Battersea Park Road 2 3 2 Manley's Yard, Falcon Road 4 5 6 Manley's Yard, Cabul Road 23† 27 32 Donovan's Ground, Cabul Road 19† 36 22 Rear of 55 Cabul Road 1 1 — Mill's Yard, Culvert Road 11‡ 16 22 " Gray's Fair," Lavender Hill 5 5 8 Total 74 104 101 * Including one shed. † Including one cottage. ‡ Including 1 shed and 1 tramcar. These vans undergo frequent inspection by the Councils' Sanitary Inspectors, both by night as well as day. During the year twenty-one vans were found to be overcrowded and notices under the by-laws were served where necessary to abate. Four cases of infectious disease were notified from amongst van dwellers during 1911. The patients were immediately removed to the Isolation Hospital and the usual further precautions taken to prevent the spread of infection. 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 July, 1895 Females 59 „ 24 Males and June, 1903 Females 89 28 Males August, 1885 91 30 Males Nov., 1887 6 Orville Road 18 Males June, 1902 67 Winstanley Road.. 66 Females July, 1910 37 Under the Common Lodging Houses Act, 1853-5 the London County Council has control of all the common lodging houses situate within the administrative county. All common lodging houses must be licensed annually by the London County Council, L.C.C. (General Powers) Act, 1902. Part IX., sec. 46. The common lodging houses in Battersea are visited from time to time by the Borough Councils' Sanitary Officers in connection with drainage defects, infectious disease, &c., &c. Block Dwellings. The following is a list of the Artizan's 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 Customs and Inland Revenue Act, 1903. During 1911, eight applications were received for the Certificate of the Medical Officer of Health under the provisions of the Revenue Act, 1903 in connection with 29 tenements (or dwellings) so constructed as to afford suitable accommodation for each of the families inhabiting such tenements. After inspection certificates were granted in respect of 12 tenements, the remainder having been refused or postponed. In the new Housing and Town Planning, &c., Act, 1909, a further extension has been made 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 6 pence a night for each person, if certified by the Medical Officer of Health to have one provision made for the sanitary requirements of the lodgers using such lodging houses. No applications were made for certificates in respect of this class of lodging house during 1911. 38 Water Supply. During the year 1911, 74 applications were received for certificates of water supply in accordance with sec. 48 of the Public Health (London) Act, 1891 and granted in each instance. Notices of withdrawal of supply for various reasons were received from the Metropolitan Water Board and in 4 instances the supply was reinstated under Notice. In one case it was found necessary to take proceedings to obtain a Closing Order in respect of a dwelling-house owing to the withdrawal of the water supply. Some difficulty was experienced in enforcing the Order but eventually the occupants moved out. Disinfecting Department. During the year 1911, 4,711 rooms and 38,952 infected articles were disinfected, as compared with 3,834 rooms and 48,205 infected articles in 1910. A total number (excluding chicken-pox) of 753 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, whooping cough, verminous houses, &c. In eighty instances schools or departments of schools were disinfected in connection with cases of infectious disease. The following table gives particulars of the work carried out at the disinfecting station since it was opened in 1902:- 1902. 1903. 1904. 1905. 1906. 1907 1908. 1909. 1910. 1911. Premises 1,161 1,187 1,215 2,589 1,991 2,995 2,418 2,656 2,337 3,394 Rooms 1,771 1,616 1,637 3,308 2,848 5,085 4,583 4,192 3,834 4,711 Articles disinfected 92,368 67,001 54,626 64,052 72,531 72,220 85,117 58,474 48,205 38,952 Articles destroyed 984 847 1,288 929 1,244 1,084 778 607 720 777 Books disinfected — 271 215 332 337 399 387 331 230 166 Persons admitted to shelter — — — 33 31 33 28 4 — — The laundry attached to the Station and which was opened in 1907 has been found a most useful addition. During the year 1911, 22,080 articles were after disinfection laundered before being returned to their owners. 39 The total weight of articles removed for disinfection during 1911 was 101 tons, 13 cwts. In addition to the work carried out in the disinfection of rooms, clothing, &c., bedding belonging to the Council was lent out during the year to persons whose bedding had been removed for disinfection. As soon as this bedding has been disinfected it is returned and the Council's bedding collected, disinfected and returned to store. The total weight of bedding belonging to the Council dealt with in this way and not included in the table on page 38 amounted to 5 tons, 5 cwts., 2 qrs. Verminous clothing weighing over 7 tons belonging to verminous persons cleansed at the Council's personal cleansing station, Sheepcote Lane, was disinfected at the disinfecting station during the year, and this also is not included in the return shown in the table. Temporary Shelter or House Accommodation. During 1911, at the reception shelter situate at Sheepcote Lane, eight midwives and six 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, two hundred and twenty-two persons including laundry hands, milk vendors, dressmakers, &c., 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 (established by the Council under the provisions of the Cleansing of Persons Act, 1897,), was largely availed of during 1911 by persons requiring the facilities therein provided. The total number of verminous persons cleansed and their clothing disinfected during the year was 1,650. Of the total number cleansed 1,439 were adult males, 20 adult females and 191 children, the latter coming mainly from the Public Elementary Schools. An agreement was entered into during the year between the London County Council and the Borough Council for the use of the latter Council's Personal Cleansing Station for the cleansing of verminous school children. The agreement provides for the payment to the Borough Council of the sum of two shillings per child cleansed, irrespective of the number of attendances before the child is certified as being cleansed. The term of the agreement is for 12 months and may be renewed at the option of the contracting parties. 40 The Midwives Act, 1902. The Midwives Act, in London is administered by the London County Council as the local supervising authority. The important duty of disinfection however devolves upon the Borough Councils. Rule V. of the rules framed by the Central Midwives Board states:— "Wherever a midwife has been in attendance upon a patient suffering from puerperal fever or from any other illness supposed to be infectious, she must disinfect herself and all her appliances before going to another labour. Unless otherwise directed by the local supervising authority all washable 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 this purpose. The midwife or monthly nurse who has been in attendance on a patient suffering from puerperal fever or other infectious illness is required to attend at the shelter and is given a disinfectant bath, her instruments, clothing, &c., being at the same time disinfected at the disinfecting station adjoining in one of the steam disinfectors. Mortuary. The total number of bodies received at the Mortuary in Sheepcote Lane during 1911 was 287 as compared with 234 in 1910 and 269 in 1909, and an annual average for the Old Parish of Battersea for the five years 1896-1900 of 288. On 277 of these bodies, inquests were held and ten bodies were received at the Mortuary for sanitary or other reasons. The following table give 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 1910 234 137 222 1911 287 173 277 41 Inquests. During the year 1911, inquests were held in 277 cases with the following results:— Natural causes 172 Open Verdict— Found dead 2 Found drowned 6 8 Accidental Causes— Drowning 3 Burns and Scalds 17 Poisoning 2 Falls, &c. 30 Run over (in street and on railway) 20 Suffocation 3 Other injuries 10 85 Suicide— Cut throat 1 Hanging and Strangulation 2 Poison 7 10 Homicide— Fractured Skull 1 Suffocation 1 2 Total 277 Ambulances. The Council have provided for some years past 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 Surrey Lane South 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 valuable service in connection with street accidents, &c. Each ambulance is fitted with the necessary appliances, dressings, &c., for rendering " first aid " to the injured. 42 Infectious and other Zymotic Diseases. Zymotic Diseases. The principal zymotic diseases are seven in number, viz., small pox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough "fever" (including typhus, enteric or typhoid and simple or continued) and 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 for the year 1911 arc on the whole very satisfactory though the death-rate from these diseases is slightly higher than the rate for 1910, which was the lowest zymotic death-rate previously recorded in the Old Parish or Borough of Battersea. The higher zymotic death-rate for 1911 is accounted for by the severe and fatal epidemic of measles which was prevalent during the earlier months of the year and by the high mortality from epidemic diarrhoea and enteritis among infants during the remarkably hot and prolonged summer. In the Borough of Battersea during 1911 there were registered from the principal zymotic diseases 331 deaths, giving a corrected zymotic death-rate of 1.97 per 1,000, the corrected death-rate for the County of London being 2.2, varying in the different Metropolitan Boroughs from 0.7 in Hampstead to 4.0 in Poplar. The zymotic death-rate varies considerably for the three sub-districts into which for registration purposes the Borough is divided. Thus in the North-West districts the rate was 3.03; in East Battersea the rate was 2.19 while in South-West Battersea the rate was only 0.59 per 1,000. This is in accordance with the rule that generally speaking the highest incidence and mortality from zymotic disease will be found in the less sanitary areas of the Borough, and is accounted for by the crowding and absence of facilities for home isolation in the two first-named districts as compared with the latter in which the 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 43. The number of deaths registered from the chief zymotic diseases during 1911 was 122 (i.e. 36.8 per cent), in excess of that for 1910, but was 20 fewer than the average for the ten years 1901-10. The following Table gives the death-rate from each of the chief zymotic diseases compared with the mean death-rate for the decennium 1901-10, the gain or loss in each case being also shown:— 43 Diseases. Mean Deathrate per 1,000 1901-1910. Death-rate per 1,000 1911. Gain in 1911. Loss in 1911. Small-pox 0.01 0.00 0.01 .. Measles 0.45 0.66 . . 0.21 Erysipelas 0.05 0.02 0.03 . . Scarlet Fever 0.08 0.02 0.06 . . Diphtheria 0.10 0.12 .. 0.02 Enteric Fever 0.05 0.02 0.03 . . Puerperal Fever 0.03 0.01 0.02 . . Whooping Cough 0.33 0.20 0.13 . . Diarrhœa 0.63 0.94 .. 0.31 In the next table is shown the death-rate per 1,000 population from the chief zymotic diseases arranged in Wards:— Ward. Population, Census 1911. Small-pox. Measles. Erysipelas. Scarlet Fever. Diphtheria Enteric, &c. Puerperal Fever. Whooping Cough. Epidemic Diarrhœa. All chief Zymotic diseases. 1. Nine Elms 27,376 •00 1•09 •00 •04 •22 •00 •00 •58 1•28 3•21 2. Park 17,592 •00 •45 •00 •00 •11 •00 •00 •17 •96 1•70 3. Latchmere 20,094 •00 •34 •04 •00 •00 •00 •00 •00 •84 1•24 4. Shaftesbury 16,031 •00 •31 •06 •12 •18 •06 •00 •18 •87 1•80 5. Church 19,377 •00 1•03 •00 •00 •10 •05 •00 •31 1•70 3•19 6. Winstanley 20,247 •00 1•53 •04 •00 1•97 •00 •00 •09 1•67 3•55 7. St. John 8,216 •00 •00 •00 •00 •12 •12 •12 •00 •00 0•36 8. Bolingbroke 18,495 •00 •32 •00 •00 •16 •00 •00 •10 •32 0•92 9. Broomwood 20,315 •00 •19 •00 •04 •00 •00 •04 •09 •09 0•49 In the next table the Seasonal Mortality from the different important zymotic diseases is well shown by arranging the deaths quarterly thus:— Quarter No. Small-pox. Measles. Whooping Cough. Scarlet Fever. Diphtheria. Fever. Diarrhœa. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus. Typhoid. Continued. 1 — 90 21 1 11 — — — 6 — 2 131 2 — 13 6 2 7 — - — 2 — 1 — 3 34 3 — 5 5 1 — — 1 — 135 2 - — — 149 4 — 3 2 — 3 — 2 — 16 1 1 — 6 34 Year — 111 34 4 21 — 3 - 159 3 2 — 11 348 44 Drains and sanitary fittings are tested as a routine procedure in all infected houses in cases of diphtheria, enteric and puerperal fever, and as regards other diseases in such instances as may be found necessary. The following table gives the drainage defects, &c., in houses in which cases of infectious disease were notified during 1911:— 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 182 19 21 40 22 78 Erysipelas 158 1 9 10 6 94 Scarlet Fever 271 6 22 28 10 90 Typhoid 19 2 5 7 37 63 Puerperal Fever 9 1 — 1 11 89 Total 639 29 57 86 13 87 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). Year. 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. 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 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 1910 0.00 0.00 0.90 0.04 1.10 0.06 2.33 0.03 1.21 0.03 0.08 0.03 0.02 0.02 Average 1901-1910 0.15 0.01 0.90 0.05 1.43 0.10 4.05 0.08 0.30 0.05 0.08 0.03 — — 1911 0.00 0. 00 0.96 •02 1.23 0.12 1.93 •02 0.12 .02 0.05 0.01 0.04 0.04 45 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." 46 Notifiable Infectious Diseases. During 1911 under the Notification clauses of the Public Health (London) Act, 1891, 753 cases of infectious diseases excluding chicken-pox have been notified as compared with 880 cases notified in 1910. Of the 753 cases notified, 580 (i.e. 77 per cent.) were removed to hospitals of the Metropolitan Asylums Board or to other hospitals and 173 (i.e. 23 per cent.) remained under treatment at their houses. As pointed out in previous annual reports it is satisfactory to note that the high percentage of removals to hospital for isolation purposes of cases of dangerous infectious diseases is being well maintained. Examining the removals to hospital more in detail (e.g., nature of disease) it is seen that during 1911 in the Borough of Battersea the following are the percentages. Scarlet fever 98 Diphtheria and membranous croup 94 Enteric fever 85 Erysipelas 21 Puerperal fever 77 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 notified. Total number of cases notified excluding Chicken Pox. Notifications per 1,000 excluding Chicken Pox. The Borough 981 753 4.5 East Battersea 475 349 5.0 North West Battersea 309 252 5.1 South West Battersea 197 152 3.1 On the 14th March, 1911, owing to the presence of small-pox in certain parts of London, chicken-pox was temporarily added to the list of notifiable infectious diseases in the County of London for a period of 3 months. The following diseases were added during the year to the list of notifiable diseases under the provisions of the Public Health (London) Act , 1891:— Acute polio-myelitis or acute polio-encephalitis (temporarily). Ophthalmia neonatorum. Anthrax. Glanders. Hydrophobia. 47 The total amount paid in fees to medical practitioners as fees for notifications of infectious diseases in Battersea during 1911 was £168 17s. 0d. This amount includes fees paid for Notification 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 1911, viz., 26 per cent. as compared with 1910, and 55 per cent. below the average for the past ten years 1901-1910. The 325 cases occurred in 271 houses. A decrease has also to be recorded in the number of diphtheria notifications received during the year as compared with 1910. The notifications were 18 per cent. below the average for the ten years 1901-1910. The 208 diphtheria cases occurred in 182 houses and in only 19 of these were the drains on testing found defective. The enteric fever notifications were 21 fewer than in 1910 and were 61 per cent. below the average for the decennium 19011910. The 20 enteric fever cases occurred in 19 houses in 2 of which the drains on testing were found to be defective. The following tables show the number of cases of the principal infectious diseases received during 1911 arranged in Wards and the case-rate per 1,000 of the population:— Ward. Diphtheria & Membranous Comp. Erysipelas. Scarlet Fever. Typhoid or Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever Totals. No. 1 (Nine Elms) 36 28 40 4 — 2 5 115 „ 2 (Park) 26 30 42 1 — — 1 100 „ 3 (Latchmere) 16 26 34 2 — 2 1 81 „ 4 (Shaftesbury) 25 11 46 3 — — — 84 ,, 5 (Church) 33 21 49 4 — 2 — 109 „ 6 (Winstanley) 28 20 51 — — — — 99 „ 7 (St. John) 8 6 9 2 — 1 — 26 „ 8 (Bolingbroke) 13 11 25 2 — 1 — 52 „ 9 (Broomwood) 23 8 29 2 — 1 — 64 Totals 208 161 325 20 — 9 7 730 48 Ward. Population, Census 1911. Diphtheria & Membranous Croup. Erysipelas. Scarlet Fever. Enteric & Continued Fever. Puerperal Fever. Cerebrospinal fever. All Notifiable Infecti's diseases. No 1 (Nine Elms) 27,376 1.31 1.02 1.46 0.14 0.07 0.18 4.31 „ 2 (Park) 17,592 1.47 1.70 2.33 0.05 0.00 0.05 5.85 „ 3 (Latchmere) 20,094 0.79 1.29 1.69 0.09 0.09 0.04 4.23 „ 4 (Shaftesbury) 16,031 1.56 0.68 2.93 0.18 0.00 0.00 5.30 „ 5 (Church) 19,377 1.70 1.07 2.53 0.20 0.10 0.00 5.77 „ 6 (Winstanley) 20,247 1.38 0.98 2.51 0.00 0.00 0.00 5.13 „ 7 (St. John) 8,216 0.97 0.73 1.09 0.24 0.12 0.00 3.27 „ 8 (Bolingbroke) 18,495 0.70 0.59 1.35 0.10 0.05 0.00 2.92 „ 9 (Broomwood) 20,315 1.13 0.39 1.42 0.09 0.04 0.00 3.15 Small-pox. No case of small-pox was notified in Battersea during 1911. Owing to a small outbreak which occurred in the East of London, chicken-pox was made temporarily notifiable in the County of London. The number of cases of small-pox notified in the County of London during the year was 72. Contacts were watched on arrival within the Borough in connection with small-pox cases that had occurred on board vessels arriving from abroad, and also in connection with cases which occurred in other Metropolitan districts. All such contacts were kept under observation for a period of 16 days. Scarlet Fever. The number of cases of scarlet fever notified in Battersea during 1911 was 325. This is the lowest number ever recorded in the Old Parish or Borough of Battersea. Four deaths were registered from the disease giving a death-rate per 1,000 of the population of 0.02. In the following table are shown the number of cases and the case mortality per cent. in the Borough and sub-districts during 1911. CHART showing the number of cases of Scarlet Fever notified during each week of the year 1911. 49 Sub Registration Districts. East Battersea Nth.-West Battersea. Sth.-West Battersea. Borough. No. of Cases 150 112 63 325 Case-rate per 1,000 population 21 23 13 193 No. of Deaths 3 — 1 4 Death-rate per 1,000 population 0.04 0.00 0.02 0.02 Case-mortality per cent. 2.0 0.00 1.58 1.23 Of the 325 cases of Scarlet fever notified 198 (i.e., 61 per cent.) were of children of school age. In 39 of the houses invaded, multiple cases occurred as follows: No. of times. 5 cases in one house 1 4 „ „ 2 3 „ „ 8 2 „ „ 28 In other words 93 cases of scarlet fever occurred in 39 houses, two or more members of the same family or persons living in the same house being infected. In most cases the source of infection was traceable to the presence of 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. The percentage of so-called return cases to total cases was slightly higher during 1911 than in the previous year. The following table gives 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 1910 439 20 4.55 1911 325 16 4.92 The number of cases sent back from hospital notified as scarlet fever and in which the diagnosis was found to be erroneous was 27 or 8 per cent., as compared with 10 per cent. in 1910. 50 The remarkable decrease in the incidence of scarlet fever during the year 1911 is a satisfactory feature of the annual report. The prompt removal of patients for isolation to the hospitals of the Metropolitan Asylums Board and the following up and keeping under observation of contacts, there can be no doubt, has been partly responsible for this desirable state of affairs. Diphtheria. The number of Diphtheria notifications (including membranous croup) received during 1911 was 208 as against 209 cases notified during 1910. There has been a marked decrease in the incidence of the disease in Battersea during the ten years 1901-10 as compared with 1891-1900. The case-rate, death-rate and case-mortality from diphtheria and membranous croup since 1891 are set out in the following table:— Year. Cases. Case-rate per 1,000 population. Deaths. Death-rate per 1,000 population. Casemortality per cent. 1891 260 1.72 68 0.45 26.1 1892 366 2.38 57 0.37 15.6 1893 682 4.35 176 1.12 25.8 1894 505 3.16 118 0.73 23.3 1895 411 2.52 94 0.57 22.8 1896 426 2.57 82 0.49 19.2 1897 614 3.69 108 0.65 17.6 1898 791 4.74 120 0.71 15.1 1899 606 3.61 63 0.37 10.4 1900 306 1.81 32 0.19 10.4 1901 264 1.56 20 0.11 7.5 1902 275 1.60 18 0.10 6.5 1903 282 1.62 29 0.16 10.3 1904 199 1.13 14 0.07 7.0 1905 166 0.93 11 0.06 6.6 1906 251 1.39 17 0.09 6.7 1907 315 1.73 38 0.20 12.0 1908 340 1.84 22 0.11 7.0 1909 265 1.42 23 0.12 8.6 1910 209 1.10 12 0.06 5.7 1911 208 1.23 21 0.12 10.1 Twenty-one deaths were registered from the disease in the Borough giving a fatality rate of 0.12 per 1,000 population. CHART showing the number of cases of Diphtheria notified during each week of the year 1911. 51 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 1911 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 91 2 89 2 9 11 12.1 1.3 North-West Battersea 68 2 66 2 6 8 11.7 1.3 South-West Battersea 49 7 42 1 1 2 4.1 1.0 In the above table it will be seen that the disease has been fairly equally distributed over the population of East and NorthWest Battersea, South-West Battersea as would be expected suffering less than the two first-mentioned districts. One hundred and ninety-seven, or 94.7 per cent., of the cases notified were removed to hospital. In 1910 the percentage of cases removed to hospital was 92.3 and in 1909 94.7 per cent. In the sub-districts the percentages of cases removed to hospital were as follows:—East Battersea 98, North-West Battersea 97, South-West Battersea 86. The following table gives the age distribution of the cases notified and of the fatal cases. Age Periods—Years. Boro'. Under 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 65— No. of Cases , 3 14 17 30 33 67 28 11 5 .. 208 No. of Deaths 1 2 4 1 6 7 .. .. .. .. 21 Case Mortality per cent. 33.3 14.3 23.5 3.3 18.2 10.5 .. .. .. .. 10.1 The total number of houses invaded by diphtheria was 182. In 19 houses (i.e., 10 per cent.), the drainage was found to be defective. 52 During the year 15 cases (i.e. 7.2 per cent.) notified as diphtheria and removed to hospital were found not to be suffering from the disease and were discharged to their homes. Three hundred and ninety-four bacteriological examinations of suspected cases of dipthheria we re made during 1911 as compared with 410 in 1910, and 628 in 1909. In 96 a positive and in 298 a negative result was obtained. Provision of Diphtheria Antitoxin. The Local Government Board made an Order dated 15th August, 1910, sanctioning the provision by the Councils of Metropolitan Boroughs of a temporary supply of Diphtheria antitoxin and of medical attendance in connection therewith. The Board issued a Circular letter with the Order in which they point out that the object they had in view was to facilitate the prompt use of diphtheria antitoxin in the case of persons who may be attacked by diphtheria or exposed to the infection of the disease. The arrangements with respect to the keeping, distribution and use of the diphtheria antitoxin were to be made in accordance with the advice of the Medical Officer of Health. In considering the matter the Council should take into special account the possible requirements of the Poor Law Medical Officers, as it appears to the Board to be desirable, where the Council avail themselves of the powers now given them, that the Poor Law Medical Officers should be able to obtain from the store of the Council the antitoxin which they may require from time to time for use in connection with patients under their care. To prevent misapprehension it should be observed that the free provision of diphtheria antitoxin which is authorised by the Order must not be regarded as a substitute for removal to hospital of a patient suffering from diphtheria nor as implying that the patient to whom the antitoxin has been administered may properly be retained for treatment at home unless means are available for his efficient isolation to the satisfaction of the Medical Officer of Health. The prompt administration of antitoxin before the patient is removed to hospital may especially if delay in removal is inevitable, go far towards preventing the attack of diphtheria from being fatal. The Council considered the Board's Order and the report of the Medical Officer of Health (vide appendix) thereon in January, 1911. when they resolved" to adjourn consideration of the whole matter for a period of six months," CHART showing the number of cases of Enteric Fever notified during each week of the year 1911. 53 Enteric Fever. During 1911, 20 cases of enteric fever were notified in the Borough of Battersea as compared with 41 in 1910 and 48 in 1909. Three deaths were registered from the disease giving a case mortality of 15 per cent. and a death-rate per 1,000 population of 0.02. The number of deaths in 1910 was 7. This was the lowest number of cases and deaths recorded in the Old Parish and Borough of Battersea since 1891, and is a most satisfactory feature to be able to record of the Borough statistics. In the following table are set out the case-rate, death-rate and case-mortality from enteric fever in the Borough of Battersea since 1900:— Year. Cases. Case-rate per 1,000 population. Deaths. Death-rate per 1,000 population. Case mortality per cent. 1891 118 0.78 23 0.15 19.5 1892 82 0.53 10 0.06 12.1 1893 138 0.88 22 0.14 16.0 1894 154 0.96 29 0.18 18.8 1895 140 0.86 23 0.14 16.4 1896 111 0.67 17 0.10 15.4 1897 95 0.57 18 0.10 19.0 1898 94 0.56 15 0.08 16.0 1899 157 0.93 39 0.23 24.9 1900 206 1.22 32 0.19 15.5 1901 90 0.53 18 0.10 20.0 1902 88 0.51 16 0.09 18.2 1903 85 0.49 17 0.09 20.0 1904 51 0.29 12 0.06 23.5 1905 27 0.15 6 0.03 22.2 1906 40 0.22 8 0.04 20.0 1907 37 0.20 4 0.02 10.8 1908 36 0.19 7 0.03 19.4 1909 48 0.25 7 0.03 14.5 1910 41 0.21 7 0.03 17.0 1911 20 0.12 3 0.02 15.0 A glance at the above table will show the great decline in the incidence and mortality from this disease in Battersea since 1900. 54 The age distribution of the cases, and the death-rate, case-rate and case-mortality in the Borough and in the sub-districts during 1911 are set out in the following tables:— Ages. Under 5. 5-15. 15-30. Above 30. Totals. Males 1 3 5 2 11 Females — 4 4 1 9 Totals 1 7 9 3 20 Case-rate per 1,000 population. Death-rate per 1,000 population. Casemortality per cent. East Battersea 0.11 0.00 0.0 North-West Battersea 0.10 0.02 12.5 South-West Battersea 0.14 0.04 28.5 The Borough 0.12 0.02 15.0 In the County of London the case-rate was 0.23 and the deathrate 0.03 per 1,000 population. Of the 19 typhoid-inlected houses 7 (i.e. 37 per cent.) showed on inspection defective traps, fittings or appliances. In 2 of the houses the drains themselves were found to be defective. The source of infection in 7 cases there was reason to believe was traceable to the consumption of shell fish. In two instances there was evidence pointing to the disease having been contracted out of the Borough, and one case was probably due to personal contact with a previous case. As regards the remaining ten cases no evidence was obtainable as to the probable source of infection. Puerperal Fever. During 1911 in the Borough of Battersea, 9 cases of puerperal fever were notified and 2 deaths were registered from the disease giving a case-mortality of 22 per cent. The case-rate was 0.05 or 0.01 below the mean case-rate for the preceding ten years. The death-rate was 0.01 per 1,000 and was 0.02 below the decennial average. The death-rate for London was 0.04 per 1,000 population. The two deaths from puerperal fever in Battersea in 1911 occurred in South-West Battersea. 55 In 1910, 16 cases of puerperal fever were notified in Battersea and 6 deaths were registered from the disease giving a case-mortality of 37 per cent, and a death-rate of 0.03 per 1,000 population. Puerperal fever is a preventable disease and is caused by want of care by those in attendance on the lying-in woman. During 1911, 4,381 births were registered in or as belonging to Battersea. It is satisfactory to note therefore that the death-rate from this cause was exceedingly small. In all cases of puerperal fever notified to the Medical Officer of Health, enquiries are at once made and the midwife or nurse in attendance is visited at her home. Arrangements are immediately made for the attendance of the midwife at the Shelter, Sheepcote Lane, where she is provided with a sanitary bath and her clothing, instruments, &c., are at the same time sterilised by steam at the disinfecting station adjoining. Cases are at once reported to the London County Council who are the local supervising authority under the Midwives Act, 1902. The important duty of disinfection, however, devolves upon the Borough Council as the Local Sanitary Authority. Six nurses and 8 midwives who had been in attendance on puerperal fever cases or in contact while attending lying-in cases with other infectious diseases, attended at the Shelter for purposes of disinfection. Erysipelas. During 1911, in the Borough of Battersea, 161 cases of erysipelas were notified and 3 deaths were registered from the disease as compared with 170 cases and 8 deaths in 1910. The case-mortality was 1.8 per cent, as compared with 4.7 per cent, in 1910 and 2.7 per cent, in 1909. The case-rate was 0.96 and the death-rate 0.02 being 0.06 above and 0.03 below the decennial average respectively. Thirty-five cases were removed to hospital, the majority going to Union Infirmaries and the remainder to general hospitals. In London during 1911, 4,845 cases of erysipelas were notified and 202 deaths registered from the disease, giving a case -mortality of 4.0 per cent. Epidemic Cerebrospinal Meningitis. During 1911, 7 cases of Cerebro-spinal Meningitis were notified in Battersea as compared with 5 cases notified in 1910 and 4 in 1909, and 5 deaths were registered from the disease. In the County of London 101 cases of Epidemic Cerebro-spinal Meningitis were notified during 1911. 56 Acute Polio-Myelitis or Acute Polio-Encephalitis. This disease which in some of its symptons may give rise to difficulties of diagnosis between it and epidemic cerebro-spinal and other forms of meningitis, has been made a notifiable infectious disease to which the provisions as to Notification, &c., of the Public Health (London) Act, 1891 apply. The disease is commonly known as infantile paralysis, and has occurred in epidemic form in America, Australia and in some parts of Europe and recently in the South West of England the disease has appeared in localised outbreaks. The disease attacks the nervous system causing inflammation of the grey matter of the spinal cord, and subsequently the brain itself and its membranes may become involved. The disease is probably of microbial origin, but the actual germ has not been isolated. The symptoms of the disease may simulate those associated with epidemic cerebro-spinal meningitis, and on this account and because of its tendency to spread in the form of localised outbreaks, it has been considered desirable to include the disease amongst the lists of notifiable diseases. An Order to this effect came into force in London on the 1st September, 1911. During 1911, three cases were notified in the Borough of Battersea, the three cases being distributed in the three subdistricts of the Borough. Opthalmia Neonatorum. This disease was by Order added to the list of Notifiable Diseases to which the provisions of the Public Health (London) Act, 1891, apply. The Order came into force on the 13th March, 1911, and up to the end of the year 21 cases were notified. Each case on receipt of notification was visited by the Council's Health Visitors and steps are taken, if required, to secure that proper medical and nursing attendance is provided, and the case is kept under observation as long as may be found necessary. It is satisfactory to be able to record that of the 21 cases notified during 1911, 19 recovered completely, and two only resulted in partial impairment of eye-sight. One hundred and fifty-five visits were paid by the Council's Health Visitor to cases of opthalmia neonatorum. There can be no doubt that excellent results have followed the Order making the disease notifiable and so enabling timely steps to be taken to prevent the disastrous consequences which only too frequently follow from neglect to provide prompt treatment for these cases. Measles. During 1912, 111 deaths were registered within the Borough of Battersea from Measles as compared with 74 deaths in 1910 and 86 deaths in 1909. 57 The death-rate was 0.66 per 1,000 population as compared with 0-45 the mean death-rate for the preceding ten years. The death-rate in East Battersea was 0.65, North-West Battersea 1.12, South-West Battersea 0.20 per 1,000. The London death-rate for Measles was 0.57 per 1,000, there being 2,570 deaths from this cause registered during 1911. The number of deaths registered from measles in each of the registration sub-districts in 1909, 1910 and 1911 is as follows :— 1911. 1910. 1909. East Battersea 46 39 50 North-West Battersea 55 29 31 South-West Battersea 10 6 5 Eighteen deaths were of infants under one year and 87 of children aged one to five years. Only 6 deaths occurred among children over 5 years old. The deaths in each of the four quarters of the year were as follows :— First quarter 90 Second quarter 13 Third quarter 5 Fourth quarter 3 The number of deaths from measles in Battersea during 1911 was the highest number recorded since 1905 when 124 deaths were registered from this cause in the Borough. The disease began to be prevalent towards the end of 1910 in Battersea as part of an epidemic wave which spread through South London. No less than 90 of the 111 deaths occurred in the first quarter of the year. East and North-West Battersea suffered very heavily, while SouthWest Battersea was only slightly affected. The heaviest mortality occurred in the poorer and more crowded parts of the Borough where the facilities for isolation and home nursing are wanting. Vigorous measures were resorted to by the Health Department of the Council to check the spread of the outbreak, each of the district sanitary inspectors making a domiciliary visit to houses in the localities affected. Leaflets were distributed giving advice as to the precautions to be taken to prevent the spread of infection and disinfection of the rooms was carried out as soon as was practicable. As a result of the active steps taken the outbreak was considerably checked, but the efforts of the Sanitary authority were impeded through lack of some satisfactory system of compulsory notification by means of which early information of the occurrence of cases could be obtained. 58 A Conference was held at the Local Government Board in March to which the Metropolitan Medical Officers of Health were invited to meet the Board's Medical Officers to discuss the preventive measures which might be taken in dealing with measles. The President of the Local Government Board was present and took an active part in the discussion. The question of the practicability of carrying out a system of notification was discussed, there being, as was to be expected, considerable difference of opinion, having regard to the clinical features of the disease, as to its usefulness or expediency. It was generally felt, however, that unless at the same time facilities were provided for the removal and isolation of the patients, any system of notification of measles was of little value. Other matters discussed at the Conference were, the distribution of printed leaflets or cards giving advice as to the nature of the disease and the precautionary measures to be taken to prevent its spread ; disinfection, domiciliary visits, &c. There was generally speaking agreement as to the value of these measures. Considerable unanimity prevailed as to the importance of public Elementary Schools as foci from whence the disease is spread and the necessity for the exclusion of children under 5 years of age as suggested in the Board of Education Consultative Committee's Report. The President promised to give full consideration to the views of the Conference . The Board subsequently issued a Memorandum to Metropolitan local authorities. Measles in London. The Order provides that such non-pauper cases shall be received into hospitals of the Board of Management only when there is room available beyond the requirements of pauper cases of measles ; and, subject to the exceptional cases provided for in Article 11 of the Order, non-pauper cases may only be admitted upon the recommendation of the Medical Officer of Health of the locality in which the patient is residing, and the recommendation must be accompanied by such information respecting the circumstances of the case as the Board of Management require. It will be seen from the terms of the Memorandum that the Conference has been followed by satisfactory results. The facilities for removal to the hospital of the Metropolitan Asylums Board were availed of in Battersea in appropriate cases. Fortunately owing to the precautionary measures already taken by the Council the course of the outbreak had been checked and the need for any extended hospital accommodation for Battersea cases was therefore unnecessary. Measles is essentially a preventable disease and it is to be regretted that it is only when formidable epidemics of the disease arise that its deadly nature is appreciated by the public. It is in my opinion desirable that in the poorer districts of the Borough there should be some more satisfactory system of notification 59 available by which early information of measles cases might be obtainable by the Local authorities. The deaths of 111 children in Battersea during 1911 from a preventable disease such as measles, a number in excess of those from all the other infectious diseases, with the exception of phthisis, put together, does not suggest that all practicable steps that could be taken are being taken and it should not be impossible to devise some more satisfactory means by which information might be made available by which many if not most of these deaths might be prevented. Whooping- Cough. During 1911, in the Borough of Battersea, 34 deaths were registered from whooping-cough, as compared with 50 in 1910 The deaths were 28 below the average for the preceding ten years and were equivalent to a death-rate of -20 per 1,000 as compared with -33 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 22 .31 North-West Battersea 8 .16 South-West Battersea 4 .08 The deaths under one year of age were 64 per cent, of the total deaths and from one to five years of age 32 per cent., the total percentage of deaths under 5 years of age being 97. The deaths in each of the four quarters of the year were as follows :— First quarter 21 Second quarter 6 Third quarter 5 Fourth quarter 2 The following is a summary of the number of children excluded from school attendance during the year 1911, in connection with the more common infectious diseases, e.g., measles, whooping cough, &c. Disease. Children excluded on account of infection in their homes. Number of children suffering. Measles 1940 1068 Chicken pox 427 206 Whooping cough 211 51 Mumps 435 30 60 Diarrhoea. During 1911, the number of deaths from diarrhoea registered as belonging to the Borough of Battersea was 159 as compared with 59 in 1910. Seventy-eight of these deaths were registered as being due to epidemic or zymotic enteritis. The death-rate was -94 per 1,000 or -31 above the decennial average -63. Of the 159 deaths 145 (i.e. 92 per cent.) were of children under five years, and 113 (i.e. 71 per cent.) were of children under one year of age. During 1910 of the 59 deaths from diarrhoea, 47 (i.e. 79 per cent.) were of infants under one year old. The number of deaths and the death-rate in the sub-districts in 1911, 1910 and 1909, were as follows :— Registration Sub-District. No. of Deaths. Death-rate per 1,000 population. 1911. 1910. 1909. 1911. 1910. 1909. East Battersea 72 28 33 1.01 .35 .42 North-West Battersea 77 26 16 1.56 .52 .32 South-West Battersea 10 5 4 .20 .08 .06 In the next table are set out the deaths registered in each of the four quarterly periods in 1911, 1910 and 1909 :— 1911. 1910. 1909. First quarter 6 5 4 Second quarter 2 3 6 Third quarter 135 37 27 Fourth quarter 16 14 16 Of the 113 deaths of infants under one year old from diarrhoea or epidemic enteritis, 98 occurred in the third quarter of the year, distributed as follows in the three sub-districts of the Borough— East Battersea, 44 ; North-West Battersea, 49; South-West Battersea, 5. The next Table gives the age-periods at which these 98 infants died during 1911 :— 61 Deaths of Infants under 1 year of age from Zymotic Diarrhoea and Epidemic Enteritis. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total. 20 34 24 20 98 Of the total number of deaths under one year from diarrhoea 58 (i.e., 59 per cent.) were of infants between three and nine months old. The summer of 1911 will long be remembered as one of the hottest and most prolonged summers in living memory. The temperature reached over 90 deg. F. on several days, and a high level of temperature was maintained during the months of July, August and September. Very little rain fell during the whole period. As is well known, a hot dry summer is invariably associated with a high incidence and mortality from diarrhoea, especially amongst infants and very young children, and the high mortality from diarrhoeal diseases during 1911 as compared with the two preceding years is to be ascribed mainly to the unfavourable meteorological conditions prevailing during that year. Notwithstanding the remarkable climatic conditions prevailing during the summer of 1911, it is satisfactory to note that the mortality as compared with previous years, cannot be considered unduly abnormal. Taking the 5 years 1901-5, the average number of deaths from diarrhoea was 137-8. While in the next quinquennium 1906-10 the average number of deaths from the disease was 77-4. The year 1906 which is included in this quinquennium was also a very hot dry summer, but not so prolonged as that of the year 1911. In 1906, 149 deaths were recorded in Battersea from diarrhoea, a figure only slightly lower than that for 1911. It is apparent therefore that notwithstanding the occurrence of unfavourable climatic conditions, there has been a marked decrease in the death rate from this scourge of infant life due cheifly to the persistent efforts of the Council. In addition to the 159 deaths registered, as belonging to the Borough, from summer diarrhoea or zymotic enteritis, there were also registered 99 deaths from enteritis. A large proportion of these 99 deaths were in all probability cases of epidemic or infective diarrhoea. No less than 59 occurring in the third quarter of the year when infective diarrhoea is most prevalent. Of the 99 deaths, 73 were of children under one year old. 62 Owing to the excessive prevalence of diarrhoeal disease during the late summer and autumn of 1911, special efforts were made by the Health Department of the Council to cope with the outbreak. The Health Committee authorised the issue of the following leaflet, which was distributed throughout the Borough— HOW TO PREVENT DIARRHCEA. With the advent of hot weather, Diarrhoea becomes very prevalent, and it is most important that precautions should be adopted to prevent the occurrence of the disease. These are best carried out by paying attention to the ordinary rules of health as regards personal cleanliness, proper ventilation of the rooms, removal of dust and dirt, and the protection of the food from contamination. Diarrhoea is caused by eating food which has become contaminated by germs. These germs are carried by dirt and dust, and by the agency of house flies, and the way to prevent diarrhoea is to keep your house and everything in it scrupulously clean. The yards should be kept free from accumulations of refuse and dust, and the dust-bin should be used for the reception of dry refuse and dust only, and should be kept covered. Burn all animal and vegetable refuse. Milk should be boiled the moment it comes into the house. Stand the jug containing the milk in a saucepan of water, and boil for half an hour. Then keep it covered to prevent other germs getting in. Do not eat tainted meat or fish, or unripe or unsound fruit Keep your water cisterns clean, and boil your drinking water. Diarrhoea is excessively fatal to hand-fed babies, thousands dying every summer, but breast-fed babies are seldom attacked. It is most important therefore not to wean babies during the hot weather, and that hand-fed babies should have their food prepared with scrupulous care. All utensils used must be most carefully examined to see that they are perfectly clean. The Council's Health Visitors and Sanitary Inspectors were instructed to pay special attention to those districts of the Borough where from the weekly mortality returns the disease was shown to be most prevalent. A large number of cases were as a result of this action discovered and 93 of them (68 infants under one year old and 25 aged from 1-5 years) recovered. A full enquiry was carried out into the history of each of these cases and also into that of 189 fatal cases. The results of the investigation carried out are summarised as follows :— 63 Recovered Cases. Distribution in Wards. Wards. 1 2 3 4 5 6 7 8 9 Recovered cases 20 13 9 18 15 10 4 4 — Occupation of parents :— Father,—Labourers, 52 ; Artisans, 15 ; Trades and Clerks, 17 ; other, 2 ; not stated, 5. Mother.—Home, 71 ; domestic servant, 4 ; Trades, 5 ; Factory Hand and Charing, 8 ; not stated, 5. No. of rooms occupied by family of patient. No. of rooms. 1 2 3 4 5 6 7 Families 5 20 46 19 1 — 2 Light and Ventilation of dwelling,—Bad, 1 ; Fair, 12 ; Good, 80. Condition of Yard,—Partly paved, 61 ; Wholly paved, 30 ; not stated, 2. Feeding,—Breast, 30 ; breast and other, 29 ; cow's milk, 12 ; condensed milk, 6 ; other food, 15 ; not stated, 1. No. of children living in family of patient. No. living. 0 1 2 3 4 5 6 7 8 9 Not state . Families 3 21 10 22 12 12 5 4 — 3 1 Fatal Cases. Distribution in Wards. Wards. 1 2 3 4 5 6 7 8 9 Fatal cases 42 20 21 16 44 36 2 6 2 64 Occupation of parents :— Father,—Labourers, 98 ; Artisans, 32 ; Trades and Clerks. 35 ; other, 3 ; not stated, 21. Mother,—Home, 124 ; Domestic servants, 10 ; Trades, &c., 9 ; Factory hands and Charing, 30; other, 2; not stated, 14. No. of Rooms occupied by family of deceased. No. of rooms. 1 2 3 4 5 6 7 8 9 10 Not stated. Families 22 38 71 36 13 4 1 — — 1 3 Light and ventilation of dwellings.—Bad, 2 ; Fair, 80 ; Good, 104 ; not stated, 3. Condition of Yard,—Unpaved, 2 ; partly paved, 37 ; wholly paved, 138 ; not stated, 12. Feeding,—Breast, 20 ; breast and other, 59 ; cows' milk, 37 ; condensed milk, 41 ; other food, 24 ; not stated, 8. No. of children living in family of deceased. No. living. 0 1 2 3 4 5 6 7 8 9 Not stated. Families 46 40 27 29 19 13 4 3 3 1 4 The conclusions to be drawn from an examination of the above summary are that («) the disease is mainly confined to the poorer quarters of the Borough ; Nine Elms, Church and Winstanley Wards, between them contributing 122 of the 189 fatal cases and 45 of the 93 recovered cases investigated ; (b) that only a small proportion of the children were breast fed; (c) the Sanitary conditions of the homes having regard to the class of dwelling, were generally speaking satisfactory. In the three upper Wards of the Borough (St. John, Bolingbroke and Broomwood) there were only 8 deaths from summer diarrhoea, which is in striking contrast to the three first mentioned wards, where the conditions as regards the standard of living prevailing, are very different. 65 It is clear therefore that environment, in this as in other causes of infant mortality, plays an important part, and that unfavourable meteorological conditions, such as those which so remarkably characterised the summer of 1911, are only to be regarded with apprehension in those urban districts where, owing to poverty and its attendant evils, e.g., insufficient housing accommodation, absence of facilities for proper storage of food, lack of early medical attendance and efficient nursing, &c., summer diarrhoea is prone to attack a susceptible population. The disease is largely preventable and it is evident that the steps which are at present being taken are inadequate to guard against outbreaks, especially in epidemic years. It would be very desirable to provide by means of a temporary system of notification, information of the incidence of summer diarrhoea and in suitable cases facilities for the removal to hospital of the patient. Much good work has been done in Battersea as in other districts by the measures at present being carried out by the sanitary authority, but these measures are hampered through lack of early information of the incidence of the disease and of provision for the proper treatment of the little sufferers while there is yet time to save them. The Local Government Board issued the following memorandum to sanitary authorities, dated 18th August, 1911, on " Prevalence of Summer Diarrhoea Amongst Children." The Local Government Board have had under their consideration the excessive child mortality, especially from diarrhoea and enteritis, which is accompanying the very hot and dry summer of the present year. They realise that some excess of mortality over that occurring in cool and wet summers is inevitable ; but they desire to impress upon the Council the importance of taking such special steps as are practicable with a view to minimising the excess. The Board are aware that in a large number of sanitary districts special efforts are made each summer to remove the nuisances and other conditions which favour excessive mortality amongst children. They suggest the following lines along which it is most important that action should be taken, but they do not wish it to be understood that this advice covers the entire ground or that it does not need to be supplemented by action directed towards the special needs of individual districts. Firstly, it is important that exact advice should be given as to the feeding and management of children, and more generally as to preventing the exposure of their food to contamination from decomposing organic matter. This distribution of clearly worded leaflets is useful in this connection : but even more important are personal visits and the offer of practical advice to the mothers of babies born within the last twelve months. Exact and simple instructions are most likely to be followed if given during a period of special danger. In districts and towns in which the Notification of Births Act has been adopted, the records obtained under that Act will give valuable information in selecting the, homes to which visits are now most urgently required. 66 Secondly, the full value of the personal instructions indicated above cannot be realised unless vigorous efforts are made to prevent the accumulation in or in the vicinity of the house of decomposing animal and vegetable matter. It is not necessary to do more than mention the importance of efficient scavenging, of frequent and, if practicable, daily removal of house and stable refuse, of domestic cleanliness, and of keeping all food properly protected. The Council may consider it advisable during the next few weeks to divert the sanitary inspectors from less urgent work, and to instruct them to make rapid visits with a view to securing efficient sanitation, especially in and about the houses of the working classes. Thirdly, it is important that the Council should promptly ascertain in which parts of their district diarrhoea is especially prevalent, and should devote close attention to street and court scavenging and to the removal of stable and domestic refuse in these areas. Without waiting for the weekly health returns, efforts should be made to obtain information of cases of diarrhoea from health visitors and others who make domestic visits ; and to impress upon parents the importance of immediate treatment of infantile diarrhoea. Apart from the medical notification of cases of epidemic diarrhoea in children, the visits of health visitors can be utilised for impressing upon parents the seriousness of diarrhoea amongst young children and the desirability of information being given to the Medical Officer of Health should a case of diarrhoea occur. The Board will be glad if the Medical Officer of Health, in his annual report dealing with the current year, will set out the course of action adopted in the district to prevent diarrhoea and child mortality generally, in the special circumstances of the present year. The suggestions contained in the Board's memorandum so far as the Borough of Battersea is concerned were in the main already in operation. The services of one of the male sanitary inspectors were entirely set aside while the epidemic lasted to assist the female inspectors and health visitors, in addition to the general instruction to the other male inspectors to pay special attention to the streets and premises in their respective districts where summer diarrhoea was prevalent, with the object of promptly removing all insanitary conditions which might be found to exist. Yards, stables, premises where food was stored, &c., received frequent and systematic inspection, and generally speaking all effective steps that could be, were taken to deal with the outbreak. Tuberculosis. During 1911, 289 deaths from tuberculosis were registered as belonging to the Borough of Battersea. Of this number, 217 (i.e. 75 per cent.) were due to phthisis (tuberculosis of the lungs), 34 to tubercular meningitis, 19 to general tuberculosis, 12 to tubercular disease of the intestines and 7 to other forms of the disease. In 1910, the total number of deaths from tuberculosis was 252 and in 1909, 289. The following table shows the death-rate from phthisis and other tubercular diseases per 100,000 persons in each year since 1901. 67 Year. Deaths from Phthisis per 100,000 persons. Deaths from other Tubercular Diseases per 100,000 persons. 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 1910 103 30 1911 129 42 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 are set out in the following table :— District. Phthisis. Other Tubercular Disbases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 94 1.34 39 0.56 133 1.90 Nth.-West Battersea 64 1.30 24 0.48 88 1.79 Sth.-West Battersea 59 1.20 8 0.18 67 1.39 The Borough 217 1.29 71 0.42 288 1.72 The deaths from tuberculosis were 11.9 per cent, of the total deaths. The death-rate from phthisis (the most common form of tubercular disease) was in 1911, 1.29 or 0.26 higher than in 1910 and 0.13 higher than in 1909. PREVENTIVE MEASURES. Public Health Tuberculosis Regulations. The series of Orders dealing with tuberculosis issued by the Local Government Board with regard to the disease known as pulmonary tuberculosis (consumption) began with the Public Health (Tuberculosis) Regulations, 1908, which came into force 68 on the 1st January, 1909. Under these regulations a partial system of compulsory notification dealing with the inmates of Poor Law Institutions and persons under the care of Poor Law Medical Officers came into operation. This was followed in the early part of 1911 by the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into force on the 1st May, 1911 and provided for the compulsory notification of cases of pulmonary tuberculosis occurring amongst the in-patients and out-patients at Hospitals. In November, 1911 the series of orders was completed by the issue by the Board of the Public Health (Tuberculosis) Regulations, 1911, extending (and to some extent supplementing) the partfal compulsory systems already in force so as to include all cases of pulmonary tuberculosis occurring in the practice of medical men. Under these regulations it is now the duty of every medical practitioner (with certain specified exceptions) to notify every case of pulmonary tuberculosis occurring in the course either of his public or his private practice. With the regulations the Board issued a circular letter to local authorities which deals with pulmonary tuberculosis which it is pointed out " is now generally recognised as a communicable disease. It has, however, certain special characteristics which raise new administrative problems and some of the measures which were appropriate to diseases notifiable under the Infectious Diseases (notification) Act, 1889, and the Public Health (Lond.) Act, 1891, are hardly applicable to pulmonary tuberculosis. It was necessary therefore that special methods should be applied to the disease and the Board felt as they explained in their circular letter of the 22nd March last, that the objects in view could be best attained if the procedure were by stages and by a gradual development of administrative machinery." Accordingly in 1908 they issued regulations limited to cases of pulmonary tuberculosis occurring amongst the inmates of Poor Law Institutions or amongst the care of district medical officers. In March of the year 1911 further regulations were made extending the system of notifications to cases occurring amongst the in-patients or out-patients at hospitals or other similar institutions for the treatment of the sick which are supported wholly or partially, otherwise than by the contributions of the patients (or of their relatives or guardians) and otherwise than from rates and taxes. Object of Notification. The primary object in requiring notification is to enable the local authority to assist in the eradication of the disease and the Board desire to take this opportunity of offering certain observations as to the ways in which local authorities can render assistance. 69 It is worthy of note that the death-rate from pulmonary tuberculosis, though still far higher than that resulting from any other disease to which the principle of Notification has hitherto been applied, has nevertheless shown a marked decline in the last thirty years. In 1881, the death-rate per 1,000 of the (population was 18.25, in 1891 it was 15.99, in 1901 it was 12.64 and in 1909 it was 10.93. This decrease has coincided with a marked increase in the activities of local authorities including greatly improved sanitary administration and the treatment of the sick under more satisfactory conditions. It is impossible to estimate precisely the influence of these causes on the diminution of the death-rate, but there can be no doubt that they have been powerful factors in bringing about the reduction. With the information by means of general notification local authorities will be able to take action with a view to preventing the spread of infection or removing conditions favourable to infection. Powers and Duties of Councils. In a disease such as tuberculosis the prevention of infection and the treatment of the patient frequently cannot be separated The Board have by the Order given a general power to the local authority on the advice of their medical officer of health to supply such medical assistance, facilities and articles as may be necessary for detecting pulmonary tuberculosis, for preventing the spread of infection and for removing conditions favourable to infection. The local authority are also empowered to appoint any additional officers. Finance. The financial aspect of the problem has been considerably altered by proposals which have been recently laid before Parliament. Under the Finance and National Insurance Bills (now Acts) it is proposed that a capital sum of one and a half millions shall be made available for grants for the provision of sanatoria and other institutions. The National Insurance Bill (Act) also makes provision for defraying expenses of sanatorium treatment of insured persons and it is proposed in certain circumstances to enable this treatment to be given to the dependents of the insured. The Position of Persons Notified. The circular letter of the Board lays particular stress on this matter. It is of course, it goes on to state, unnecessary and undesirable that notification should involve publicity. The Board have no doubt that local authorities and their officers will avoid doing anything which could cause pain or annoyance to patients or their friends. 70 The new regulations may be summarised as follows :— (i) Every medical practitioner attending or called on to visit any person is to notify the medical officer of health of the sanitary authority for the district in which the case occurs with 48 hours any case of pulmonary tuberculosis. (ii.) Every school medical inspector within 48 hours of inspecting any children attending a public elementary school shall notify to the medical officer of health for the area within which the school is situate all cases of pulmonary tuberculosis of which he becomes aware during the course of inspection. (iii.) The medical officer of health of each sanitary authority is to keep a register of all cases of pulmonary tuberculosis notified to him. The register is to be open to inspection only by a person specially authorised. (iv.) Upon the receipt of a notification the medical officer of health either personally or through an officer acting under his instructions is to make such enquiries and take such steps as may appear to him to be necessary or desirable for preventing the spread of infection or for removing conditions favourable to infection. (v.) The medical officer of health of each metropolitan borough is to send to the medical officer of health of the County of London a weekly statement of the notifications received by him. (vi.) The sanitary authority on the advice of its medical officer of health may supply such medical assistance, facilities and articles as mav be necessary for detecting pulmonary tuberculosis, for preventing the spread of infection and for removing conditions favourable to infection and may publish and distribute information respecting the disease and the precautions to be taken against the spread of infection. The sanitary authority is also empowered to appoint any additional officers. The new regulations it is to be anticipated will be found to still further assist local authorities in combating consumption, more especially in relation to the provision of sanatorium benefit contained in the National Insurance Act, which will come into operation in July, 1912. During 1911, 888 notifications of pulmonary tuberculosis were received relating to 444 cases which are set out in the following table, which gives particulars of the notifications received under the Public Health (Tuberculosis) Regulations, 1908; Public Health (Tuberculosis in Hospitals) Regulations, 1911 and the voluntary notification system :— 71 Source. Cases. Duplicates. Total Notifications. Poor Law 175 325 500 Hospitals 168 100 268 Voluntary 101 19 120 Total 444 444 888 The number of notifications of pulmonary tuberculosis received during 1911 was 152 (i.e. 34 per cent.) higher than in 1910. In the following tables are set out particulars as regards age periods and distribution in the sub-districts and wards of the notified cases, voluntary and compulsory, of pulmonary tuberculosis during 1911. 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 — 3 — — — 8 14 23 114 13 175 P.H. (Tin H.) R., 1911 — 2 — 1 — 9 9 41 106 — 168 Voluntary 1 — — 2 2 10 10 19 57 — 101 Total 1 5 — 3 2 27 33 83 277 13 444 East Battersea. N.-W. Battersea. s.-w. Battersea. Borough. Poor Law 69 70 36 175 P.H. (Tin H) R., 1911 83 57 28 168 Voluntary 42 43 16 101 Total 194 170 80 444 72 Arranged in Wards. Notified under I 2 3 4 5 6 7 8 9 Total. P.H. (T.) R., 1908 32 25 16 10 27 29 14 2 20 175 P.H. (T in H.) R.,1911 39 24 25 13 23 18 4 14 8 168 Voluntary 18 11 17 7 15 17 3 7 6 101 Total 89 60 58 30 65 64 21 23 34 444 In the next table are set out the occupations of the 444 notified cases of consumption received during 1911 :— Occupation. Poor Law. Hospital. Voluntary. Total. Domestic work 30 42 18 90 Shop assistants, clerks, &c. 1 22 17 40 Sempstresses, &c. 2 11 4 17 Factory workers, &c. 2 5 4 11 Laundry workers' 5 3 3 11 Potmen 2 2 — 4 Labourers, Printers, &c. 29 19 6 54 Carmen, conductors, &c. 11 7 4 22 Stokers, Engine drivers 3 1 2 6 Bakers — — 2 2 Printers — 4 2 6 Wood-choppers 2 — — 2 Railway, &c., Porters 1 2 3 6 Gardeners 1 1 — 2 Soldiers & Sailors 1 — 2 3 Chauffeur 1 — — 1 Zinc worker 1 — — 1 Musician — 1 1 2 Schoolchildren 19 15 20 54 Chemical workers 1 1 1 3 Rag & Paper sorters 2 — — 2 Hairdresser — — 2 2 Lodging-house keeper — 1 — 1 Bootmakers — 3 — 3 P.O. Sorter — — 1 1 Various 1 6 1 8 Unknown 60 22 8 90 Totals 175 168 101 444 73 In 123 cases there is a history of father, mother, brother, sister, husband or wife or child having suffered from phthisis. In 20 cases the premises occupied by the patient were found to be in a dirty condition or affected with dampness. History of death from phthisis in:— Parent, brother or sister 77 Husband or wife 5 Child 1 — 83 History of case amongst— Parent, brother or sister 38 Husband or wife 1 Child 1 — 40 123 The home of nearly every patient notified was visited during the year, and where the patient was being treated at home a periodical visitation was carried out. In the great majority of cases a careful inquiry was conducted into the history of the case, and the sanitary condition of the home, and particular attention was devoted to searching for suspected cases, i.e. members of the family or person living in the same house, exhibiting signs of ill-health of a suspicious nature, with a view to urging them to seek early medical advice. Advice, both written and oral was given to the patient or his friends and sputum vessels were supplied where indicated. Particular attention was paid to those districts where owing to the circumstances of the patients it was most needed. A large proportion of the cases were notified, it will be noted from the poorer districts of the Borough. No less than 79 per cent, of the patients were notified from East and North-West Battersea. The problem of consumption is intimately bound up with poverty, insanitary conditions, drink, &c. The decline which has taken place in recent years in the death-rate from consumption is doubtless to a large extent, the result of increased attention devoted to the subject by sanitary authorities. Their efforts to eradicate the disease have been greatly assisted by recent legislation and the action of Government Departments. What is still required in my opinion is a co-ordinate scheme which will be a national one and by means of which all the agencies for fighting consumption are linked up and rendered more effective. Signs are not wanting 74 that this aspect of the problem is receiving increased attention as is apparent from the increasing number of tuberculosis dispensaries and increased hospital and sanatorium provision for dealing with the disease. In October, 1911, a tuberculosis dispensaiy was opened in the Borough by the Mayor (Councillor J. Astill, J.P.). The dispensary was established by voluntary effort, and promises to be a useful factor in the measures, both preventive and curative, which are being carried on in Battersea. The initial expenditure has been small as no building had to be erected, an ordinary dwellinghouse in a central part of the Borough being taken and provided with the necessary fittings. The upkeep of course of such an institution must necessarily be annually a considerable item of expense. The dispensary is intended to be a centre for diagnosis and treatment as well as a clearing house for the distribution of cases. It is to be in close touch with the medical officer of health, and with other bodies engaged in promoting the health and social welfare of the community. There can be no doubt that if the institution is conducted on these lines satisfactory results must follow. It is, however, important to bear in mind that a tuberculosis dispensary per se, is unlikely to produce the best results. As was pointed out in a report presented by me to the Council in December, 1908 (vide Ann. Report) the dispensary should be an important adjunct to the other preventive measures carried on in the district of the local authority and all of which should be in my opinion directly under the control of the sanitary authority. The measures which received the favourable consideration of the health committee to the Council in connection with this report were. 1. An effective and uniform system of notification. 2. A rigid supervision of the food supply. 3. The effective application of the Public Health and Housing Acts in connection with insanitary property. 4. The provision of sanatoria and dispensaries for the diagnosis and treatment &c., of suitable cases. 5. The removal of advanced cases to special infirmaries and isolation wards. The views of the Council advocating an effective and coordinated national scheme for fighting consumption have since been endorsed by the action of Parliament in providing funds for sanatorium benefit in the National Insurance Act, and of the 75 Local Government Board in making the disease notifiable. It is not clear so far how the various agencies are to be linked together to produce the desired result, i.e. the eradication of consumption. Some difficulty will no doubt be found in arranging the details of a scheme of such magnitude, but should not prove insurmountable. The Battersea tuberculosis dispensary has not been sufficiently long at work to give statistics showing the results of i ts work as a factor in dealing with the disease in the Borough. There is no doubt, however, that much good will follow, especially as a centre for diagnosis of contacts and early suspected cases. Much assistance is already being rendered to the work of the Council's Health Department in this respect, and the value of such assistance as a preventive measure in a district like Battersea cannot be overestimated. Cancer. The number of deaths from cancer registered of persons belonging to Battersea during the year 1911, was 163 (males 75, females 88, as compared with 141 in 1910 and 180 in 1909. The average number of deaths from cancer during the ten years 1900-10 was 154. The death-rate from the disease during 1911 was therefore slightly in excess of the average for the decennium. Alcoholism. During 1911 in the Borough of Battersea, 2 deaths were registered from acute and chronic alcoholism (males —, females 2). In addition to these 24 deaths were registered from cirrhosis of the liver (male 11, females 13) a disease mainly due to alcohol. The total number of deaths therefore to be ascribed to alcohol was 26 as compared with 22 in 1910 and 25 in 1909. Deaths really due to this course are frequently certified under less invidious headings such as apoplexy. Bright's disease, &c. The number of deaths under this heading is probably greatly understated, and cannot be even approximately estimated from the deaths returns. There are, however, indications that the evils of intemperance are being more generally appreciated, and certainly the Borough of Battersea compares favourably in this respect with other large centres of population in England and Wales. 76 Bacteriological Examinations. During the year 1911, 612 bacteriological examinations of specimens sent in by medical practitioners practising in the Borough of Battersea have been made at the Clinical Research Association Laboratories at a cost of £21 0s. 0d. particulars of which are set out in the following table. Suspected disease. Positive Results. Negative Results. Total. Diphtheria 96 298 394 Enteric fever 3 23 26 Tuberculosis 55 133 188 Cerebro-spinal fever — 2 2 Other specimens - 2 2 Total 154 458 612 77 The Protection of the Food Supply. During 1911 as in past years, the food supply was carefully supervised. The work has comprised meat inspection and seizure, registration and strict supervision of milk shops. Attention has also been given to the sanitation of bakehouses (vide section of report dealing with administration of Factory and Workshop Act) and to premises wherein food is prepared, e.g. sausages, potted meats, &c., other premises in which the sale of and preparation of food in various ways is carried on, such as ice-cream, restaurant kitchens, butchers' shops, &c., have been visited and systematically inspected by the Council's officers. Unsound Food. The following is a tabulated return of unsound food inspected, condemned and destroyed under the supervision of the Council's sanitary inspectors during 1911, having been brought to the Health Department by the respective owners for the purpose. :— Food. Quantity. Where Purchased. Bananas 1 crate Covent Garden Market „ 1 „ Borough Market Coalfish 11 Billingsgate Market Codling 1 box „ „ „ 1 trunk „ „ Cod's Roe 2 boxes „ „ „ „ 1 box „ „ Haddock 1 case „ „ „ 2 boxes „ „ ,, (Smoked) 2 „ „ „ „ „ 4 „ „ „ Hake 1 box „ „ Halibut 1 „ „ „ Herrings 2 boxes „ „ Kippers 21 „ „ „ „ 3½ „ „ „ Mackerel 1 box „ „ „ 5 boxes Lower Thames St., E.C. „ 10 „ Billingsgate Market „ 1 box „ „ Megrims 1 „ „ „ Mixed Fish 1 trunk „ „ 78 Food. Quantity. Where Purchased. Mussels 1 bag Lower Thames St., E.C. Onions (Spanish) 9 cases Spitalfields Market Pears 731 cratcs Surrendered at Nine Elms Goods Yard Plaice 6 stone Billingsgate Market „ 1 turn Plums 4 half-bushels James St., Covent Gdn. Sausage Rolls 8 Holman Road, Battersea Strawberries 60 handles Covent Garden Market Tomatoes 22 boxes „ Walnuts 3 bags „ Winkles 1 bag Billingsgate Market In connection with the above-mentioned articles 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 . During 1911, 33 certificates were granted in respect of the articles shown in the tables. During 1911, one seizure of unsound meat was made from a butcher's shop situate in the Borough. On Sunday morning, May 28th, a quantity of unsound meat which was exposed for sale on the premises of a butcher, was seized by Inspector Chuter. Some difficulty was experienced by the Inspector in removing the meat owing to the threatening attitude of the proprietor and of his wife. The meat seized consisted of beef and mutton weighing about 381bs. and was subsequently condemned by the Magistrate and ordered to be destroyed. Proceedings were instituted by the Council against the proprietor, but before the case came on for hearing he left the premises and up to the present has not been traced. During 1911, the carcases of 1,897 pigs slaughtered at one slaughterhouse, were inspected by the Council's Meat Inspector. Of this number seven whole carcases and the heads of 79 pigs, which showed slight evidence of incipient tuberculosis in the neck (pharyngeal) glands were surrendered and destroyed under the supervision of the Council's Officers. The duty of inspecting this large number of carcases has taken up a good deal of the Food Inspector's time, on Sundays as well as 79 week days. During the year 273 visits were paid to this slaughter house of which 56 were Sunday inspections. Owing to the importance of the work it is necessary that great care should be taken to prevent diseased meat being overlooked. It would be an immense gain to the public health if private slaughter houses were abolished as experience shows it is quite impossible to satisfactorily carry out the examination of meat in these ill-equipped (for examination purposes) and frequently badly constructed premises. Slaughter-houses. There are now only 4 slaughter-houses in the Borough of Battersea, as against 5 in 1910. The use of the slaughter-house at Falcon Road was discontinued in 1911 and the license has not since been renewed. The following is a list of the slaughter-houses licensed in the Borough of Battersea in 1911. 345, Battersea Park Rd. St. Johns Hill. 235, Battersea Park Rd. Usk Road (small animals only). These premises are frequently and systematically inspected during the year by the officers of the Council. It is satisfactory to note that the private slaughter-house is slowly but surely disappearing in Battersea. In practically only two of these is any regular business carried on and one of the two is licensed only for the slaughter of small animals. This desirable end is being brought about by the fact that it is no longer a profitable business to deal in home bred meat in districts such as Battersea, where the vast majority of the meat consumed comes from abroad. Slaughterhouses are licensed annually by the London County Council, but the important duty of the enforcement of all by-laws and regulations made for the sanitation of these premises is vested in the Borough Councils. During 1911, 328 inspections of slaughter-houses was made in connection with the inspection of food, &c. Owing to the large number of animals (pigs) slaughtered weekly in the slaughter-house at Usk Road, special arrangements have had to be made for the inspection of the carcases. The details of this inspection are referred to in the part of the report dealing with unsound food. Cowhouses. There are only three licensed cowhouses in Battersea situate as under— Bellevue Road. Usk Road Wiseton Road. 80 Very few cows are kept in these sheds, the keeping of cows in London, it is satisfactory to note, being a dying industry. These premises require to be annually licensed as in the case of slaughterhouses by the London County Council, but the enforcement of the by-laws and regulations governing their sanitation, &c., devolves upon the Borough Council. The premises were systematically inspected during the year and may be Said to be (sanitarily) in a fairly satisfactory condition. Ice-Cream. During the year the number of premises in which ice-cream is manufactured or sold was 174 as compared with 185 in 1910. Notwithstanding the favourable conditions for its sale, namely, the hot and prolonged summer of 1911, there has been a decrease in the number of premises where this article is manufactured or sold. This does not necessarily mean that less ice-cream is sold, but is probably due to the more effective control and supervision exercised by the Council and the enforcement of a satisfactory standard of sanitation of premises where ice-cream is manufactured and sold. Of the 174 premises 10 are occupied by Italians who employ 26 barrows in the sale of the article. Owing to the very hot weather during the summer of 1911, an increased amount of attention was devoted to the supervision of these premises, a frequent and systematic inspection of the premises and of the ice-cream barrows in the streets being carried out by Inspector Benjamin. Owing to this and the sanitary effect of the proceedings taken by the Council during the previous year there were few cases of neglect to carry out the requirements of the Act of Parliament dealing with the manufacture and sale of ice-cream. It was only necessary to take proceedings in one instance. In this case an Italian ice-cream vendor who had just moved into Battersea from another district was found to be carrying on his business in insanitary premises. The Inspector finding ice-cream being made and stored in a room containing a water-closet. Proceedings were taken by the Council against this man and he was convicted and fined. 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 1911 was 100 as compared with 103 in 1910, and 95 in 1909. During the year it was found necessary to serve 12 preliminary and 3 statutory notices in connection with sanitary defects 81 These defects were not of a serious character and had reference mainly to dirty condition of premises (walls, floors and ceilings), defective sanitary appliances, &c. The powers of the Council for controlling the sanitary condition of premises where food for human consumption is prepared, stored and sold, are considerably augmented by the London County Councils (General Powers) Act, 1908. The systematic inspection of the eating houses and restaurants of the Borough, carried out during the past few years in Battersea has resulted in a general improvement in the conditions under which this class of business is conducted. Milk Shops. The number of registered milkshops in Battersea at the end of 1910 was 185. During 1911, 25 new milkshops were added and 34 removed from the register, the total number on the register at the end of 1911, being 176. The character of the business carried on in premises in which milk was sold in Battersea during 1911, as compared with the three preceding years is as follows :— 1908. 1909. 1910. 1911. Dairy produce only 70 72 88 84 General shops 131 78 70 65 Confectioners 13 11 16 16 Dwelling houses 22 14 9 9 Wholesale 5 3 2 2 241 178 185 176 It will be seen from the above list that there has been a considerable decrease in the number of general shops and other unsuitable premises where milk is sold in Battersea, since 1908. Owing to the nature and variety of the articles sold in such shops it is most undesirable that milk should be sold in premises other than those in which dairy produce alone is the business carried on. Owing to the action of the Council in removing from the register under the provisions of the London County Council (General Powers) Act, 1908, the names of a large number of milk vendors carrying on their business in general shops, which on sanitary grounds were unsuitable, a very great improvement has been effected as regards the conditions under which milk is now sold in Battersea. All general shops in which the sale of milk is now carried on, have had to remove from their shops any articles likely • 82 to give rise to contamination of the milk, and in addition to providing a suitable cover for the counter pan containing the milk, the vendor is required to provide a properly lighted and ventilated safe to hold the counter pan. The milk is thus protected as far as possible from the risk of pollution from dust, flies, &c., a matter of the greatest importance from the public health standpoint Milk is a highly sensitive article to contamination, and forming as it does a pabulum for the growth of almost all kinds of pathogenic organisms, and as it is, moreover, the staple article of food of infants and invalids, every possible precaution should be taken by those engaged in the milk trade to protect their milk supply. During the year 620 visits of inspection were paid to milk shops in the Borough. Only 20 defects, mostly unimportant, were reported as a result of these inspections . In one case, however, the offence was of a more serious character and from the point of view of interest requires to be dealt with in detail. On the 19th April, Inspector Benjamin visited in the course of his duty, the premises of a firm of dairymen in a large way of business in Battersea. He found stored therein fourteen full and partly full churns of milk which was in all cases in his opinion in a dirty condition. The milk was later seen by the Council's Chief Sanitary Inspector and Food Inspector who confirmed the opinion of Inspector Benjamin as to its dirty condition. The chief inspector in the absence of the Medical Officer of Health did not feel justified in seizing the milk under Sec. 47 of the Public Health (London) Act, 1891, but decided to take action under the Regulations. The matter was subsequently reported to the Health Committee who referred the case to the Borough Solicitor for proceedings to be taken against the firm of dairymen in whose possession the milk was found. A summons was accordingly taken out against the Firm in question for breach of the Regulations made under the Dairies, Cowsheds and Milkshops Order. The particular regulation relied on and under which the summons was taken was regulation 32, which is as follows :— " Every purveyor of milk or person selling milk by retail shall at all times employ such means and adopt such precautions as may be necessary for preserving the purity of milk and for protecting it against infection or contamination." Evidence was given on behalf of the Borough Council by the Officers of the Council who inspected the milk. The evidence of these Officers was that the milk, which was exposed in a passage way leading from a public street thereby permitting dust and other deleterious matters to be blown into the 83 milk, was found by them in a very dirty state. Expert evidence was given by the Medical Officer of Health supported by the Medical Officer of Health of Lambeth to the effect that, if the milk were in the condition in which it was reported by the Inspectors to be, it ought to have been seized as being unfit for human food. The line of defence adopted is worthy of being put on record. The defendants' Solicitors contended that, even assuming that the milk was exposed to contamination, which they did not admit, a prosecution could not lie against them under regulation 32 because that regulation was ultra vires in that it did not prescribe any precautions to be taken for preserving the purity of the milk and protecting it against infection or contamination as under the Order of 1885, the local authority were bound to do in order to make their regulation effective. On behalf of the Borough Council it was contended that the regulation sufficiently defined the precautions to be taken in a general way, and that they were entitled to call upon the defendants under that regulation to take all reasonable precautions. The Magistrate in giving his decision said " The powers of the Borough Council to make these regulations are limited. They are to make regulations prescribing precautions to be taken. Under regulations 30 und 31 they have done this. They have laid down in terms the precautions to be taken respecting the places where, and the vessels in which milk is to be kept for sale and then in regulation 32 they have laid down a general rule covering or intended to cover all other conceivable cases connected with the storing of milk which might not be covered by the preceding regulations. Obviously such a regulation as this might be liable to abuse. A dealer in milk might reasonably say " You had the power to prescribe—that is to lay down directions which I should be bound to follow as to the places where and the manner in which I should keep the milk which I intended to offer for sale. You might for instance have said that when in the open air all receptacles in which the milk is kept shall be properly covered so as to prevent contamination by any foreign bodies—but you have not done so—consequently I can never be safe from a prosecution although I may take what I considered sufficient precautions, it is always open to you to say that these precautions are insufficient unless and until you have done what the powers given you enable you to do, namely to prescribe what precautions I am required to take." "For these reasons I come reluctantly to the conclusion that this summons must be dismissed. I say reluctantly because from the evidence before me I cannot help feeling that until this by-law 84 is added to or amended there is a grave danger of contamination to milk left open in exposed situations. I must, however, decide this case according to the view I take of the law as it stands. Therefore the summons must be dismissed with costs." The decision of the Magistrate is of considerable importance in its bearing on the powers of Sanitary Authorities in relation to the Regulations made under the Dairies, Cowsheds and Milkshops Order. The magistrate at the request of the Borough Solicitor offered to state a case but this Council did not see their way to take the case to the High Court. It was decided, however, to ask the London County Council to take steps to have the Regulations amended so as to provide that all those engaged in the milk trade shall be required at all times to protect milk against infection or contamination by the provision of suitable covers for milk vessels, &c. Fish Shops. The fish shops in the Borough are 74 in number, a decrease of 5 as compared with 1910. In 52 of these places fried fish is sold, in 13 wet and dried fish is sold and 9 sell wet, dried and fried fish. These premises are frequently inspected and during the year, 24 preliminary and 4 statutory notices were served for various insanitary conditions, all of which notices were complied with. In addition 56 inspections were made by the Council's Food inspector at these premises. The new by-laws relating to the business of fried fish vendor which have been made by the London County Council and are awaiting confirmation by the Local Government Board and the Home Office, will provide additional powers to sanitary authorities for dealing with premises where this business is carried on. Butchers' Shops. There are 91 butchers' shops in Battersea, and a systematic inspection of these premises is carried out by the Council's food inspector. In 51 of them sausage making or food-chopping is carried on, the work being done by hand in 37 instances and by machinery in 14 cases. Eighty-eight of the shops are provided with ice-safes. The trade refuse is in most cases removed bi-weekly or oftener from their premises and they are well-kept and on the whole, in a satisfactory condition. During 1911, 884 inspections of butchers' shops were made. 85 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 danger to health in regard to food and drugs. During 1911, 1,000 samples were purchased within the Borough of Battersea and submitted to the Public Analyst for analysis. Of these, 1,000 samples 99 (i.e. 9-9 per cent.) were reported by the analyst to be adulterated, and in addition 37 samples 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 Sam[ples taken. Genuine. Adulterated. Inferior. Arrowroot 5 5 — — Bread 9 9 — — Butter 181 142 9 30 Cheese 6 4 1 1 Cocoa 11 7 — 4 Coffee 13 12 1 — Cream 10 2 8 — Flour 5 5 — — Gin 2 2 — — Honey 5 5 — — Lard 20 20 — — Margarine 8 8 — — Meat (preserved) 20 18 2 — Milk 635 567 68 — Mustard 5 5 — — Oatmeal 4 4 — — Olive Oil 5 5 — — Pepper 4 4 — — Rice 5 3 2 — Rum 2 2 — — Sausages 27 23 4 — Vinegar 12 8 2 2 Whisky _6 4 2 — Totals 1,000 864 99 37 86 The next table shows the percentage of adulteration during the ten years 1901-1910 and during 1911 :— Year. No. of Samples taken. Adulterated. Percentage of Adulterated. 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 1910 1,000 87 8.7 1911 1,000 99 9.9 • Since 1904 a new system has been adopted, a special inspector being appointed to carry out the duties under the Sale of Food and Drugs Acts, instead of, as formerly, several of the district inspectors doing this work. A glance at the above table shows that the improvement manifested during the last few years in the percentage rate of adulteration was on the whole maintained during 1911. These results are the more satisfactory having regard to the increased number of samples taken in each year since 1906, and is largely the result of the policy of the Council in enforcing their powers under these important statutes in the interest of the public health of their district. Of the total number of samples purchased under the provisions of these Acts during 1911, 635 (i.e. 63.5 per cent.) were milk samples. Of this number 68 (i.e. 10.7 per cent.) were reported by the public analyst to be adulterated. During 1910, 642 of the samples purchased referred to Milk of which 54 (i.e. 8.4 per cent.) were found to be adulterated. The nature of the adulteration in the adulterated samples of milk were as follows :— 1. Extraneous water (43) varying from a miniumum of 1.5 per cent, to a maximum of 15-0 per cent., viz., 1-5, 1-5, 1-5,2-0, 2.0, 2.0, 2.0, 2.0, 2.5, 3.0, 3.0, 3.0, 4.0, 4.2, 4.4, 4.5, 5.0, 5.0, 5.5, 5.6, 6.0, 6.8, 6.8, 7.0, 7.2, 7.5, 7.5, 8.0,8.0, 9.0, 9.3, 10.0, 10.0, 10.3, 10.5, 11.2, 11.4, 12.5, 13.0, 13.3, 13.5, 15.0. 2. Deficiency in milk fat (16) varying from a minimum of 1.0 percent, to a maximum of 35.0 per cent, viz., 1.0, 2.3, 3.0, 3.0, 4.0, 5.0, 6.0, 6.0, 6.0, 7.3, 11.0, 14.0, 16.0, 25.0, 30.6, 35.0. 87 3. Extraneous water and fat deficiency (3) viz., 3.4 and 10.6, 4.0 and 8.7, and 4.0 and 24.7. 4. Skimmed milk (3) extraneous water 7.0 per cent, fat deficiency 52.0, 82.0. 5. Separated milk (3) extraneous water 3.0, 4.0, 4.0. Of the total number of samples taken during the year under report, 530 were taken on week days and 105 on Sundays. Samples were taken on 20 Sundays in the year. Of the 530 week day samples, 55 (i.e. 10.3 per cent.) were found to be adulterated, while out of 105 samples taken on Sundays, 12 (i.e. 12 per cent.) were adulterated. A few years ago the percentage of samples taken on Sundays found to be adulterated was considerably higher, but owing to the more frequent sampling on Sundays, there has been a marked improvement. On the 25th January proceedings were taken for false warranty against a firm of milk contractors, in respect of milk sold by them to a retail vendor in the Borough. The magistrate upon the facts admitted or proved before him stated that he should have convicted if the company's servants who gave the warranty on their behalf had been principals, but as he was of opinion that the section of the Act of Parliament under which the proceedings were brought implied that only such a person could commit the offence as was capable of " believing " and as a Corporation having no mind, could not exercise that faculty if it was not liable under the Section, he dismissed the summons, but offered to state a case for the opinion of the High Court. The Council decided to appeal against the magistrate's decision, with the result that the Court did not uphold the decision in the police court, and the case was remitted to the magistrate for further hearing and determination. The magistrate on again hearing the case convicted and inflicted a fine of £3 and costs. Another warranty case, is of some interest, was that in which a large firm of milk contractors were summoned for giving a false warranty (the case against the retailer having previously been dismissed). The defendants admitted under cross-examination that the milk in question did not pass through their hands until it arrived at Clapham Junction. It was put on rail in the country by the farmer who had a contract with the defendant firm and was consigned direct to the retailer in London. A fine of £3 and 14s. 6d. costs was imposed. 88 These cases show that it is occasionally possible to upset a warranty defence, but in the majority of instances the warranty defence is successful. It is to be hoped that the new Milk Bill which has been promised for so many years will contain a clause which in the case of milk adulteration will do away with the warranty defence and which has proved so successful in thwarting the efforts of sanitary authorities in the administration of the Sale of Food and Drugs Acts. A large firm of milk dealers were summoned by the Council for selling milk containing 6-8 per cent, extraneous water. The sample was purchased by the inspector from one of their roundsmen, who admitted to the inspector at the time the sample was taken that he himself had adulterated the milk. The firm in question immediately discharged and prosecuted this man for " wilfully damaging their milk " and he was convicted and fined £2, and £2 2s. Od. costs. When the Council's case came into court a few weeks later the magistrate suggested the withdrawal of the summons which was accordingly acted upon. Butter. One hundred and eighty-one samples of butter were taken and of these 9 (i.e. 5.0 per cent.) were reported by the Analyst to be adulterated. This is the lowest percentage of adulteration recorded in the case of butter samples during recent years. The form of adulteration found to be present in all these 9 samples was in each instance foreign fat. The added foreign fat (margarine) ranged from a minimum of 47 per cent, to a maximum of 86.0 per cent, vis., 47.0, 48.0, 60.0, 75.8, 79.0, 79.0, 79.5, 81.0 82.8, 86.0. A very profitable kind of fraud was that of a man whose practice was to go about with a pony cart selling to householders as butter, margarine neatly done up in ½lb. packets. He only worked a particular locality for a few weeks and then moved elsewhere. The inspector located him serving customers in a street in East Battersea, and having arranged with an agent to purchase " butter " from this peripatetic dealer for a week or two, the inspector at length visited the house where his agent resided and waited inside until the dealer appeared when two samples were purchased as butter for analysis and were subsequently reported by the analyst to be Margarine. The man's cart was then overhauled and some 40-50 lbs. of the same article was discovered contained in 2 baskets. It was later ascertained that this man had a depot in the neighbourhood in which he kept his stock. With the inspector I visited the premises the same day. It proved to be a small shed, in the 89 same yard and quite close, in which a vendor of cats meat carried on the preparatory part of his business. The shed used by this man contained a large quantity of margarine and there were as well, scales for weighing and a slab evidently for the purpose of making up the pats of " butter." The shed was in a very filthy condition. Proceedings were taken against this man and fines and costs amounting to £16 12s. Od. were imposed, previous convictions in an adjoining Borough having been proved at the same time against him. Sausages. Twenty-seven samples of sausages were taken and submitted to the public analyst. Of these 27 samples 4 (i.e. 14.8 percent.) were reported by the analyst to contain added preservative (boric acid) in varying proportions from 4.95 grains per lb. to 13.63 grains per lb. Owing to the action of the Council in giving notice to vendors of sausages in cases in which adulteration was reported that proceedings would follow, there is apparently a marked decrease in the number of cases and in the amount of adulteration reported. Thus in 1910, of 13 samples of sausages purchased for analysis under the provisions of the Sale of Food and Drugs Acts, 7 (i.e. 54.0 per cent.) were found to be adulterated with boric acid, in amounts varying from 7.42 grains per lb. to 29.79 grains per lb. Although the number of samples taken in 1911 was more than double those taken in the previous year, the percentage and amount of adulterated reported by the analyst was found to be considerably less. It is to be hoped that some official pronouncement will soon be made with regard to the use of so-called preservatives in foods. It is generally agreed by those best qualified to judge that their use is a danger to the public health and should be prohibited in foods intended for infants and invalids, and in other cases allowed only under stringent regulations and with a declaration that the article of food contains a preservative. In almost every article of food consumed nowadays, one runs the risk of taking boric or salicylic acid or other drugs, and in this way in the aggregate quite a large quantity of drugs may be taken throughout the day, the cumulative action of which may be productive of serious injury to health. It is shown from the experience of many reputable firms who do not use these so-called preservatives in their business, that their use is unnecessary and that if proper and reasonable care is taken in the manufacture, preparation and storage of perishable food stuffs, these will keep for relatively long periods. As a general rule it may be inferred that articles which it is found necessary to thus doctor, are of inferior quality, and can only be safely exposed for sale, when treated with antiseptics to prevent the incipient decomposition of 90 the constituents becoming so pronounced as to lead to the risk of seizure and condemnation followed by the liability of legal proceedings against the vendor. That the Local Goverment Board is fully alive to the question of the purity of the food supply is apparent from the number of valuable and instructive reports on various food stuffs from officers of their Medical Department, published within the last 4 or 5 years. It is to be hoped that these reports will be followed by some action by the Board which will be of assistance to sanitary authorities in carrying out the important duty of protecting the food supply in regard to many points which at present give rise to considerable difficulty as to the steps legal or otherwise which should be taken. Coffee and Cocoa. Thirteen samples of coffee were taken and submitted for analysis, of which one was reported to be adulterated and 11 of cocoa which on analysis were found not to be adulterated though 4 were reported on as inferior. Other Articles. Arrowroot, 5; bread, 9; cheese, 6 (one adulterated but no legal proceedings taken); cream, 10 (of which 8 were adulterated with boric acid to an extent varying from 10.78gr. per lb. to 23.926 grains per lb.); flour, 5; honey, 5; lard, 20 (2 adulterated) ; margarine, 8 ; meat (preserved), 20 ; mustard, 4 ; oatmeal, 4 ; olive oil, 5; pepper, 4; rice, 5; vinegar, 2 (2 adulterated); gin, 2; rum, 2; whisky, 6 (2 adulterated). 91 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 32 of the Act directs that the medical officer of health 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 part 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 restaurant kitchens and milk-shops 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 1169 Factories 195 Bakehouses 82 Restaurant Kitchens, &c. 100 Ice Cream Premises 174 Home Workers 241 Stables 548 Factories. Factories include all places in which mechanical power is used in aid of the manufacturing processes. There are 195 of these premises registered in the Health Department employing 8,367 persons (males, 6,310; females, 2,057) as follows:— 92 Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Barge Builder 1 10 3 Baker 8 132 33 40 29 Bootmaker 8 26 2 — Builder 4 29 — Butter blender 3 31 54 2 Carpenter 7 48 10 — — Chemical Works 3 115 18 34 3 Chaff Cutter and — Forage 7 85 — Cycle Maker 2 5 2 — — Dyer 2 37 1 35 5 Engineer 18 554 36 — — ' Flour Mills 2 137 15 — Firewood Cutter 7 42 10 27 2 Founder 3 98 3 — — Liftmaker 1 12 1 — Mason 7 187 1 Mineral Water 2 27 — 15 — Printer 23 112 20 8 1 Steam Laundry 33 167 20 901 127 Other Trades 54 3806 421 637 191 Totals 195 5660 650 1699 358 The duties of sanitary authorities in relation to tactories are few and limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. The Factory Act contains a code which is administered by the Factory Inspectors. There is no statutory obligation upon the sanitary authority to register factories, but for the purposes of the Health Department a register is kept of all factory premises in the Borough of Battersea. During 1911, 30 defects were found on factory premises, for the most part relating to unsuitable or insufficient sanitary accommodation or to defects in sanitary fittings and appliances. Twentyfive preliminary and two 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, 93 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 were up to the early part of the year 1911, under the supervision of two workshop inspectors, one male and one female, who dealt respectively with premises where male and female labour is employed. Owing to the resignation of the the female workshop inspector (Miss Fairbairn) and the decision of the Council to postpone the filling of the vacancy pending a report from the medical officer of health as to the necessity for doing so, the work of this officer was handed over to the male workshop inspector temporarily. The following is a list of the workshops on the register at the end of 1911 :— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 74 113 165 5 Billiard Table maker 2 5 18 3 — — Blind maker 4 9 17 1 — — Bootmaker 79 81 151 15 2 Carpenter 14 15 29 7 — — Coach builder .. 13 25 55 6 — — Cycle maker 14 20 22 6 — — Dressmaker 86 121 — — 255 63 Embroiderer 3 9 7 1 64 21 Farrier and Smith 25 25 71 9 — — Firewood cutter 12 12 22 2 4 — Laundry 48 115 18 — 155 7 Mason 7 7 55 1 — .— Millinery 21 25 — — 46 18 Musical ments 2 4 35 - - - Photographer 4 9 6 1 17 4 Picture framer 6 6 10 2 — — Ragsorter 9 11 42 3 — — Saddler 7 7 16 — — Tailor 42 62 61 12 63 19 Upholsterer 4 9 19 — 6 — Other Trades 88 104 223 27 55 45 Totals 564 794 1042 101 667 177 94 At the beginning of 1911, the number of workshops on the register was 600 as compared with 530 at the beginning of 1910. During 1911, the occupation of 68 of these premises was discontinued while on the other hand 32 new workshops were added so that at the end of 1911 the total number of these premises was 564 in which were employed 1,987 persons (1,143 males, 844 females). During the year 1911, twenty-eight workshops were notified to H.M. Inspector in pursuance of sec. 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 affixed as by this Act required and the medical officer of health becomes aware thereof, he shall forthwith give written notice thereof to the Inspector for the district." 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 1911. Trade. No. of Work shops. Protected Persons employed. Women Young Persons. Total. Bootmaking 3 — 3 3 Dressmaking 3 13 4 17 Laundry 2 8 — 8 Tailoring 2 3 3 6 Miscellaneous 18 4 23 27 Totals 28 28 33 61 Sanitary Condition of Workshops. The local authority is the authority responsible for the condition 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 1911, 3,609 visits of inspection were paid by the workshop inspectors to factories, workshops, and workplaces, exclusive of visits to home workers. The following is a tabulated statement of the work carried out in connection with workshop inspection during 1911, so far as it admits of tabulation :— 95 Workshops inspections and re-inspections 1,314 Workrooms measured 124 Workshops notified to H.M. Inspector 28 Cards distributed showing number of persons legally employed in workrooms 32 Written intimations issued 69 Statutory notices served 6 Defects discovered in Workshops and remedied:— Workrooms in a dirty condition 63 „ overcrowded 1 „ badly ventilated 4 „ with defective walls or ceilings 8 „ with defective floors 2 Workshops with defective yard paving 3 „ with defective drains — „ with blocked drains 4 „ without proper dustbins 9 „ with defective w.c. apparatus 18 „ with sanitary conveniences insufficient in number or absent 5 ,, with sanitary conveniences opening into workrooms 3 ,, with sanitary conveniences without proper doors or fastenings — „ with sanitary conveniences in dirty condition 14 Coal bins provided in bakehouses 7 Accumulation of refuse removed 7 Other defects remedied 10 The following notices of defects were received from H.M. Inspector of Factories during 1911 and received attention:— Premises. Trade. Nature of Complaint. Nine Elms Lane Engineers W.C's. not partitioned off. Este Road Firewood Entrances to W.C's. not screened off. 96 Underground Workrooms. Excluding the underground bakehouses there are 28 underground workshops and workplaces in Battersea compared with 29 in 1910, and 37 in 1909. The number of such premises and the business carried on is shown below:— Workshops. Laundries 8 Picture-frame making 2 Cycle making 2 Fitters 2 Workplaces. Restaurant kitchens 4 Meat chopping 6 Small exempted laundries 4 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 Borough Council as the sanitary authority. In the Borough of Battersea during 1911, there were on the register 86 bakehouses, 8 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. 257 Battersea Park Road 292 „ „ „ 343 „ „ „ 1 Battersea Rise 78 ,, ,, 31 Bridge Road 84 „ „ 64 Castle Street 83 Culvert Road 139 Chatham Road 47 Este Road 29 Falcon Road Addresses. 88 Grayshott Road 45 Harroway Road 11 Hanbury Road 49 High Street 80 „ „ 173 „ „ 213 Lavender Hill 64 Latch mere Road 93 „ „ 29 Meyrick Road 48 New Road 97 Addresses. 89 New Road 148 „ „ 205 „ „ 10 Northcote Road 23 „ „ 64 „ „ 94 „ „ 175 „ „ 62 Plough Road 76 „ „ 112 „ „ 41 Queen's Road Addresses. 121 Queen's Road 10 St. Phillip Street 93 Stewarts Road 29 Stockdale Road 90 St. Johns Hill 32 Tyneham Road 47 „ „ 102 Usk Road 70 York Road 187 „ „ 198 „ „ 287 „ „ 31 Bakehouses Under Ground. Addresses. 163 Battersea Park Road 189 „ „ „ 200 „ „ „ 219 „ „ „ 265 „ „ „ 310„ „ „ 373 „ ,, „ 501 „ „ „ 525 „ „ „ 48 Broomwood Road 2 Burland Road 35 Castle Street 83 Chatham Road 83 Church Road 4 Currie Street 43 Falcon Road Addresses. 103 Falcon Road 46 Francis Street 30 Lavender Hill 123 Maysoule Road 36 Orkney Street 23 Plough Road 34 „ „ 109 Salcott Road 140 St. Johns Hill 8 Tyneham Road 23 Webbs Road 47 Winstanley Road 79 „ „ 6 York Road 345 ,, ,, The bakehouses were systematically inspected during the year and on the whole may be said to be in a (sanitarily) 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 the summarised result of bakehouses inspection here recorded are included in the tables giving the results of general factory and workshop inspection. 98 Above ground bakehouses:—21 intimation notices and one statutory notice were served for defects, all of which were duly complied with. Underground bakehouses:-26 intimation and 4 statutory notices were served for various defects, all of which were complied with. The defects for which these notices were required had reference mainly to neglect to carry out the half yearly cleansing and limewashing of the bakehouses, defective sanitary fittings, refuse accumulation, &c. Factory Bakehouses. The following is a list of the factory bakehouses in Battersea :— 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 ,, It was found necessary to serve 3 intimation notices in respect of nuisances on factory bakehouse premises, which were duly complied with. Homework. This term has reference to persons who carry on certain classes of work in their own homes. Under the Factory and Workshop Act 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 (1) in dwellings which are injurious to the health of the workers themselves, viz., through overcrowding inadequate ventilation, &c., and (2) in premises where there is dangerous infectious disease. The home-workers residing in Battersea are employed by firms established in the Borough and by firms belonging to other Boroughs. The lists of trades specified by the Home Secretary to which sections 107-110 of the Factory and Workshop Act apply, are set out in Orders made by the Secretary of State (vide previous Annual Reports). 99 A report was issued by the Medical Officer of Health for the Borough of Islington, that Caramel wrapping was being carried on, for trade purposes, by certain outworkers dwelling within that Borough under conditions unsatisfactory, possibly dangerous to health. He reported finding quite small children, some of whom were only 5 years of age, putting on the wrappers, and that in one family the children were put to work immediately on their return from school and were kept working until 9 or 10 o'clock at night. In one case a boy recovering from a recent illness was sitting up in bed at work, the wrapping being done on the bed. The Islington Borough Council brought these facts to the knowledge of the Secretary of State and intination has been given that an Order is proposed to be made by the Secretary of State adding this class of work to the list of specified trades to which the provisions of Sec. 107-110 of the Factory Act apply. During 1911, the names and addresses of 749 outworkers were received as compared with 842 in 1910, and 832 in 1909. Lists were sent in by employers and by the medical officers of health of the following metropolitan Boroughs and District Councils:— District. Lists. Outworkers Camberwell 1 1 Chelsea 6 64 City of London13 27 Finsbury 5 9 Islington 1 1 Kensington 5 24 Lambeth 5 18 Paddington 1 1 District. Lists. workers St. Marylebone 2 15 Shoreditch 4 4 Southwark 3 9 Wandsworth 12 67 Westminster 3 93 Wimbledon 1 1 Totals 61 334 The names and addresses of 160 outworkers which were sent in by employers were found to refer to other districts and were accordingly forwarded to the medical officers of these districts. The premises occupied by outworkers are systematically inspected and any insanitary conditions found, remedied. The following table shows the number of outworkers' premises registered in the Borough, together with the trades and number of persons employed. 100 Up to the early part of 1911 the inspection of outworkers' premises was carried out by the male and female workshop inspectors, the former dealing with male and the latter with female outworkers. Owing, however, to the resignation of the female workshop inspector the whole of this important duty has devolved upon the male workshop inspector. During 1911, 610 inspections of outworkers dwellings were made, 115 of which were made by the female workshop inspector, prior to her resignation in February, 1911. It was found necessary to serve 25 notices in connection with homework inspection the results of which are summarised as follows:— Total number of inspections 610 Number of notices served 25 Number of Outworkers on register 241 On the resignation of the female Workshop Inspector (Miss Fairbairn) early in 1911, the Medical Officer of Health reported that he was of opinion that the vacancy should be filled. The Committee, however, decided to hold over consideration of the matter for a period of six months, and suggested a rearrangement of the duties of the outdoor inspectorial staff, by which the work of the female Workshop Inspector should be distributed amongst the other officers and instructed the Medical Officer of Health to submit at the end of the year, a report as to the working of the new arrangement. Trade. Number on Register. Persons Employed. Premises Workrooms. Males. Females. Blousemaking 11 11 — 14 Bootmaking 42 42 48 3 Boxmaking 7 7 — 8 Dressmaking 11 11 — 11 Embroidery 28 28 — 29 Glovemaking 44 44 1 47 Tailoring 54 54 34 32 Underclothing 20 20 — 22 Other trades 24 24 2 23 Totals 241 241 85 189 101 Notwithstanding the impossibility of equalling the extent of the work of preceding years a fair amount of inspection was carried out in connection with Workshops during 1911, and no very serious breaches of the Factory Act relating to the sanitation of these premises were reported during the year. . In 1910, 954 inspections were made by two inspectors and 55 notices were required to remedy defects found. It will be seen that there has been a considerable decrease in the number of inspections carried out in 1911. The defects found in Outworkers premises were mainly those referring to want of cleanliness of rooms, defective sanitary fittings, &c. Twelve cases of infectious disease, four of dipthheria and eight of scarlet fever, were reported from Outworkers dwellings during 1911. The patients were immediately removed to Hospital and special precautions taken to prevent the spread of infection. 102 Legal Proceedings. Summary of Legal Proceedings. The facus 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 103 to 105, and are summarised below:— No. of Prosecutions. No of Convictions. Fines. Costs. £ s. d. £ s. d. Sale of Food and Drugs Acts 102 47 94 5 0 34 10 6 Smoke Nuisances — — — — Unsound Food 2 Contravention of ByeLaws - - - - Other proceedings 11 4 5 5 0 2 16 0 Total 115 51 £99 10 0 £37 6 6 103 APPENDIX No. 1. APPENDIX No.1. (i ) Legal Proceedings under the Sale of Food and Drugs and Margarine Acts. Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 602 Milk 7 per cent. added water Dismissed (warranty). 674 Butter 66 per cent. foreign fat, and selling Margarine in a plain wrapper Ordered to pay 14s. 6d. costs. 646 „ 67 per cent. foreign fat, and selling Margarine in a plain wrapper Fined £2 and 14s. 6d. costs. 645 „ Exposing margarine for sale as butter Withdrawn. 246 Separated milk 10 per cent. extraneous water, and less than 9 per cent. of milk solids Fined £3 and 12s 6d. costs, or 5 weeks in default. — Milk Giving false warranty Dismissed. 702 Separated milk 12 per cent. extraneous water, and less than 9 per cent of milk solids Fined £2 and 12s. 6d. costs; or, in default of distress, 14 days. 526 Sausages 24•794 grains per lb. boric acid Fined £2 and 12s. 6d. costs, or, in default of distress, 21 days. 544 Milk 7 per cent. added water Fined £3 and 12s. 6d. costs. 740 „ 28•48 grains per gallon boric acid Dismissed, but actual seller ordered to pay 3s. 6d. costs. 736 Butter 82 per cent. foreign fat, and selling margarine in a plain wrapper Fined £2 and 18s. 6d. costs. — - Giving false warranty Fined £1 and 2s. costs. 793 Milk 11 per cent. of fat abstracted. Fined £1 and 14s. 6d. costs. 809 »» 13 per cent. added water Fined £4 and 14s. 6d. costs. 836 ,, 13•3 per cent added water Fined £3 and 14s. 6d. costs. 884 ,, 3•4 per cent. added water, and 10•6 per cent. devoid of fat Fined £1 and 14s. 6d. costs. 852 „ 8 per cent. added water Fined £1 and 14s. 6d. costs. 943 „ 9 per cent. added water Fined 10s. and 14s. 6d. costs 910 >> 5•6 per cent. added water Withdrawn. 931 ,, 6•8 per cent. added water Withdrawn. 993 11 per cent. of fat abstracted Fined £2 and 23s. costs. 967 ,, 9•3 per cent. added water Fined £1 and 23s. costs. 991 „ 7•5 per cent. added water Fined £1 and 23s. costs. 777 „ 10 per cent. added water Fined £2 and 14s. 6d. costs. 992 Milk 15 per cent. added water Fined 30s. and 14s. 6d. costs in default 7 days. 30 - 10•5 per cent. added water Fined 30s. and 14s. 6d. costs in default 7 days. 28 „ 12•5 per cent. added water Fined 30s. and 14s. 6d. costs in default 7 days. 104 APPENDIX No. 1—continued. Number of Sample. Article. Nature of Offence or Adulteration, See. Result of Proceedings. — Milk No name and address on can Fined 5s. and 4s. costs, in default 7 days. 4 „ 4 per cent. added water, and 24 • 7 per cent devoid of fat Fined 15s. and 12s. 6d. costs 50 „ 6 per cent. added water Fined £1 and 12s. 6d. costs. 964 „ 35 per cent. of fat abstracted. Fined £3 and 12s. 6d. costs. 998 " 6 per cent. of fat abstracted Withdrawn 35 Butter 79.5 per cent. foreign fat, and selling margarine in a plain wrapper Defendant not appearing. Warrant granted. 129 Coffee 57 per cent. chicory Fined £2 and 14s. 6d. costs. 121 Butter 48 per cent. foreign fat, and selling margarine in a plain wrapper Fined £3 and 12s. 6d. costs. 117 Milk 7 • 3 per cent. of fat abstracted Dismissed (warranty). 128 „ 5 per cent. added water Withdrawn. — „ Giving false warranty Fined £3 to include costs. 105 Milk 6 per cent. of fat abstracted Fined £2 and 14s. 6d. costs 169 Cream 23•926 grains per lb. boric acid Fined £1 and 14s. 6d. costs. 150 Butter 47 per cent. foreign fat, and selling margarine in a plain wrapper Fined £3 and 18s. 6d. costs. 174 Milk 5 per cent. of fat abstracted Dismissed (warranty). — „ Giving false warranty Dismissed 194 „ 5•5 per cent. added water Withdrawn £1 1s. costs. 220 Vinegar 10 per cent. added water Fined £1 and 12s. 6d. costs. 273 Milk 10•3 per cent. added water Dismissed (warranty). 308 German sausage 19•83 grains per lb. boric acid Ordered to pay 14s. 6d. costs. 168 Cream 10•78 grains per lb. boric acid Withdrawn 48 Milk 8 per cent. added water . . Dismissed (warranty). 345 .. 7•2 per cent. added water Fined £1 10s. and 12s. 6d. costs. 334 " 4 per cent. added water, and 8•7 per cent. devoid of fat Fined £1 5s. and 14s. 6d. costs 436 7•5 per cent. added water Fined £5 and 12s. 6d. costs, or in default 1 month. 401 Milk 4•2 per cent. added water Fined £3 and 14s. 6d. costs. — „ Giving false warranty Dismissed. 279 „ 6•8 per cent. added water Dismissed 472 „ 30•6 per cent. of fat abstracted Fined £2 and 12s. 6d. costs. — It Giving false warranty Fined £3 and 14s. 6d. costs. 468 Butter 75•8 per cent. foreign fat, and selling margarine in a plain wrapper Fined £2 and 14s. 6d. costs. 105 APPENDIX No. 1—continued. Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 318 Milk 11•2 per cent. added water Fined £2 and 14s. 6d. costs. 522 Butter 81•0 per cent. foreign fat, and selling margarine in a plain wrapper Fined £7 and £2 12s. costs, or one month. 523 ,, 82•8 per cent. foreign fat, and selling margarine in a plain wrapper Fined £7, or one month. 516 „ 79 per cent. foreign fat, and selling margarine in a plain wrapper Fined £2 and £1 0s. 6d. costs 545 Milk 11•4 per cent. added water Dismissed (warranty). 563 ,, 7 per cent. added water, and 50•4 per cent. devoid of fat Fined 10s. and 12s. 6d. costs 589 ,, 14 per cent. of fat abstracted Fined £2 and 14s. 6d. costs. Legal Proceedings under the Public Health (London) Act, 1891; London County Council (General Powers) Act, 1902; Contagious Diseases (Animals) Acts, 1878 to 1886; and Public Health Act, 1875. Nature of Offence. Result of Proceedings. Nuisance at No. 26 Alfred Street Nuisance abated and ash-pit provided, summonses withdrawn, £1 ls. costs. Insufficient ash-pit at No. 26 Alfred Street Nuisance at No. 80 Bridge Rd. West Abatement Order and 15s. costs. Non-compliance with notice to abate nuisance Adjourned sine die pending compliance with Order. Exposing and depositing for sale unsound meat Summonses adjourned sine die for service. Non-compliance with nuisance order Fined £5 and 4s. costs. Manufacture of ice-cream under improper conditions Fined 5s. and 6s. costs. Insufficient water supply at No. 80 Bridge Road West Order made for premises to be closed unless supply reinstated within 7 days and 10s. costs. Nuisance at No. 125 Winstanley Road Summonses adjourned sine die. No proper water supply to w.c. at No. 125 Winstanley Road No sufficient ash-pit at No. 125 Winstanley Road Breach of L.C.C. regulation as to Dairies, &c. Dismissed with £4 4s. costs. 106 APPENDIX No. 2—(contiuued) TABLE 1. (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 1911 and Previous Years. Year. Population estimated to middle of each Year. Births. total deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Un2 corrected Number. Nett. Number. Rate.* of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Nett Births Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 179,622 4,597 4,654 25.9 2,425 13.5 444 403 588 126 2,384 13.2 1907 181,736 4,497 4,574 25.1 2,431 13.4 446 421 526 115 2,406 13.2 1908 183,873 4,500 4,629 25.1 2,265 12.4 408 415 494 107 2,272 12.3 1909 186,036 4,253 4,450 23.9 2,445 13.1 502 474 478 107 2,417 13.0 1910 188,222 4,288 4,489 23.7 2,165 11.5 444 403 434 97 2,124 11.3 1911 167,765 4,154 4,381 26.1 2,437 14.5 506 473 546 125 2,404 14.3 * Rates calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 2,139 acres. Total population at all ages, 167,793; number of inhabited houses, 22,078; average number of persons per house, at Census of 1911. 107 APPENDIX No. 2—(continued). TABLE II. 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 1911. 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 206 3 92 95 11 5 .. 89 68 49 88 66 42 Membranous croup 2 .. 2 .. .. .. .. 2 .. .. 1 .. .. Erysipelas 161 4 6 9 24 97 21 84 51 26 18 11 6 Scarlet fever 325 4 93 198 21 8 1 150 112 63 149 112 60 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 20 .. 1 7 8 4 .. 8 5 7 8 5 4 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 9 .. .. .. 2 7 .. 3 3 3 3 3 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 7 3 4 .. .. .. .. 4 3 .. 2 1 .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. • • .. .. .. .. .. .. Ophthalmia Neonatorum 21 21 .. .. .. .. .. 8 10 3 .. .. .. Polio-encephalitis 2 .. 1 1 .. .. .. 1 .. 1 .. .. .. Chicken-pox 228 18 105 96 6 3 .. 126 57 45 .. .. .. Phthisis. Under Tuberculosis Regulations, 1908 175 .. 3 22 23 114 13 69 70 36 .. .. .. Under Tuberculosis (in Hospital) Regulations, 1911 168 .. 3 18 41 106 .. 83 57 28 .. .. .. Voluntary 101 1 4 20 19 57 .. 42 47 16 .. .. .. Totals 981 53 304 406 72 124 22 475 309 197 269 198 113 108 APPENDIX No. 2—(contiuued.). TABLE III. (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 1911. Causes of Death. Nett Deaths at the Subjoined ages of "residents" whether occuring within or within the district. Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 1 2 and under 5 years. i 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Enteric Fever 3 .. .. .. 1 1 1 .. .. 2 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 111 18 55 32 6 .. .. .. .. 3 Scarlet Fever 4 .. .. 1 3 .. .. .. .. .. Whooping Cough 34 22 8 3 1 .. .. .. .. 5 Diphtheria and Croup. 21 1 2 11 7 1 .. .. .. 1 Influenza 11 1 .. .. 1 2 3 2 2 .. Erysipelas 3 .. .. .. .. .. 1 1 1 3 Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis 217 1 1 2 2 47 101 56 7 108 Tuberculosis Meningitis 34 4 12 3 12 3 .. .. .. 9 Other Tuberculous Diseases 38 11 5 2 9 2 6 2 1 11 Rheumatic Fever 7 .. .. .. 1 1 3 1 1 .. Cancer, malignant disease 163 .. .. .. .. 3 14 76 70 68 Bronchitis 237 45 17 4 1 2 8 44 116 41 Broncho-Pneumonia 77 33 19 9 3 .. 1 7 5 5 Pneumonia (all other forms) 120 20 7 8 7 4 16 32 26 49 Other diseases of Respiratory organs 14 .. .. .. 1 .. 3 5 5 8 Diarrhoea and Enteritis 258 186 39 8 2 1 1 6 15 88 Appendicitis and Typhlitis 6 .. .. .. 3 .. 2 .. 1 3 Alcoholism 2 .. .. .. .. .. .. 2 .. 3 Cirrhosis of Liver 24 1 .. .. .. .. 3 14 6 14 Nephritis and Bright's Disease 71 .. .. .. 1 .. 17 34 17 27 Puerperal Fever 2 .. .. .. .. 1 1 .. .. 5 Other accidents and diseases of Pregnancy and Parturition 5 .. .. .. .. 1 4 .. .. 1 Congenital Debility and .Malformation, including Premature Birth 163 155 8 .. .. .. .. .. .. 32 Violent deaths, excluding 81 6 3 7 10 10 19 20 6 50 Suicides 8 .. .. .. .. .. 5 3 .. 2 Other Defined Diseases 688 42 10 13 28 25 86 172 312 313 Diseases ill-defined or unknown 2 .. .. .. .. 1 .. 1 .. • • All causes 2404 546 186 103 99 106 295 478 591 851 109 APPENDIX No. 2—(centinued). TABLE IV. Required by the Local Government Board to be used in the Annual Reports of the Medical Officer of Health. East Battersea. Infantile Mortality during the year 1911. CAUSE OF DEATH Under 1 Week. 1-2 Weeks. 2-3 Weeks. Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 4 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Whooping-cough .. .. 1 .. 1 4 2 3 3 13 Diarrhœa .. 3 .. 1 4 9 14 14 11 52 Enteritis .. .. 1 .. 1 7 13 8 4 33 Tuberculous Meningitis .. .. .. .. .. .. 1 .. .. 1 Abdominal Tuberculosis .. .. .. .. .. 1 2 1 1 5 Other Tuberculous Diseases .. .. .. .. .. .. 2 .. 2 4 Congenital Malformations 7 1 1 .. 9 .. 2 .. .. 11 Premature birth 19 3 4 2 28 .. .. .. .. 28 Atrophy, Debility and Marasmus 3 2 3 3 11 3 3 .. 2 19 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. 1 .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. 1 2 .. 3 Convulsions 1 1 .. .. 2 1 2 .. .. 5 Gastritis .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. 1 7 6 .. 3 19 Pneumonia (all forms) .. 2 .. 2 4 6 6 12 7 35 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Other causes 6 .. 1 .. 7 2 .. 5 1 15 37 13 11 8 69 40 54 48 41 252 Nett Births in the year—Legitimate, 1862; Illegitimate, 59. Nett Deaths in the year of Legitimate infants, 1035; Illegitimate Infants, 7. 110 APPENDIX No. 2—(continued). TABLE IV.-(continued). North-WestBattersea. Infantile Mortality during the year 1911. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. 1 1 .. 1 3 5 10 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 1 3 1 2 7 Diarrhœa .. .. 1 2 3 7 21 12 12 55 Enteritis .. .. 2 .. 2 10 6 4 8 30 Tuberculous Meningitis .. .. .. .. .. 1 .. 1 1 3 Abdominal Tuberculosis .. .. .. .. .. .. .. 1 2 3 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Congenital Malformations 9 1 .. .. 10 .. .. .. .. 10 Premature Birth 15 4 2 .. 21 .. .. .. .. 21 Atrophy, Debility and Marasmus 7 2 5 3 17 3 3 3 4 30 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis 1 1 .. .. 2 .. 1 .. .. 3 Rickets .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 1 .. 1 Convulsions .. .. .. .. .. 1 .. .. .. 1 Gastritis .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. 1 7 6 3 4 21 Pneumonia (all forms) .. .. .. .. .. .. 5 3 3 11 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Other causes 4 .. 1 .. 5 .. 2 1 .. 8 36 9 11 6 62 30 48 33 42 215 Nett Births in the year—Legitimate, 1,534; Illegitimate, 55. Nett Deaths in the year of Legitimate Infants, 813; Illegitimate Infants, 13. 111 APPENDIX No. 2—(continued). TABLE IV.-(continued). S.W. Battersea. Infantile Mortality during year 1911. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. 1 .. 1 .. 1 .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. 1 1 2 Diarrhœa .. .. .. .. .. 1 1 2 2 6 Enteritis .. .. .. 2 2 1 .. 2 5 10 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Congenital Malformations 2 1 .. .. 3 3 .. 1 1 8 Premature birth 12 .. 1 2 15 .. .. .. .. 15 Atrophy, Debility and Marasmus 3 .. 3 .. 6 5 1 .. 1 13 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. 1 1 .. .. .. .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. 1 1 .. .. .. .. 1 Convulsions 1 .. .. .. 1 .. .. .. .. l Gastritis .. .. .. 1 1 .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. .. .. 1 1 1 .. 2 5 Pneumonia (all forms) 1 .. .. .. 1 1 .. 3 2 7 Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Other causes 1 .. .. 1 2 l 2 2 .. 7 21 1 5 8 35 13 6 11 14 79 Nett Births in the year—Legitimate, 849; Illegitimate, 22. Nett Deaths in the year of Legitimate Infants, 529; Illegitimate Infants, 7. 112 APPENDIX No. 2—(contiuued). TABLE IV. Borough of Battersea. Infantile Mortality during the year 1911. CAUSE Oh' DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Small pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. 1 1 2 .. 2 5 9 18 Scarfet Fever .. .. .. .. .. .. .. .. .. .. Dipthheria and Croup .. .. .. .. .. .. .. .. 1 l Whooping-cough .. .. 1 .. 1 5 5 5 6 22 Diarrhœa .. 3 1 3 7 17 36 28 25 113 Enteritis .. .. 3 2 5 18 19 14 17 73 Tuberculous Meningitis .. .. .. .. .. 1 1 1 1 4 Abdominal Tuberculosis .. .. .. .. .. 1 2 2 3 8 Other Tuberculous Diseases .. .. .. .. .. .. 2 .. 2 4 Congenital Malformations 18 3 1 .. 22 3 2 1 1 29 Premature Birth 46 7 7 4 64 .. .. .. .. 64 Atrophy, Debility and Marasmas 13 4 11 6 34 11 7 3 7 62 Atelectasis .. .. .. .. .. .. .. .. .. .. Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis 1 1 .. 1 3 .. 1 1 .. 5 Rickets .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. 1 1 .. 1 3 .. 5 Convulsions 2 1 .. .. 3 2 2 .. .. 7 Gastritis .. .. .. 1 1 .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 2 .. .. 3 15 13 3 11 45 Pneumonia (all forms) 1 2 .. 2 5 7 11 18 12 53 Saffocation, overlying .. .. .. .. .. .. .. .. .. .. Other causes 11 .. 2 1 14 3 4 8 1 30 94 23 27 22 166 83 108 92 97 546 Nett Births in the year—Legitimate, 4,245; Illegitimate, 136. Nett Deaths in the year of Legitimate Infants, 2,377; Illegitimate Infants, 27. 113 Factories, Workshops, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 579 28 — Workshops (including Workshop Laundries) 1,314 75 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1,716 73 — Total 3,609 176 — 2.—Defects Found. Particulars Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— NIL. NIL. Want of Cleanliness 51 51 Want of Ventilation 4 4 Overcrowding 1 1 Want of drainage of floors 2 2 Other nuisances 71 71 Sanitary accommodation { Insufficient 10 10 Unsuitable or defective 87 87 Not separate for sexes 4 4 Offences under the Factory and Workshop Act: — — Illegal occupation of underground bakehouse (Sec. 101) — — Breach of Special Sanitary Requirements for Bakehouses (Sees. 97 to 100) 32 32 Other Offences (excluding Offences relating to Outwork which are included in Part 3 of this report) — — Total 262 262 114 3.—Home Work. NATURE OF WORK. OUTWORKERS' LISTS. SECTION 107. Outwork in Unwholesome Premises, Sec. 108 • Outwork in Inpected Premises, Secs. 109,110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Secs. 109,110) Sending twice in the year. Sending once in the year. Failing to keep or permit inpection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making, &c. 68 38 324 6 1 27 — — — 5 5 — — — — (2) Cleaning and washing 4 10 2 2 3 4 — — — — — — — — — Furniture and upholstery 2 — 4 — — — — — — — — — — — — Sacks 2 — 2 — — — — — — — — — — — — Total 76 48 332 8 4 31 — — — 5 5 — — — — 115 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year:— Bakehouses 74 Bootmakers 79 Dressmakers 86 Laundries 48 Milliners 21 Tailors 42 Other Trades 204 Total number of workshops on Register 564 5.—Other Matters. Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 28 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 2 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 31 116 Proceeding's during 1911. (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, 1911. No. of tion Notices 1911. No of Prosecutions 1911. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Milk premises 185 25 34 176 620 18 1 Cowsheds 3 — — 3 * — — Slaughterhouses 5 — 1 4 328 — — Other offensive trade premises 2 — — 2 19 — — Ice-cream premises 185 16 27 174 583 4 1 Registered houses let in lodgings 123 — — 123 330 127 — * These premises are subject to frequent inspection. Total number of intimation notices served for all purposes 4,351 Overcrowding— Number of dwelling-rooms overcrowded 84 Number remedied 84 Number of prosecutions — Underground rooms— Illegal occupation dealt with during the year 19 Number of rooms closed 19 Insanitary houses— Number closed under the Public Health (London) Act - Number closed under the Housing of the Working Classes Act — Number of verminous premises cleansed under Section 20 of the L.C.C. (General Powers) Act, 1904 - 117 Shelters provided under Section 60 (4) of the Public Health (London) Act— Number of persons accommodated during the year Revenue Acts— Number of houses for which applications were received during year 17 Number of tenements comprised therein 29 Number of tenements for which certificates were:—(a) Granted 12 (6) Refused 9 (c) Deferred 8 Number of prosecutions under bye-laws under Public Health (London) 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, cis- terns, &c. — (h) With respect to water-closets, &c. — (i) With respect to sufficiency of water supply to water closets — (j) 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) — Mortuary— Total number of bodies removed 287 Total number of infectious bodies removed 10 118 RELATIVE TO THE SUPPLY OF DIPHTHERIA ANTI-TOXIN SERUM. 13th December, 1910. In accordance with the instructions of the Committee, I beg to report on the recent order issued by the Local Government Board under the provisions of Section 77 of the Public Health (London) Act, 1891, sanctioning the provision of a temporary supply of diphtheria anti-toxin serum and of medical assistance in connection therewith by sanitary authorities. The Order provides that the arrangements with respect to the keeping, distribution and use of the diphtheria anti-toxin are to be made in accordance with the advice of the Medical Officer of Health. In cases in which the patient is under the care of a medical practitioner, the latter should in ordinary circumstances, be the person to administer the anti-toxin. In the circular letter of the Board, accompanying the Order, the Board state that the Council should take into consideration the possible requirements in this connection of the Poor Law Medical Officers, who should, in the event of the Council availing themselves of the powers now given them, be able to obtain frnm the Council the anti-toxin they may require from time to time for use in connection with patients under their care. The Board further draw attention, in the letter referred to, to the advantages which may be derived form the prompt administration of anti-toxin before the patient is removed to hospital, but that the free provision of anti-toxin sanctioned by the Order is not to be regarded as a substitute for removal to hospital of a patient suffering from diphtheria. The duties of the Medical Officer of Health are to be deemed to extend to and include all action by him in the execution of this Order (Art. II.) and provision is made for the payment by the Council to the Medical Officer of Health of reasonable compensation for such action taken by him. The arrangements which the Council may make for the supply of diphtheria anti-toxin should be brought to the knowledge of all medical practitioners practising within their jurisdiction, and in any circular letter which Council may send out to medical practitioners it is desirable that emphasis should be laid on the importance of prompt treatment by anti-toxin, and on the saving of life which may thereby be effected. The new Order has been anticipated so far as the provision and distribution of diphtheria anti-toxin serum to medical practitioners 119 is concerned, by many sanitary authorities in London and the provinces, and the official sanction provided by the new Order will enable a wider use to be made of this beneficient agent. It is not clear to what extent the duties of the Medical Officer of Health are to be affected by the new Order, but it would appear from Article 1 that it is mainly in an advisory capacity that his services will be utilised. The advantages to be derived from the free provision of antitoxin by sanitary authorities are twofold in character. In the first place, delay will be avoided in administering the remedy: and secondly, the remedy is placed at the disposal of the poorer inhabitants of the community. As the Committee are aware, most of the diphtheria cases occurring in Battersea are removed for treatment to the hospitals of the Metropolitan Asylums Board. It should be remembered, however, that in a considerable number of cases it is a difficult matter to diagnose diphtheria, particularly in slight attacks and in the earlier stages of the disease in severer cases, and recourse has to be had to a bacteriological examination. This gives rise to a delay of approximately twenty four hours, and it is in regard to such cases more especially that valuable results are to be obtained by the free provision of anti-toxin serum by the sanitary authority, enabling the medical attendant to make use of the remedy while awaiting the result of the bacteriological examination. I would therefore advise the Committee to recommend the Council to avail themselves of the powers sanctioned by the new Order. No difficulty will be found in making the necessary arrangements for the distribution of the serum. From the enquiries I have made with regard to the experience of some of those sanitary authorities who have been supplying anti-toxin for some years, I do not anticipate that the adoption of these powers will entail any very great expenditure. ADDENDUM. Since writing the above report, which was ordered to be printed and circulated amongst members of the Council at the last Council meeting, the Health Committee at their meeting on 13th December, when the report was submitted to them decided to adjourn the consideration of the matter for information to be obtained as to the action taken in regard to the Order by other Sanitary Authorities in Metropolitan and Extra-Metropolitan districts. I herewith, with the approval of the Health Committee, submit a summary of the replies received from 34 Sanitary 120 ties, from which it will be seen that the great majority of these bodies have adopted the Order and that a considerable number of them had some more or less similar system as that now sanctioned by the Local Government Board already in operation. Number of Sanitary \uthorities who have made provision under L.G.B. Order. Number of Sanitary Authorities who have not made provision under L.G.B. Order. Number of Sanitary Authorities having matter under consideration. Number of Sanitary Authorities who have had a system in operation prior to Order. 21 9 4 19 The extent to which the facilities provided have been availed of, in the districts of those authorities who have had a system in operation prior to the issue of the Local Government Board Order, appears to have varied considerably, the cost to the respective authorities ranging from £1 to £50 per annum. REPORT OF THE MEDICAL OFFICER OF HEALTH IN RE HOUSING AND TOWN PLANNING ACT, 1909. To the Health Committee. A pril, 1911. Under the provisions of Sec. 17 (1) of the Housing and Town Planning Act, 1909, the Local Government Board have issued an Orde:- to Local Authorities prescribing Regulations with respect to the manner in which the inspection of their districts under this Section shall be carried out and the keeping of the records of such inspection. I note with satisfaction that the Legislature has at length recognised the principle which Battersea and other sanitary well-governed districts have adopted, and that systematic house inspection shall be conducted under statutory authority as a duty devolving on the Local Authority. The Regulations provide that as early as practicable after the date of the Order the Local Authority shall take into consideration the provisions of Sec. 17 (1) of the Act of 1909, and shall determine the procedure to be adopted by them to give effect to the requirements of the sub-section in regard to the systematic inspection of their district for the purposes of such Section. 121 Under the Regulations it is the duty of the Medical Officer of Health to supervise and direct the preparation from time to time of lists of dwelling-houses, the early inspection of which, in his opinion, is desirable, and the matters in relation to which the inspection should be made and the manner in which the records of such inspections are to be kept are set out in the Regulations. These records shall be considered at each of their ordinary meetings by the Local Authority, who shall take such action as may be desirable in each case, and the results of such action are to be added to the records. The annual report of the Medical Officer of Health is to contain certain information and particulars as to the inspections and the results. I propose, therefore, in accordance with the duty imposed on me under the regulations, to submit from time to time, for the consideration of the Committee, a list or lists of houses which, in my opinion, require to be dealt with under the provisions of Sec. 17 (1) of the Act of 1909. With regard to the keeping of the records as prescribed by the Regulations, the present system of house inspection as carried out in this Borough is recorded in book-register form, which is submitted to the Committee at their ordinary meetings. It would appear that this method of record is not to be superseded, provided that it includes all the matters mentioned in that part of the Regulations dealing with the keeping of records under Sec. 17 (1) of the Act of 1909. I am giving this matter careful consideration, and as it will be necessary to revise the present house inspection registers so as to make them conform to the requirements of the order, it would seem to me that this would most conveniently be carried out by adopting a more concise register to take the place of the present unwieldy book system. Another matter to which the Committee will find it necessary to give their early attention in connection with this Order is that dealing with underground rooms (cellar dwellings). The provisions of the Public Health (London) Act, 1891, giving power to sanitary authorities in regard to these premises, have proved ineffective, owing to the exemption clause. Under the provisions of Sec. 17, Sub-sec. 7 of the Housing and Town Planning Act such rooms, if habitually used as sleeping rooms shall be deemed dwellinghouses unfit for human habitation, unless they conform to certain conditions, and as such are liable to have Closing Orders made in regard to them. Thus, a room used as a sleeping place the surface of the floor of which is more than 3ft. below the surface of that part 122 of the street adjoining or nearest to the room, is, for the purpose of Sec. 17 (7), to be deemed to be a dwelling so dangerous or injurious to health as to be unfit for human habitation if the room either:— (a) Is not at least on the average 7ft. high, or, (b) Does not comply with such Regulations as the Council with the consent of the Board may prescribe for securing the proper ventilation and lighting of such rooms and the protection of the rooms against dampness, exhalation and effluvia. As there are a considerable number of such premises in the Borough, numerous examples of the illegal occupation of which come to light from time to time, the Committee will no doubt take an early opportunity of framing for the approval, as required, of the Local Government Board, a suitable code of regulations. (See copy). The new Order, it will be seen, is a document of the highest importance to Local Authorities, and although for purposes of this report it only refers to procedure under Sec. 17 of the Act of 1909, dealing with Closing Orders and Demolition Orders, it is necessary to point out to the Committee the position in regard to the administration of the Section in their district. To warrant the making of a Closing Order under the Section, the house must be in a condition "so dangerous or injurious to health" as to be unfit for human habitation. There is no definition in the Housing Acts, however, as to what constitutes "unfitness," though in the 1909 Act such a definition is provided in the case of underground rooms which under Sec. 17 (7) are deemed unfit if they do not comply with the Section and the Regulations made thereunder. The general test of unfitness under these enactments appears to be the existence of one or more conditions which are capable of being dealt with as a nuisance under the Public Health Acts, rendering the premises or any apartment therein unfit for habitation. Danger or injury to health does not necessarily include structural defects, e.g., defects to stairs, floors, &c., which make the house unsafe. In London mere dilapidation is dealt with, if at all, under the Building Acts (Sec. 102-117), but in considering the question of unfitness regard would be had to and would include dirt and vermin, dampness of roofs, walls or floors, defective drains, noxious effluvia rising from the site, and inadequate light and ventilation. It will be open to the Committee in regard to houses which are not in such a state as to warrant proceedings being taken under Sec. 17, to deal with such houses under Secs. 14, 15 and 16 of the same Act. Under these Sections the provision as to fitness implied in the letting of houses in London has been extended from £20 per 123 annum to £40. These provisions apply only to lettings made after 3rd December, 1909, and do not apply to any tenancies, weekly or otherwise, created before the Act. Such tenancies are, however, subject to similar obligations under Sec. 75 of the principal Act when the rents are within the limits therein specified. Secs. 14-15 of the Act of 1909 impose on the landlord the obligation to have the house at the beginning of, and throughout the term of the tenancy, "in all respects reasonably fit for human habitation." This obligation is wider in its scope than the definition in the Closing Order sections, and extends to the condition of the floors, staircases, roofs and walls. Under these sections the landlord would apparently be liable to the tenant for injuries arising from defective floors and staircases, defective and leaky rooms, as well as from nuisances within the Public Health Acts. It is important to note that the obligation is on the "landlord," as defined in Sec. 15 (7), and not on the "owner," as defined in the Public Health Act. This may give rise to a difficulty in fixing the responsible persons in the event of the Sanitary Authority taking action under Sec. 15, as under such circumstances it may be found that the "landlord" is himself only a weekly tenant who sub-lets and who is incapable of recouping the Authority any expenses incurred by them in putting the property into proper order. The Council's Solicitor will, however, fully deal with the legal details in his report, so that it is only necessary for me in this report to refer thus briefly to the administrative difficulties which may arise in carrying out the provisions of this part of the Act. (Signed) G. Quin Lennane, Medical Officer oj Health. APPENDIX. [Copy.] REGULATIONS AS TO UNDERGROUND ROOMS HABITUALLY USED AS SLEEPING PLACES. Whereas by Sec. 17 of the Housing, Town Planning, &c., Act, 1909, it is enacted as follows:— Sub-Section 7.—A room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining, or nearest to the rooms, shall, for the purposes of this Section, be deemed to be a dwelling house so dangerous or injurious to health as to be unfit for human habitation if the room either— (a) Is not on an average at least seven feet in height from floor to ceiling; or, 124 (b) Does not comply with such regulations as the Local Authority, with the consent of the Local Government Board may prescribe for securing the proper ventilation and lighting of such rooms and the protection thereof against dampness, effluvia or exhalation. Provided that if the Local Authority, after being required to do so by the Local Government Board, fail to make such regulations or such regulations as the Board approve, the Board may themselves make them, and the regulations so made shall have effect as if they had been made by the Local Authority with the consent of the Board. Provided that a Closing Order made in respect of a room to which this Sub-section applies shall not prevent the room being used for purposes other than those of a sleeping place; and that, if the occupier of the room, after notice of an Order has been served upon him, fails to comply with the Order, an Order to comply therewith may, on summary conviction, be made against him. Now, therefore, we, the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea, being the Local Authority for the said Metropolitan Borough, hereby prescribe the following regulations with which a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street or ground adjoining or nearest to the room, shall comply, namely:— (a) Such room shall in every part thereof have at least three feet of its height above the level of the surface of the street or ground adjoining or nearest to such room. Provided that if the width of the area hereinafter mentioned is not less than the height of the room from the floor to the said surface or is not less than six feet, the eight of the room above such surface may be less than three feet, but not in any case less than one foot. (b) Every wall of such room shall be constructed with a proper damp-proof course, and, if in contact with the soil, shall be effectually protected against dampness from that soil by means of a vertical damp-proof course, or otherwise. (c) There shall be outside of and adjoining such room and extending along the entire frontage thereof and open upwards from six inches below the level of the floor 125 thereof an area properly paved and effectually drained and at least four feet wide in every part thereof, provided that the width of such area may not be less in any part than three feet, if the mean width of the area be not less than four feet; provided also, that in the area there may be placed steps necessary for access to the room, and over and across such area there may be steps necessary for access to any buildings above the room, if the steps are so placed in such case as not to be over or across any external window of the room. (d) The space, if any, beneath the floor of such room shall be provided with adequate means of ventilation. (e) Every drain passing under any such room shall be perly constructed of a gas-tight pipe. (f) Such room shall be effectually protected against the rising of any effluvia or exhalation by means of a layer of good cement concrete at least six inches thick laid upon the soil of the site of the entire room, or by some other equally effective means. (g) Every such room which is without a fireplace and a flue properly constructed and properly connected with such fireplace, shall be provided with special and adequate means of ventilation by a sufficient aperture or air-shaft which shall provide an unobstructed sectional area of 100 square inches at the least. (h) Such room shall have one or more windows opening directly into the external air, with a total area clear of the sash frames equal to at least one-tenth of the floor area of the room, and so constructed that one-half, at least, of every such window can be opened, and that the opening may be in every case extend to the top of the window. These regulations shall come into force [on the Second day of October, 1911,