BAT 18 Metropolitan horough of Battmra. REPORT on the HEALTH of the Metropolitan Borough of Battersea, For the YEAR 1912 BY G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. 3 Health Committee. (November, 1912.) Chairman. Councillor J. W. TAYLOR. HIS WORSHIP THE MAYOR. (Councillor T. P. Brogan, j.p.) Alderman J. HOLLY . " J. RANSON. Councillor C. BARRINGTON. " H. C. BIGDEN. " W. M. BRADFORD. " F. E. HOVENDEN. " J. KENNY. " J. W. O'BRIEN. " Dr. J. T. RICHARDS. " J. J. TAYLOR. " J. W. TAYLOR. " 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 E. C. Peacock, San.Insp. Board's Cert., Nursing Cert. Miss M. E. Ross Brown, b.a., San. Insp. Board's Cert. Food Inspector. A. Chuter, Cert. San. Inst, and Meat Insp. Cert. Workshop Inspector. W. E. Benjamin, Cert. San. Inst. District Sanitary Inspectors. No.l 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. Purnell, Cert. San. Inst. „ 5 „ J. T. Baxter „ „ „ 6 „ H. Marrable „ „ „ 7 „ A. Odell, Cert. San. Inst. and Meat Insp. Cert. „ 8 „ H. H. May, Cert. San. Inst. Clerks. Chief Clerk B. W. Sears. Second Class Clerks F. H. Preston, Cert. San. Inst. E. Cole. Third Class Clerks W. Halstead. F. Ebbutt. W. Roberts. Office Youth R. Graham. Manageress of Milk Depôt. Miss A. Lowe. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper. G. Streat. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Gentlemen, I beg to present the Annual Report on the Health and Sanitary Condition of the Borough of Battersea for the year 1912. In doing so it is my privilege to be able to state that Battersea continues to maintain the high position it has attained as one of the healthiest of the Metropolitan Boroughs. The death and infantile mortality rates are the lowest ever recorded in the Borough or the Old Parish of Battersea. Although the incidence of infectious disease was slightly higher than in 1911, it is satisfactory to be able to report that the death rate from infectious diseases was the lowest recorded in the Borough statistics. The appointment of a female Workshop Inspector, although she only commenced her duties in the latter half of the year, has been fully justified. In conclusion, I desire to express my thanks to the members of the Council for the support extended to me. To the officials also my thanks are due for assistance always willingly rendered. G. QUIN LENNANE. 6 CONTENTS. Births, Marriages and Deaths. page Births 9 Deaths 11 Deaths in Public Institutions 15 Infantile Mortality 15 Marriages 11 Notification of Births Act 18 Population 9 Senile Mortality 26 Infectious and other Diseases. Alcoholism 58 Bacteriological Examinations 58 Cancer 58 Diarrhoea 41 Diphtheria 34 Enteric Fever 36 Epidemic Cerebro-spinal Meningitis 38 Erysipelas 38 Measles 39 Notifiable Infectious Diseases 31 Puerperal Fever 37 Scarlet Fever 33 Small Pox 33 Tuberculosis 42 Whooping Cough 40 Zymotic Diseases 27 General Sanitary Administration. Ambulances 78 Block Dwellings 72 Cleansing of Persons Act, 1897 75 Common Lodging Houses 72 Customs and Inland Revenue Act 73 Disinfection 73 7 General Sanitary Administration (continued). page House-to-house Inspection 61 Houses Let in Lodgings 65 Housing, Town Planning, &c., Act 63 Inquests 77 Midwives Act 76 Mortuary 76 Paving of Back-yards and forecourts 69 Sanitation of House Property 60 Sewer Ventilation 70 Shelter, Temporary 75 Smoke Nuisances 69 Underground Rooms 64 Van Dwellings 71 Water Supply 73 Protection of the Food Supply. Butchers' Shops 83 Cow-houses 81 Fish Shops 83 Ice Cream 81 Milkshops 81 Restaurants, &c 82 Sale of Food and Drugs Act 84 Slaughter-houses 80 Unsound food Factory and Workshop Act, 1901. Bakehouses 98 Factories 93 Homework 100 Underground Workrooms 98 Workshops 95 Legal Proceedings 103 Infants' Milk Depôt 23 Appendices. Legal Proceedings 103 Tables 107 Reports 119 8 Summary of Vital Statistics for 1912. Area of Borough (excluding water) 2,139.9 acres Population (Census 1901) 168,907 „ ( „ 1911) 167,793 „ Estimated to middle of 1912 167,589 Density 78.3 persons per acre Inhabited Houses (Census 1911) 22,078 Marriages 1,434 Births 4,255 Birth-rate 254 Deaths 2,052 Death-rate 12-2 Infantile Mortality 83 per 1,000 births 9 Births, Marriages and Deaths. Population. In 1901 the population of the Metropolitan Borough of Battersea 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.). The population of the Borough estimated to the middle of the year is 167,589, on which the rates in this report are based. The estimated population for each of the sub-districts into which for registration purposes the Borough is divided, is as follows:— East Battersea 69,700 North-West Battersea 49,085 South-West Battersea 48,804 The natural increase of population by excess of births over deaths during the year 1912 amounted to 2,203. The area of the Borough (excluding water) is 2,139.9 acres, the density of population being 78 3 person per acre. Births. The total number of births belonging to the Borough of Battersea during 1912 was 4,255. Of the total births 2,188 were males and 2,067 females, showing an excess of 121 males. The births were 126 fewer than in 1911 and were 413 below the decennial average 1902-1911. The births in the sub-districts were as follows:— Males. Females. Total. East Battersea 1,032 947 1,979 North-West Battersea 731 687 1,418 South-West Battersea 425 433 858 Borough 2,188 2,067 4,255 10 The birth-rate, i.e., the number of births per 1,000 of the population was 25 4, as compared with 26 1 in 1911. Last year there was apparently a marked increase in the birth-rate as compared with the rate for 1910 (viz., 26 1 as compared with 23 7). This was not a real increase however, but is to be accounted for by the fact that the rates were based on the estimated population as calculated by the Registrar General, but which the Census enumeration of 1911 has now shown to have been greatly in excess of the actual population. There is therefore no doubt that the decline in the birth-rate still continues, though the rate of decline is not so rapid as appeared to be the case prior to the Census of 1911. In the sub-districts the birth-rates during 1912 were as follows: North-West Battersea 289, East Battersea 284, South-West Battersea 17 6. The decline in the birth-rate in Battersea as compared with that in England and Wales is shown in the following table :— Birth-rate per 1,000 Population. Years. Englan 1 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 1912 23.8 24.5 25.4 The next table shows the birth-rate in the Borough and in each of the sub-districts during the ten years 1902-1911 and in 1912:— 11 Birth-rate per 1,000 Population. Year. The Borough. Bast Battersea. North-West Battersea. South-West Battersea. 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 1911 26.1 27.5 32.3 17.8 Average 1902-1911 26.1 28.7 32.2 17.2 1912 25.4 28.4 28.9 17.6 Marriages. The marriages registered in Battersea during 1912 numbers 1,434, and 58 more than the decennial average. The marriagerate, i.e., the number of persons married per 1,000 of the population was 171, or 1-7 above the decennial average. Deaths. The total number of deaths registered in the Borough of Battersea during the year 1912 was 2,125, as compared with 2,437 during 1911, and a yearly average of 2,849 in the old Parish of Battersea for the decennium 1891-1900. Of the total deaths registered, 1,110 were males and 1,015 females, showing an excess of 95 males. The death-rate for Battersea is therefore 12-7 per 1,000 inhabitants, as compared with 13-6 for London. This rate is, however, uncorrected, and on analysing the 2,125 deaths registered in the Borough of Battersea, it is found that 530 represent deaths occurring within the Borough amongst persons not belonging thereto. These deaths are to be deducted; but on the other hand there are 457 deaths of Battersea residents, and these must be added, giving a corrected number of deaths for Battersea during 1911 of 2,052 (1,039 males and 1,013 females, an excess of 26 males), and a corrected death-rate of 12 2, as compared with 13 6 for London (the total corrected number of London deaths being 61A 00). 12 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. For the purpose of ascertaining this rate, a factor forcorrection is supplied by the Registrar General for each Metropolitan Borough, which is obtained by him from the Census returns, and which varies for each Metropolitan district according to the age and sex distribution of its inhabitants. The recorded death-rate of the district multiplied by this factor gives the death-rate which would obtain in that district if the age and sex distribution of the population of the district were in the same proportions as it is in the country as a whole. The death-rate for the Borough calculated in this way is 13 08 for the year 1912. Sub-dividing the death-rate amongst the three registration sub-districts it will be noted that there has been a decrease in the death-rate, most marked in North-West Battersea. The following table shows the death-rates per 1,000 of the population in the Borough and sub-districts for the ten years 1902-1911:— Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Bat ersea. South-West Battersea. 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 1911 14.3 14.9 16.8 10.9 Average 1902-1911 13.5 14.5 16.4 9.6 1912 12.2 12.8 13.5 10.1 13 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 1912. Number of Deaths. Death Rates. Nine Elms 27,189 372 13.7 Park 17,500 248 14.2 Latchmere 20,172 244 12.1 Shaftesbury 16,010 164 10.3 Church 19,342 266 13.8 Winstanley 20,187 279 13.8 St. John 8,200 84 10.3 Bolingbroke 18,449 212 11 .5 Broomwood 20,540 183 8.9 It is satisfactory to be able to record the very low general death-rate for the year 1912, which is probably the lowest rate ever recorded in the Old Parish or Borough of Battersea. When it is remembered that the rate is calculated on the recent Census figures, which show that the estimated population of the Borough for the years immediately preceding the Census figures was considerably overstated and that the death-rate was consequently seriously understated, the mortality-rate for the Borough in 1912 is the more noteworthy and gratifying. It is interesting to note the position which the Borough takes during 1912 in the Registrar-General's corrected returns amongst the twenty-nine Metropolitan Cities and Boroughs. There are twenty-one Boroughs with a higher general death-rate, and only six of the twenty-nine have a lower death-rate than Battersea. Twenty Boroughs have a higher zymotic death-rate and twentyone a higher infant mortality rate Taking the ten South Metropolitan Boroughs, Lewi sham has the lowest general death-rate (10 2), and Bermondsey and Southwark the highest (16 8); only three of the ten Southern Boroughs having a lower death-rate than Battersea. London as a whole has a birth-rate of 24.5, a corrected zymotic (death) rate of 1.1 per 1,000, and an infantile mortality (corrected) rate of 91 per 1,000 births. For England and Wales the figures are, birth-rate 238, infantile mortality 95. The corrected number of deaths iered in each quarter of the year is s of males and females regiset out as follows :— Males. Females. Total. First quarter 292 267 559 Second quarter 219 219 438 Third quarter 209 212 421 Fourth quarter 319 315 634 14 Comparative Statistics of Births, Mortality, &c. Year. Mean population for year. Births. Birth Rate. Deaths, Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.0 343 21 .4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22 .1 96 292 1860 18,676 680 36.4 399 21 .3 62 281 1861 19,582 750 38.3 595 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 1 178 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 2055 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 1 138,565 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 2,994 181 642 2,364 1897 166,059 5,266 31 .7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901.. 169,100 5,025 29.7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 375 2,282 1906 179,622 4,654 25.9 2,384 13.2 338 2,270 1907 181,736 4,574 25 1 2,406 13.2 255 2,168 1908 183,873 4,629 25.1 2,272 12.3 238 2,357 1909 186,036 4,450 23.9 2,417 12.9 283 1,033 1910 188,222 4,489 23.7 2,124 11.3 242 1,365 191 i 167,765 4,381 261 2,404 14.3 331 1,977 1912 167,589 4,255 25.4 2,052 12.2 183 2,203 The years marked thus .. were census years. CHART showing the Infantile Mortality in the Borough of Battersea during the last ten years. 15 Deaths in Public Institutions. During the year 1912 the deaths of Battersea residents occurring in public institutions numbered 795, as compared with 857 in 1911. Of this number 338 occurred within and 457 outside the Borough. Three hundred and eighty occurred in workhouses or union infirmaries, as against 415 in 1911 and 370 in 1910. 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 children in any given year bears to every thousand children born in the same year. Infant mortality varies widely in different districts and is 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 others interested, and there has followed in consequence a marked improvement in the vital statistics of the whole country. There has up to 1911 been a steady decline in infant mortality throughout England and Wales. In 1911, owing to the very hot, dry and prolonged summer prevailing during that year, there was a temporary set-back, an increase of about 30 per cent, over the rate for 1910 having to be recorded. That this increase in mortality was only of a temporary character the returns for 1912 abundantly indicate, the infant mortality rate for the year being the lowest ever previously recorded. Infant Mortality in Battersea in 1912. During the year 1912 the deaths of 353 infants were registered as belonging to Battersea. The total number of births registered during the year was 4,255, a decrease of 126 births from those of 1911, giving an infant mortality-rate of 82 9 per 1,000 births. This is the lowest infant mortality ever recorded in Battersea, and constitutes a noteworthy and highly satisfactory feature of the Annual Report. It is true that, to some extent at least, this decline in the infant death-rate for 1912 was contributed to by the climatic conditions prevailing during the summer of that year, viz., low temperature and a heavy rainfall. There can be no doubt, however, that this only partially explains the decline, and that the measures which the Council have so energetically and consistently carried out for combatting the high mortality which, prior to 1902, was such an unsatisfactory feature of the Borough statistics, have been responsible mainly for the present satisfactory position. The efforts of the Council in this direction have been greatly assisted by the Notification of Births Act, 1907, which, in addition to securing early information of the occurrence of births, empowered sanitary authorities to employ health visitors. 16 Since the formation of the Borough, and for the previous decennium, the infant mortality in Battersea and in London is set out as in the following table:— TABLE IX. 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 1912 91 83 It will be seen from the above table that with the exception of slight oscillations in individual years, due no doubt to climatic conditions, there has been (1) a steady and progressive decline in infant mortality in Battersea, and (2) that the decline in Battersea has been greater than in London. In the County of London during 1912 there was a total of 10,056 infant deaths registered, giving an infantile mortality rate of 91 per 1,000 births, as compared with 14,440 deaths, giving an infantile mortality rate of 129 per 1,000 births in 1911. The next table shows the distribution of the 353 infant deaths in the sub-districts. TABLE X. Registration Sub-Districts. Deaths of Infants under 1 year of age,. Infantile Mortality per 1,000 births. East Battersea 159 80.3 North-West Battersea 139 98.0 South-West Battersea 55 62.9 The Borough 353 82.9 17 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. TABLE XI. Certified Causes of Death. Months. 0.3. Months. 3.6. Months. 6.12. Total. Diarhoea 11 17 10 38 Prematurity 80 1 — 81 Marasmus and debility 35 7 8 50 Developmental disease 2 - 1 3 Bronchitis 8 8 9 25 Pneumonia 10 12 21 43 Convulsions 5 2 - 7 Suffocation - - 1 1 Measles - - 11 11 Whooping cough 4 6 9 19 Tuberculosis — 2 5 7 Meningitis 1 — 1 2 Miscellaneous 49 7 10 66 205 62 86 353 From the above table it will be seen (a) that the mortality is heaviest in the first three months of life, (b) that three groups of diseases between them account for 240 (i.e., 67.7 per cent.) of the total deaths of infants during 1912, viz., congenital and develop mental diseases, respiratory diseases and diarrhoea. Looking more in detail into these figures it will be seen that of the 353 infant deaths, 155 (i.e., 43-3 per cent.) were due to congenital diseases. The respiratory group was responsible for 68 (i.e., 19 8 per cent.) of the total infant deaths. There was a very considerable decrease in the deaths from diarrhceal disease as compared with 1911; the deaths from this group numbering 38 (i.e., 10.7 per cent.) of the total infant deaths. It is satisfactory to be able to record that in the three principal groups of diseases set out in the table there was a decrease in infant mortality, as compared with the previous year. 18 Preventive Measures. The causes responsible for these 353 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. Infants Milk Depot. 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 births. The Act has in this way proved of great value to health authorities in their efforts to prevent a high death-rate amongst infants. The Act has now been in force in Battersea for the past five years, and enacts that the birth of every child shall be notified to the Medical Officer of Health within thirty-six hours. The notification is " in addition to and not in substitution for the requirements of any Act relating to the registration of births," and applies to any child born " after the expiration of the twenty-eighth week of pregnancy whether alive or dead." For default in notification a penalty of 20s. is provided. During the year 1912, 3,413 notifications of births were received. Of this number 1,195 (i.e., 35 per cent.) were notified by medical practitioners, 907 (i.e., 27 per cent.) by midwives, and 1,311 (i.e., 38 per cent.) by other persons. The number of births notified from each of the three sub-districts of the Borough were as follows :— East Battersea 1,634 North-West Battersea 1,080 South-West Battersea 699 The number of births registered in Battersea during 1912 was 4,255. The proportion of notified to registered births was therefore 83 5 per cent., as compared with 69 per cent in 1911, and 70 per cent, in 1910. It is satisfactory to be able to record such a considerable increase in the number of births notified in 1912. Owing to the Act being new, no attempt was made to enforce its provisions as to notification by resorting to legal proceedings. Last year, however, it was found necessary, owing to the requirements of the Act being insufficiently complied with, to bring its provisions as 19 to the duty of notification to the notice of the public in Battersea. A circular letter was sent by the Council drawing the attention of those whose duty it was to notify the occurrence of births within the statutory period, and to the penalty incurred for default. That this timely reminder has yielded satisfactory results is shown by the greatly increased return in the number of births notified during 1912 in the Borough. No prosecutions have been instituted during the year for failure to notify. Health Visitors. Of the total number of births notified during 1912, 1,045 were visited by the Council's health visitors. In addition 569 re-visits were made, and a considerable number of visits were made by the voluntary workers of the Battersea Voluntary Health Society, who keep under continuous observation infants visited in the first instance by the Council's officers. Much good work in this direction has been carried on during the year, which is exemplified in the satisfactory statistics of mortality in the Borough in 1912. As in past years, attention has been mainly directed 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 situated principally in the more congested areas of East and North-West Battersea. The results of the enquiries made by the health visitors at the homes of the 1,045 infants visited are summarised as follows:— The enquiries made had reference to the— (a) Mothers : health and occupation of, number of children, whether mother attended in her confinement by a doctor or midwife, condition of the house and the number of rooms occupied. (b) Child : condition of health at birth and nature of food given. Two hundred and eleven of the mothers of the 1,045 children visited were found to be suffering more or less seriously from illhealth. In 600 instances a doctor was in attendance at the birth, in 393 cases the mother was attended by a midwife, in only 12 cases was the mother attended by an uncertified nurse, as compared with 23 cases in 1911, 29 in 1910, and 65 in 1909, showing a satisfactory decline in the demand for the service of these irresponsible, usually ignorant, and frequently dirty persons. 20 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. No. of previous Children in family. 1 2 3 4 5 6 7 8 9 10 11 12 12 14 15 16 142 113 118 88 86 60 46 44 37 24 6 13 3 3 1 1 No. of previous Deaths of Children in Family. 1 2 3 4 5 6 7 8 9 141 76 23 16 12 3 6 2 2 No. of Rooms occupied by Family. 1 2 3 4 5 5 111 211 384 133 53 20 Sanitary Condition oj Homes. Twenty-three of these 1,045 homes were found to be very dirty and 142 others showed evidence more or less of uncleanliness. There is a continuous improvement, it is satisfactory to report, in the sanitary condition of the homes as compared with previous years. As regards the child : health at birth :— Of the 1,045 infants visited at their homes 243 were found to be at the time of the first visit more or less seriously ill. There were 53 twin births in the Borough, distributed as follows:—East Battersea, 21; North-West Battersea, 17; SouthWest Battersea, 15. Of the 53 twin births, in 18 instances the twins were fed from the Council's Milk Dep6t. 21 The majority of the work in connection with visiting of infants at their homes notified under the Notification of Births Act is carried out by one of the health visitors (Miss Peacock), who states in her report : " Visiting under the Notification of Births Act brings us face to face with difficulties with which only the very poor have to cope. It is a recognised fact that the poorest people have the largest families, and as a natural consequence the health of the children is bound to suffer. Quite recently a sugeestion has been made that a clinic should be opened for children between the ages of one and five years, where they may be examined by a doctor and then passed on to the hospitals, if necessary. Now judging from experience in visiting, the children who are most likely to need the services of such a clinic are those whose parents have large families, including several children under ten years of age. For instance, to quote an actual case, the mother is a delicate young woman and her husband a labourer, they have five children, the eldest only four years old, two pairs of twins. All of the twins are in need of constant medical attention, but it seems almost an impossibility for them to obtain it for it is quite unlikely that any other woman would be willing to look after three or four young children and prepare dinner for a husband without payment, while the mother is visiting a hospital and perhaps not arriving home until late in the afternoon or evening. This is only one case among many. Several of the women visited have five children under seven years of age. The result is that the mother's health is undermined by lack of food and continual strain of maternity. Each baby as it arrives is weaker than the last. It seems almost impossible to obtain help to enable the mother to pay someone to look after the children while she visits the hospital, the consequence being that her own health permanently suffers, so they are, if not actually unhealthy, yet weakly, and unable to resist attacks of disease when they do come. The Battersea Mothers' Dining-room is the only adequate attempt to cope with this weakness. It is a voluntary effort which carries on its work in an admirable manner, but unfortunately it suffers from lack of funds. Unfortunately, too, there is only one branch of the institution in the Borough, and therefore too far distant from other districts of the Borough requiring its services." To the superstition still prevailing amongst mothers with regard to the cutting of the nails of their children is attributed by the health visitor the frequent appearance of suppurating sores on babies' heads and faces, with swollen glands. Miss Peacock quotes an amusing instance of this superstition that if a child's finger nails are cut it will grow up a thief, one woman assuring her that the only one of her children who had had his nails cut during that period, and who was then four years old, could not keep his fingers from the sugar basin. 22 It is satisfactory to note, however, that the results of the visits of the health visitors continue to be appreciated and welcomed by the mothers. The educational effects of their visits will no doubt in time tend to banish all unhygienic and insanitary practices. The Notification of Births Act has proved to be one of the most useful legislative measures ever enacted, providing, as it has done, early information of the occurrences of birth, and enabling sanitary authorities to employ the services of trained and experienced women to look after the welfare of the little ones. The results in Battersea are reflected in the record low mortality rate among infants during the year, for which the Council have every reason to congratulate themselves. Infants' Milk Depot. During 1912 the number of infants fed from the Council's Infants' Milk Depfit was 400, as compared with 470 in 1911. Of this number 368 were resident in Battersea and the remainder in adjoining Boroughs. The age at which these children commenced taking the milk and the length of time fed are shown in the following table. 23 MILK DEPOT TABLE, 1912. Age Started. Period Fed. Over 1 year. 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. Under 1 wk .. .. 1 1 1 4 2 2 ..- 2 4 2 1 10 33 1-2 wks. .. 1 3 2 3 1 .. 1 .. .. .. .. .. 3 2 5 21 2-3 „ .. .. 2 1 2 1 1 2 1 1 .. 3 .. 1 1 2 18 3-4 „ .. 2 1 3 1 .. 1 3 .. 1 1 2 1 3 .. •• 19 1-2 mos. .. 2 3 2 10 6 7 3 7 4 6 1 .. 7 2 15 75 2-3 „ .. 1 3 4 7 4 8 4 4 3 4 7 2 3 4 4 62 3-4 „ .. .. 1 2 6 1 6 8 2 3 .. 3 4 1 3 6 46 4-5 „ .. 2 2 1 3 2 3 2 1 2 1 3 5 .. 1 5 33 5-6 „ .. .. 3 .. 6 .. 1 2 6 3 6 1 2 .. .. 2 32 6-7 „ .. • • .. .. 2 .. 2 3 2 .. 2 1 .. .. .. 4 16 7-8 „ .. .. . . •• 1 2 1 .. .. 1 2 1 1 .. 1 2 13 8-9 „ .. 1 .. .. .. .. 3 1 2 1 1 2 •• " .. 1 12 9-10 „ .. •• .. .. 1 .. 2 2 .. •• .. •• •• .. .. .. 5 10-11 „ .. • • .. .. 1 2 1 .. • • .. .. 1 .. .. .. 1 6 11-12 „ .. .. 1 .. * 1 •• ... .. .. 1 •• •• .. 1 1 5 Over 1 year. .. 2 .. 1 .. .. .. .. .. 1 .. .. .. .. • • % .. 4 Totals .. .. 11 20 17 44 24 38 33 28 22 28 26 17 19 15 58 400 24 Of the 400 Infants fed from the Milk Depot, 248 were admitted during 1912. The majority of the children admitted during the year were more or less suffering from ill-health on admission. The state of health on admission of the infants fed from the Milk Dep6t during the year are classified in the Registers as follows:— Good health, 43; malnutrition, 22; congenital debility, 21; wasting, 19; jndisgestion, 17; congenital syphilis, 9; prematurity and immaturity, 9: rickets, 10; bronchitis, 5; pneumonia, 1; whooping cough, 4; dentition, 3; ophthalmia, 3; hare lip and cleft palate, 3; thrush, 2; convulsions, 2; gastric catarrh, 2; tuberculois, 2; anaemia, 1; stomatitis, 1; eczema, 1: nephritis, 1: gastro-intestinal catarrh, 1; jaundice, 1; cretin, 1; haemorrhage of bowel, 1; hernia, 4; deformity, 1; other surgical defects, 6. It will be seen from the above list that few of the children admitted were, on admission, in normal health. The total number of deaths amongst the children fed from the Milk Dep6t was 23, giving a death-rate of 49.3, as compared with 830, the general infantile mortality for the Borough. Seven of the dead children were only taking the milk for a few days before death, having been put on as a last resort. In six other instances the children had ceased taking the milk for periods varying from one week to twenty-nine weeks before death. The mortality statistics of the babies fed on the dep6t milk are, having regard to the condition of health of the great majority of them on admission, highly satisfactory. 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 Depot and the work of the Health Visitors during the year. The weighing-room at the Latchmere Baths is open on two afternoons a week, and that at Nine Elms Baths on one afternoon a week, the hours of attendance being from three o'clock to five. The children are brought by the mothers to be weighed weekly or fortnightly, and the practice continues to be a very popular feature of the Council's efforts in the prevention of infant mortality. In this way a continuous supervision is maintained over the children fed from the Milk Depôt, the weight of each child being recorded in the registers, and its progress noted. The mothers are also advised by the Health Visitors in such cases as may be found necessary, and any serious deviations from the normal progress of the children are reported at once to the Medical Officer of Health. 25 Miss Moss, in charge of the weighing-room at the Latchmere Baths, reports: "It is very gratifying to report on the sustained interest in this department of my work, 3,168 weights being registered. Of them, 1,359 were of children not fed from the Milk Depot. There is no inducement, other than real interest in the baby's welfare, to attend. Advice is freely asked, and in the majority of cases followed." Miss Moss, in commenting on the fact that there was a decline in the number of babies using the Depot Milk during 1912, states: "This is not discouraging in view of the increased number of mothers who are breast-feeding." The cool, wet summer of 1912, with a very low incidence of summer diarrhoea amongst infants, was also a factor in reducing the number of applications for admission to the Milk Depot, which usually during the summer months are more frequent than at other periods of the year. At the weighing-room at Nine Elms Baths 88 babies attended, of whom 35 were being visited at their homes, during the year, and the work there was supervised by Miss Peacock, the number of weights registered totalling 577. The following is a summary of the work done by the Health Visitors during 1912:— Total visits paid 5,010 New Milk Depôt babies visited 247 Re-visits to Milk Depôt babies 1,045 Attendances at weighing-rooms 149 Infants' weights registered 3,745 No. of children attending 719 Notified births visited 1,045 Re-visits 569 Infant deaths visited 302 Re-visits 41 Special cases visited 171 Re-visits for sanitary defects 45 Puerperal fever cases visited 6 Opthalmia neonatorum 30 Re-visits 176 Intimation notices served 32 Statutory notices served 5 Complaints investigated 10 Whooping cough cases visited 12 26 Senile Mortality. During the year 1912 in the Borough of Battersea 570 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 124 79 20 223 North-West Battersea 86 56 22 164 South-West Battersea 111 54 18 183 Borough of Battersea 321 189 60 570 The 570 deaths over 65 were equivalent to 28 per cent. of the deaths at all ages. The deaths over 65 in each year during the nine, years 19031912 were:— 1903 404 1904 508 1905 537 1906 495 1907 510 1908 564 1909 630 1910 510 1911 591 1912 570 27 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, simple and 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 1912 from this standpoint exhibit very satisfactory results. There has been a great decrease in the death-rate from these diseases during the year under report, constituting a record for the Borough. In the Borough of Battersea during 1912 there were registered from the principal zymotic diseases 133 deaths, as against 331 deaths in 1911, and 209 in 1910, giving a corrected zymotic deathrate of 0.79 per 1,000, the corrected death-rate for the County of London being 1.1, varying in the different Metropolitan Boroughs from 0.2 in Stoke Newington and 04 in Hampstead to 2.6 in Shoreditch and Finsbury. The zymotic death-rate varies considerably for the three sub-districts into which for registration purposes the Borough is divided. Thus in East Battersea the rate was 1.0, in North-West Battersea 0 95, while in South-West Battersea the rate was only 0.32 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, 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 28. 28 Diseases. Mean Deathrate per 1,000 1902-1911. Death-rate per 1,000 1912. Gain in 1912. Loss in 1912. Small-pox .01 .00 .01 - Measles .45 .32 .13 — Erysipelas .04 .02 .02 — Scarlet Fever .08 .03 .05 — Diphtheria .10 .10 — — Enteric Fever .04 .01 .03 — Puerperal Fever .03 .005 .02 — Whooping Cough .32 .23 .09 — Zymotic Diarrhœa .68 .07 61 - In the next table is shown the death-rate per 1,000 population from the chief zymotic diseases arranged in Wards:— Ward. Population, estimated to middle 1912. Small-pox. Measles. Erysipelas. Scarlet Fever. Diphtheria Enteric,&c. Puerperal Fever. Whooping Cough. Zymotic Diarrhoea. All chief Zymotic diseases. 1. Nine Elms 27,189 - .33 .07 .07 .14 .03 .00 .25 .03 .95 2. Park 17,500 - .91 .11 .05 .00 .00 .00 .34 .05 1.48 3. Latchmere 20,172 - .69 .00 .00 .04 .00 04 .24 .14 1.19 4. Shaftesbury 16,010 - .31 .00 .00 .24 .00 .00 .12 .12 .81 5. Church 19,342 - .20 .00 .00 .00 .00 .00 .36 .05 .62 6. Winstanley 20,187 - .34 .00 .04 .09 .00 .00 .34 .19 1.04 7. St. John 8,200 - .00 .00 .12 .12 .00 .00 .60 .00 .85 8. Bolingbroke 18,499 - .00 .00 .00 .16 .05 .00 .00 .00 .21 9. Broomwood 20,540 - .00 .00 .04 .09 .00 .00 .04 .04 .24 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. Zymotic Diarrhoea. Erysipelas. Puerperal Fever. Cholera. Influenza. Total. Typhus Typhoid. Continued. 1 - 2 6 1 8 - 2 - 1 3 - - 6 29 2 - 2 12 2 2 - — - 2 - - - 5 25 3 - 8 7 2 2 - — - 8 - - - 1 28 4 - 43 15 1 5 - — - 2 1 1 — 5 73 Year - 55 40 6 17 - 2 - 13 4 1 — 17 155 29 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, etc., in houses in which cases of infectious disease were notified during 1912:- 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 186 8 20 28 15 85 Erysipelas 132 2 7 9 7 93 Scarlet Fever 355 7 23 30 8 92 Typhoid 15 3 2 5 33 77 Puerperal Fever 5 2 — 2 40 60 Total 693 22 52 74 11 89 30 Comparison of Prevalence of Sickness and Death From Infectious Diseases (Rates calculated per 1,000 persons on the population estimated to the middle of each year). Years. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Enteric and Continued Fever. Puerperal Fever. Cerebro-spinal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Death. Cases. Deaths. Cases. Deaths. Cases. Deaths. 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 1911 0.00 0.00 0.96 0.02 1.23 0.12 1.93 0.02 0.12 0.02 0.05 0.01 0.04 0.04 Average 1902-1911 0.12 0.01 0.92 0.04 1.39 0.10 3.88 0.08 0.36 0.04 0.06 0.03 — — 1912 0.00 0.00 0.79 0.02 1.25 0.10 2.54 0.03 0.12 0.01 0.03 0.005 0.00 0.00 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 " 31 Notifiable Infectious Diseases. During 1912, under the Notification Clauses of the Public Health (London) Act, 1891, 826 cases of infectious diseases have been notified, as compared with 753 in 1911. Of the 826 cases notified 665 (i.e., 80 per cent.) were removed to hospitals of the Metropolitan Asylums Board or to other hospitals, and 161 (i.e., 20 per cent.) remained under treatment at home. It is satisfactory to note that the high percentage of removals to hospital of cases of dangerous infections has been maintained at the level of the past few years. Examining the removals to hospital more in detail (e.g., nature of disease) it is seen that during 1912 in the Borough of Battersea the following are the percentages:- Scarlet fever 97 Diphtheria and membranous croup 96 Enteric fever 90 Erysipelas 22 Puerperal fever 60 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. Notifications per 1,000 pop. The Borough 826 4.9 East Battersea 377 5.4 North-West Battersea 256 5.2 South-West Battersea 193 3.9 The total amount paid in fees to medical practitioners for notifications of infectious disease in Battersea during 1912 was £172 19s. 6d. (This amount includes fees paid for notifications of phthisis.) There was an increase in the number of scarlet fever notifications during 1912, viz., 31 per cent., as compared with 1911. The number of notifications during the year 1912 was, however, 38 per cent. less than the average for the ten years 1902-1911. The 427 cases of scarlet fever occurred in 353 houses. The number of notifications of diphtheria received during 1912 was 2 in excess of the number notified in 1911. The notifications were 16 per cent, below the average for the ten years 1902-1911. The 210 cases of diphtheria occurred in 186 houses, and in only 8 of these were the drains on testing found defective. 32 The enteric fever notifications were equal to the number received during 1911, and were 57 per cent. below the average for the decennium 1902-1911. The 20 enteric fever cases occurred in 15 houses, in three 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 1912 arranged in Wards and the case-rate per 1,000 population:- Ward. Diphtheria & Membranous Comp. Erysipelas. Scarlet Fever. Typhoid or Enteric Fever. Ophthalmia Neon. Puerperal Fever. Poliomyelitis. Totals. No. 1 (Nine Elms) 23 26 78 4 14 - 1 146 „ 2 (Park) 24 25 52 1 — - 1 103 „ 3 (Latchmere) 19 14 42 — 3 1 — 79 „ 4 (Shaftesbury) 39 9 56 — 3 — — 107 „ 5 (Church) 22 24 54 3 3 - — 106 ,, 6 (Winstanley) 27 13 45 9 3 1 — 98 „ 7 (St. John) 6 3 19 — — - — 28 ,, 8 (Bolingbroke) 32 16 37 3 2 2 — 92 „ 9 (Broomwood) 18 4 44 — — 1 — 67 Totals 210 134 427 20 28 5 2 826 Ward Population, estimated to middle 1912. Diphtheria & Membranous Croup. Erysipelas. Scarlet Fever. Enteric Fever. Ophthalmia Neon. Puerperal Fever. Poliomyelitis. All Notifiable Infecti's diseases. No. 1 (Nine Elms) 27,189 .84 .91 2.86 .15 .51 .00 .03 5.37 „ 2 (Park) 17,500 1.37 1.42 2.90 .05 .00 .00 .05 5.88 „ 3 (Latchmere) 20,172 .94 .69 2.08 .00 .14 .04 .00 3.91 „ 4 (Shaftesbury) 16,010 2.42 .56 3.49 .00 .18 .00 .00 6.68 „ 5 (Church) 19,342 1.13 1.24 2.74 .15 .15 .00 .00 5.47 ,, 6 (Winstanley) 20,187 1.33 .64 2.22 .44 .14 .04 .00 4.81 „ 7 (St. John) 8,200 .73 .36 2.31 .00 .00 .00 .00 3.41 ,, 8 (Bolingbroke) 18,499 1.73 .86 2.00 .16 .10 .10 .00 4.97 „ 9 (Broomwood) 20,540 .87 .19 2.14 .00 .04 .04 .00 3.26 CHART showing the number of cases of Scarlet Fever notified during each week of the vear 1912. 33 Small-pox. No case of small-pox was notified in Battersea during 1912. The number of cases of small-pox notified in the County of London during the year was 6. Contacts were watched on arrival within the Borough in connection with small-pox cases that had occurred on board vessels arriving from abroad. All such contacts were kept under observation for a period of 16 days. Scarlet Fever. 'l'he number of cases of scarlet fever notified in Battersea during 1912 was 427. This was an increase of 31 per cent, over that of 1911, which was the lowest number of cases ever previously notified in the Old Parish or Borough. There are indications that the quinquennial wave of epidemic prevalence of the disease has begun to rise, and we may probably look forward to a progressive increase in incidence for the next two or three years. Six deaths were registered from the disease in the Borough during 1912, giving a death-rate per 1,000 of the population of 03. In the following table is shown the number of cases and the case mortality per cent. in the Borough and sub-districts during 1912:- Sub Registration Districts. East Battersea. Nth.-West Battersea. Sth.-West Battersea. Borough. No. of Cases 198 127 102 427 Case-rate per 1,000 population 2.84 1.58 2.09 2.48 No. of Deaths 3 1 2 6 Death-rate per 1,000 population .04 .02 .04 .03 Case-mortality per cent. 1.51 8 1.96 1.40 Of the 427 cases of scarlet fever notified during the year 263 (i.e., 61 per cent.) were of children of school age. In 56 of the houses invaded multiple cases occurred as follows:- No. of times. 5 cases in one house 2 4 ,, ,, ,, 3 3 ,, ,, ,, 4 2 ,, ,, ,, 47 34 In other words 128 cases of scarlet fever occurred in 56 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. "Return cases," i.e., cases infected by a patient recently discharged from hospital, were relatively considerably fewer than in the previous year, the percentage of "return cases" to total cases being 3.51, as compared with 4.92 in 1911. The number of cases sent back from hospital notified as scarlet fever, and in which the diagnosis was found to be erroneous, was 35 or 7.5 per cent., as compared with 8 per cent, in 1911. Diphtheria. The number of diphtheria notifications (including membranous croup) received during 1912 was 210, as against 208 notified during 1911. During the decennium 1902-1911, there has been a marked decrease in the number of diphtheria cases notified in the Borough as compared with the preceding decennium. 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 1912 210 1.25 17 0.10 8.0 CHART showing the number of cases of Diphtheria notified during each week of the year 1912. 35 Seventeen deaths were registered from the disease in the Borough giving a fatality rate of 0.10 per 1,000 population. 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 1912, 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 90 3 87 2 6 8 8.8 1.3 North-West Battersea 61 — 61 — 3 3 4.9 1.2 South-West Battersea 59 6 53 — 6 6 10.1 1.2 In the above table is will be seen that the incidence of the disease has been greater relatively in East Battersea. Two hundred and one patients were removed to hospital, or 96 per cent, of the total cases notified. In 1911 the percentage of cases removed to hospital was 94, and in 1910 92 per cent. In the sub-districts the percentages of cases removed to hospital were as follows: North-West Battersea, 1000; East Battersea, 96 0; South-West Battersea, 90.0. The following table gives the age distribution of the cases notified, and of the fatal cases:- Age Periods—Years. Boro'. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-65 65— No. of Cases 5 7 19 22 23 89 25 12 8 — 210 No. of Deaths 2 1 2 2 2 6 1 1 — - 17 Case Mortality per cent. 4.0 14.4 10.5 9.0 8.7 6.7 4 8.3 - - 8.0 The total number of houses invaded by diphtheria was 186. In 8 houses (i.e., 43 per cent.), the drainage was found to be defective. 36 During the year 21 cases (i.e., 9.0 per cent.) notified as diphtheria and removed to hospital were found not to be suffering from the disease and were discharged to their homes. Five-hundred and fifty-four bacteriological examinations of suspected cases of diphtheria were made during 1912, as compared with 384 in 1911 and 410 in 1910. In 135 a positive, and in 419 a negative, result was obtained. Enteric Fever. During 1912, twenty cases of enteric fever were notified in the Borough of Battersea, being exactly equal to the number notified in 1911, and as compared with 41 in 1910. Two deaths were registered from the disease, giving a case mortality of 10 per cent., and a death-rate per 1,000 population of 0.01. This was equal to the lowest number of cases and deathrate recorded in the Old Parish or Borough of Battersea. In the following table are set out the case-rate, death-rate and case-mortality from enteric fever in the Borough of Battersea since 1891:- 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 1912 20 0.12 2 0.01 10.0 CHART showing the number of cases of Enteric Fever notified during each week of the year 1912. 37 The great decline which has taken place in the incidence and mortality from enteric fever is seen at a glance in the above table. The age distribution of the cases, and the death-rate, caserate and case-mortality in the Borough and in the sub-districts during 1912 are set out in the following tables:- Ages. Under 5. 5-15. 15-30. Above 30. Totals. Males 1 4 3 1 9 Females 1 3 4 3 11 Totals 2 7 7 4 20 Case-rate per 1,000 population. Death-rate per 1,000 population. Casemortality per cent. East Battersea 0.07 0.01 20.0 North-West Battersea 0.24 0.00 0.0 South-West Battersea 0. 06 0.02 33.3 The Borough 0.12 0.01 10.0 In the County of London the case-rate was 0.16 per 1,000 population. Of the 15 typhoid-infected houses 2 (i.e., 13 per cent.) showed on inspection defective traps, fittings or appliances. In three of the houses the drains themselves were found to be defective. The source of infection in four cases was probably personal contact with a previous case. In four instances there was reason to suspect the disease having been contracted from the eating of shell-fish or fried fish. In two other cases the disease was probably contracted out of the Borough. While, in the remaining ten cases, no evidence could be obtained as to the probable source of infection. Puerperal Fever. During 1912 in the Borough of Battersea five cases of puerperal fever were notified and one death was registered from the disease, giving a case-mortality of 20 per cent. The case-rate was 0.03 or 0.02 below the mean case-rate for the preceding ten 38 years. The death-rate was 0.005 per 1,000 population. The death-rate for London was 0.03 per 1,000 population. The only death from puerperal fever in 1912 occurred in NorthWest Battersea. In 1911 nine cases of puerperal fever were notified and two deaths were registered from the disease. In 1910 sixteen cases were notified and six deaths were registered from the disease. Puerperal fever is a preventable disease and is caused by want of care by those in attendance on the lying-in woman. During 1912, 4,255 births were registered in or as belonging to the Borough of Battersea. It is satisfactory to note, therefore, that the death-rate from this disease 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, her clothing, instruments, etc., being at the same time disinfected at the Disinfecting Station adjoining. Nurses and midwives who had been in attendance on puerperal fever cases or in contact with other diseases while attending lying-in cases, attended at the Shelter for purpose of disinfection. Erysipelas. During 1912, in the Borough of Battersea, 134 cases of erysipelas were notified and four deaths were registered from the disease, as compared with 161 cases and three deaths in 1911. The case-mortality was 2.9 per cent., as compared with 1.8 per cent, in 1911, and 4.7 per cent, in 1910. The case-rate was 0.79 and the death-rate 0.02, being 0.13 and 0.02 below the decennial average respectively. Twenty-nine cases were removed to hospital, the majority going to union infimaries and the remainder to general hospitals. In London during 1912, 4,098 cases of erysipelas were notified and 152 deaths registered from the disease;giving a case-mortality of 3.7 per cent. Epidemic Cerebro-spinal Meningitis. During 1912 no case of epidemic cerebro-spinal meningitis was notified in Battersea. In 1911, seven cases, and in 1910, five were notified. In the County of London 105 cases of epidemic cerebro-spinal meningitis were notified during 1912. 39 Acute Polio-Myelitis or Acute Polio-Encephalitis. During 1912, two cases of acute polio-myelitis were notified in Battersea. Measles. During 1912, 55 deaths were registered from measles within the Borough of Battersea, as compared with 111 deaths from the disease in 1911 and 74 deaths in 1910. The death-rate was 0.32 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 0.54, and in North-West Batter sea 0.35. In South-West Battersea no death was recorded during the year from measles. In London the death-rate from measles was 0.4 per 1,000 population, 1,799 deaths from this cause being registered during 1912. The number of deaths registered from measles in each of the registration sub-districts during the past three years is as follows:- 1912 1911 1910 East Battersea 38 46 39 North-West Battersea 17 55 29 South-West Battersea Nil 10 6 Eleven deaths were of infants under one year and 37 of children aged one to five years. Seven deaths occurred among children over five years old. The deaths in each of the four quarters of the year were as follows:- First quarter 2 Second quarter 2 Third quarter 8 Fourth quarter 43 The mortality from measles was low compared with previous years during 1912. There was, as will be noted from the statistics, a sudden and explosive outbreak towards the end of the year, four-fifth of the deaths occurring in the last quarter of the year. This high mortality was still maintained in the early part of 1913. The usual precautions were taken to limit the high mortality from the disease, but in the absence of a satisfactory 40 system of compulsory notification it is to be feared that the recent preventive measures suggested by the Local Government Board, following the Conference held in 1911 at the Board's offices (vide Annual Report 1911) will not prove effective in controlling these explosive outbreaks of measles, which are unfortunately responsible for such a heavy mortality amongst children. Whooping Cough. During 1912, in the Borough of Battersea, 40 deaths were registered from whooping cough, as compared with 34 in 1911. The deaths were 17 below the average for the preceding ten years, and were equivalent to a death-rate of 0.23 per 1,000, as compared with 0.32, 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 15 0.21 North-West Battersea 19 0.38 South-West Battersea 6 0.12 The death-rate under one year of age was 47 per cent. of the total deaths, and from one to five years of age 50 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:- Firth quarter 6 Second quarter 12 Third quarter 7 Fourth quarter 15 The following is the summary of the childien excluded from school attendance during the year 1912 in connection with the more common infectious diseases, e.g., measles, whooping cough, etc. Disease. Children excluded on account of infection in their homes. Number of children suffering.{/###] Measles 472 706 Chicken pox 274 746 Whooping cough 195 802 Mumps 33 543 41 Diarrhœa. During 1912 the number of deaths from zymotic diarrhœa registered as belonging to Battersea was 13, as compared with 159 in 1911. The death-rate was 0.07 per 1,000, or 0.61 below the decennial average of 0.68. Of the 13 deaths from summer diarrhœa . 10 (i.e. 77 per cent.) were of children under five years of age and 7 (i.e., 54 per cent.) were of children under one year of age. During 1911, of the 159 deaths from diarrhoea, 113 (i.e., 71 per cent.) were of infants under one year old. The number of deaths and the death-rate in the sub-districts in 1912, 1911, and 1910 were as follows:- Registration Sub-District. No. of Deaths. Death-rate per 1,000 population. 1912. 1911. 1910. 1912. 1911. 1910. East Battersea 5 72 28 .07 1.01 .35 North-West Battersea 7 77 26 .13 1.56 .52 South-West Battersea 1 10 5 .02 .20 .08 In the next table are set out the deaths registered in each of the four quarterly periods in 1912, 1911 and 1910:- 1912. 1911. 1910. First quarter 1 6 5 Second quarter 2 2 3 Third quarter 8 135 37 Fourth quarter 2 16 14 Of the seven deaths of infants under one year old from zymotic diarrhoea, six occurred in the third quarter of the year, distributed as follows in the three sub-districts of the Borough: East Battersea, 1; North-West Battersea, 5; South-West Battersea, nil. The next table gives the age-periods at which these seven infants died during 1912:- Deaths of Infants under 1 year of age from Zymotic Diarrhœa. 1-3 months. 3-6 months. 6-9 months. 9-12 months Total. 1 2 2 2 7 42 The great decrease in the incidence and mortality from zymotic diarrhoea during 1912 was mainly due to the climatic conditions prevailing in the summer, and forms a striking contrast to the statistics relating to the same disease in the previous year, when the climatic conditions prevailing during the summer of that year were the reverse of those which were experienced in 1912. The summer of 1911 will long be remembered as probably the hottest and most prolonged in living memory, the temperature reaching 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 this 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. On the other hand the summer of 1912 was cold and wet, and the meteorological conditions prevailing were unfavourable to the spread of the disease. The great decrease in the mortality from zymotic diarrhoea is reflected in the associated decline in infant mortality. This is a satisfactory feature of the year's morbidity and mortality statistics. At the same time, as was shown in the annual report for 1911, it is clear that while climatic conditions exercise a very important influence on the prevalence of epidemic diarrhoea, these conditions are capable of being combatted by such preventive measures as those which the Council for the past few years have been so successfully employing. In addition to the 13 deaths registered from zymotic diarrhoea, 45 deaths were registered in the Borough from diarrhoea ascribed to other causes. The total number of deaths in the Borough from diarrhoeal diseases was therefore 58. Tuberculosis. During 1912, 233 deaths from tuberculosis were registered as belonging to the Borough of Battersea. Of this number 190 (i.e., 81 per cent.) were due to phthisis (tuberculosis of the lungs), 24 to tubercular meningitis, 6 to general tuberculosis, 5 to tubercular disease of the intestines, and 8 to other forms of the disease. In 1911 the total number of deaths from tuberculosis was 289, and in 1910 252. 43 The following table shows the death rate from phthisis and other tubercular diseases in each year since 1901:— 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 1912 113 25 The number of deaths from phthisis and other tubercular diseases, and the death-rate per 1,000 population in each of the sub-districts and the Borough are set out in the following table:— District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 77 1.10 26 .7 103 1.47 Nth-West Battersea 68 1.38 11 .22 79 1.60 Sth.-West Battersea 45 .92 6 .12 51 1.04 The Borough 190 1.13 43 .25 233 1.39 The deaths from tuberculosis were 11.3 per cent. of the total deaths. The death-rate from phthisis (the most common form of tubercular diseases) was in 1912, 1.13, or 0.16 lower than in 1911, and 0.10 higher than in 1910. 44 PREVENTIVE MEASURES. Public Health (Tuberculosis) Regulations. The passing into law of the National Insurance Act has given rise to an enormous advance in the methods which have heretofore been carried on for fighting tuberculosis. Much good work has been accomplished by sanitary authorities, especially during the past two years, to check the ravages of this scourge of the human race, which is responsible for so much of the misery and destitution prevailing in large centres of population. The problem of tuberculosis is, however, a national one, and requires to be dealt with as such on broad general principles which should be uniform and co-ordinated for the whole country. This fact has been recognised by Parliament, and the National Insurance Act in its "Sanatorium Benefit "provisions has provided means by which this can be developed. With the object of organising a national and comprehensive scheme by means of which tuberculosis in all its forms can be eradicated, a departmental committee was appointed by the Government, and in due course a report was presented which has been received with general approval. In the introduction to this report, the Committee state that " in order that the field of enquiry by the Committee may properly be appreciated it is necessary to indicate briefly a few general aspects of the problem with which the Committee is called upon to deal. The facts as to the prevalence of tuberculosis in the United Kingdom, the mortality due to the disease, and the general and economic waste which it causes have become so far matters of common knowledge that it would be out of place in a report of this nature to furnish statistics. It is sufficient to say that the disease has a wide prevalence and that a large proportion of the population has, at some time or other, developed tuberculosis although it may have remained latent or unrecognised. The seeds of the disease have been present and in many cases the dose of infective material has been too small to produce active disease, or the resisting power of the body into which they have been introduced has been sufficient to protect it from a well-defined attack. The problem of the prevention and treatment of the disease presents therefore two aspects, that of the seed of the disease, and that of the soil in which the seed may be planted." "With regard to the seed of the disease it is now generally accepted that both the human and the bovine types of the bacillus of tuberculosis are capable of giving rise to the disease in human beings. The question whether the introduction of these bacilli 45 into the human body will result in the production of definite disease depends largely upon the amount and virulence of the infective material invading the vulnerable tissues of the body. Certain factors tend to weaken those defensive forces and thus to render the body less able to resist the infecting organisms. Among these factors may be cited (1) the constitution of the individual, (2) the surroundings in which he lives, (3) his standard, habits, and methods of life, (4) the nature of his occupation or employment, (5) the diseases and accidents to which he has been subjected. It should be added that the disease has its own peculiar age incidence in regard to which there are of course a considerable variety of operative factors. A discussion as to the origin and possible elimination of the seeds of the disease or of the relation of the several factors aforesaid to the general problem of tuberculosis is not within the scope of this report. The Committee however, desire it to be understood that these matters have not been overlooked in preparing the scheme which is hereinafter described, and that they hope to deal with them as may be required when their final report is submitted. Any scheme which is to form the basis of an attempt to deal with Tuberculosis should provide:— 1. That it should be available for the whole community. 2. That the means which experience has proved to be most effective should be adopted for the prevention of the disease. 3. That a definite organisation should exist for the detection of the disease at the earliest possible moment. 4. That within practicable limits the best methods of treatment should be available for all those suffering from the disease. 5. That concurrently with the measures for prevention, detection and treatment provision should be made for increasing the existing knowledge of the disease and the methods for its prevention, detection and cure by way of research. The chief recommendations of the Committee are as follows: — 1. That schemes dealing with the whole population should be drawn up by Councils of Counties and County 46 Boroughs or by combinations of these bodies at the earliest possible date on the lines recommended in this report, with due regard to the incidence of the disease and the special conditions and circumstances of the area. 2. That the early establishment, in working order, of an adequate number of tuberculosis dispensaries is essential. 3. That, so far as possible, grants in aid of tuberculosis dispensaries should only be given where such institutions will eventually form constitutional parts of complete schemes. 4. That in framing complete schemes, regard should be had to all the existing available authorities, organisations, and institutions, with a view to avoiding waste by overlapping and to obtaining their co-operation and inclusion within the schemes proposed. 5. That special regard should be given to securing the operation of medical practitioners in the working of the schemes, particularly in relation to the early detection of the disease and its domiciliary and dispensary treatment. 6. That special attention should be paid to securing suitably qualified and experienced medical practitioners for the senior appointments in connection with institutions established as the ultimate result obtained by the treatment recommended, must depend to a great extent upon these medical and administrative qualifications. 7. That in erecting or adapting institutions, local authorities and other bodies should avoid pretentious and extravagant buildings, and should aim rather at providing institutions of a simple and inexpensive character. It would seem desirable that provisions similar to those of Sec. 3 of the Education Act, 1911. should be made applicable, and that due regard should be had to any Town Planning Schemes. 8. That inasmuch as the opportunities which are now afforded in general hospitals to students of medicine for the observation of the course and treatment of tuberculosis are insufficient to secure provision of an adequate number of expert medical officers, advantage should be taken of the extended opportunities which will be afforded under the proposed scheme to obtain additional instruction. 47 The scheme as outlined by the Departmental Committee should consist of two units linked up to the general public health and medical work now carried on and working in harmony with the general practitioners. The first unit consists of the Tuberculosis Dispensary, or clinic; the second unit consists of institutions in which in-patient treatment is given. It may be of interest here, to mention the various bodies concerned with the cure and prevention and treatment of tuberculosis. These are the Sanitary Authority, the Poor Law Authority, the Education Authority, the County Council and the Local Government Board. Each of these bodies carries on important work in combatting the disease, both from the treatment and prevention standpoints. Their numbers have now been reinforced by. another body, the Insurance Committee, whose duties are concerned inter alia with the treatment of insured persons under the provisions of the; National Insurance Act. The functions of all these bodies are more or less co-related in dealing with tuberculosis, and in considering a co-ordinate and comprehensive scheme, it is essential, if success in eradicating the disease is to be attained, that they should be linked up with the other agencies working in the same direction, e.g., the Medical Practioners' Philanthropic bodies, etc. Poor Law Institutions are not available for insured persons under the "Sanatorium Benefit" of the National Insurance Act. During the year 1912, 542 cases of pulmonary tuberculosis were notified in Battersea under the Regulations of 1908, 1911 (Hospitals) and 1911 (Private), particulars relating to which are set out in the following tables:— Source. Cases. Duplicates. Total Notifications. P.H. (T) R., 1908 109 403 512 P.H. (T in H), R.,1911 209 162 371 P.H. (T) R., 1911 224 55 279 Total 542 620 1,162 48  Age Periods—Years. Notified under Under 1 1 2 3 4 5-10 10-15 15-25 25-65 65 Total. P.H.(T)R.,'08 - — 1 3 4 9 10 76 6 109 P.H(T in H)R„ 1911 - 1 l 1 3 23 24 38 118 — 209 P.H.(T)R.,'11 — 1 - 1 — 20 15 48 133 6 224 Total - 2 1 3 6 47 48 96 327 12 542 East Battersea N.W. Battersea S.W. Battersea. Borough. P.H. (T) R., 1908 52 34 23 109 P.H. (T in H) R., 1911 129 59 21 209 P.H. (T) R., 1911 102 59 63 224 Total 283 152 107 542 Arranged in Wards. Notified under 1 2 3 4 5 6 7 8 9 Total. P.H.(T) R.,' 1908 29 12 9 7 15 16 9 2 10 109 P.H (T. in H.) R., 1911 50 45 24 20 35 14 4 9 8 209 P.H. (T) R., 1911 41 34 30 15 22 21 8 32 21 224 Total 120 91 63 42 72 51 21 43 39 542 49 In the next table are set out the occupations of the 542 cases of consumption notified during the year 1912:— Occupation. P.H. (T) R 1908 P.H. (T in H) R 1911 P.H. (T)R 1911 Total. Domestic work 20 47 52 119 Shop assistants 2 5 5 12 Clerks 3 8 12 23 Sempstresses, Tailoring 4 7 11 22 Factory workers - 4 4 8 Laundry workers 2 7 7 16 Potmen, Barmaids 1 3 2 6 Labourers 8 10 8 26 Printing trade 1 4 3 8 Carmen, Conductors 4 2 3 9 Stokers, Engine Drivers 1 - 1 2 Bakers - 1 2 3 Railway, &c., Porters - 4 7 11 Gardeners - 1 1 2 Soldiers and Sailors - 3 2 5 Pottery workers - 1 — 1 Chauffeurs - 2 2 4 Schoolchildren 9 44 33 86 Chemical workers - 3 3 6 Carpenters, wood turners 1 4 3 8 Lodging-house keepers - - 2 2 Bootmakers _ 1 - 1 Dustmen & Roadsweepers 1 1 - 2 Mechanics 1 7 8 16 Warehousemen 1 4 5 10 Metal workers - 2 3 5 Plumbers 1 - - 1 Painters 3 5 1 9 Stonemasons — 1 2 3 Hawkers 3 3 2 8 Various 8 10 12 30 Unknown 35 15 28 78 Total 109 209 224 542 In 178 cases there is a history of father, mother, brother, sister, husband, wife or child having suffered from phthisis. 50 History of death from phthisis in— Parent, brother or sister 119 Husband or wife 7 Child 4 130 History of case amongst— Parent, brother or sister 44 Husband or wife 3 Child 1 48 178 The homes of patients notified were visited during the year, and where the patients were being treated at home, revisits as required were made. These visits and revisits are carried out by the district sanitary inspectors and health visitors acting under the supervision of the Medical Officer of Health. An enquiry is conducted into the history of each case, the results of of which are recorded on a card-index register. The sanitary condition of the home is investigated, and any unsatisfactory condition found remedied. Particular attention is devoted to searching for suspected cases or contacts, i.e., members of patient's family or persons 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 is given to the patient or his friends for the prevention of the spread of infection; sputum vessels are provided free of charge where needed, and disinfection is carried out at frequent intervals. Facilities for the bacteriological examination of the sputum of suspected cases of tuberculosis are provided by the Council free of charge to medical practitioners practising in the Borough. Women and children patients are visited by the female inspectorial staff, six hundred and forty visits and revisits having been paid to the homes of women and children patients by the female inspectors. At the end of 1912, the number of children in the Borough notified to be suffering from consumption was 158. Enquiries made showed that 62 of these children have been exposed to infection at home. In the cases of 50 of these children there was a history of tuberculosis in a relative of the patient. Seven children died from consumption during the year. Two deaths were of children under two years of age. In two cases the children developed consumption after an attack of whooping-cough. 51 The number of women known to be suffering from consumption in the Borough at the end of 1912 was 204. Of these 128 were married women and 76 unmarried. There were 71 deaths of women patients during the year (54 married, 17 unmarried). In 102 cases the isolation of the patient was inadequate owing, in the majority of cases, to the straitened circumstances of the patient. This was also an unsatisfactory feature of the investigations made amongst the children patients visited. At the first visit 60 of the 158 children were found to be sleeping in the same bed with their parents or with other children. In most cases it was possible for the inspector to make some more or less satisfactory arrangements for isolation. This was found more practicable in summer than during the colder months, the lack of sufficient bedding making it a difficult problem for the parents to provide separate sleeping accommodation for the patient. The enquiries made showed that the circumstances of a large proportion of these women and children patients were unsatisfactory. No less than 93 of the women patients were in poor circumstances, 38 being in very straitened circumstances, 54 children were found to be living under poor circumstances, in 44 cases in very poor circumstances. Only 29 of the children were sent to Carshalton or other sanatoria. The only other agency removing any of these children to sanatoria was the Invalid Children's Aid Association working in conjunction with the Charity Organisation Society. Unfortunately, the applicants for sanatorium or other forms of treatment in many cases resent the inquisitional methods of investigation carried out as a preliminary by philanthropic bodies, and in consequence the patient is frequently not removed for the treatment so essential to his case. Of the 29 children sent away for sanatorium treatment, 8 were considerably improved on their return home, but these are rapidly deteriorating in health owing to the unsatisfactory home conditions. The importance of the "after cure" of these cases cannot be overlooked. Five of the children sent away for sanatorium treatment returned home apparently cured. One example will sufficiently illustrate this fact. A child patient, aged three years, was sent away to Carshalton and returned apparently recovered. This child was one of a family of eight children living with their parents in three small rooms. Soon after the child's return home, another child was born : the mother becoming very ill, she was removed to the infirmary, where she remained six weeks. The 52 father was out of work at the time. The returned child was perforce left to the care of an elder child aged 11 years, and to the chance assistance of a kindly neighbour. Some material assistance was supplied by philanthropic effort, but this was quite inadequate. It is not surprising, therefore, that under the circumstances the child's health again began to suffer. The number of women patients receiving sanatorium treatment was very small, outside of Poor Law institutions, philanthropic bodies being the only agencies able to give help. It is to be hoped that with the coming into active operation of the National Insurance Act in 1913, these difficulties will be surmounted, and that provision to meet the requirements of the district will be available. What has been written above with regard to the women and children suffering from consumption applies to investigations made into the history of the disease among male adult patients; the results of the investigations made presenting features more or less similar in detail. THE TUBERCULOSIS DISPENSARY. On the 14th May a circular letter was received from the Local Government Board relative to the sum of £1,500,000 available for distribution in grants, for the provision of sanatoria and other institutions under the provisions of the National Insurance Act, and with it a copy of the Interim Report of the Departmental Committee on Tuberculosis. In their circular letter the Board ask that "any applications for grants which are made otherwise than by the Council of a County or County Borough, should be transmitted to the Board through the Council (i.e., in London, the London County Council), in order that the Board may be satisfied that any proposals for providing treatment will form part of a satisfactory general scheme." The circular letter was considered by the Law and General Purposes Committee of the Borough Council together with a letter which was received about the same date from the London County Council, stating that they were drawing up a general scheme for the County which, when it was ready, they would invite the opinions of the Borough Councils thereon. Certain information was asked for in this letter to enable them to prepare a draft scheme, which, on the instructions of the Committee, was prepared by the Medical Officer of Health and forwarded to the County Council, and the Law and General Purposes Committee informed the Borough Council that they proposed to consider the whole question when the County Council had prepared theii general scheme. 53 In the meantime the Law and General Purposes Committee communicated with the Health Committee suggesting that the question might receive their consideration, and that the Medical Officer of Health should be asked to prepare an exhaustive report on the whole subject, and then furnish the Law and General Purposes Committee with a copy of the report and the conclusions of the Health Committee thereon. On the instructions of the Health Committee a report was prepared by the Medical Officer of Health. In view of the fact that the preparation of a draft general scheme for London was being considered by the London County Council, the report of the Medical Officer of Health was necessarily limited to the question as it most immediately affected the Borough Council, with special reference to the function of the Tuberculosis Dispensary, forming as it does, one of the two units in the scheme outlined in the Departmental Committee's report. In that report the Committee suggest that as regards London, the Borough Councils should be the Authorities responsible for their provision. The report of the Medical Officer of Health was submitted to the Council on the 27th November. In connection with the administration of the Sanatorium Benefit under the National Insurance Act, 1911, certain additional important duties devolve upon the Borough Council as the Sanitary Authority for Battersea, and it is necessary for the Council to prepare a scheme by which these additional duties will be effectively carried out. To quote from the Interim Report of the Departmental Committee, "the scheme which the Committee desire to recommend for the prevention, detection and treatment of the disease is intended to complete existing Public Health Administration in respect of Tuberculosis, and is based on the establishment and equipment of two units related to the Public Health and Medical work carried on by the Medical Officers of Health as described later and working in harmony with the General Practitioners. The first unit consists of the Tuberculosis Dispensary or an equivalent staff as set out in this report. The second unit consists of Sanatoria, Hospitals, &c., in which Institutional treatment is given. . . . The Committee are of opinion that the Tuberculosis Dispensary should be the common Centre for the diagnosis and for the organisation of treatment of Tuberculosis in each area at which the various bodies and persons connected with the campaign against Tuberculosis will be brought together. The aim should be that no single case of Tuberculosis should remain uncared for in the community, and that whatever services the scheme provides should be available for all cases of the disease." It is with the first, or Dispensary unit, that the Council will have to deal. The Report sets out what the functions of the Tuberculosis Dispensary should be :—- 1. Receiving house and centre of diagnosis. 2. Clearing house and centre for observation. 3. Centre for curative treatment. 4. Centre for the examination of " contacts." 5. Centre for "After Care." 6. Information Bureau and educational Centre. 54 It will be noted that the work of the Dispensary will include in addition to Clinical work, Preventive and Administrative work. The Departmental Committee in their Interim Report point out that the powers and duties of the Borough Council as the Sanitary Authority in connection with Tuberculosis are very wide in their scope. They exercise in their jurisdiction the powers of the Public Health Acts and Regulations made under them as to infectious disease, and since Tuberculosis has been recognised as an infectious disease the Council have taken additional steps to combat it from this point of view. Pulmonary Tuberculosis has been made a compulsorily notifiable disease for England and Wales and under Regulations made by the Local Government Board definite powers and duties are imposed on Sanitary Authorities and their Officers for the administrative control of Tuberculosis. The scope of these can be gathered from Articles VIII. and IX. of the Public Health (Tuberculosis) Regulations, 1911, given below. These should be read in conjunction with all the clauses of the Public Health Acts relating to sanitation and the control of infectious disease. Article VIII.—Upon receipt of a notification under these Regulations or under the Poor Law Regulations or under the Hospital Regulations the Medical Officer of Health or an Officer acting under his instructions shall make such enquiries and take such steps as may appear to him to be necessary or desirable for preventing the spread of infection and for removing conditions favourable to infection. Article IX.— For the purposes of these Regulations and of the Poor Law Regulations and of the Hospitals Regulations, a Council on the advice of their Medical Officer of Health, may supply all such Medical or other assistance and all such facilities and articles as may reasonably be required for the detection of Pulmonary Tuberculosis and for preventing the spread of infection and for removing conditions favourable to infection and for that purpose may appoint such officers, do such acts, and make such arrangements as may be necessary. (2) A Council, on the advice of their Medical Officer of Health, may provide and publish or distribute in the form of placards, handbills or leaflets suitable summaries of information and instruction respecting Pulmonary Tuberculosis and the precautions to be taken against the spread of infection from that disease. "It will be observed that by these Regulations Sanitary Authorities have had conferred upon them the power of treating Pulmonary Tuberculosis in the homes in addition to their already existing powers of treating this disease in Dispensaries and other Institutions. Under these powers much work has already been done by Sanitary Authorities in the provision of Hospital or Sanatorium accommodation or of Dispensaries and shelters by the Authorities themselves or more generally by a subscription to a Sanatorium or to a Dispensary erected by a Voluntary Society, inspection of houses occupied by patients suffering from Tuberculosis, examination of patients, and ' contacts,' together with advice as to the prevention of the spread of infection, the provision of treatment by Tuberculin, the bacteriological examination of sputum, the disinfection of premises and bedding, the making of by-laws for the prevention of spitting, the distribution of leaflets and handbills giving instruction and advice with regard to the management of Tuberculosis. The Sanitary Authorities have power to deal with overcrowding and insanitary condition of dwellings, to control the milk supply and to stop the supply of Tuberculous milk and to seize and condemn Tuberculous meat exposed for sale. These powers they exercise through their Medical Officers of Health, Sanitary Inspectors and Health Visitors." 55 It is clear from the position which the Tuberculosis Dispensary occupies in the Scheme recommended by the Interim Report that it must necessarily become the centre for co-ordinating the various agencies in the Borough for fighting Tuberculosis. The Dispensary (after notification) will be the first step in the preventive measures to be taken in connection with Tuberculosis as such Dispensary would be the receiving house and clearing house for all cases within the district, acting as a centre for observation and diagnosis; and in connection therewith the patients would be able to obtain curative treatment at the Dispensary or at their homes, together with a subsequent Institutional treatment as required elsewhere than at their homes, e.g., at a Sanatorium, a Hospital or a Convalescent Home (excluding Poor-law Institutions), followed by "After Care" treatment. The Dispensary would also act as an Information Bureau and general Educational Centre for Tuberculosis. The Departmental Committee in their Interim Report suggest that Tuberculosis Dispensaries should be provided by the Metropolitan Borough Councils in so far as London is concerned. All are agreed that Dispensaries are needed and that such Institutions should be established and maintained in each Borough (the estimate suggested in the Report is one Dispensary for every 200,000 population). It is, however, to Municipalities that one must look for the best results in checking the ravages of Tuberculosis and for preventing its further spread. As has already been pointed out in this report, such bodies are the Sanitary Authorities entrusted with important powers for dealing with infectious disease. On grounds of efficiency and economy a Municipal Dispensary for the treatment and prevention of Tuberculosis would be the best for each Metropolitan Borough, and much overlapping of administration would there by be avoided. As it is, all notifications of Consumption have to be sent to the Medical Officers of Health and recorded by them in private registers, and all preventive measures necessary have to be taken by the Councils' Public Health Staffs. To systematise this work, and for the purpose of obtaining the maximum value subsequently from the information obtained, a Tuberculosis Dispensary is absolutely necessary. At such an institution all cases would be classified for treatment (a) at their homes, or (6) in some institution. Until the "Sanatorium Benefit" provided by the National Insurance Act came into operation, though the Borough Council were aware of a large number of cases, practically very little or no provision was available for their efficient treatment. Excluding the Poor-Law Dispensaries and the few special Tuberculosis Hospitals, there were no institutions to which such patients could be sent. These institutions must now be provided under the provisions of the Act, and the Borough Councils are the proper Authorities to undertake this important duty, and to arrange to provide a scheme whereby the best results may be obtained. Tuberculosis is now a recognised infectious disease, and should consequently be under the care of the Borough Councils through the Medical Officers of Health as in the case of all other infectious diseases. Merely to give a Council a representation on a Voluntary Institution would be insufficient and unsatisfactory and would only increase difficulties of administration. There are in Battersea two Dispensaries which have been officially approved by the Local Government Board for a period of six months expiring early in January, 1913. One is known as the Battersea Tuberculin Dispensary, and is, I believe, more or less a private Institution. The other, in the establishing of which I have been associated, is the Battersea Dispensary for the Prevention of Consumption, a voluntary organisation, and has been open for the reception and treatment of patients for the past twelve months. The period for which the Dispensary was approved is now rapidly drawing to a close, and the object of the Board in provisionally approving these Dispen 56 saries for six months was to enable the Borough Council as the Sanitary Authority to consider seriously their position and the advisability of the Council establishing and maintaining a Municipal Dispensary. It will therefore be necessary for the Council to consider immediately the course they will adopt in connection with the subject. All things being considered, it is, in my opinion, an opinion shared by those best qualified to judge, that Municipal Dispensaries are, from the point of view of efficiency and economy and on the grounds of administrative expediency, the schemes of the future. A municipally controlled Dispensary would result in a co-ordination of the work of the Borough Council, and of that of the other agencies working in the Borough for the eradication of Tuberculosis. Under such a scheme these agencies assisting the Council's work could be given a representation on the Dispensary Committee. The linking up of domiciliary treatment of insured persons with Dispensary treatment would be facilitated, and the Medical Officer of the Dispensary would become, as the Tuberculosis Officer, an Officer of the Borough Council, independent, so far as clinical work is concerned, of any other officer, but under the administrative control of the Medical Officer of Health. His services would also be available as consultant for the Medical Practitioners carrying out domiciliary treatment. The Council, will, in respect of insured persons, if the Tuberculosis Dispensary is carried on as a Municipal Dispensary, receive from the Insurance Commissioners such payments as must be made in connection with the treatment of such insured persons. It is estimated that two-thirds of the maintenance of local Tuberculosis Dispensaries will be paid through the Insurance Commissioners. (Signed) G. Quin Lennane, Medical Officer of Health. Ordered by the Health Committee to be circulated. W. Marcus Wilkins, Town Clerk. The Health Committee on consideration of the Report of the Medical Officer of Health, reported to the Council that they were in favour of the principle of the establishment of a Municipal Dispensary in the Borough. In November, 1911, a Tuberculosis Dispensary was established in Battersea at 179 Bridge Road by voluntary subscriptions, and which, for purposes of the Insurance Act, was temporarily approved by the Local Government Board for a period of six months expiring in January, 1913. A conference was arranged between the Health Committee, the Committee of the Battersea Dispensary for the Prevention of Consumption, and the (temporary) Local Insurance Committee. At the Conference, which held two sittings, certain proposals were discussed but no decision was arrived at. Subsequently the Health Committee reported to the Council on the 8th January, 1913, as follows: — "We have had under consideration the question of a Tuberculosis Dispensary for the Borough in connection with the 57 National Insurance Act, 1911, and the Public Health (London) Act, 1891, and have conferred with the Committee of the Battersea Dispensary and the Local Insurance Committee on the subject. The Council will remember that they are waiting to receive from the London County Council a scheme for dispensary and sanatorium treatment for the metropolis generally, and therefore, though we are in favour of the establishment of a Municipal Dispensary, it appears to us to be inadvisable at the present moment to make substantive recommendations to the Council. Moreover, we desire to confer with the Law and General Purposes Committee on certain matters before doing so. We submit a memorandum which gives the material points involved in the consideration of the whole question. In the meantime the period of approval of the existing dispensaries (six months) expires on the 15th January, and we recommend— That the Local Government Board be informed of the Council's position in the matter, and that the Council suggest an extension of approval for a period of six months." It is, in my opinion, a matter for regret that difficulties ana delays have arisen in connection with the establishment of a municipally controlled Tuberculosis Dispensary in the Borough. As will be seen from the report of the Medical Officer of Health, the powers and duties of the Council as the Sanitary Authority in connection with the prevention of infectious disease are clearly defined. Since consumption (in all its forms) has been made compulsorily notifiable, the disease has been placed in the same category as other notifiable infectious diseases with which the Council have to deal, and greatly increased facilities have there by been provided, and by the National Insurance Act enabling sanitary authorities to improve the preventive measures in connection with consumption which they have been carrying on with considerable success for years past. Any scheme for dealing with consumption must necessarily include the entire population, and this fact has been recognised by the Government, who have agreed to contribute not alone in respect of insured persons, but the dependents of insured persons as well, suffering from tuberculosis, half of any deficiency resulting from the cost of treatment of such persons. The Dispensary as a unit in the scheme for carrying out sanatorium benefit must form a very important centre for the carrying on of both treatment and prevention. The Council in deciding to adopt the principle of a municipally controlled institution have adopted the only logical and satisfactory course. Merely to be represented on a voluntary institution controlled by an outside body would be insufficient and give rise to administrative difficulties, which are naturally bound to interfere 58 with the efficiency of the work incumbent upon the Borough Council in connection with the treatment and prevention of consumption in their district. Cancer. The number of deaths from Cancer registered of persons belonging to Battersea during 1912 was 179 (males 76, females 103), as compared with 163 in 1911, and 141 in 1910. The average number of deaths from Cancer during the ten years 1902-1911 was 159. The death-rate from the disease was during 1912 1.06, the number of deaths during the year being 20 in excess of the average for the decennium. Alcoholism. During 1912 in the Borough of Battersea, 5 deaths were registered from acute and chronic alcoholism (males 2, females 3). In addition to these 16 deaths were registered from cirrhosis of the liver (males 6, females 10) a disease mainly due to alcohol. The total number of deaths therefore to be ascribed to alcohol was 21 as compared with 26 in 1911 and 22 in 1910. Bacteriological Examinations. During the year 1912, 1161 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 £172 3s. 9d., particulars of which are set out in the following table:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 135 419 554 Enteric fever 2 29 31 Tuberculosis 172 403 575 Other specimens .. - 1 1 Total 309 852 1,161 59 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 1912. Total Sanitary Operations 68,116 Number of house inspections 47,540 Bakehouse inspections 270 ' Bakehouse nuisances abated 54 Urinals—inspections 194 Do. altered, repaired or water laid on 50 Intimations served under Sec. 3 3,865 Notices served under Sec. 4., &c. 966 Notices served under Sec.62 &65 1,732 Complaints received & attended to3,091 Number of houses disinfected 2,285 Houses supplied with disinfectants2,336 House drains flushed with disinfectants after infectious disease 1,245 Overcrowding abated 72 Premises improved, cleansed and repaired 3,472 Drains tested By smoke. 918 „ water 2,776 Drains cleansed and repaired 342 Drains relaid 366 Frontage drains constructed or re-constructed 40 Soil pipes and drains ventilated 117 Sink and rain water pipes disconnected or repaired 574 Water Closets cleansed & repaired 781 Cesspools abolished — Mews & Stables drained & paved 10 Yards and forecourts paved and repaired 407 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 77 Dust receptacles provided 414 Leaky house-roofs and gutters repaired 425 Houses supplied with water, and fittings repaired 132 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 347 Cisterns covered, cleansed and repaired 477 Additional water supplies to upper floors .. 96 Keeping of animals in unfit state discontinued 23 Smoke observations 80 Certificates of disinfection granted 1,708 Houses inspected and certificates granted (Sec. 48) 66 Proceedings ordered by Council and Health Committee 3,428 Summonses issued 108 Magisterial Orders obtained and enforced 52 Factori es. Workshops, &c. ,i nspec- tions 3,769 Sanitary conveniences provided or improvements effected in Factones & Workshops (Sec. 38) .279 Underground sleeping rooms disused 113 Gipsy van inspections 104 Drains laid to new houses and tenements 66 Samples taken under the Sale of Food and Drugs Acts 1,000 Miscellaneous 394 60 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 1912 the total number of houses inspected in houseto-house inspection was 2,228 as compared with 2,736 in 1911. The following is a summary of the number of houses inspected in each year since 1901:— 1902 1,740 1903 2,670 1904 3,020 1905 4,503 1906 3,609 1907 4,101 1908 3,609 1909 3,218 1910 3,441 1911 2,736 Average for the ten years 1902-1911 = 3,264 1912 2,228 The number of houses inspected it will be seen has varied from year to year. The fluctuations in this important branch of sanitary administrative work are due to many causes. The excessive prevalence of infectious disease in certain years, taking up a good deal of the time of the inspectors in securing the isolation, removal to hospital of patients, disinfection of premises, searching for sources of infection, contacts, etc. In two of the sanitary districts during the past year the supervision of extensive drainage work in new buildings took up a good deal of the time of the Inspectors. The severe epidemic of measles which spread through the Borough in the latter part of 1911 and the first quarter of 1912 was largely responsible for the considerable decline in house inspection in these years. Moreover, the recent Order making Tuberculosis (all forms) compulsorily notifiable has still further added to the duties and responsibilities of the sanitary inspectorial staff, and it is probable that it will be impossible with the present staff to maintain quite the same high level of houseinspection carried out during the past ten years. It will be seen, however, that making allowances for the increased work imposed on the Health Department owing to recent legislative enactments and departmental Orders, that a fair average of house-to-house inspection has, on the whole, been maintained, and if all house inspections are included, it will be found that the number (47,540) exceeds that of the previous year by over 2,000. 61 The more detailed system of house inspection registration adopted in the Health Department since the passing of the Housing and Town Planning, etc., Act, 1909, and the more extensive requirements imposed on property owners, e.g., additional water supplies to houses, necessitating a considerable number of reinspections by the District Inspectors, are further factors which have tended to a reduction of house-to-house inspections. The inspection of houses reported by the London County Council (Education Authority) to be verminous has also taken up a good deal of the time of the Inspectors. The following summary shows the number of houses inspected, and the number of defects found in each of the sanitary districts in 1912:— Summary. House-to-House Inspection. District No. No. of houses inspected. No. of houses in which defects found. 1 239 115 2 260 174 3 266 210 4 298 229 5 395 203 6 200 161 7 219 176 8 351 221 Totals 2,228 1,489 The percentage of houses in which sanitary defects were on inspection found to exist was 66 8 per cent., as compared with 61 per cent. in 1911, and varied from 48 per cent. in No. 1 district to 80 per cent. in Nos. 6 and 7 districts. 62 House-to-House Inspection. EAST BATTERSEA. NORTH-WEST BATTERSEA. SOUTH-WEST BATTERSEA. Name of Road. No. of houses inspected. No. of houses in which defects existed Name of Road. No. of houses inspected. No. of houses in which defects existed Name of Road. No. of houses inspected. No. of houses in which defectsexisted Arthur Street 70 55 Abercrombie Street 33 23 Amies Street 40 35 Beaufoy Road 171 79 Andoe Road 14 8 Ballingdon Road 34 12 Ingelow Road 148 48 Barmore Street 21 21 Berber Road 24 14 Knowsley Road 95 38 Benfield Street 39 39 Chatham Road 130 92 Landseer Street 22 12 Bourne's Place 14 14 Darley Road 61 48 Leitrim Grove 15 8 Crescent Place 21 17 Elspeth Road 24 20 Longhedge Street 81 58 Este Road 62 42 Gayville Road 13 3 Palmerston Street 39 18 Gosling's Yard 8 6 Hafer Road 16 15 Ponton Road 23 8 Green Lane 31 31 Hauberk Road 8 5 Poyntz Road 34 20 Henry Street 67 51 Honeywell Road 103 63 Shellwood Road 18 11 Lavender Road 91 64 Kathleen Road 31 14 Tidemore Street 35 26 Little Europa Place 37 35 Longbeach Road 46 35 Woodgate Street 33 33 Livingstone Road 99 83 St. Johns Hill Grove 18 4 Wycliffe Road 6 6 Lombard Road 10 4 Stonells Road 10 3 Lothair Street 11 9 Sugden Road 101 87 Meyrick Road 28 27 Orville Road 35 31 Parkham Street 43 20 Speke Road 107 89 Winstanley Road 8 5 Totals 790 420 Totals 779 619 Totals 659 450 63 Housing and Town Planning, &c., Act, 1909. This Act imposes upon Sanitary Authorities duties of a most important character in connection with the sanitation of house property. Under section 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 dwellinghouse 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. During the year closing orders were made by the Council under section 17 (1) Housing and Town Planning, etc., Act, 1909, in respect of Nos. 20, 21, 23, 24, 25, and 27, Little Europa Place, which were represented by the Medical Officer of Health in a special report to the Council in October, 1911. The property in question was subsequently acquired and demolished for building purposes by a large manufacturing firm in order to extend their premises, and no further action by the Council in the enforcement of the Order was therefore necessary. The dwelling-house, No. 58, Lavender Road, was represented to the Council by the Medical Officer of Health as being unfit for human habitation. As most of the works of repairs were carried out, the consideration of the matter was adjourned for six months. The dwelling-house No. 3, Poyntz Road, was represented to the Council as being unfit for human habitation. The owner was informed that unless the premises were put into a habitable state of repair a closing order would be made by the Council. The requirements of the Council were subsequently carried out, and no further action was needed. An inspection of a considerable number of insanitary dwellinghouses was carried out by the Medical Officer of Health in various districts of the Borough—-Nine Elms Ward, Winstanley Ward, etc. Interviews were had with the owners, who were given to understand that unless the requirements of the Council to put the premises into a satisfactory condition of repair were not carried out action would be taken under the Housing Act. As a result the necessary works of repair were carried out under notices under the Public Health Act, and no further action by the Council was called for. 64 The dwelling-houses Nos. 19 and 21 Arthur Street were reported to the Council as being not reasonably fit for human habitation, and notices under section 15 were ordered to be served on the owner requiring him to execute the necessary repairs to the houses. The notices under the Housing Act were subsequently complied with. Underground Rooms. The Housing, Town Planning, etc., Act, 1909, 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 seven feet 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 the upper floor. Regulations were made by the Council as required by the Housing, Town Planning, etc., Act, which were duly approved by the Local Government Board, and are now in operation in the Borough. An inspection of the underground rooms in the Borough, which was commenced in 1911, was continued during 1912. The total number of rooms inspected was 113, all of which 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 113 Space beneath floor insufficiently ventilated 113 Site not concreted 113 Other defects 65 In 90 cases the illegal occupation of the rooms was discontinued. In the remaining cases the owners were called upon to carry out the necessary structural alterations to make the rooms comply with the requirements of 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. Closing orders were made by the Council in respect of 21 of underground rooms illegally occupied. 65 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 1912 123 premises were on the register, and no additional house was registered during the year. The sanitary condition of these premises is governed by by-laws, which were revised in 1904, and duly approved by the Local Government Board. The Housing, Town Planning, etc., Act, 1909, which extends the power of making by-laws with respect to lodging-houses intended for the working classes rendered it necessary for the Council to re-make the by-laws so far at least as they relate to houses intended for the working classes. The by-laws were accordingly re-made and submitted to the Local Government Board, and were duly approved, and are now in force. PUBLIC HEALTH (LONDON) ACT, 1891. Housing, Town Planning, &c., Act, 1909. By-Laws made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea, in the County of London, with respect to Houses let in Lodgings or occupied by members of more than one Family in the Metropolitan Borough of Battersea. Interpretation of Terms. 1. In these by-laws, unless the context otherwise requires, the following words and expressions have the meanings hereinafter respectively assigned to them; that is to say:— Council " means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. "Lodging-house" means a house or part of a house intended for the working classes which is let in lodgings or occupied by members of more than one family. "Landlord," in relation to a lodging-house, means the person for the time being receiving the rack rent of the lodging-house, whether on his own account, or as Agent or Trustee for any other person, or who would so receive the same if such premises were let at a rack rent. "Rack rent" has the same meaning as in the Public Health (London) Act, 1891. "Tenant," in relation to a lodging-house means the person who, whether as landlord or otherwise, has an interest in the premises of such nature and extent as to entitle such person to let the lodging house in lodgings or for occupation by members of more than one family, .for the time being to receive the profits arising from the said letting. 66 "Lodger," in relation to a lodging-house, means a person to whom any room or rooms in the lodging-house may have been let as a lodging or for his use and occupation. (а) For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family. (b) For the registration of houses so let or occupied: (c) For the inspection of such houses: (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses: (e) For the cleansing and lime-washing at stated times of the premises: (f) For the taking of precautions in case of any infectious disease. 2. A lodger in a lodging-house and, subject to the provisions of these by-laws the tenant of the lodging-house, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred and fifty cubic feet of free air space for each person of an age exceeding ten years, and of one hundred and seventy-five cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which in the case of the lodger has been let to such lodger. 3. A lodger in a lodging-house and, subject to the provisions of these by-laws the tenant of the lodging-house, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred and fifty cubic feet of free air space for each person of an age not exceeding ten years, and of two hundred and twenty-five cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which in the case of the lodger has been let to that lodger. 4. The tenant of a lodging-house, within a period of fourteen days after he shall have been required by a notice in writing, signed by the Town Clerk and duly served upon or delivered to the tenant, to supply the information necessary for the registration of the lodging-house by the Council, shall, himself, or by his agent duly authorised in that behalf, sign and furnish to the Council a true statement of the following particulars with respect to the lodging-house ; that is to say— (а) The total number of rooms in the house : (б) The total number of rooms let in lodgings or occupied by members of more than one family: (c) The manner of use of each room: (d) The number, age, and sex of the occupants of each room used for sleeping: (e) The Christian name and surname of the lessee of each room; and (/) The amount of rent or charge per week payable by each lessee. 5. Where the tenant of a lodging-house resides in any part of the premises, the tenant, and in any case where the tenant of a lodging-house does not reside in any part of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises, and every other person who, being resident in any part of the premises, is entitled to have or to 67 exercise the like control, shall, at all times, when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 6. Every lodger in a lodging-house shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access for the purpose of inspection to the interior of any room or rooms which may have been let to the lodger. 7. Where the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, has, for the purpose of inspection, obtained access to the interior of a lodginghouse or to the interior of any room or rooms in a lodging-house, a person shall not wilfully obstruct any such officer in the inspection of any part of the premises, or, without reasonable excuse, neglect or refuse, when required by any such officer, to render him such assistance as is reasonably necessary for the purpose of his inspection. 8. In any case where a lodger in a lodging-house is entitled to the exclusive use of any court, courtyard, area, or other open space within the curtilage of the premises, the lodger, and in any case where two or more lodgers in a lodging-house are entitled to the use in common of any court, courtyard, area, or other open space within the curtilage of the premises, the tenant shall, subject to the provisions of these by-laws, cause the court, courtyard, area or other open space to be thoroughly cleansed from time to time as often as is requisite for the purpose of keeping the same in a cleanly condition. 9. Subject to the provision of these by-laws— The landlord of a lodging-house shall cause every drain or means of drainage, with which any water-closet belonging to the lodging-house may communicate, to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as are provided in or in connection therewith to be maintained at all times in good order. 10. Every lodger in a lodging-house shall cause all solid or liquid filth or refuse to be removed once at least in every day from every room which has been let to him, and shall once at least in every day cause every vessel, utensil, or other receptacle for such filth or refuse to be thoroughly cleansed. 11. Where a lodger in a lodging-house is entitled to the exclusive use of any staircase, landing, or passage in the lodging-house, the lodger shall cause every part of the staircase, landing, or passage to be throughly cleansed from time to time as often as is requisite. 12. A lodger in a lodging-house shall not cause or suffer any animal to be kept in any room which has been let to the lodger or elsewhere upon the premises in such a manner as to render the condition of the room or premises filthy. 13. Subject to the provisions of these by-laws, the tenant of a lodginghouse shall cause every common passage or staircase in the lodging-house to be thoroughly cleansed from time to time as aften as is requisite. 14. Subject to the provisions of these by-laws— The tenant of a lodging-house shall, at least once, and when required by the Council, at a specified date in every year, cause every part of the premises to be cleansed. 68 He shall, at the same time, when it is necessary for thorough cleansing, cause the walls of every area, the surface of every ceiling, and the interior surface of every wall of every room, staircase, and passage in the lodginghouse, and of every water-closet belonging to the premises to be thoroughly lime-washed. Provided that the foregoing requirement with respect to lime-washing shall not apply in any case where the internal surface of any such ceiling or wall is painted, or where the material of or with which that surface is constructed or covered is such as to render the lime-washing thereof unsuitable or inexpedient, and where the said surface is thoroughly cleansed, and the paint or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 15. Subject to the provisions of these by-laws, the landlord of a lodginghouse shall provide adequate means of ventilation in or in connection with every common passage or staircase in the lodging-house, and shall cause the said means of ventilation to be maintained at all times in good order. 16. Subject to the provisions of these by-laws, the landlord of a lodginghouse shall cause all such means of ventilation as are provided in or in connection with any room in the lodging-house to be maintained at all times in good order. 17. Where, in pursuance of any statutory provision in that behalf, an order of a justice has been obtained for the removal from a lodging-house to a hospital, of a person who is suffering from any dangerous infectious disease and is without proper lodging or accommodation, the tenant of the lodging-house where the tenant resides in any part of the premises, and the lodger to whom any room whereof the person aforesaid may be an occupant has been let shall, on being informed of the order, forthwith take all such steps as are requisite on the part of the tenant and of the lodger respectively, to secure the safe and prompt removal of the said person in compliance with the order, and shall, in and about the removal adopt all such precautions as, in accordance with any instructions which such tenant and such lodger, respectively, may receive from the Medical Officer of Health of the Council, are most suitable for the circumstances of the case. 18. Where a duty imposed upon or a prohibition applied to the tenant or the landlord of a lodging-house as the case may be is by any by-law expressly imposed or applied subject to the provisions of these by-laws, proceedings shall not be taken against the tenant or landlord as the case may be for an offence against the by-law unless and until the tenant or landlord, as the case may be, after service upon him of a notice in writing by the Council requiring him within such reasonable time as is specified in the notice to comply with the by-law within the time so specified. Penalties. 19. Every person who shall offend against any of the foregoing by-laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Council. Provided, nevertheless, that the justices or court before whom any complaint may be made, or any proceedings may be taken in respect of any such offence, may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by-law. 69 Repeal of By-Laws. 20. From and after the date of the confirmation of these by-laws any by-laws with respect to houses let in lodgings or occupied by members of more than one family, in force in the Metropolitan Borough of Battersea shall be repealed. These by-laws were made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea, at a meeting of the Council held on the 11th day of September, 1912, and the Common Seal of the Council was hereunto affixed on the 11th day of September, 1912. W. Marcus Wilkins, Town Clerk. Allowed by the Local Government Board this twentyfifth day of October, 1912. H. C. Monro, Secretary. Acting on behalf of the said Board under the authority of their General Order dated the twenty-sixth day of May, 1877. Smoke Nuisance. Emissions of black smoke were reported during the year on 80 occasions. In 51 instances these were reported by the Coal Smoke Abatement Society, in 15 by the Council's Sanitary Inspectors, and 14 were reported by the London County Council. Thirty-two preliminary and three statutory notices were served to abate smoke nuisances, but no prosecutions were instituted during the year. Paving of Yards and Forecourts. The following table shows the number of back-yards and forecourts wholly or partly paved during 1912:— Sanitary District. Backyards. Forecourts. Wholly paved. Partly paved. Wholly paved. Partly paved. 12 ft. or more from back addition. Less than 12 ft. from back addition. 1 4 - 36 38 20 2 7 - 23 6 25 3 24 - 38 4 3 4 23 13 41 11 2 5 - - - - 1 6 3 - 22 2 14 7 9 4 5 - 15 8 - 2 12 - - Totals 70 19 177 61 80 70 Street Paving. It is satisfactory to be able to report that a considerable extension of this useful hygienic work has been carried on during the year, a large number of additional streets in the Borough having been paved with impermeable material to the already considerable number thus paved. As I have already pointed out in previous annual reports the advantages of this method of paving from the public health standpoint cannot be over-estimated, and I have not the slightest hesitation in stating that the high position which Battersea has attained in metropolitan public health statistics is to some extent to be attributed to the action of the Council in continuing this policy of paving the streets of the Borough with a material which minimises the risk of spreading infection through germ laden dust. In the more crowded and less sanitary districts of the Borough the side streets are largely used as playgrounds by the children, and it becomes therefore a matter of great importance to provide roadways which can be kept readily scavenged, a not easily obtainable feature of the ordinary macadam thoroughfare. During 1912 the following streets were partly or wholly paved with impervious material:— Square yards. Alfriston Road (part) 1,275 Benfield Street 1,235 Bontflower Road 1,719 Bowood Road 1,033 Canford Road (part) 1,107 Cringh Street 1,856 Henry Street 1,368 Kirtling Street 1,621 Lavender Gardens 2,819 Little Europa Place (part) 1,006 Stanmer Street 1,457 Sterndale Road 1 ,911 Strath Terrace 788 The Avenue (Clapham Common) 10,950 Wakehurst Road (part) 2,285 West Side, Clapham Common (part) 3,328 Total 35,758 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. 71 In four instances it was found necessary to erect upcast ventilating shafts in the following situations :— Bolingbroke Grove. Candahar Road. Clapham Junction Approach. Linford Street. Van Dwellings. The number of van dwellings in Battersea during 1912 was 81, as compared with 74 in 1911. In the following table are set out the situation and number of occupants:— Situation of Vans. No. of Vans. No. of Occupants. Males. Females. Mill's Yard, 88 Sheepcote Lane 3* 3 3 „ 80 „ 4* 4 4 Manley's Yard, Falcon Road 4 6 5 Manley's Yard, Cabul Road 25† 30 35 Donovan's Ground, Cabul Road 25† 48 28 Mill's Yard, Culvert Road 13‡ 18 24 "Gray's Fair," Lavender Hill 7 8 8 Total 81 117 107 * Including one shed. † Including one cottage. ‡ Including one shed and one tramcar. These vans undergo frequent inspection by the Council's Sanitary Inspectors, both by night as well as day. During the year twenty-three 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 1912. The patients were immediately removed to the Isolation Hospital, and the usual further precautions taken to prevent the spread of infection. 72 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 6 Orville Road 18 Males June, 1902 67 Winstanley Road 66 Females July, 1910 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 Council's Sanitary Officers in connection with drainage defects, infectious disease, &c., &c. Block Dwellings. The following is a list of the Artizans' dwellings of the "Block" type in the Borough of Battersea with the number of tenements in each:— Name of Buildings. Situation. Owner. No. of tenements. Battersea Bridge Buildings Bridge Road London County Council 69 Durham Buildings York Road " 108 Victoria Dwellings Battersea Park Road Victoria Dwelings Asso., Ltd. 189 Lombard Dwellings Lombard Road Exors. of Francis Ravenscroft 36 Shaftesbury Chambers Ashbury Road Artizans, &c., Dwellings Co. 22 73 Revenue Act, 1903. During 1912 three applications were received for the certificate of the Medical Officer of Health under the provisions of the Revenue Act, 1903, in respect of 18 tenements (or dwelling's) so constructed as to afford suitable accommodation for each of the families inhabiting such tenements. After inspection, certificates were granted in respect of 9 tenements, the remainder having been refused or postponed. Water Supply. During 1912 66 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 water supply for various reasons were received from the Metropolitan Water Board. Water supplies to Upper Floors. —Additional water supplies to the upper floors of tenement houses under the provisions of sec. 78 London County Council (General Powers) Act, and sec. 48 Public Health (London) Act, 1891, were required by notice served upon the owners, and duly complied with during 1912 as follows: No. of Houses. District No. 1 1 „ „ 2 — „ „ 3 1 „ „ 4 20 „ „ 5 — „ „ 6 70 „ „ 7 - „ „ 8 4 Total 96 Disinfecting' Department. During 1912 3,793 rooms and 43,920 articles were disinfected by the Council's Disinfecting Staff, as compared with 4,711 rooms and 38,952 articles in 1911. A total number of 826 cases of notifiable infectious diseases was reported during the year, but in addition to these a large amount of disinfection was carried out in connection with nonnotifiable diseases, e.g., measles, whooping-cough, etc., and in connection with verminous premises, 74 In 116 instances schools, or departments of schools, were disinfected in connection with cases of infectious diseases from amongst the children attending such schools The following table gives particulars of the work carried out at the Council's disinfecting station since it was opened in 1902:— 1902. 1903. 1904. 1905. 1906. 1907 1908. 1909. 1910. 1911. 1912. Premises 1,161 1,187 1,215 2,589 1,991 2,995 2,418 2,656 2,337 3,394 2,285 Rooms 1,771 1,616 1,637 3,308 2,848 5,085 4,583 4,192 3,834 4,711 3,793 Articles disinfected 92,368 67,001 54,626 64,052 72,531 72,220 85,117 58,474 48,205 38,952 43,920 Articles destroyed 984 847 1,288 929 1,244 1,084 778 607 720 777 1,014 Books disinfected — 271 215 332 337 399 387 331 230 166 193 Persons admitted to shelter — — — 33 31 33 28 4 — — — The laundry attached to the station, which was added in 1907, has continued to do useful work. During the year 23,986 articles were, after disinfection, laundered before being returned to their owners. The total weight of articles removed for disinfection during the year was 107 tons 0 cwts. 0 qrs. 9 lbs. In addition to the work carried out in the disinfection of rooms, clothing, etc., bedding belonging to the Council was lent out during the year to persons whose bedding had been removed to the Station for disinfection. The total weight of bedding belonging to the Council dealt with in this way, which on return required to be disinfected before returning to store, amounted to 7 tons 0 cwts. 2 qrs. This is not included in the above table. Verminous clothing weighing 8 tons belonging to verminous persons undergoing cleansing at the Personal Clothing Station, Sheepcote Lane, was disinfected at the Disinfecting Station during the year. This, also, is not included in the return shown in the table. 75 Temporary Shelter or House Accommodation. During 1912, at the Reception Shelter situate at Sheepcote Lane, five midwives and eight nurses who had been in attendance on puerperal fever or in contact with other forms of infectious disease had the use of one of the tenements at the Reception Shelter for purposes of personal disinfection. Two hundred and sixty-three persons, including laundry hands, milk vendors, dressmakers, etc., whose occupation rendered it desirable, attended for personal disinfection at the Shelter on account of exposure to infectious disease. Cleansing of Persons Act, 1897. During 1912 2,192 verminous persons attended at the Personal Cleansing station, Sheepcote Lane. Of the total number cleansed 1,336 were adult males, 15 adult females, and 841 children, the latter coming mainly from the public elementary schools. An agreement was entered into 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 two shillings per child cleansed irrespective of the number of attendances within a calendar month before the child is certified as cleansed. The term of the agreement is for twelve months, and may be renewed at the option of the contracting parties. I have repeatedly in my annual report called attention to the unsuitability of the present cleansing station for the purpose for which it is used. It is small, structurally unsuitable, and otherwise ill-adapted for carrying on this useful work. In other words the use made of the station has long outgrown its capacity. This is not a matter for surprise when the numbers of persons using the station in each year since it was opened in August, 1906, are examined. These are as follows:— 1906 (August onwards) 141 1907 621 1908 1,662 1909 1,694 1910 1,924 1911 1,650 1912 2,192 A glance at these figures sufficiently indicates the extent to which the work has grown, and the result is that unless a newstation is speedily provided, it will be quite impossible to continue this useful work except under conditions which would be a discredit to the Council. 76 The present station is a small tenement in the Reception Shelter, and when the Council decided in 1906 to avail themselves of the powers provided by the Cleansing of Persons Act, 1897, it was considered quite sufficient as a tentative measure for the purpose. The popularity of the facilities provided by the Council is shown by the great and increasing use made of the station, and in consequence the difficulty of carrying on the work under existing conditions has pari-passu increased every year. Owing to the impossibility of coping with the work, some two or three years since it was found necessary, with the approval of the Health Committee of the Council, to take over another tenement in the Shelter for the cleansing of verminous school-children. Some difficulty has arisen in obtaining a suitable site in the event of the Council deciding to erect a new station. The matter is, however, one of considerable urgency, which I trust at an early date will receive the sympathetic consideration of the Council. The work carried on at the Station has proved most successful, and is, in my opinion, a distinct advantage from the public health standpoint to the Borough. The Midwives Act, 1902. The Midwives Act in London is administered by the London County Council as the local supervising authority, and only the disinfection of the nurses is left in the hands of the Borough Council. 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 clothing, instruments, etc., being at the same time disinfected by steam at the Disinfecting Station adjoining. Mortuary. The total number of bodies received at the Mortuary in Sheepcote Lane during 1912 was 264, as compared with 287 in 1911, and 234 in 1910, and an annual average for the ten years 1902-11 of 253. On 257 of these bodies inquests were held, and seven bodies were received at the mortuary for sanitary or other reasons. The following table gives the number of bodies received at the Mortuary in each year since 1900:— 77 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 1912 264 174 257 Of the 257 bodies upon which inquests were held, in 174 instances post-mortem examinations were made. Inquests. During 1912 inquests were held in 257 cases with the following results:— Natural causes 141 Open Verdict— Found dead 3 Found drowned 2 5 Accidental Causes— Drowning 4 Burns and Scalds 10 Poisoning 5 Falls, &c. 18 Run over (in street and on railway) 20 Suffocation 15 Other injuries 10 85 Suicide— Cut throat 6 Hanging and Strangulation 1 Poison 8 Drowning 4 Other methods 2 - 21 Homicide— Fractured Skull 2 Suffocation 2 Abortion 1 5 Total 257 78 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. 79 The Protection of the Food Supply. During 1911 the food supply was, as in past years, carefully supervised. The work has comprised meat inspection and seizure, registration of milk vendors, and the strict supervision of all milk shops in the Borough. Attention has also been given to the sanitation of bakehouses (vide section of report dealing with the 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 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 1912, having been brought to the Health department by the respective owners for the purpose:— Food. Quantity. Where Purchased. Apples 1 barrel Covent Garden Market Broccoli Tops 2 bags Borough Market BrusselsSprouts 30 lbs. Covent Garden Market Cocoanuts 50 Spitalfields Market Codling 1 trunk Billingsgate Market Haddock 2 boxes „ „ „ (Dried) 1 box „ „ Herrings 1 „ „ „ „ 1 kit „ „ „ (Salted) 1 barrel „ „ „ 1 case „ „ Mackerel 1 box „ „ Mixed Fish 1 „ „ „ Mussels 1 bag „ „ Oranges 1 box Spitalfields Market Plaice 1 „ Billingsgate Market „ 11½ stone „ „ „ 2 boxes „ „ Roe 2 „ „ „ Tomatoes 3 bundles Covent Garden Market „ 7 „ „ „ 1 bundle „ „ „ 8 bundles „ „ Turnips ½ bag „ „ Whelks 1 „ Billingsgate Market Whiting 1 trunk „ „ Winkles 1 bag „ „ 80 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 when he has made no attempt to sell them, to grant a certificate which enables him to claim the return of his money. During 1912 twenty-seven certificates were granted in respect of the articles shown above. During 1912 the carcases of 3,351 pigs slaughtered at one slaughterhouse in the Borough were inspected by the Council's Meat Inspector. Of this number six diseased whole carcases, and the heads of 133 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. Owing to the unsatisfactory conditions under which the slaughtering of the pigs at this slaughterhouse was carried on, and the consequent difficulty of securing adequate inspection of the animals both before and after slaughter, representations were made by the Council at the Session for the annual licensing of slaughterhouses held by the London County Council. The licensee was cautioned as to his future conduct of his business, and in order to afford proper facilities for the inspection of the carcases, he was required to confine, the hours between which slaughtering was carried on to 9 a.m. to 7 p.m. in summer, and 9 a.m. to 5 p.m. in winter, and carry out such other reasonable requirements as would assist the Sanitary Authority in enforcing the by-laws governing the conduct of his business. Slaughterhouses. There are now only three slaughterhouses in the Borough of Battersea, as against four in 1911, and five in 1910. The passing of the private slaughterhouse in Battersea is, from the public health standpoint, a satisfactory state of things. Generally speaking, such places are structurally ill-adapted for the purposes for which they are used, and it is consequently a difficult matter for the officers of the Council to carry out effectively the important duty of inspecting the meat of animals slaughtered therein. In other ways as well as has happened within recent years these premises lent themselves to abuses, and it is matter for congratulation that there now remain only three of them licensed, in only one of which is business of any magnitude carried on. The following is a list of the slaughterhouses licensed in the Borough of Battersea in 1912:— 345, Battersea Park Road. 205, St. John's Hill. 351, York Road (small animals only). 81 These premises are frequently and systematically inspected by the Council's Officers. During 1912 504 inspections of slaughterhouses were made in connection with the inspection of food, etc. Slaughterhouses are annually licensed by the London County Council as the licensing authority, but the duty of inspection and the enforcement of the by-laws and regulations made for the sanitation of these premises is carried out by the Borough Council as the Sanitary Authority. Cow-houses. There are now remaining in the Borough only two licensed cow-houses situate as under:— 14, Bellevue Road. 17, Wiseton Road. Very few cows are kept in these sheds, the keeping of cows in London being, it is satisfactory to note, a dying industry. These premises require to be annually licensed as in the case of slaughterhouses by the licensing authority, the London County Council, but the enforcement of the by-laws and regulations governing the sanitation, etc., devolves upon the Borough Council. The cowsheds in the Borough 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 known premises in which icecream is manufactured or sold was 181, as compared with 174 in 1911. Of the 181 premises, ten are occupied by Italians, who employ twenty-six barrows in the sale of the article. The premises where the ice-cream is made are frequently and systematically inspected. During 1912 491 visits of inspection were made to ice-cream dealers' premises. Nine intimation and one statutory notices were served to abate ten defects, mostly of an unimportant character. Owing no doubt to the salutary effect of the proceedings which the Council found it advisable to take against one or two ice-cream vendors during recent years, there has been a decided improvement in the conditions under which this article is prepared and sold in the Borough. During 1912 no legal proceedings were required for breaches of the Act of Parliament governing the preparation and sale of ice-cream. Milk Shops. The number of milk shops in Battersea at the end of 1911 was 176. During 1912 six new milk shops were added, and twelve removed from the register kept of these premises, the total number on the register at the end of 1912 being 170. 82 The character of the business carried on in premises in which milk was sold in Battersea during 1912 as compared with the four preceding years is as follows:— 1908 1909 1910 1911 1912 Dairy produce only 70 72 88 84 86 General shops 131 78 70 65 60 Confectioners 13 11 16 16 15 Dwelling houses 22 14 9 9 7 Wholesale 5 3 2 2 2 241 178 185 176 170 The above list shows the decline that has taken place in the number of general shops and other unsuitable premises where milk is sold in Battersea since 1908. Having regard to the nature and variety of the articles sold in such shops, it is most undesirable that milk should be sold from premises other than those in which dairy produce alone is the business carried on. The action of the Council in enforcing the powers which they possess for controlling the conditions under which milk is sold in Battersea has yielded satisfactory results. During the past four or five years a large number of persons carrying on a milk business in conjunction with that of a general shop have been removed from the Council's register, and particular care is taken in registering any fresh applicants to secure that the requirements of the Council are fully satisfied as a condition precedent to registration. Systematic inspection of the milk shops in the Borough is rigidly carried out, and all milk vendors in Battersea are required to provide suitable covers and properly ventilated and lighted safes for holding the counter pans containing the milk. In this way the risk of contamination of this sensitive article of food by dust, flies, etc., is minimised, a matter of prime importance from the public health standpoint. The New Milk and Dairies Bill which is now before Parliament will, it is to be hoped, still further secure that milk shall be protected in all stages from the farm to the consumer. It is more especially at the source of supply that milk should be protected from infection and contamination, and legislation in that direction is badly needed and long overdue. Restaurants and Eating Houses. The total number of these premises in the Borough of Battersea at the end of 1912 was 94, as compared with 100 in 1911, and 103 in 1910. 83 The systematic inspection of restaurants and eating houses was commenced in 1902 on the Factory and Workshop Act, 1901, coming into operation. Since then a general sanitary supervision has been exercised over them by the Workshop Inspector. During the year it was found necessary to serve nineteen preliminary notices and one statutory notice in connection with twenty-seven sanitary defects. These defects were not of a serious character, and had reference mainly to dirty condition of premises (walls, floors, and ceilings), defective sanitary appliances, etc. Very considerable improvement in the manner in which these premises are conducted has, during the past few years, resulted from the frequent inspections carried out by the Council's Inspector. The powers of the Council for controlling the conditions under which this class of business is carried on have been strengthened by the London County Council (General Powers) Act, 1908. Fish Shops. The fish shops in the Borough are 73 in number, a decrease of one as compared with 1911. In fifty-five of these premises fried fish is sold, in thirteen wet and dried fish is sold, while five sell wet, dried, and fried fish. These premises are frequently inspected, and during 1912 twenty-six preliminary and five statutory notices were served for various insanitary conditions, all of which notices were duly complied with. In addition, 159 inspections were made by the Council's Food Inspector at these premises. The new by-laws made by the London County Council governing the conduct of the business of fried fish vendors are awaiting confirmation by the Local Government Board and the Home Office, and will, when in force, strengthen the hands of Sanitary Authorities in dealing with this frequently objectionable class of business. Butchers' Shops. The number of these premises in Battersea is 91, all of which are systematically inspected by the Food Inspector. In the majority of them sausage-making or food-chopping is carried on, the work in most instances being done by hand. Practically all of them are provided with ice safes, and they are, generally speaking, well kept, the trade refuse being removed quickly from the premises. During the year 864 inspections of butchers' shops were made by the Food Inspector. 84 Sale of Food and Drug's Acts. The object of these Acts is two-fold in character, viz.: (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 1912 1,000 samples were purchased within the Borough of Battersea and submitted to the Public Analyst for analysis. Of these 1,000 samples 96 (i.e., 9.6 per cent.) were reported by the analyst to be adulterated, and in addition 16 of these 1,000 samples were certified by him to be of inferior quality. The following table gives details of the number of samples purchased during the year, and the number found to be genuine or otherwise. Description of Article. Total No. of Samples taken. Genuine. Adulterated. Inferior. Arrowroot 4 4 - - Bread 6 6 — — Butter 155 138 10 7 Cheese 11 7 2 2 Cocoa 18 17 — 1 Coffee 18 18 — — Cream 6 2 4 — Cream of Tartar 4 4 — — Flour 6 6 — — Fruit Jelly 5 5 — — Gin 2 2 — — Honey 5 5 — — Lard 14 13 1 — Margarine 10 10 — — Milk 629 576 53 — Mustard 4 4 — — Oatmeal 3 3 — — Olive Oil 5 3 — 2 Pepper 4 4 — — Potted and Preserved Meats 34 26 8 - Rice 9 1 8 — Rum 3 3 - — Sausages 20 12 8 — Soda (Bicarbonate) 4 4 — — Tartaric Acid 4 2 - 2 Vinegar 10 6 2 2 Whisky 7 7 — — Totals 1,000 888 96 16 85 The next table shows the percentage of adulteration during the ten years 1902-1911, and during 1912:— Year. No. of Samples taken. Adulterated. Percentage of Adulteration. 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 1912 1,000 96 9.6 * 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 effected by the vigorous enforcement of the Acts in their District by the Council has been well maintained during the year. These results are even more satisfactory if it is recognised that they are coincident with the increase in the number of samples taken during the past six years. Milk. Of the total number of samples purchased under the provisions of these Acts during 1912 629 (i.e., 62.9 per cent.) were milk samples. Of this number 53 (i.e., 8.4 per cent.) were reported by the Public Analyst to be adulterated. During 1911 635 of the samples purchased referred to milk of which 68 (i.e., 10.7 per cent.) were found to be adulterated. The nature of the adulteration in the adulterated samples of milk was as follows :— 1. Extraneous water (30) varying from a minimum of 1 per cent. to a maximum of 19 per cent., viz.: 1, 1, 1, 2, 2, 2, 2.5, 3, 3, 3, 4.7, 4.8, 5.4, 6.3, 7.4, 8.3, 8.7, 9, 9.6, 9.6, 9.6, 10, 10, 10, 10.5, 11, 12.8, 13.6, 18, 19. 2. Deficiency in milk fat (14) varying from a minimum of 3 per cent. to a maximum of 25.3 per cent., viz.: 3, 4, 7, 8, 10, 10, 10, 10, 15.3, 17.3, 18, 19, 20, 25.3. 86 3. Extraneous water and fat deficiency (3), viz. : 4.2 and 15.6, 7.3 and 11.51, 13.17 and 10.7. 4. Addition of boric acid (2), 2.01 and 5.73 grains per pint. 5. Separated milk (4), extraneous water 2.1, 4.2, 17, 23. Of the total number of samples taken during the year under report, 527 were taken on week days and 102 on Sundays. Samples were taken on nineteen Sundays in the year. Of the 527 week-day samples 43 (i.e., 81 per cent.) were found to be adulterated, while out of 102 samples taken on Sundays 10 (i.e., 10 7 per cent.) were adulterated. Although the percentage of adulteration in samples taken on Sundays was slightly higher than in the case of week-day samples, since the practice of Sunday sampling has been carried out by the Council there has been a very marked decrease in the percentage of adulterated samples. A large firm of wholesale milk, separated milk and butter dealers in the Borough were prosecuted by the Council for selling separated milk containing 23 per cent. and 18 per cent. of added water. The Food Inspector purchased on March 3rd a sample of "separated milk" from a local retail dealer, which, on analysis, was reported to be adulterated. This man obtained his supply from the firm in question, and he stated to the Inspector that he had sold the milk in the same state as he received it. The Inspector accordingly made arrangements to take samples in course of delivery, and on Sunday morning, March 28th, he took two samples from six churns of separated milk, which were being delivered to this retailer. Both samples were reported to be adulterated to the extent mentioned. The magistrate convicted the wholesale firm, inflicting a fine of £2 and £1 5s. costs. The summons against the retailer was withdrawn. This case is of interest as showing the extent of the business in separated milk carried on in Battersea, especially on Sundays, there being a ready sale of this article of food for pudding-making, a small retail dealer being able to dispose of the large quantity of six churns on his round on one day—and the ridiculously inadequate fines inflicted. A case of some interest as indicating the need of constant watchfulness to protect the milk supply from the fraudulent practices of dishonest milk vendors was that in which a milk vendor in the Borough was prosecuted for selling milk adulterated with 18 per cent. of added water. This man was kept under observation by the Food Inspector, who noticed that in the course of his round he and his employees always carried a hand-can 87 containing milk. The customers were invariably served from the churn on the barrow. On asking to be supplied with a pint of milk the Inspector was served from the hand-can. He insisted on being supplied as well from the churn. The milk from the former was reported to be genuine, while that supplied from the churn containing the bulk of the supply was found to be adulterated to the serious extent stated. The defendant was convicted and fined. Separated Milk. A letter was received from the Board of Agriculture and Fisheries dated the 20th August, 1912, enclosing copy of the Sale of Milk Regulations, 1912, in which they state that "these regulations amend the Sale of Milk Regulations, 1901, so far as they relate to skimmed or separated milk, and replace the limit of 9 per cent. of total milk solids on which, under article 3 of these regulations a presumption is based that the milk is not genuine, by a limit of 8.7 per cent. of milk solids other than milk fat. Representations have been received from time to time from local authorities of districts where there is a trade in skimmed and separated milk that considerable practical difficulties arise in instituting proceedings in cases in which water has been added to skimmed milk, but owing to the fact that the milk has been imperfectly skimmed, the total solids have not fallen below 9 per cent. Thus a sample containing 1.5 per cent. of fat and 7.5 per cent. of milk solids other than milk fat would probably contain over 12 per cent. of added water, but the total solids are up to the limit of 9 per cent. The present regulations are intended to obviate these difficulties, and to facilitate the prevention of the adulteration of skimmed milk with water." It will be remembered that representations have been made from time to time by the Council as to the difficulties met with in administering the Acts in their district in relation to skimmed milk owing to the existence of this regulation which has now been amended. There is a considerable trade done in the poorer districts of the Borough in skimmed and separated milk. It is satisfactory to find that the regulations in question have been amended in the direction indicated. Milk and Cream Regulations. The Public Health (Milk and Cream) Regulations which are now in force deal with the question of preservatives in milk and cream. Copies of the regulations have been forwarded to local authorities with a covering letter from the Local Government Board dated 6th August, 1912. 88 The regulations are designed to secure that no preservative shall be added to milk or to cream containing less than 35 per cent. by weight of milk fat at any stage from the place of production to the consumer. In the case of cream containing over 35 per cent. by weight of milk fat the addition of boric acid, borax, or a mixture of these preservative substances, or of hydrogen peroxide is not prohibited by the Regulations, but is subject to a system of declaration which is required to be followed by all persons dealing with such cream for the purpose of sale for human consumption. By this system (Part II. of the Regulations) it is intended that preserved cream as an article of commerce shall in all stages be differentiated from cream to which no preservative has been added. Further, Article IV. (a) prohibits the addition of any thickening substance to cream or preserved crcam. Except as regards Part III. the duty of administering the Regulations has been placed upon local authorities empowered to administer the Sale of Food and Drugs Acts. Existing arrangements for the collection and examination of milk samples under the Sale of Food and Drugs Acts can be extended so as to enable the Council to receive such reports from the public analyst as are requisite. Arrangements will be required for the periodical examination of samples of cream in accordance with the requirements of the Order. Provision is made in the Regulations before the local authority institute proceedings, affording any person contravening the regulations an opportunity of furnishing an explanation, which shall be considered by the Authority with all the circumstances of the case. Proceedings, it is pointed out, are those authorised by the Public Health (Regulations as to Food) Act, 1907, and the enactments referred to in the notice at the foot of the Order. The letter of the Board further states that "it will be desirable that the Medical Officer of Health should be instructed to exercise general supervision over the action taken in pursuance of these Regulations.... as to details of procedure necessary to secure the observance of the Regulations over which the Council has supervision." The Regulations were under consideration by the Borough Council at the beginning of the year 1913. Milk and Dairies Bill. The Milk and Dairies Bill was introduced by the President of the Local Government Board, and it is to be hoped that it 89 will have better fortune than its predecessors, which, owing to pressure of Parliamentary business or other causes, have had to be withdrawn. The present Bill is defective in some of its clauses, but doubtless these will be remedied in the passage of the Bill through the Committee Stage. The clauses which appear to me to require amendment are those relating to the transfer of the powers and duties of Sanitary Authorities by regulations of the Local Government Board, which, under the London Government Act were given to the Borough Councils as the Sanitary Authorities for London. The Bill also proposes to confer a new power upon the London County Council. Outside London the local authorities may require dairymen to furnish complete lists of the sources of their supply. The Bill proposes to confer this power on the London County Council in regard to dairymen in London. The definition of the expression "dairy" is unsatisfactory, having regard to the recent decision of the High Court in the Appeal Case of Spiers and Pond, Ltd. v. Green. The appellants, who were tenants and occupiers of a refreshment buffet at a railway station in London, sold milk for consumption on the premises. It was held that the appellants did not, in respect of the sale of milk at their buffet, carry on the trade of purveyors of milk, and, therefore, did not require to be registered under the provisions of the Dairies, Cowsheds, and Milk Shops Order, 1886. This decision is of great importance to the Council as it thereby removes from the supervision of the Sanitary Authority many small general shops in their district in which small quantities of milk are sold. The Bill proposes to give power to the Sanitary Authority of any district (other than rural districts) with a population of 50,000 or upwards to establish and maintain depots for the sale of milk for infants under the age of two years. In the case of districts with a population of under 50,000 but over 10,000, this power is also given if approved by the Local Government Board. This clause is of interest to the Council, who have carried on successfully an Infants' Milk Depot in their district for the past eleven years. The Bill also provides that the Warranty Defence in the case of milk shall be no longer available in regard to proceedings under the Sale of Food and Drugs Acts. This will be a very satisfactory legislative enactment, removing, as it will do, a great injustice to the consumer. 90 The Bill, when it becomes law, should be of considerable assistance to those interested in securing a clean and pure milk supply. Butter. One hundred and fifty-five samples of butter were taken, and of these 10 samples (i.e., 6.4 per cent.) were reported by the Analyst to be adulterated. The percentage of adulteration in butter samples was considerably higher than in 1911. The form of adulteration found to be present in eight of these ten samples was in each instance foreign fat. The added foreign fat (margarine) ranged from a minimum of 33 per cent. to a maximum of 81.8 per cent., viz., 33, 46, 56.8, 69.7, 72.7, 78.5, 79, 81.8. Two samples contained excess of water to the extent of 0.65 and 0.87 per cent. in excess of the amount allowed by the Regulations made by the Board of Agriculture and Fisheries. A retail trader having a milk round in the Borough was convicted for selling butter certified by the Analyst to be adulterated with 59.7 per cent. of foreign fat. An employee of this man on his round was kept under observation by the Inspector, who sent an agent to purchase a sample of milk and butter, as the Inspector had received information that it was this traders' practice to employ his men to sell so-called butter to their customers while on the round. The employee sold the agent a sample of milk, but on being asked for butter declared that he had none. The Inspector, who was lying in ambush, followed the man as he was passing along a street in Winstanley Ward. When the man saw him he quickened his pace, and turning round the corner of a street, he stopped his barrow outside a general shop at which he supplied milk for sale by the proprietor, but not butter. The Inspector, who followed him closely, saw him take some packages from a drawer in his barrow and run into this shop, leaving the drawer open in his hurry. He was seen by the Inspector to pass behind the counter of the shop with the packages containing what purported to be butter in his arms, and seeing he was caught, he piled the butter on the window board of the shop. The proprietor of the shop on being asked by the Inspector if the butter was for him replied in the negative, and turning to the man said, "I wish you had not brought it in here. I don't want to be mixed up in the matter." The Inspector demanded to be supplied with ½-lb. of butter, and paid 6id. for it. His employer was convicted and fined £2 and 9s. costs. 91 Sausages. Twenty' samples of sausages were taken and submitted to the Public Analyst. Of these twenty samples eight (i.e., 40 per cent.) were reported by the Analyst to contain added preservative (boric acid) in varying proportions from 4.71 grains per pound to 16.73 grains per pound. Coffee and Cocoa. Eighteen samples of coffee were purchased and submitted to the Public Analyst for analysis. All of these samples were reported not to be adulterated, though one was certified as inferior. Other Articles. Arrowroot 4; bicarbonate of soda 4; bread 6; cheese 11 (two deficient in fat); cream 6 (of which 4 were adulterated with boric acid varying from 4.95 grains per pound to 24.79 grains per pound); cream of tartar 4; currant jelly 5; flour 6; honey 5; lard 14 (one adulterated); margarine 10; meat (preserved) 34 (of which 8 were adulterated with boric acid, viz., brawn, one sample contained 7.42 grains, and another 12.39 grains of boric acid per pound); chicken and ham paste (one sample contained 20.82 grains per pound); ham and tongue, one sample contained 4.2 grains per pound; German sausage, one sample contained 5.81 grains, and another 13.63 grains per pound; salmon and shrimp paste, two samples, each contained 17.35 grains per pound; mustard 4; oatmeal 3; olive oil 5 (two inferior); pepper 4; rice 9 (8 adulterated by the process known as "facing," which is done with talc powder, so as to give the rice grain a lustrous appearance); tartaric acid 4 (two inferior); vinegar 10 (two samples contained extraneous water in the proportions of 1 per cent. and 5 per cent. respectively); gin 2 ; rum 3; whisky 7. The "facing" of Rice. This method of treating rice so as to improve the appearance of the grain is done by means of talc (French chalk) or steatite in the form of a white powder, a substance which contains a considerable percentage of silica and other adventitious mineral matter. The rice, after milling, is subjected to a glazing process by means of which appreciable quantities of mineral matter adhere to the finished article. Other methods used in the sophistication of rice for the purpose of giving a bleached and pearly appearance to the grain are by treating it with colouring matters, e.g., ultramarine and Prussian blue, and with oil, usually petroleum. The practice is one which is not devoid of risk of injury to health, especially when, as is frequently the case, considerable 92 quantities of mineral or other deleterious matter is present. During the year samples of rice purchased under the provisions of the Sale of Food and Drugs Acts were submitted to the Public Analyst, and were reported by him to be adulterated with mineral matter (talc) in varying quantities. The cases were submitted to the Health Committee, but in view of the small quantities of the mineral matter present the Committee decided not to take legal proceedings, but directed that the vendors were to be cautioned, and instructed the Medical Officer of Health to send a circular letter to the traders in the Borough, drawing their attention to the practice which they were advised may be injurious to health, and will render the vendors of such adulterated rice liable to prosecution by the Council. The following letter was sent to all traders in rice in the Borough:— 1st June, 1912. "Dear Sir,—The attention of the Council has been called to the practice of what is known as the 'facing' of rice with talc and similar foreign matter, with the apparent object of improving the appearance of the grain. The Council are advised that the practice in no way adds to the value of the rice as an article of food, but, on the contrary, constitutes a form of adulteration which, under the provisions of the Sale of Food and Drugs Acts, is to be deemed to be to the prejudice of the purchaser, and may be injurious to health. "I am, therefore, instructed to inform you that samples taken within this district, under the Sale of Food and Drugs Acts, which are reported by the Public Analyst to be thus adulterated, will render the vendors liable to proceedings being taken against them. "Yours faithfully, "G. Quin Lennane, " Medical Officer of Health." The practice of treating rice in this manner in no way adds to the dietetic value of the article. Having regard to the fact that rice is a common article of diet for children and invalids, the risk of injury to health is, in my opinion, considerable. The consumer gains nothing from the practice, any aesthetic advantage being nullified by the cooking process. On the other hand he is liable to be defrauded, as this process of "facing" no doubt enables inferior quality rice to be substituted for, or mixed with a better grade article. 93 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 Borough Council. The Act has been amended in 1907 in matters relating to laundries, and a Bill is now before Parliament to amend the Act relating to underground workrooms and workplaces. 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 of the Report 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 1,162 Factories 200 Bakehouses 86 Restaurant Kitchens, &c. 94 Ice Cream Premises 181 Home Workers 240 Stables 548 Factories. Factories include all places in which mechanical power is used in aid of the manufacturing processes. 94 There are 200 of these premises registered in the Health Department, employing 8,278 persons (males 6,311, females 1,967) as follows:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Barge Builder 1 12 4 - - Baker 7 132 33 32 28 Bootmaker 13 43 1 — - Builder 3 17 — — — Butter blender 3 72 29 17 - Carpenter 8 63 7 — — Chemical Works 3 114 7 34 13 Chaff Cutter and Forage 7 89 — — — Cycle Maker 2 5 3 — — Dyer 2 36 1 35 5 Engineer 29 710 19 — — Flour Mills 2 120 — — — Firewood Cutter 7 55 2 21 3 Founder 3 68 3 — — Liftmaker 2 14 1 — — Mason 4 190 2 — - Mineral Water 1 29 — 16 - Printer 21 99 24 7 4 Steam Laundry 31 151 19 824 127 Other Trades 51 3,790 447 612 189 Totals 200 5,709 602 1,598 369 The duties of sanitary authorities in relation to factories are few and limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employes. During 1912, 38 defects were found on factory premises, for the most part relating to unsuitable and insufficient sanitary accommodation or to defects in sanitary fittings and appliances. In only 6 cases was it found necessary to serve notices to remedy defects, all of which were complied with. Fifteen new factory premises were inspected and added to the register during the year. All were found to be provided with suitable and sufficient sanitary accommodation except in one instance, which was subsequently remedied. 95 Workshops. Workshops include any premises (not being factories) in which manual labour is exercised by way of trade or for purposes of gain in or incidental to the making, altering, repairing, finishing or adapting for sale of any article, and to or over which the employer of the persons there has the right of access or control. The workshops in Battersea were up to the early part of 1911 under the supervision of two Workshop Inspectors, one male and one female, who dealt respectively with premises where male or female labour is employed. Owing to the resignation of the female Workshop Inspector 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. A report (vide Appendix) was subsequently submitted by the Medical Officer of Health at the end of the year, and as a result the Council decided to fill the vacancy, and Miss Ross Brown, who filled a similar appointment at Warrington, was appointed. The following is a list of the workshops in the register at the end of 1912:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 79 116 173 1 1 — Billiard Table maker 1 2 8 2 — — Blind maker 4 5 13 1 — — Bootmaker 72 75 132 11 1 — Carpenter 14 15 27 6 — 1 Coach builder 5 12 27 — — — Cycle maker 13 19 21 5 — 5 Dressmaker 80 115 — — 202 72 Embroiderer 4 10 — — 97 10 Farrier and Smith 19 19 53 3 — — Firewood cutter 14 14 29 1 8 1 Laundry 29 75 9 — 94 — Mason 7 7 59 1 — — Millinery 19 25 — — 36 13 Musical instrument 2 3 21 3 - - Photographer 4 10 6 1 9 5 Picture framer 6 7 13 2 — — Ragsorter 12 13 35 7 — — Saddler 8 8 13 3 — — Tailor 46 73 69 3 181 22 Upholsterer 9 9 47 — 4 3 Other Trades 113 134 394 55 58 17 Totals 560 766 1,149 105 691 149 96 At the beginning of 1912 the number of workshops on the register was 564, as compared with 600 at the beginning of 1911. During 1912 the occupation of 35 of these premises was discontinued, while on the other hand 31 new workshops were added, so that at the end of 1912 the total number of these premises was 560, in which were employed 2,094 persons (1,254 males, 840 females). During 1912, 28 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 1912:— Trade. No. of Work shops. Protected Persons employed Women Young Persons. Total. Bootmaking 1 - 1 1 Dressmaking 5 12 4 16 Laundry 1 3 — 3 Tailoring 3 — 6 6 Miscellaneous 18 12 18 30 Totals 28 27 29 56 Sanitary Condition of Workshops. The local authority is the authority responsible for the condition of workshops and workplaces in its district. Sanitary conditions includc (a) cleanliness, (b) air space, (c) ventilation, (d) drainage of floors, (e) provision of sanitary accommodation. During 1912, 3,769 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 97 the work carried out in connection with workshop inspection during 1912 so far as it admits of tabulation:— Workshops inspections and re-inspections 1,638 Workrooms measured 50 Workshops notified to H.M. Inspector 28 Cards distributed showing number of persons legally employed in workrooms 33 Written intimations issued 106 Statutory notices served 13 Defects discovered in Workshops and remedied — Workrooms in a dirty condition 54 „ overcrowded 8 „ badly ventilated 1 „ with defective Walls or ceilings — „ with defective floors 3 Workshops with defective yard paving 1 „ with defective drains 1 „ with blocked drains 3 „ without proper dustbins 11 „ with defective w.c. apparatus 14 „ with sanitary conveniences insufficient in number or absent 7 „ with sanitary conveniences opening into workrooms — „ with sanitary conveniences without proper doors or fastenings 2 „ with sanitary conveniences in dirty condition 8 Coal bins provided in bakehouses — Accumulation of refuse removed 6 Other defects remedied 22 The following notice of defects was received from H.M. Inspector of Factories during 1912, and received attention:— Premises. Trade. Nature of Complaint. Falcon Terrace Boxmaking Leaky W.C. fittings. 98 Underground Workrooms. Excluding the underground bakehouses, there are 30 underground workshops and workplaces in Battersea, as compared with 28 in 1911, and 29 in 1910. The number of such premises and the business carried on is shown below:— Workshops. Laundries 8 Picture-frame making 2 Cycle Making 3 Fitters 1 Rag-sorting 1 Coffin-making 1 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 1912 there were on the register 86 bakehouses, 9 of which were factory bakehouses with regard to which the duties of the Council are few, and 77 workshop bakehouses. Of the latter 47 are above ground and 30 underground according to the definition given in the Factory Act. The following is a list of the workshop bakehouses:– 47 Bakehouses above Ground. Addresses. Addresses. 257 Battersea Park Road 139 ChathamRoad 292 „ „ „ 47 Este Road 343 „ „ „ 29 Falcon Road 1 Battersea Rise 88 Grayshott Road 78 45 Harroway Road 31 Bridge Road 11 Hanbury Road 84 „ „ 49 High Street 64 Castle Street 80 „ „ 83 Culvert Road 173 „ „ 99 Addresses. Addresses. 213 Lavender Hill 41 Queens Road 64 Latchmere Road 121 „ „ 93 „ „ 38 Rowena Crescent 29 Meyrick Road 10 St. Phillip Street 48 New Road 93 Stewarts Road 89 „ „ 29 Stockdale Road 148 ,, „ 90 St. Johns Hill 205 „ „ 32 Tyneham Road 10 Northcote Road 47 „ „ 64 „ „ 102 Usk Road 94 „ „ 70 York Road 175 „ „ 187 „ „ 62 Plough Road 198 „ „ 76 „ „ 287 „ „ 112 „ „ 30 Bakehouses Under Ground. Addresses. Addresses. 163 Battersea Park Road 103 Falcon Road 189 „ „ „ 46 Francis Street 200 „ „ „ 30 Lavender Hill 219 „ „ „ 123 Maysoule Road 265 „ „ „ 33 Orkney Street 310 ,, „ „ 23 Plough Road 373 „ „ „ 34 „ „ 501 „ „ „ 109 Salcott Road 525 „ ,, „ 140 St. Johns Hill 48 Broomwood Road 8 Tyneham Road 2 Burland Road 23 Webbs Road 35 Castle Street 47 Winstanley Road 83 Church Road 79 „ „ 4 Currie Street 6 York Road 43 Falcon Road 345 „ ,, The bakehouses were systematically inspected during the year, and 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 may, for convenience, be set down here. It should, however, be 100 remembered that the summarised results of bakehouse inspection here recorded are included in the tables giving the results of general factory and workshop inspection. Above ground bakehouses:—26 intimation notices and two statutory notices were served for defects, all of which were duly complied with. Underground bakehouses:—21 intimation and two 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, dilapidations. &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 „ „ „ 23, Northcote Road „ „ „ Broughton Street Biscuits only. 37, Grayshott Road Bread. 465, Battersea Park Road „ 465, Battersea Park Road „ — Sugden Road „ Homework. This term has reference to persons who carry on certain classes of work in their 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 workers themselves, viz., through overcrowding, inadequate ventilation, &c., and (2) in premises where there is dangerous infectious disease. The outworkers 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). 101 During 1912 the names and addresses of 825 outworkers were received as compared with 749 in 1911 and 832 in 1910. Lists were sent in by employers and by the Medical Officers of Health of the following Metropolitan Boroughs and District Councils:— District. Lists. Outworkers District. Lists. Outworkers Chelsea 2 73 St. Marylebone 3 25 Finsbury 2 13 Shoreditch 3 10 Fulham 2 2 Southwark 3 7 Hackney 2 2 Walthamstow 1 1 Kensington 3 26 Wandsworth 9 74 Lambeth 5 26 Westminster 3 138 New Maiden 1 1 City of London 17 29 Paddington 2 3 Totals 59 431 Poplar 1 1 The names and addresses of 181 outworkers which were sent in by employers were found to refer to other districts and were accordingly forwarded to the Medical Officers of Health of these districts. The premises occupied by outworkers are 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:— Trade. Number on Register. Persons Employed. Premises Workrooms. Males. Females. Blousemaking 15 15 - 17 Bootmaking 39 39 39 — Boxmaking 9 9 — 10 Dressmaking 7 7 - 7 Embroidery 35 35 — 35 Glovemaking 35 35 1 39 Tailoring 53 53 35 25 Underclothing 29 29 — 29 Other trades 18 18 4 16 Totals 240 240 79 178 102 The systematic inspection of outworkers' premises is carried out by the two Workshop Inspectors (Inspector Benjamin and Miss Ross Brown). The former deals with male outworkers and the latter with female. In addition to the inspection of the homes of outworkers the lists kept by the firms established in Battersea of outworkers employed by them are regularly inspected, and care taken that these lists are kept in the manner and form prescribed by sec. 107 of the Factory and Workshop Act. During 1912, 760 inspections of outworkers' dwellings were made, 357 of which were made by the female Workshop Inspector. It was found necessary to serve 39 notices in connection with homework inspection, the results of which are summarised as follows:— Total number of inspections 760 Number of notices served 39 Number of outworkers on register 240 There has been a marked increase in the number of inspections of outworkers' dwellings during 1912 as compared with the previous year, rendered possible by the filling up of the vacancy caused by the resignation of the female Workshop Inspector (Miss Fairbairn) early in 1911. The new female Workshop Inspector entered on her duties in the second half of the year 1912, and some of the arrears of Workshop and homework inspection were worked off, and it is to be anticipated that at the end of 1913 the annual average of inspections for the ten years prior to 1911 will have been maintained. The defects found in outworkers' premises were mainly those referring to want of cleanliness of rooms, defective sanitary fittings, &c. Five cases of infectious disease, viz., diphtheria, were notified from outworkers' homes during 1912. The patients were immediately removed to hospital, and precautions taken to prevent the spread of infection. 103 Legal Proceedings. Summary of Legal Proceeding's. The facts relating to the legal proceedings instituted by the Council in connection with the work of the Health Department are set out in Appendix No. 1, pages 104 to 106, and are summarised below:— No. of Prosecutions. No of Convictions. Fines. Costs. £ s. d. £ s. d. Sale of Food and Drugs Acts 94 41 64 11 0 24 2 6 Smoke Nuisances — — — — Unsound Food — — — — Contravention of Bye-Laws 3 3 — 1 1 0 Other proceedings 11 8 — 3 5 0 Total 108 52 64 11 0 28 8 6 104 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. 536 Milk 7% added water Fined £2 and 12s. 6d. costs. — ” Giving false warranty Fined £2 and 10s., including costs. 677 ” 25% of fat abstracted Dismissed. 678 ” 16% of fat abstracted Dismissed. 604 ” 4.5% added water Withdrawn, £1 1s. costs. 693 ” 10% added water Fined £3, including costs. 688 ” 13.5% added water Fined £3, including costs. 687 Butter 86% foreign fat and selling Margarine in a plain wrapper Fined £2, including costs. 715 ” 60% foreign fat and selling Margarine in a plain wrapper Fined £5 and 2s. costs. 705 Irish Whisky 28.24 degrees under proof Fined £2, including costs. 701 Scotch Whisky 28.24 degrees under proof Fined £2, including costs. 771 Milk 10% added water Fined £2 and 12s. 6d. costs. 853 ” 25.3% of fat abstracted Fined £1 and 14s. 6d. costs. 788 ” 9% added water Fined £1 and 14s. 6d. costs. 817 Butter 56.8% foreign fat and selling Margarine in a plain wrapper Fined £5 and 14s. 6d. costs. 848 ” Offence under Sec. 4 of Butter and Margarine Act, 1907 Dismissed. 849 ” Offence under Sec. 4 of Butter and Margarine Act, 1907 Dismissed. 865 Milk 17.3% of fat abstracted. Fined £1 and 14s. 6d. costs. 900 Butter 72.7% foreign fat and selling Margarine in a plain wrapper Fined £2 and £1 9s. costs. 901 ” 69.7% foreign fat and selling Margarine in a plain wrapper Fined £2 and £1 9s. costs. 913 ” 79% foreign fat and selling Margarine in a plain wrapper Fined £1 1s. Fined £1. 925 Vinegar 5% added water 860 Dutch Cheese 37.18% deficient in fat Withdrawn, £2 2s. costs. 963 Milk 10.5% added water Dismissed (warranty). 4 ” 20% of fat abstracted Fined £5 and 27s. costs. 5 ” 6.3% added water Fined £5 and 27s. costs. 19 ” 9.6% added water Fined £3 and 14s. 6d. costs. 34 ” 8.3% added water Dismissed. — ” Giving false warranty Dismissed. 56 ,, 9.6% added water Fined £3 and 14s. 6d. costs. 64 ” 19% of fat abstracted Dismissed (warranty). 105 APPENDIX No. 1—continued. Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 988 Separated Milk 17% extraneous water and less than 9% of milk solids Fined £2 and £1 5s. costs. 989 ” 23% extraneous water and less than 9% of milk solids Fined £2 and £1 5s. costs. 935 ” 4.2% extraneous water and less than 9% of milk solids Withdrawn. 102 Milk 11% added water Fined £2 and 12s. 6d. costs. 87 Butter 78.5% foreign fat and selling Margarine in a plain wrapper Fined £5 and 14s. 6d. costs. 59 Milk 10% added water Fined 10s. and 14s. 6d. costs 114 ” 7% of fat abstracted Dismissed (warranty). 80 ” 16.08 grains (per gallon) boric acid Dismissed (warranty). — ” Giving false warranty Dismissed. 122 ” 18% of fat abstracted Ordered to pay 12s. 6d. costs. 187 ” 4.2% added water and 15.6% of fat abstracted Fined 5s. and 14s. 6d. costs. 188 ” 7.3% added water and 11.51% of fat abstracted Fined 5s. and 12s. 6d. costs. 189 ” 10% of fat abstracted Fined 5s. and 12s. 6d. costs. 223 ” 10% of fat abstracted Dismissed (warranty). 222 ” 10% of fat abstracted Dismissed (warranty). 754 ” 4.8% added water Dismissed (warranty). 229 ” 8% of fat abstracted Fined 5s. and 14s. 6d. costs. 237 ” 10% of fat abstracted Dismissed (warranty). — ” Giving false warranty Dismissed. 270 ” 18% added water Fined £2 and 14s. 6d. costs. 304 ” 45.91 grains (per gallon) boric acid Dismissed (warranty). 333 ” 13.7% added water and 10.7% of fat abstracted Fined 10s. and 12s. 6d. costs. 344 Butter 81.8% foreign fat and selling Margarine in a plain wrapper Fined £1 and 14s. 6d. costs. — Milk Giving false warranty Dismissed. — ” Giving false warranty Dismissed. — ” Giving false warranty Dismissed. — ” Giving false warranty Dismissed. 456 Butter 46% foreign fat and selling Margarine in a plain wrapper Fined £2 and 18s. 6d. costs. 461 Milk 10% added water Dismissed (warranty). 505 ” 8.7% added water Dismissed (warranty). - ” Giving false warranty Withdrawn, £1 1s. costs. - ” Giving false warranty Withdrawn, £1 1s. costs. 580 ” 5.4% added water Fined £2 and 14s. 6d. costs. 106 APPENDIX No. 1 —continued. Legal Proceedings under the Public Health (London) Act, 1891; Metropolis Management Act, 1855; Metropolis Management Acts Amendment (Bye-laws) Act, 1899; Dairies, Cowsheds, and Milkshops Order, 1855. Nature of Offence. Result of Proceedings. Nuisances at Nos. 12, 14, 16 Usk Road Summonses adjourned sine die for work to be done. Non-deposit of plans of drainage work at 98 and 100 Speke Road Plans deposited. Withdrawn, 10s. 6d. costs. Non-deposit of plans of drainage work at 93 Battersea Park Road Plans deposited. Withdrawn, 10s. 6d. costs. Nuisances at 25 and 27 Longhedge Street Nuisances at 15 and 16 Aegis Grove Paving of yard at 16 Aegis Grove Work done and summonses withdrawn, £2 2s. costs. Carrying on the trade of purveyors of milk without being registered Ordered to pay 2s. costs. Nuisances at Nos. 81 and 101 Speke Road Work done, ordered to pay £1 1s. costs. 107 TABLE I. (.Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole District during 1912 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. Uncorrected 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.0 Rate per 1,000 Nett Births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1912 167,589 4,030 4,255 25.4 2,125 12.7 530 457 353 82.9 2,054 12.2 * Rates calculated per 1.000 of estimated population. Area of District in acres (land and inland water), 2,309 acres. Total population at all ages, 167,793; number of inhabited houses, 22,078; average number of persons per house, 7.6 at Census of 1911. 108 TABLE II. (Required by the Government Board to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1912. 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. • Cast 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 205 4 67 114 12 8 .. 85 61 59 82 61 53 Membranous croup 5 1 4 .. .. .. .. 5 .. .. 5 .. .. Erysipelas 134 2 6 8 10 91 17 65 46 23 14 13 2 Scarlet fever 427 4 111 263 35 14 .. 198 127 102 198 125 91 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 20 .. 2 7 5 6 .. 5 12 3 4 12 2 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 5 .. .. .. 1 4 .. .. 2 3 .. 1 2 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 28 28 .. .. .. .. .. 18 8 2 .. .. .. Polio-encephalitis 2 .. 2 .. .. .. .. 1 .. 1 .. .. .. Phthisis. Under Tuberculosis Regulations, 1908 109 .. 4 13 10 76 6 52 34 23 .. .. .. Under Tuberculosis (in Hospital) Regulations, 1911 209 .. 6 47 38 118 .. 129 59 21 .. .. .. Under Tuberculosis Regulations, 1911 224 .. 2 35 48 133 6 102 59 63 •• •• •• Totals 826 39 192 392 63 123 17 377 256 193 303 212 150 109 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 1912. Causes of Death. Nett Deaths at the Subjoined ages of "Residents" whether occuring within or without the district Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 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 2 .. .. .. .. 1 1 .. .. 1 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 55 11 15 22 7 .. .. .. .. 1 Scarlet Fever 6 .. 1 2 2 .. 1 .. .. .. Whooping Cough 40 19 13 7 1 .. .. .. .. 1 Diphtheria and Croup. 17 2 2 6 7 .. .. .. .. .. Influenza 17 .. .. 1 .. .. 2 7 7 .. Erysipelas 4 1 .. .. .. .. 1 1 1 2 Phthisis (Pulmonary Tuberculosis) 190 1 1 3 6 38 70 56 15 69 Tuberculous Meningitis 24 3 7 5 9 .. .. .. .. 12 Other Tuberculous Diseases 19 3 2 .. 4 1 5 2 2 7 Cancer, malignant disease 179 .. .. .. .. .. 22 88 69 108 Rheumatic Fever 6 .. .. .. 1 .. 4 1 .. 4 Meningitis 7 2 .. 3 .. 1 .. 1 .. 4 Organic Heart Disease 192 .. .. .. 8 12 35 60 77 56 Bronchitis 185 25 6 4 .. 2 11 46 91 69 Pneumonia (all forms) 190 43 19 21 7 6 25 41 28 61 Other diseases of respiratory organs 36 3 1 1 2 1 3 12 13 13 Diarrhœa and Enteritis 58 38 10 .. .. .. 6 2 2 43 Appendicitis and Typhlitis 13 .. .. 2 2 2 4 2 1 5 Cirrhosis of Liver 16 .. .. .. .. .. 6 8 2 13 Alcoholism 5 .. .. .. .. .. 2 3 .. 12 Nephritis and Bright's Disease 59 1 .. 1 3 3 10 24 17 33 Puerperal Fever 1 .. .. .. .. .. 1 .. .. 3 Other accidents and diseases of Pregnancy and Parturition 5 .. .. .. .. .. 5 .. .. 3 Congenital Debility and Malformation, including Premature Birth 143 139 1 .. 1 2 .. .. .. 38 Violent deaths, excluding Suicide 76 12 5 6 11 7 10 19 6 35 Suicides 15 .. .. .. .. 1 6 5 3 9 Other Defined Diseases 488 50 5 4 7 16 57 114 235 242 Diseases ill-defined or unknown 4 .. 3 .. .. .. .. .. 1 1 All causes 2052 353 91 88 78 93 287 492 570 845 110 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 1912. 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 6 8 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 2 4 1 1 8 Diphtheria arid Croup .. .. .. .. .. 1 .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. 1 .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. 2 1 3 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 1 1 Convulsions 1 1 .. .. 2 3 2 .. .. 7 Laryngitis .. .. .. .. .. .. .. .. 1 1 Bronchitis .. .. 1 1 2 2 1 1 2 8 Pneumonia (all forms) .. .. 2 1 3 4 6 2 3 18 Diarrhœa .. .. .. .. .. 3 4 2 .. 9 Enteritis .. .. .. .. .. 2 4 2 .. 8 Gastritis .. 1 .. .. 1 1 .. .. .. 2 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. 2 2 1 2 1 .. 6 Atelectasis l 1 .. .. 2 .. .. .. .. 2 Congenital Malformations .. .. 1 .. 1 .. .. .. 1 2 Premature birth 20 6 2 3 31 2 1 .. .. 34 Atrophy, Debility and Marasmus 3 1 4 4 12 5 4 2 3 26 Other causes 4 2 1 .. 7 3 .. 3 .. 13 29 12 11 11 63 29 29 19 19 159 Nett Births in the year—Legitimate, 1943; Illegitimate, 36. Nett Deaths in the year of Legitimate infants, 886; Illegitimate Infants, 9. 111 TABLE IV.–(continued). North-West Battersea. Infantile Mortality during the Year 1912. 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 .. .. .. .. .. .. .. .. 3 3 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 1 2 4 2 9 Diphtheria and Croup .. .. .. .. .. 1 .. .. 1 2 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 .. 1 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. 1 1 .. .. .. .. 1 Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 3 6 2 2 13 Pneumonia (all forms) .. .. .. 1 1 .. 4 4 5 14 Diarrhœa .. .. .. .. .. 3 4 2 1 10 Enteritis .. .. 1 .. 1 1 5 .. 1 8 Gastritis .. .. .. .. .. 3 .. 2 .. 5 Syphilis .. 1 1 .. 2 2 .. 1 .. 5 Rickets .. .. .. 1 1 .. .. .. .. 1 Suffocation, overlying .. .. .. .. .. .. .. 1 .. 1 Injury at birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 2 .. .. .. 2 .. .. .. .. 2 Congenital Malformations .. 1 .. .. 1 .. .. .. .. 1 Premature Birth 19 3 3 1 26 2 .. .. .. 28 Atrophy, Debility and Marasmus 3 2 4 l 10 5 3 2 1 21 Other causes 4 1 2 .. 7 2 2 1 .. 12 29 8 11 5 53 23 27 19 17 139 Nett Births in the year—Legitimate, 1,386; Illegitimate, 32. Nett Deaths in the year of Legitimate Infants, 661; Illegitimate Infants, 11. 112 TABLE IV.—(continued). S.W. Battersea. Infantile Mortality during Year 1912. 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 .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. 1 1 .. .. .. 1 2 Diphtheria and Croup .. .. .. .. .. .. .. .. .... .. Erysipelas .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. 1 1 .. 1 1 1 4 Pneumonia (all forms) .. .. .. .. .. 2 2 3 4 11 Diarrhœa .. .. .. .. .. .. .. .. 2 2 Enteritis .. .. .. .. .. 1 .. .. .. 1 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 1 .. .. .. 1 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis .. .. .. .. .. .. .. .. .. .. Congenital Malformations .. .. .. .. .. .. .. .. .. .. Premature birth 14 .. .. .. 14 5 .. .. .. 19 Atrophy, Debility and Marasmus l 1 .. .. 2 1 .. .. .. 3 Other causes 3 2 .. 1 6 1 3 .. .. 10 20 3 .. 3 26 11 6 4 8 55 Nett Births in the year-Legitimate, 840; Illegitimate, 18. Nett Deaths in the year of Legitimate Infants, 496; Illegitimate Infants, 2. 113 TABLE IV.-(continued). Borough of Battersea. Infantile Mortality during the Year 1912. 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 .. .. .. .. .. .. .. 2 9 11 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. 1 1 3 6 5 4 19 Diphtheria and Croup .. .. .. .. .. 2 .. .. 1 3 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 1 1 3 Abdominal Tuberculosis .. .. .. .. .. .. .. 2 1 3 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. .. 1 Meningitis (not Tuberculous) .. .. .. 1 1 .. .. .. 1 2 Convulsions 1 1 .. .. 2 3 2 .. .. 7 Laryngitis .. .. .. .. .. .. .. .. 1 1 Bronchitis .. .. 1 2 3 5 8 4 5 25 Pneumonia (all forms) .. .. 2 2 4 6 12 9 12 43 Diarrhœa .. .. .. .. .. 6 8 4 3 21 Enteritis .. .. 1 .. 1 4 9 2 1 17 Gastritis .. 1 .. .. 1 4 .. 2 .. 7 Syphilis .. 1 1 .. 2 3 .. 1 .. 6 Rickets .. .. .. 1 1 .. .. .. .. 1 Suffocation, overlying .. .. .. .. .. .. .. 1 .. 1 Injury at Birth 3 .. .. 2 5 1 2 1 .. 9 Atelectasis 3 1 .. .. 4 .. .. .. .. 4 Congenital Malformations .. 1 1 .. 2 .. .. .. 1 3 Premature Birth 53 9 5 4 71 9 1 .. .. 81 Atrophy, Debility and Marasmas 7 4 8 5 24 11 7 4 4 50 Other causes 11 5 3 1 20 6 5 4 .. 35 78 23 22 19 142 63 62 42 44 353 Nett Births in the year-Legitimate, 4,169; Illegitimate, 86. Nett Deaths in the year of Legitimate, 2,030; Illegitimate Infants, 22. 114 Factories, Workshops, Workplaces and Homework. 1.—Inspections (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries 556 35 - Workshops (including Workshop Laundries) 1,638 106 - Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1.575 70 - Total 3,769 211 — 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 77 77 Want of Ventilation 3 3 Overcrowding 8 8 Want of drainage of floors 3 3 Other nuisances 113 113 Sanitary accommodation Insufficient 11 11 Unsuitable or defective 26 26 Not separate for sexes 1 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (Sec. 101) - - Breach of Special Sanitary Requirements for Bakehouses (Secs. 97 to 100) 37 37 Other Offences (excluding Offences relating to Outwork which are included in Part 3 of this Report) - - Total 279 279 115 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 41 305 7 1 22 — — — 33 33 — — — — (2) Cleaning and washing 4 — 15 — — — — — — — — — — — — Furniture and upholstery 2 — 8 — — — — — — — — — — — — Other Trades 2 — 2 — — — — — — — — — — — — Total 76 41 320 7 1 22 — — — 33 33 — — — — 116 4.-Registered Workshope. Workshope on the Register (Sec. 131) at the end of the year:- Bakehouses 79 Bootmakers 72 Dressmakers 80 Laundries 29 Milliners 19 Tailors 46 Other Trades 235 Total number of workshops on Register 560 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 1 Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 30 117 Proceedings during 1912. (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, 1912. No. of Intimation Notices 1912. No of Prosecutions 1912. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end of 1912. Milk premises 176 6 12 170 576 12 — Cowsheds 3 — 1 2 * — — Slaughterhouses 4 — 1 3 504 — — Other offensive trade premises 2 — — 2 22 — — Ice-cream premises 174 25 18 181 491 9 — Registered houses let in lodgings 123 — — 123 321 98 — * These premises are subject to frequent inspection. Total number of intimation notices served for all purposes 3865 Overcrowding— Number of dwelling-rooms overcrowded 72 Number remedied 72 Number of prosecutions — Underground rooms— Illegal occupation dealt with during the year 113 Number of rooms closed 113 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 — 118 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 6 Number of tenements comprised therein .. 18 Number of tenements for which certificates were :—(a) Granted 9 (b) Refused 4 (c) Deferred 5 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, terns, &c. — (h) With respect to water-closets, &c. — (t) 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) 3 Mortuary— Total number of bodies removed 264 Total number of infectious bodies removed 7 119 APPENDIX. Public Health Department. Municipal Buildings, Battersea, S.W. 20th February, 1912. To the Health Committee. In accordance with the instructions of the Committee, I beg to submit my report on the work in connection with the carrying out of the Orders of the Local Government Board dealing with the Compulsory Notification of Pulmonary Tuberculosis. I propose, at the same time, to deal with the letter of the Local Government Board with regard to the rearrangement of the work of the Sanitary Staff, rendered necessary by the new Regulations, and by the decision of the Council to tentatively hold over the question of filling the vacancy created by the resignation of Miss Fairbairn, Female Workshop Inspector, in the early part of 1911. 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 operation on the 1st January, 1909. Under these Regulations a partial system of Compulsory Notification of Pulmonary Tuberculosis, 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 notification of cases of Pulmonary Tuberculosis occurring amongst the in-patients and out-patients at hospitals. At the end of the year 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 partial 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. It will be convenient here to briefly recapitulate the provisions of the New Regulations:— (i.) Every Medical Practitioner attending on or called in to visit any person is to notify the Medical Officer of 120 Health of the Sanitary Authority for the district in which the case occurs, within 48 hours, any case of Pulmonary Tuberculosis. The Medical Practitioner is to receive a fee of 2s. 6d., payable by the Sanitary Authority. (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 of the Metropolitan Boroughs 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 may 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 necessary additional Officers. The New Regulations, as was to be anticipated, have added considerably to the work of the Health Department of the Council. Since the 1st January the number of notifications received relating to Pulmonary Tuberculosis has increased by about 50 per cent, as compared with the same period of 1911. The majority of these cases require to be investigated, and in a large number of them a systematic visitation of the homes has to be carried out, involving much of the time of the Sanitary Inspectorial Staff and of the Health Visitors, as well as that of the Office Staff, in the keeping of the records. 121 It is clear, therefore, that a considerable increase in the work of the Health Department is to be looked forward to in carrying out the important duties set forth in the Regulations, to which the attention of Sanitary Authorities and their Officers was specially drawn by the Local Government Board in their circular letter accompanying the Regulations. It may be of interest to the Committee to outline the steps taken at present in this Borough to carry out the objects for which these Regulations were issued. (1) Notification.—Each notification as received is entered in the register, and, in addition, a card-index relating to each patient is prepared, containing a full history of the case for record purposes. (2) Visitation of the Homes.—Each case, as soon as notified, is visited at the home. Enquiries are made by the Sanitary Inspector or Health Visitor as to the history of each case. Advice, both oral and written, is given to the patient or his friends as to The precautions to be taken to prevent tHe spread of infection to others, and efforts are made to ascertain whether " contacts "—i.e., other members of the family or perons living in the same house—are exhibiting symptoms of illness of a suspicious character. In such instances steps are taken to induce such " suspects " to be medically examined. A careful inspection of the house is also made to ascertain whether any insanitary conditions exist requiring to be dealt with. (3) Disinfection.—In all cases disinfection of the room and clothing is offered, and in the great majority of cases carried out. Disinfectants are supplied to the patient. A pocket spittoon is also given to each patient to enable him to dispose of his sputum with a minimum of risk to others. (4) Facilities are provided by the Council for the use of Medical Practitioners for the bacteriological examination of sputum. (5) Such other measures are taken as are at present available to secure the welfare of the patient and protect others from risk of infection. Patients being treated at home are periodically visited, a monthly return of such cases, with a report as to the progress or otherwise of the patient, being submitted to the Medical Officer of Health by each of the officers entrusted with this important duty. It will be seen, therefore, that the organisation for carrying out the provisions of the Regulations is one requiring a large amount of the time and energy of a Sanitary and Health Visitor Staff. The 122 duties of this staff are, however, of a multifarious character. In the case of the Sanitary Inspectors, in addition to their ordinary routine work of house inspection, nuisance inspection, drainage work, &c., their duties include, as well, the investigation of infectious disease, both notifiable and non-notifiable, e.g., Scarlet-fever, Diphtheria, Pulmonary Tuberculosis, Measles, Whooping-cough, &c., &c. During 1911 the number of case of Pulmonary Tuberculosis notified, and the number of domiciliary visits paid by the Sanitary Inspectors and Health Visitors in connection therewith, was as follows:— Total number of cases notified 444 Total number of domiciliary visits paid 1,380 These visits were divided amongst nine officers, and give, therefore, an average of 154 visits paid by each officer in connection with cases of Pulmonary Tuberculosis notified during the year. The Tuberculosis notifications received during 1911 were those under the two previous sets of Regulations, viz., the "Poor Law" and the " Hospitals," and Voluntary Notifications of cases in the private practice of medical men practising in the Borough. It is to be anticipated that, under the New Regulations which came into force on the 1st January, 1912, there will be a considerable increase in the number of these notifications. Support is given to this anticipation by a comparison of the figures for the first five weeks of 1911 and 1912 respectively, which are as follows :— 1911—1st seven weeks' Pulmonary Tuberculosis Notifications 67 1912— Do. do. 118 Increase 76 per cent. The New Regulations, as already stated, give power to local authorities to "supply all such medical or other assistance and all "such facilities and articles as may reasonably be required for the "detection of Pulmonary Tuberculosis, and for preventing the "spread of infection, and for removing conditions favourable to "infection, and for that purpose the Council may appoint such "additional officers and make such arrangements as may be neces" sary." It is clear from this that an extension of the work at present being carried on by the Council in connection with Pulmonary Tuberculosis is indicated. In their circular letter accompanying the Board's Order, in the paragraph headed " Powers and Duties of Councils," the Board state:—"In certain cases it is no doubt 123 desirable that the local authority should be able to offer Sanatorium treatment, and for this the powers of the Public Health Act, 1875, and the Public Health (London) Act, 1891, are available. Under these powers local authorities may either themselves provide Sanatoria or may contract for the use of such institutions." It is open, therefore, to the Council to make provision for Sanatorium treatment for inhabitants of the Borough suffering from Pulmonary Tuberculosis. Such a policy on the part of the Council would, having regard to the needs of an industrial population, such as that which comprises the majority of the inhabitants of the Borough, be of great assistance in supplementing the value of the work already being carried out by the Council. Sanatorium accommodation could be obtained at a cost from £70 to £80 per bed per annum, and the allocation of, say, half a dozen beds per annum would be of great assistance in dealing with such suitable cases as from time to time come to my knowledge. Several of the Metropolitan Boroughs have already availed themselves of the powers to provide Sanatorium accommodation suggested by the Board. It may be desirable, however, to postpone consideration of this suggestion until the arrangements as to the Sanatorium provision contained in the National Insurance Act are completed. In dealing with the arrangements for carrying out the work in connection with the Tuberculosis Regulations it will be necessary to bear in mind the personnel of the Staff of the Health Department and the nature of their duties. At the present time the staff consists as follows :— Indoor Staff. 1 Chief Clerk. 3 Third-class Clerks. 1 Second-class Clerk. 1 Office Youth. Outdoor Staff. 1 Chief Inspector. 1 Food Inspector. 1 Factory and Workshop Inspector. 8 District Inspectors. 1 Female Sanitary Inspector. 1 Health Visitor. Drain-testers, Disinfectors, &c. In February, 1911, the Female Workshop Inspector resigned her post, and the vacancy thus caused has not been filled. Since my appointment as Medical Officer of Health for the Borough in April, 1906, a great increase in the work of the Health Department has taken place owing to recent Legislative Enactments and Departmental Orders, either directly or indirectly affecting the Department. I herewith submit a list of these Enactments, &c., 124 which will enable the Committee to appreciate the extent by which the duties and responsibilities have been increased :— Education (Administrative Provisions) Act, 1907. Butter and Margarine Act, 1907. Children's Act, 1908. Housing, Town Planning, &c., Act, 1909. Notification of Births Act, 1907. L.C.C. (General Powers) Act, 1906. ,, ,, 1907. ,, ,, 1908. ,, ,, 1909. Rag Flock Act, 1911. National Insurance Act, 1911. (The two latter are not yet in force.) Orders:— Public Health (Tuberculosis) Regulations, 1909. „ (Tuberculosis in Hospitals) Regulations, 1911. „ (Tuberculosis) Regulations, 1911. Diphtheria (Anti-toxin) Order, 1911. Measles Order, 1911. Summer Diarrhoea Order, 1911. Additional diseases made notifiable under Public Health (London) Act, 1891 :— Ophthalmia Neonatorum. Cerebro Spinal Fever. Polio-myelitis. Anthrax. Hydrophobia. Glanders. Chicken-Pox (temporarily). This does not exhaust the list of additional duties, but it is sufficiently extensive to show that a very considerable increase has taken place in the work of the Health Department. On the resignation of the Female Workshop Inspector, the Medical Officer of Health reported that he was of opinion that a Female Sanitary Inspector should be appointed to fill the vacancy. The Committee decided not to do so immediately, but suggested a re-arrangement of the duties of the outdoor inspectorial staff, by which the work of the Female Workshop Inspector should be distributed among other officers, and resolved that at the end of the year a report as to the working of the new arrangement should be submitted to them. 125 I have again to advise the Committee that, in my opinion, it is absolutely necessary to fill the vacant appointment. The results of the work carried out during 1911 amply demonstrate that the advice I tendered the Committee at the time of Miss Fairbairn's resignation was justified. The duties of the female Workshop Inspector were mainly concerned with Workshop duties under the Factory and Workshop Act, but, in addition, she was able to do other work of a highly important character, e.g., enquiries into the deaths of infants, visiting and inspecting the house of verminous children, &c. The main part of her duties was handed over to the Male Workshop Inspector, who, indeed, has carried it out to the best of his ability, but it is apparent that his own work has, in consequence, suffered by comparison with his work of past years. This officer had already as much work as he could with efficiency accomplish, and, apart from the undesirability, in my opinion, of his carrying out the inspection of female workshops and outworkers' premises, duties which should always be entrusted to a woman inspector, it could not be expected that he could successfully cope with another officer's duties added to his own. The Male Workshop Inspector, in addition to his routine Factory, Workshop and Home Work inspection, has had other important duties to fulfil, viz., the inspection of dairies and milkshops, ice-cream premises, restaurant kitchens, fish-shops and other premises where food is stored or prepared for human food. In comparing the figures for 1910 with those for 1911,1 find that there has been, as was to be expected, a large decrease in the number of inspections under the Factory and Workshop Act. The figures for the years 1910 and 1911 are as follows :— Factories— Total Number on Register No. of Inspections and Re-inspections. 1910. 1911. 1910. 1911. 189 195 702 579 Workshops— 600 564 1.947 1.314 133 of the 1,314 inspections during 1911 were carried out by the Female Inspector, so that the difference is even greater than it appears. Home Work- Total Number on Register. No. of Inspections and Re-inspections. 1910. 1911. 1910. 1911. 270 241 954 610 115 of the inspections during 1911 were carried out by the Female Workshop Inspector. 126 So far as the duties of the Workshop Inspector are concerned it is sufficiently evident, from the above tabulated statement, that the re-arrangement of the work has not proved satisfactory. As regards the other duties of the Female Workshop Inspector, part has been distributed amongst the District Inspectors and part given to the Health Visitor and Female Sanitary Inspector. That the change has not reacted to the advantage of the efficient discharge of the latter officer's duties is also apparent. The Female Sanitary Inspector (Miss Moss) devotes a considerable portion of her time to Health Visitor's work, though appointed as a Female Sanitary Inspector. She supervises the milk depot work under the direction of the Medical Officer of Health. This important.duty absorbs a very large amount of her time, and, in addition to other duties, she now has to do some of the work formerly carried out by the Female Workshop Inspector. The same drawback has occurred in the case of the Health Visitor (Miss Peacock). This officer was appointed to carry out duties under the Notification of Births Act. To efficiently discharge this important duty would alone necessitate the whole of her time, but, unfortunately, it has been found necessary to entrust to her other equally important work, such as the visitation at their homes and supervision of cases notified under the Tuberculosis Regulations. She has had, in addition, to undertake part of the work formerly carried out by the Female Workshop Inspector, viz., enquiries into infantile deaths, cases of puerperal fever notified, and, more recently, the inclusion of Ophthalmia Neonatorum among the list of notifiable infectious diseases has further added to her duties. In consequence it has not been possible for her to carry out efficiently the duties for which she was originally appointed, and, having regard to the importance of this work, the fact is to be regretted. Thus, during 1911, there were registered, belonging to the Borough of Battersea, 4,381 births. Of these, 2,888 were notified under the provisions of the Notification of Births Act, 1907. The Female Sanitary Inspector and the Health Visitor between them were only able to visit 1,025, i.e., 35.4 per cent, of the notified births, and 23 per cent, of the total births registered. If the Act is to be efficiently administered the services of at least one whole-time officer are necessary. I have endeavoured to show, therefore, for the consideration of the Committee, that it is not to the interest of the public health of Battersea that any decrease in the Sanitary Staff should take place. Rather is an addition to that staff, by the appointment of one or two Health Visitors, indicated. The number of additional duties of a highly important character brought about by recent legislation, if such duties are to be efficiently discharged, will entail the keeping of the sanitary staff up to the level of modern requirements, more especially if the reputation for sanitary administration which the Borough has, especially within recent years, enjoyed is to be 127 tained. The character and status of the inhabitants of the Borough have undergone a change within the past three or four years. The extension of quick and cheap transit facilities has been largely responsible for this, and has given rise to a migration of a portion of the more respectable working-class element. There are indications that the places of the latter are being filled by a less desirable class of the population. This change will necessitate an increased energy in public health administration, as past experience has shown, and points to the fact that the time is inopportune for considering a reduction in the staff of the Health Department. (Signed) G. Quin LENNANE, Medical Officer of Health. Circulated by Order of the Health Committee. W. MARCUS WILKINS, 19th March, 1912. Town Clerk.