Metropolitan Borough of Battersea REPORT On The HEALTH On The Metropolitan Borough of Battersea, FOR THE YEAR 1922. By G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. 1 Health Committee. As constituted 9th November, 1921. As constituted 9th November, 1922. Chairman: Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor (Councillor R. C. Kiloh, j.p.) Councillor E. C. A. D. Duval. Mrs. E. H. D. Duval. Alderman Mrs. M. W. Evans. Councillor W. Geard. P. P. Haythornthwaite. J. Hendrick. Mrs. J. Hockley. T. Jones. Alderman C. W. Martin. Councillor R. Moore. J. W. O'Brien. M. J. Prior. Chairman : Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor (Alderman F. C. R. Douglas, j.p.) Councillor Miss E. Brown. „ E. W. Coles. E. C. A. D. Duval. W. R. Early. W. Geard. A. P. Godfrey. „ J. Hendrick. Alderman C. W. Martin. „ E. C. Reed. Councillor Mrs. M. H. Rose. „ A. E. Runeckles. Maternity and child Welfare Committee. As constituted 9th November, 1921. Chairman: Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor (Councillor R. C. Kiloh, j.p.) The Health Committee, as above, and the following Co-opted Members : Mrs. Orme Clarke. Mrs. F. M. Glanvill. Mrs. F. B. Payne. Mrs. M. H. Rose. Mrs. M. Varran. Mrs. F. Young. As constituted 9th November, 1922. Chairman: Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor (Alderman F. C. R. Douglas, j.p.) The Health Committee, as above, and the following Co-opted Members : Mrs. K. S. D. Baker. Mrs. F. M. Glanvill. Mrs. J. Hockley. Mrs. F. B. Payne. Mrs. M. Varran. Mrs. F. Young. Housing Committee. As constituted 9th November, 1921. Chairman: Councillor H. Harling. His Worship the Mayor (Councillor R. C. Kiloh, j.p.) Councillor J. Bruce. A. Clist. „ J. Edwards. Mrs. C. S. Ganley, j.p. W. D. Garnsey. W. Geard. Alderman C. W. Martin. „ T. Pocock. Councillor G. A. Saunders. „ E. S. Strange. H. G. White. „ C. H. Young. As constituted 9th November, 1922. Chairman: Councillor H. Harling. His Worship the Mayor (Alderman F. C. R. Douglas, j.p.) Councillor J. Bruce. „ D. Carmichael. „ W. R. Early. „ W. D. Garnsey. W. Geard. Capt. J. F. Haseldine. Alderman T. Pocock. „ Mrs. M. J. Robinson. Councillor E. S. Strange. H. G. White. C. H. Young. 2 Tuberculosis Committee. The Health Committee, as above. The Health Committee, as above. Cuberculosis Care Committee. (Reconstituted 9th November, 1922.) Chairman—Mr. J. R. Archer. Councillor Mrs. C. S. Ganley, j.p J. Hendrick. R. Moore. Mrs. M. H. Rose. Other Members: Mrs. J. Hockley. Mr. T. Jones. Miss J. Round (Health Visitor & Sanitary Insp.) Members of late Dispensary Committee: Mrs. Dermot. Mr. G. J. W. Gilder. Mr. B. R. Thorne. Members of late Voluntary Care Committee: Mrs. Causton. Miss B. Home. Miss Morris. Consultative Members : The L.C.C. District Organiser for Children's Care Committee Work. „ Representative of the War Pensions Committee. „ Representative of the Invalid Children's Aid Association. „ Lady Almoner, St. Thomas's Hospital. „ After-Care Sister, Victoria Hospital. „ Tuberculosis Almoner, St. George's Hospital. „ Lady Almoner, King's College Hospital. „ Representative of the S. L. District Nursing Association. „ Representative of the London Insurance Committee. „ Lady Almoner, Brompton Hospital. 3 Staff of Public Health Department. (At 31st December, 1922). Tuberculosis Officer—G. MACDONALD, M.A., M.B., Ch.B. Assistant Medical Officer (Maternity and Child Welfare). (Mrs.) G. SKENE, M.B., B.S., Lond. (resigned January, 1923.) Public Analyst—C. HACKMAN, F.I.C. Women Sanitary Inspectors and Health Visitors— Miss A. E. Moss, San. Insp. Board's Cert., Cert. C.M.B. Miss J. Round, H.V. Diploma, San. Insp. Board's Cert. Health Visitors— Miss C. P. Armitage, H.V. Diploma, San. Insp. Board's Diploma, Cert. C.M.B. Miss M. Carr, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss B. L. Kaye, H.V. Cert., San. Insp. Board's Cert., Cert. C.M.B. Miss N. Playne, San. Insp. Board's Cert., Cert. C.M.B. Miss O. Baggallay, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Chief Sanitary Inspector— I. Young, F.S.I.A. District Inspectors. 1. Mr. J. Herrin, Cert. San. Inst, and Meat Insp. Cert. 2. Mr. J.J. Burgess, San. Insp. Board's Cert. 3. Mr. J. Lawrence, Cert. San. Inst. and Meat Insp. Cert. 4. Mr. A. E. Purnell, Cert. San. Inst. 5. Mr. J. T. Baxter, Cert. San. Inst. 6. Mr. H. Marrable, Cert. San Inst. 8. Mr. H. H. May, Cert. San. Inst. Mr. H. E. Wheeler (Housing) San. Insp. Board's Cert., and Meat Insp. Cert. Food Inspector—Mr. A. Chuter, Cert. San. Inst., and Meat Insp. Cert. Workshops Inspector—Mr. W. E. Benjamin, Cert. San. Inst. Organising Rat Officer—Mr. H. Renham. Clerical Staff— Chief Clerk—Mr. F. E. Ward. Mr. J. W. Brown (Statistical). Mr. E. Cole. Mr. W. Halstead. Mr. H. C. Godfrey. Mr. W. F. Smith. Mr. J. R. Holloway. Mr. R. Graham. Miss G. Newton (Typist). Office youth. Miss F. M. Humphreys (temporary) Maternity and Child Welfare Records. Tuberculosis Dispensary— Tuberculosis Nurses—M. Schotburgh, B. O'Connor, C. Thompson. Secretary and Clerk—Miss L. Wadham. Dispenser—Miss E. F. Davies. Typist—Miss C. Turner. Disinfecting Station—Superintendent—C. Woodhouse. Mortuary—Keeper—W. Newman. Maternity Home— Matron—Miss C. Dickson, Cert. C.M.B. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary state of the Borough for the year 1922. It will be seen from an inspection of the vital and morbid statistics set out in the various tables in the report that the high standard of health which the Borough has enjoyed during recent years has been fully maintained. The general death-rate shows a slight increase as compared with the rates for the three preceding years. This was due to the high mortality from Influenza and Influenzal Pneumonia during the first and second quarters of 1922, a feature which also characterised the vital statistics of the metropolitan area and of England and Wales. On the other hand, it is satisfactory to note that the infant mortality rate was the lowest hitherto recorded in Battersea. Measles was very prevalent during the year, and this disease, and Whooping Cough, owing to their danger to early child life, at the request of the Council, were made compulsorily notifiable diseases in Battersea by Regulations issued by the Minister of Health. Scarlet Fever and Diphtheria, which were very prevalent during the preceding two years, showed a tendency to decline during 1922. There was a slight decrease in the number of notifications received and in the mortality from Tuberculosis recorded in Battersea during 1922. The Health Services organised by the Council under their comprehensive scheme of Maternity and Child Welfare were further developed during the year, and the summarised statistics relating to the work carried out under the scheme will be found of interest and indicative of the extent and volume of this aspect of the public health activities of the Council. In regard to Housing matters it will be noted with satisfaction that the Latchmere Extension (Housing) Scheme and the few tenements on the Savona Street site were completed by the Council's Works Department during the year, providing housing accommodation for 56 families. These, it is to be regretted, practically exhaust the available sites within the Borough at the disposal of the Council, for the bulding of working class dwellings. The repair of unfit houses was actively prosecuted during the year, and under the Housing and Public Health Acts much useful work was accomplished. I have again to express my thanks to the Chairmen of the Health and Maternity and the Housing Committees and to the members of the Council for the support extended to me. To the Chief Officers of Departments and to the Staff of the Health Department my thanks are also due for assistance loyally and ungrudgingly rendered. G. Quin LENNANE, Town Hall, Medical Officer of Health. Lavender Hill, S.W. 6 CONTENTS. Births, Marriages and Deaths. Page Vital Statistics 8, 9, 107 Acreage, Population, Private Families and Dwellings 10 Marriages 11 Births 11 Illegitimate Births 12 Deaths in Borough and in Wards 13 „ in Age Periods 14 „ in Public Institutions 14 „ Senile 14 Causes and Age Distribution 109 Comparative Table of Births, Deaths, &c. (1857-1922) 15 Infant Mortality 16,17,110-113 Notification of Births Act 19 Illegitimate Infant Deaths 18 Maternity and Child Welfare. Maternity and Child Welfare Scheme 20 Centres 20,21 Nursing Facilities 22 Health Visitors 22 Milk Order 23 Ante-Natal Work 24 Hospital Provision 21 V.D. 24, 25 Maternity Hospital 26 District Midwifery Service 29 Dental Clinic 30 Infectious Diseases.—(i.) Notifiable 32 Summary of Notifications33,108 Bacteriological Examinations 37,45 Contacts 32,43 Smallpox 32 Scarlet Fever 34 Diphtheria 34 Enteric Fever, Cerebro-Spinal Fever 35 Encephalitis Lethargica, Puerperal Fever 35 Ophthalmia Neonatorum 36 Polio-Myelitis, Erysipelas 37 Tuberculosis 37-53 Cases Notified 37,38 Localisation of Disease 38 Deaths from Tuberculosis 38-40 Dispensary 41 (Report of) 41-46 Institutional Treatment 45 Open-Air School (Day Sanatorium) 46 Care Committee 48 Non-Dispensary Patients 49-52 Tuberculosis Dental Clinic 52 Summary Table 53 Zymotic Deaths 54 (ii.) Non-Notifiable Diseases 54-57 Chicken pox Influenza 54 Diarrhoea 56 Measles, Whooping Cough 56 Cancer 57 7 Page Sanitary Circumstances. Summary Table 58 Legal Proceedings 59-62 Common Lodging Houses 62 Drainage Work 62 Revenue Act, 1903 63 Licensed Premises Urinals 63 Smoke and Effluvium Nuisances 63 Water Supply 63 Van Dwellings 64 Rag Flock Act 64 Rats and Mice Destruction Act 65 Personal Cleansing Station 66 Disinfecting Department 66 Mortuary 67 Staff 67 Protection of the Food Supply. Unsound Food 68 Butchers' Shops 68 Cow-Houses and Slaughter-Houses 68 Sale of Food and Drugs Acts 69-71 Analysts' Reports 71-80 Milk and Cream Regulations 80-82 Milk and Dairies (Amendment) Act, 1922, and Food Control Order 82-84 Ice Cream 84 Milk Shops 85 Fish Shops 85 Restaurant Kitchens 85 Street Stalls 85 Factories. Workshops, &c.—General Tables 86 Factories 87 Workshops 88 Outworkers 89, 92 Bakehouses 91 Warehouses and Wharves 91 Housing. General 93 Overcrowding 93 New Tenements and Houses erected 95-97 Repair of Unfit Houses98-100 Closing Orders 100 Underground Rooms 100 Increase of Rent, &c., Act 100 Unhealthy Areas 101 Insanitary Houses 101 Houses Let in Lodgings—By-laws 101 Statistics 104 Appendices. Table I. Summary of Vital Statistics 107 „ II. Infectious Disease Notifications 108 „ III. Causes of, and Ages at, Death 109 „ IV. Infant Mortality 110-113 8 Summary of Statistics, 1922. 1. General. Area of Borough. (Including land and inland water) acres 2,163 (Excluding water) acres 2,139.9 Population— (Census, 1921) 167,739 (Registrar-General's estimate, mid-year, 1922) 169,200 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value £1,035,723 Sum represented by a penny rate £4,269 2. Extracts from Vital Statistics of the Year. Births— (Males, 1,900; females, 1,765) 3,665 Legitimate Births 3,537 Illegitimate Births 128 Birth-rate 21.6 Deaths— (Males, 1,131; females, 1,096) 2,227 Death-rate 13.2 Number of women dying in or in consequence of childbirth:— From sepsis 3 Other causes 6 Death rate of Infants under 1 year per 1,000 69.3 births— Legitimate 65.0 Illegitimate 179-7 Deaths from Measles (all ages) 66 „ Whooping Cough (all ages) 22 „ Diarrhoea (under 2 years of age) 18 Census, 1911— Population 167,743 Number of inhabited houses 24,321 9 Births, Marriages and Deaths. VITAL STATISTICS. Population. The enumerated population of the Borough at the Census taken on the 19th June. 1921, was 167,739. In 1901 the population was found to be 168,907, and in 1911, 167,743. The Census of 1921 originally planned for the 24th April, was unavoidably postponed to the 19th June. Owing to the holiday movement having started by the latter date, the Registrar-General found it necessary to make an adjustment in the figures. So far as London was concerned, the adjustment was small, the estimate of the resident population being only 9 per 1,000 in excess of the Census figures in each of the Metropolitan Boroughs. The revised population, as estimated by the Registrar-General, for Battersea was 169,200*, showing a slight excess over the previous Census returns of 1901 and 1911. In the following table is set out the revised Census population and the estimated mid-year population in the registration subdistricts and the wards of the Borough:— Registration Sub-district. Enumerated Census Population, 1921 (Revised). Estimated mid-year Population. M. F. Total. M. F. Total. E. Battersea 33,369 36,140 69,509 33,660 36,454 70,114 N.W. „ 23,213 24,757 47,970 23,415 24,973 48,388 S:W. „ 22,076 28,184 50,260 22,268 28,430 50,698 Total 78,658 89,081 167,739 79,343 89,857 169,200 1. Nine Elms 13,287 14,022 27,309 13,403 14,144 27,547 2. Park 8,597 9,618 18,215 8,672 9,702 18,374 3. Latchmere 9,050 10,089 19,139 9,129 10,176 19,305 4. Shaftesbury 7,448 7,960 15,408 7,513 8,029 15,542 5. Church 9,060 9,437 18,497 9,139 9,519 18,658 6, Winstanley 9,964 10,651 20,615 10,050 10,745 20,795 7. St. John 3,593 4,976 8,569 3,624 5,020 8,644 8. Bolingbroke 8,487 10,492 18,979 8,561 10,583 19,144 9. Broomwood 9,172 11,836 21,008 9,252 11,939 21,191 Total 78,658 89,081 167,739 79,343 89,857 169,200 In the next table is set out particulars relating to Battersea, of the acreage, population, private families and dwellings, extracted from the Census Report for 1921:— * The various rates in this report are calculated on the estimated population. 10 ACREAGE POPULATION PRIVATE FAMILIES AND DWELLINGS. BATTERSEA MET. B. CENSUS REPORT, 1921. PART I. (TABLES). TABLE 3. Wards. Area in Statute acres (Land and Inland Water). Total Population. Private Families and Dwellings. (See definitions at foot of Table). 1911 1921. Private Families. Population in Private Families. Structurally Separate Dwellings Occupied. Rooms Occupied. Rooms per Person. Persons. Persons. Males. Females. Persons per acre. No. 1. Nine Elms 407 27,376 27,309 13,287 14,022 67 6,484 27,194 4,098 21,143 0.78 2. Park 316 17,592 18,215 8,597 9,618 58 4,619 18,194 2,896 15,993 0.88 3. Latchmere 182 20,094 19,139 9,050 10,089 105 5,093 18,916 3,190 17,029 0.90 4. Shaftesbury 140 16,031 15,408 7,448 7,960 110 4,023 15,130 2,742 14,600 0.97 5. Church 171 19,377 18,497 9,060 9,437 108 4,566 17,854 2,771 14,549 0.82 6. Winstanlev 126 20,247 20,615 9,964 10,651 164 4,850 20,545 2,889 14,981 0.73 7. St. John 117 8,216 8,569 3,593 4,976 73 1,972 7,524 1,211 8,288 1.10 8. Bolingbroke 205 18,495 18,979 8,487 10,492 93 5,641 18,851 3,349 22,543 1.20 9. Broomwood 499 20,315 21,008 9,172 11,836 42 5,740 19,962 4,045 28,197 1.41 The Borough 2,163 167,743 167,739 78,658 89,081 78 42,988 164,170 27,191 157,323 0.96 Private Family. Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i.) Institutions or (ii.) business establishments or boarding houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings. A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit; a private house which has not been structurally sub-divided is similarly a single unit whether occupied by one or by several families. But where a private house has been sub-divided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least 3 rooms, and is more than one quarter of the whole. The dwellings shown in this Table are those occupied by private families only. Rooms.—For the purpose of the Census the rooms enumerated are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office or shop rooms. 11 Marriages. The marriages registered in Battersea during 1922 numbered 1,404. The marriage.rate (i.e., the number of persons married per 1,000 of the population) was 16.6. There were 1,482 marriages and a marriage.rate of 17.5 in 1921, 1,644 marriages and a rate of 19.8 in 1920, and 1,677 marriages and a marriage.rate of 20.2 in 1919. Births. The number of births registered in the borough during 1922 was 3,577 (1,837 males, 1,740 females), an excess of 97 males. Of this number 225 were transferred out, the permanent residence of the parents being outside the Borough, and 313 births occurring elsewhere were transferred here, giving on balance a total of 3,665 births relating to Battersea residents, and a corrected birth.rate of 21.7 per 1,000 of the population. The births in the registration sub.districts of the Borough were as follows:— Sub.district. Males. Females. Total. East Battersea 861 755 1,616 North-West Battersea 612 586 1,198 South-West Battersea 427 424 851 The Borough 1,900 1,765 3,665 The following table shows comparative average birth.rates for quinquennial periods from 1877-81 to 1917-1921, and birthrates for individual years from 1917 for England and Wales, London and Battersea:— Birth.rate per 1,000 Population. Years. England & 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 1907-11 25.5 25.5 24.8 1912-16 22.9 23.5 24.4 1917-21 20.4 20.2 20.5 1917 17.8 17.9 17.7 1918 17.7 16.0 16.1 1919 18.5 18.3 18.5 1920 25.4 26.5 28.1 1921 22.4 22.3 22.1 1922 20.5 21.0 21.7 12 The following table shows the birth-rate per 1,000 of the population for each of the nine Wards of the Borough for the year 1922:— Ward. Estimated Population, 1922. Number of Births. Birthrate. No. 1, Nine Elms 27,547 673 24.4 No. 2, Park 18,374 492 26.8 No. 3, Latchmere 19,305 451 23.4 No. 4, Shaftesbury 15,542 279 18.0 No. 5, Church 18,658 389 20.8 No. 6, Winstanley 20,795 561 27.0 No. 7, St. John 8,644 163 18.9 No. 8, Bolingbroke 19,144 361 18.9 No. 9, Broomwood 21,191 296 14.0 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1922, and during the previous decennium 1912-1921:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1912 25.4 28.4 28.9 17.6 1913 25.3 27.0 29.6 18.5 1914 25.7 27.9 30.9 17.2 1915 23.6 26.2 26.8 16.7 1916 21.8 23.0 25.0 16.8 1917 17.7 19.0 19.8 13.8 1918 16.1 17.7 17.8 12.0 1919 18.5 19.3 20.8 15.1 1920 28.1 29.8 32.0 21.8 1921 22.1 23.8 26.6 15.5 Average 1912-1921 22.4 24.2 25.8 16.5 1922 21.7 23.0 24.8 16.8 Illegitimate Births. Of the total births registered in the Borough as belonging to Battersea 128 were of illegitimate children (i.e., 3.49 per cent), as compared with 131 or 3.50 per cent. in 1920. 13 Deaths. The number of deaths registered in the Borough during 1922 was 2,679. Of these 864 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were, on the other hand, 412 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths of persons belonging to the Borough was 2,227 (males 1,131, females 1,096). This gives a recorded death-rate of 13.2 as compared with 13.4 for London and 12.9 for England and Wales. The following table shows the death-rates per 1,000 of the population for the Borough and the registration sub-districts for the ten years 1912-1921 and the year 1922 respectively :— Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1912 12.2 12.8 13.5 10.1 1913 14.1 15.0 16.3 10.8 1914 13.2 14.0 14.4 10.9 1915 16.4 16.2 18.8 14.2 1916 13.9 14.5 14.7 12.4 1917 15.2 15.4 16.3 14.0 1918 18.7 19.2 20.2 16.6 1919 12.9 12.4 12.7 13.7 1920 12.5 12.8 12.4 12.3 1921 12.2 12.3 12.7 11.5 Average 1912-21 14.1 14.5 15.2 12.6 1922 13.2 13.1 13.8 12.6 The death-rate per 1,000 inhabitants for each of the nine Wards is shown in the next table:— Ward. Estimated Population 1922. Number of Deaths. Deathrate. No. 1, Nine Elms 27,547 370 13.4 No. 2, Park 18,374 254 13.8 No. 3, Latchmere 19,305 286 14.8 No. 4, Shaftesbury 15,542 164 10.6 No. 5, Church 18,658 240 12.9 No. 6, Winstanley 20,795 299 14.4 No. 7, St. John 8,644 105 12.1 No. 8, Bolingbroke 19,144 237 12.4 No. 9, Broomwood 21,191 272 12.6 14 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1922:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65- Total. M 131 110 26 16 41 111 330 366 1,131 F 123 82 28 24 58 125 225 431 1,096 Ttls. 254 192 54 40 99 236 555 797 2,227 The corrected number of deaths of males and females registered in each quarter of the year is set out as follows:— Males. Females. Total. First quarter 382 398 780 Second quarter 274 271 545 Third quarter 191 182 373 Fourth quarter 284 245 529 Deaths in Public Institutions. During 1922 the deaths of Battersea residents occurring in Public Institutions numbered 1,012. Of this number 664 occurred within and 348 outside the Borough. Of the total deaths in Public Institutions 646 occurred in Poor Law Institutions. Senile Mortality. During 1922 the deaths of 797 persons (aged 65 years and upwards) were registered in the Borough of Battersea. The 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 162 123 21 306 North-West Battersea 100 75 21 196 South-West Battersea 137 123 35 295 Borough of Battersea 399 321 77 797 15 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 36.4 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 291 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.8 669 22.1 129 471 1865 33,688 1,357 40.3 785 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 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41 .8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37 0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 5,237 34.7 2,697 17.9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16.1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2,303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31.7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901 169,100 5,025 29.7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 375 2,282 1906 179,622 4,654 25.9 2,384 13.2 338 2,270 1907 181,736 4,574 25.1 2,406 13.2 255 2,168 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 2,033 1910 188,222 4,489 23.7 2,124 11.3 242 2,365 1911 167,765 4,381 26.1 2,404 14.3 336 1,977 1912 167,589 4,255 25.4 2,052 12.2 138 2,203 1913 167,464 4,240 25.3 2,365 14.1 208 1,875 1914 167,338 4,303 25.7 2,217 13.2 142 2,086 1915 161,945 3,820 23.6 2,653 16.4 334 1,167 1916 B* 173,432 3,774 21.8 — — — — D*159,402 — — 2,221 13.9 160 1,553 1917 B*167,233 2,960 17.7 — — — — D*150,023 — — 2,285 15.2 185 675 1918 B* 168,014 2,700 16.1 — — — — D#149,951 — — 2,809 18.7 204 -109† 1919 B* 165,960 3,075 18.5 — — — — D*159,316 — — 2,061 12.9 95 1,014 1920 B* 166,093 4,669 28.1 — D*165,664 - — 2,079 12.5 188 2,590 1921 169,200 3,742 22.1 2,060 12.2 173 1,682 1922 169,200 3,665 21.1 2,227 13.2 192 1,438 * Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. † Decrease. The years marked were census years, 16 Infant Mortality. During 1922 the deaths of 254 infants were registered as belonging to Battersea. The total number of births registered during the year was 3,665, giving an infant mortality-rate of 69.3. This is the lowest infant death-rate yet recorded in Battersea. The infant mortality-rates in Battersea and in London for the years which have elapsed since the formation of the Borough, as well as for the previous decennium, are set out in the following table:— Year. London. Battersea. 1891-1900 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 1901-10 126 126 1911 129 124 1912 91 83 1913 105 111 1914 104 92 1915 112 112 1916 89 84 1917 104 101 1918 107 99 1919 85 74 1920 75 83 1911-20 100 96 1921 79.6 73.8 1922 74.4 69.3 The infant mortality-rate for the County of London for the year 1922 was 74.4 per 1,000 births. The distribution of the 254 infant deaths and the infant mortality-rates, both for the registration sub-districts and for the Wards, are shown in the following table:— CHART showing the Infant Mortality Rate (per 1,000 Registered Births) in Battersea during the last 20 years. Infant mortality rate per 1,000 births. 1891-1900—London, 158; Battersea, 162. 17 Registration Sub-Districts. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. m. f. total. East Battersea 1,616 54 58 112 69.3 North-West Battersea 1,198 60 40 100 83.5 South-West Battersea 851 17 25 42 49.4 The Borough 3,665 131 123 254 69.3 Ward. 1. Nine Elms 673 25 21 46 68.4 2. Park 492 17 24 41 83.3 3. Latchmere 451 15 19 34 75.4 4. Shaftesbury 279 9 10 19 68.1 5. Church 389 27 12 39 100.3 6. Winstanley 561 23 14 37 66.0 7. St. John 163 5 6 11 67.5 8. Bolingbroke 361 6 10 16 44.3 9. Broomwood 296 4 7 11 37.2 The next table shows the incidence of mortality from the chief diseases of infancy in the first and second trimesters and during the ages 6 to 12 months:— Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Scarlet Fever - - - - - - Diphtheria — — — 1 1 .39 Erysipelas 1 — — — 1 .39 Measles — 2 2 9 13 51.2 Influenza 4 2 2 — 8 3.15 Meningococcal Meningitis - - - - - - Whooping Cough 1 2 1 2 6 2.36 Diarrhoea and Enteritis 3 9 2 1 15 5.91 Miliary Tuberculosis — — — — — — Tuberculous Meningitis — 2 1 3 6 2.36 Abdominal Tuberculosis — Pneumonia 9 5 12 9 35 13.78 Bronchitis 11 5 6 2 24 9.45 Other Respiratory Diseases 1 — — 1 2 .79 Sarcoma — — 1 1 2 .79 Prematurity 62 — — — 62 24.41 Marasmus 9 4 1 — 14 5.51 Icterus Neonatorum 3 — — — 3 1.18 Congenital Malformations 12 2 — — 14 5.51 Injury at Birth 5 — — — 5 1.97 Suffocation (overlying) 1 — — — 1 .39 Convulsions 6 — 1 — 7 2.76 Atelectasis & Asphyxia N. 13 — — — 13 5.12 Miscellaneous 11 5 2 4 22 8.66 Total 152 38 31 33 254 100.00 % of Total 59.8 15.0 12.2 13.0 100.00 — 18 It will be seen from an examination of the above table that on grouping the principal diseases of infancy, the percentage ratios of these groups are as follows: Developmental Diseases (Prematurity, &c.). 38.6; Respiratory Diseases, 24.0; Infectious Diseases (including Diarrhoea and Enteritis), 17.3; Atelectasis, Convulsions and overlying, 8.3 per cent.; Tuberculous Meningitis, 2.4; and other miscellaneous causes (including 2 deaths from Sarcoma), 9.4. Illegitimate Infant Deaths. The death-rate amongst illegitimate children during 1922 was 179.7 per 1,000 births, as compared with 183.2 in 1921. The corresponding death-rate of legitimate infants in 1922 was 65.0, the ratio of the mortality-rate of illegitimate infants to that of legitimate being 2.76 to 1. The following table shows (a) the legitimate and illegitimate births and deaths, (b) the ratio of illegitimate to legitimate births, (c) the deaths per 1,000 legitimate and illegitimate infant births respectively, and (d) the ratio of the illegitimate infant mortality rate to that of legitimate infants during the past 5 years:— Year. Births. Ratio of Illeg. to Legit. Births. Deaths. (Infants under 1 year.) Deaths per 1,000 Births. Ratio of Illeg. I.M.R. to Legit. I.M.R. Legit. Illeg. Legit. Illeg. Legit. Illeg. 1918 2,529 171 .068 226 41 89.4 239.8 2.68 1919 2,916 159 .055 204 24 70.0 150.9 2.16 1920 4,509 160 .035 358 28 79.4 175.0 2.20 1921 3,611 131 .036 252 24 69.8 183.2 2.62 1922 3,537 128 .036 231 23 65.0 179.7 2.76 Average 19181922 3,420 150 .044 254 28 74.3 186.7 2.51 The table shows that the ratio of births registered as illegitimate to legitimate births registered has remained almost stationary during the past three years, although it is still lower than the average for the past 5 years. On the other hand the ratio of the illegitimate infant mortality rate to that of legitimate infants has risen slightly in the past 3 years, and in 1922 was 10 per cent. higher than the average ratio for the 5 years. It would therefore seem that the reduction in the rate of infant mortality has been confined, so far as the past few years are concerned, entirely to legitimate infants. 19 Notification of Births Act. During 1922, the number of notifications of live births received was 3,548. The corrected number of registered births belonging to Battersea was 3,665. The proportion of notified to registered births was therefore 96.8 per cent. as compared with 95.3 per cent. in 1921. There were 630 (or 17.4 per cent.) of the notifications, including still-births, made by medical practitioners, 1,899 (or 52.3 per cent.) by midwives, and 1,102 (or 30.3 per cent.) by other persons. The number of still-births notified during the year was 83, (or 2.3 per cent.) of the corrected total births registered. In 1921, the number of still-births notified was 88 (or 2.4 per cent.) of the total births. The notified births are visited by the Council's Official Health Visitors and by the Health Visitors of the Voluntary Organisations linked up with the Council's Comprehensive Maternity and Child Welfare Scheme. Records are kept on a card-index, setting forth the particulars of all notified births visited. Advice is given as to the care and management of the infants, and special efforts are directed towards the encouragement of breast-feeding. The mothers are also invited to bring their babies to the various Maternity and Child Welfare Centres in the Borough, and a very considerable proportion of the mothers readily avail themselves of the opportunities afforded them of keeping their infants under continuous supervision by the Medical Officers and trained Health Visitors. Weights are periodically recorded and any ailments noted are attended to by the doctor or referred to hospital for such treatment as may be required. Returns of all births registered in Battersea are received weekly from the District Registrars, and these returns serve to check the notified births returns. A weekly return of all births notified in the Borough is submitted by the London County Council in accordance with the requirements of Sec. 5, Sub-section (2) of the Notification of Births Act. Particulars relating to transferable births registered are supplied by the Registrar-General for the purpose of adjusting and correcting the birth statistics of the Borough in the periodical and Annual Reports of the Medical Officer of Health. Maternity and Child Welfare. The Maternity and Child Welfare Scheme, the revision and development of which, under the provisions of the Maternity and Child Welfare Act, 1918, was begun early in 1919, continued to make progress during the year. Much useful work was done, especially in connection with the Ante-Natal side of the scheme, the Maternity Home and District Midwifery Service, Dental Clinic, 20 Nursing Service, provision of Milk for Mothers and Children, &c., &c., full details of which will be found summarised in this chapter of the Annual Report. Maternity and Child Welfare Centres. For administrative purposes the Borough is divided into six areas and in each there is a Maternity and Child Welfare Centre (with an attached Clinic), either Municipal or Voluntary. They are situate as follows:— 1. Municipal. (a) Latchmere Baths (Burns Road). (b) All Saints Parish Hall (Prince of Wales Road). (c) Plough Road Institution. (d) Dental Centre and Clinic (Plough Road Institution). 2. Voluntary. (a) Battersea School for Mothers (55 Mundella Road). (b) Women's League of Service (111 Bridge Road West). (c) Chislehurst Mission (St. James' Hall, Ponton Road, Nine Elms). In addition to the above, ancillary activities included in the Scheme are: (l) St. Mary's Hostel (for unmarried mothers and their children, Macaulay Road, Clapham Common, and (2) St. Margaret's Day Creche and resident Hostel, 10 and 12 Cambridge Road, both of which are under Voluntary control, but Jinked up with the Maternity and Child Welfare Scheme and in receipt of an annual grant from the Council. Each of these Centres is under the superintendence of a trained Health Visitor, and to each Centre is attached a Clinic at which a Woman Medical Officer is in attendance. The Voluntary Centres are managed on similar lines to those of the Municipal Centres. An area is mapped out for each centre in which it is responsible for home visiting and other incidental welfare work. The work carried out at the various Municipal Infant Welfare Centres during 1922, is summarised as follows:— Summarised Statistics relating to Municipal Infant Centres, 1921-1922. Latchmere Centre. 1921. 1922. Sessions held 151 151 Attendances 14,312 12,178 First attendances 1,373 1,812 Average daily 94.1 80.6 Average weekly 275.2 234.1 Doctor's attendances 101 101 Babies seen by Doctor 1,832 2,711 Average daily do. do. 18.1 26.8 Weights recorded 13,769 11,062 Advice only 543 1,116 BOROUGH MATERNITY HOSPITAL. 21 Plough Road Centre. 1921. 1922. Sessions held 100 101 Attendances 4,076 4,704 First attendances 442 769 Average daily 40.7 46.5 Average weekly 79.8 90.4 Doctor's attendances 48 51 Babies seen by Doctor 1,040 1,204 Average daily do. do. 21.6 23.6 Weights recorded 3,734 4,226 Advice only 342 478 East Battersea Centre. Sessions held 103 103 Attendances 3,525 4,029 First attendances 314 549 Average daily 34.2 39.1 Average weekly 67.7 77.4 Doctor's attendances 51 48 Babies seen by Doctor 964 1,016 Average daily do. do. 18.2 21.1 Weights recorded 3,338 3,912 Advice only 187 117 Hospital Provision. Apart from the special provision for Maternity at the Borough Maternity Hospital and the District Midwifery Service, the Council contributes an annual sum to the funds of the Victoria Children's Hospital, Tite Street, Chelsea, and in return the hospital authorities have afforded facilities for the treatment of children referred from the various Maternity and Child Welfare Clinics. These facilities are, as the work at the Clinics grows, becoming year by year increasingly availed of. The value of this excellent Institution to the Council's scheme has been fully described in previous Annual Reports and the Medical Officers of the Welfare Clinics continue to make full use of the advantages its proximity offers to their little patients. Number of cases referred to hospital from the Municipal clinics:— St. Thomas's Hospital 50 Victoria Hospital for Children 197 South London Hospital for Women 10 St. James's Hospital (Balham) 1 Bolingbroke Hospital 7 Great Ormond Street Hospital 1 Belgrave Hospital (Stockwell) 1 Mothercraft Training Centre (Trebovir Road, Earls Court) 2 Borough Council T.B. Dispensary 18 Total 287 22 Nursing Facilities. In connection with the Council's Scheme, by arrangement with the South London District Nursing Association, free skilled Nursing attendance in their own homes is available for inhabitants of the Borough. Very valuable results have accrued from this useful provision, and especially during the prevalence of epidemic disease, e.g., acute infective diarrhœa, measles, whooping-cough and other dangerous diseases of child life, the Nursing service is a most necessary Public Health measure. During 1922, the total number of attendances made by the Nurses were as follows:— Nursing Service, 1922. Age. Under 5 years. Over 5 years. Total. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 112 2,743 - - 112 2,743 Measles 94 1,091 17 165 111 1,256 Whooping Cough 10 125 1 12 11 137 Diarrhoea & Vomiting 9 65 — — 9 65 Chicken Pox 1 15 1 16 2 31 Puerperal Fever - - 1 23 1 23 Pneumonia 161 2,033 99 1,457 260 3,490 Influenza 10 97 68 805 78 902 Other Diseases — — 3 64 3 64 Totals 397 6,169 190 2,542 587 8,711 The cost of the Nursing Service, particulars of which are set out in the above table, was £290 7s. 4d. Health Visitors. The work carried out during 1922 by the Council's Health Visiting Staff, and by the Health Visitors of the voluntary organisations included in the Borough Maternity and Child Welfare scheme, will be found summarised below:— 23 Health Visitors. First Visits. Re-Visits. Total. Grand Total. C'cil. Vol'y. C'cil. Vol'y. C'cil. Vol'y. 1922. 1921. Visits to Expectant Mothers 744 113 619 184 1,363 297 1,660 2,151 Visits to Notified Births 2,397 425 3,628 1,235 6,025 1,660 7,685 8,838 Visits to Still Births 29 — 4 — 33 — 33 22 Visits to Children aged 1-5 years 212 5 730 1,112 942 1,117 2,059 1,876 Visits to enquire into Infant Deaths 136 27 38 3 174 30 204 321 Visits to cases of Notifiable Infectious Disease 3,433 555 2,178 157 5,611 712 6,323 2,266 Visits to cases of Non-Notifiable Infectious Disease 412 111 248 18 660 129 789 2,209 Visits re Summer Diarrhœa 1,847 652 - - 1,847 652 2,499 1,964 Visits to Dental Cases 276 - - - 276 - 276 282 Visits to V.D. Cases 145 — — — 145 — 145 31 Other Visits 949 83 — — 949 83 1,032 760 Totals 10,580 1,971 7,445 2,709 18,025 4,680 22,705 20,720 Milk Order. During 1922, Milk, both fresh and dried, was supplied by the Council free or at reduced rates to Necessitous Expectant and Nursing Mothers and Children under 5 years of age. The followingtable gives particulars relating to the number of persons supplied, quantities distributed and cost after deducting payments made Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons Supplied. lbs. .Supplied. Persons Supplied. Pints Supplied. 1920 1,473 15,588 233 31,894 £ 3,330 1921 2,391 49,020 301 27,254½ 5,011 1922 2,469 61,511 260 23,879 5,279* The value of this public health service, which ranks for contribution from the Ministry of Health as part of the Maternity and Child Welfare Scheme, has been referred to in previous annual *During the financial year ending 31st March, 1923, the net cost of this service had been reduced to £4,746. 24 reports. It is only necessary to state therefore that it continues in my opinion to exercise a marked effect on the health and welfare of the working-class mother and child, where the financial state of the family makes it impossible to provide an adequate supply of this indispensable article of food. Ante-Natal Work. Very considerable progress was made in the development of the Ante-Natal part of the Council's Maternity and Child Welfare Scheme during the year, and an additional Ante-Natal Clinic was opened at the East Battersea Welfare Centre (All Saints' Parish Hall). There are now four clinics established, viz.: at the Borough Maternity Hospital, Bolingbroke Grove, the Latchmere Centre, the Plough Road Centre and the All Saints' Hall Centre. The popularity of these Clinics is shown by the great increase in the attendances and it is only necessary to glance at the summarised results of the year's work carried out at these Clinics to appreciate the value of the results obtained. In addition to being centres for the diagnosis of conditions which may seriously threaten the health of the expectant and nursing mother, they are valuable educational centres for the mothers as well as for the nidwives practising in the Borough (many of whom make use of them), and for the pupilmidwives undergoing their training at the Borough Maternity Hospital. The clinic at the Maternity Hospital is specially equipped for the examination of cases requiring more detailed examination, and such cases are sent on from the other clinics for this purpose. The total number of patients attending the ante-natal clinics during 1922 was:— Central Clinic (Borough Maternity Hospital) 321 Latchmere Clinic 279 Plough Road Clinic 196 All Saints' Hall Clinic (one session only held, 13th December) 7 Ante-Natal (V.D.) Clinic. This interesting and useful feature of the Council's Maternity and Child Welfare Scheme was added late in 1920, and during 1921 good progress was shown, the results of which were set out in the Annual Report for that year. During 1922, the development of the work was continued and the summarised returns set out below indicate that satisfactory results are being obtained. Provision is made both for in-patient and out-patient treatment. For inpatients a few beds have been set apart in one of the Wards in the Administrative block of the hospital. The out-patient clinic is fully equipped with all requisites and appliances necessary for the diagnosis and treatment of cases sent in from the Maternity and Child Welfare Clinics and by the medical practitioners and midwives. The clinic is under the direction of a Consultant, Dr. A. C. Roxburgh, and is held weekly from 3 to 5 p.m. 25 The following is a summary of the work carried out during 1922:— Battersea Borough Council Special Treatment Centre. 1. Tests carried out by Dr. Mackenzie Wallis (Pathologist). Wass. Neg. Pos. Gon. C.F.T. Neg. Pos. Dreyer Sigma Test. Neg. Pos. In-Patients. Maternity Home: Mothers 196 188 8 165 90 75 10 10 - Babies 3 3 — — — — — — — Out-Patients. Clinic Cases: Mothers 107 98 9 102 70 32 5 4 1 Babies 7 7 - - - - - - - Eye-slides examined. 10 (all cases babies)—Negative, 9; Positive, 1. 2. Pathological tests carried out at the Clinics. (a) Slides from eye discharge. Examined:— No evidence V.D. 27 Gonococcus found 2 Total 29 slides. (b) Slides: Urethra 102 Cervix 107 Total 209 slides. (c) Cultures:— Urethra 100 Cervix 102 Tonsil 1 Total 230 cultures. (Note.—Gonococcus found in 3 cases—3 times in 1 case examined.) 3. Notified Ophthalmia Neonatorum cases seen by Medical Officers. Mothers examined 16 Babies examined 18 of which there were:— In-patients 18 Out-patients 16 Total cases seen in connection with Ophthalmia Neonatorum 34 4. Total number of cases seen at the Clinic in the time, January 1st to December 31st, 1922, inclusive 184 cases. Total number discharged by Medical Officers, no evidence of V.D. after examination 131 „ Ceased to attend without permission 9 Discharged pro tem. by Medical Officers 9 „ Cases transferred by Medical Officers 10 26 5. Sources from which patients were referred to the Clinic : (a) Borough Council Maternity Home 46 cases. (b) Municipal and Voluntary Clinics 83 (c) Practising Midwives 4 „ (d) Medical Men 4 „ (e) Health Visitors 40 (f) Rescue Home 6 „ (g) Patients who come themselves 1 „ Total number of cases registered from the opening of the Clinic, October, 1921 to December 31st, 1922 198 6. Medical Officers in Charge. Nurse, Dr. Roxburgh, Consultant. Miss Baggallay. Assistant Medical Officer (Maternity & Child Welfare). Dr. Roxburgh, Consultant to the Ante-Natal (V.D.) Clinic, reports favourably on the progress so far made in this pioneer effort by the Council, which he states is already distinctly encouraging. In pointing out some of the difficulties associated with the work, Dr. Roxburgh refers more especially to the need for a blood test from every patient who comes for the first time to one of the Antenatal clinics. The majority of the women with syphilis, he adds, show no outward and visible sign of the disease during the first few months after infection. Apart from blood tests the disease only shows itself, in many cases, in the children; and even they may show no obvious signs until they are from 7 to 12 years old or even later. During 1922, for example, of 8 patients with syphilis who were treated at the clinic, 7 were post-natal, as the disease was only discovered at the birth of the child, and one patient was treated during her pregnancy with the result that a healthy baby was born. The further progress of this useful work will be watched with much interest, and now that some of the initial difficulties have been overcome the results should be of the highest value. Borough Maternity Hospital. The Borough Maternity Hospital, opened early in 1921. is a fully-equipped modern hospital of 30 beds, and is situated at Bolingbroke Grove, overlooking Wandsworth Common, one of the healthiest parts of London. In addition to being a lying-in hospital, it is a recognised training institution for pupil-midwives. There is a district midwifery service run in connection with the hospital, and there is an out-patient department used for the Central Ante-Natal and Special Clinics. There is a rota of local medical practitioners who are available for attendance if called upon by the Matron in cases requiring medical aid. The services of Dr. J. S. Fairbairn, Obstetric Physician, BOROUGH MATERNITY HOSPITAL.—A WARD. 27 St. Thomas's Hospital (or his deputy, Dr. Richardson), are also available as consulting physician in cases of grave emergency at the request of the medical practitioner on the rota list. The staff of the hospital consists of a Matron, 1 Sister, and 4 Staff Nurses. There are also pupil-midwives, there being accommodation for 12 pupils at a time. The popularity of the hospital is shown by the great increase in the number of cases admitted during the year 1922, particulars of which are set out as follows:— Total number of cases admitted 371 Average duration of stay 14 days. Number of cases delivered by— (a) Midwives (nursing staff) 340 (b) Doctors (on rota) 25 Of the above 371 cases, 6 patients were admitted for ante-natal treatment only. (2 cases admitted for ante-natal treatment only, and then transferred to the District Midwifery Service.) (3 cases admitted for ante-natal treatment prior to readmission at a later date for confinement.) (1 case admitted for ante-natal treatment and subsequently admitted to St. Thomas's Hospital for confinement.) Number of cases in which medical aid was sought by the midwife, with reasons for requiring assistance— (a) Ante-natal 3 (1) for observation, (2) albuminuria, (3) vaginal discharge. (b) During labour 24 (1) foetal distress, (2) transverse presentation, (3) contracted pelvis, (4) persistent occipito posterior, (5) secondary uterine inertia, (6) presentation of cord, (7) foetal distress, (8) complicated breech, (9) complicated breech, (10) complicated breech, (11) uterine inertia, (12) post-partum haemorrhage, (13) delayed labour, (15) retained placenta, (16) uterine inertia, (17) delayed labour, (18) foetal distress, (19) albuminuria, (20) accidental a.p.h., (21) delayed labour, (2^) complicated breech, (23) adherent placenta, (24) adherent placenta. (c) After labour 12 (1) puerperal insanity, (2) abscess of breast, (3) laceration of vaginal wall, rise of T. & p., (4) abscess of vagina, rise of T. & p., (5) white 28 leg, (6) flushed breast, (7) collapse after labour, (8) pain in chest, (9) varicose vein, (10) post-partum hæmorrhage after 3rd stage, (11) pleurisy, (12) influenza. (d) For infant 13 (1) asphyxia neonatorum, (2) dangerous feebleness, (3) septic gland in groin, (4) icterus, (5) prematurity, (6) illness of baby, (7) convulsions, (8) illness of baby, (9) ophthalmia, (10) ophthalmia, (12) ophthalmia, (13) ophthalmia. Number of cases notified as puerperal sepsis, with result of treatment in each case 3 (1) abscess of vagina (2) white leg (3) pleurisy Transferred to Fever Hospitals, subsequently discharged cured. Number of cases in which temperature rose above 100.4 with rise of pulse 8 Number of cases notified as ophthalmia neonatorum, with result of treatment in each case 5 (1) cured before leaving the Hospital, (2) attended St. Thomas's Hospital, subsequently discharged cured, (3)attended St. Thomas's Hospital, subsequently discharged cured, (4) cured before leaving the Hospital, (5) cured before leaving the Hospital. Number of foetal deaths (stillborn or within 10 days of births) and their causes, and the results of the postmortem examination, if obtainable 11 (1) fœtal distress in 1st stage of labour, (2) accidental ante-partum hæmorrhage, (3) prematurity, (4) macerated fœtus, (5) prolapse of cord, (6) prematurity, (7) asphyxia neonatorum, (8) icterus—post-mortem nothing definite found, (9) prematurity, (10) convulsions, (11) convulsions. Number of infants with discharge from the eyes however slight 15 Number of patients visited by consultant at the Hospital 4 (1) transverse presentation, (2) contracted pelvis—Caesarean section performed, (3) albuminuria, (4) contracted pelvis. Number of infants not entirely breast fed none Number of maternal deaths none By the courtesy of the Borough Treasurer, I have been favoured with the following statement of the expenditure upon the Borough Maternity Home during the financial year ended 31st March 1923 29 Maternity Hospital, 1922-1923. Total beds, 30; average stay, 2 weeks; total cases, 394; percentage of beds occupied, 50 per cent. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 285 0 7 3 Nursing 510 0 12 11 Domestic and other 505 0 12 10 Provisions 784 0 19 11 Drugs and other Medical Requisites 254 0 6 5 Heating, Lighting and Cleaning 475 0 12 1 Laundry 370 0 9 5 Repairs and Renewals Domestic 159 0 4 0 Structural 164 0 4 2 Rent, Rates, Taxes and Insurance 181 0 4 7 Loan Charges 1,500 1 18 1 Miscellaneous 193 0 4 11 Gross cost £5,380 £6 16 7 Income Pupil Midwives 373 0 9 6 Inmates' Payments 1,572 1 19 11 Other 6 0 0 2 Net cost £3,429 £4 7 0 District Midwifery Service. The District Midwifery Service, for the attendance of Maternity cases at their own homes, was inaugurated at the close of 1921. During 1922, progress continued. The service is directed from the Borough Maternity Hospital, and through the courtesy of the Finance Committee, accommodation has been provided for the District Midwife and her pupil in the Town Hall, a very central situation, so that she may be more readily accessible to those needing her services. The Midwife's rooms are connected to the Maternity Hospital by telephone and patients requiring her services can telephone from Police Stations at night. This service is making steady progress and particulars relating thereto are set out below:— Total number of cases attended on the district 93 Number of cases delivered by— (a) Midwife 84 (b) Doctors 9 30 Number of cases where medical assistance was called for, with reasons for requiring assistance— (a) During labour 9 (1) Prolonged 2nd stage, (2) Hydramnios— no presentation found, (3) delayed labour, (4) transverse presentation, (5) retained placenta, (6) prolonged 2nd stage, (7) delayed labour—foetal distress, (8) delayed labour— slightly contracted pelvis, (9) uterine inertia. (b) After labour 4 (1) Ruptured perineum, (2) thrombosis of leg (16th day), (3) ruptured perineum, (4) pain in chest. (c) For infant 6 (1) Icterus, (2) feebleness of infant, (3) ophthalmia neonatorum, (4) circumcision, (5) slight discharge from eyes, (6) slight discharge from eyes. Number of cases notified as ophthalmia neonatorum, with result of treatment 1 Attended St. Thomas's Hospital, subsequently discharged cured. Number of infants with discharge from the eyes, however slight 2 Number of maternal deaths none Number of infants' deaths within 10 days 1 Icterus—post-mortem nothing definite found. Number of still births 1 Cord twisted round clenched hands. Dental Clinic. The Dental Clinic in connection with the Council's Maternity and Child Welfare Scheme was opened in August, 1920. The attendances at the Clinic have increased to an extent which suggests that the provision of an extra session will soon have to be seriously considered if the efficiency of the work is to be maintained. During 1922, the results of the work carried out are summarised as follows:— Dental Clinic, Plough Road, Battersea. Yearly Report for Year Ended 31st December, 1922. Number of sessions held (24 morning, 50 afternoon) 74 Total number of patients (women 215, children 25) 240 Total attendances (women 756, children 47) 803 31 Work carried out:— Ordinary extractions 48 Local anaesthetic extractions 234 Gas extractions 276 Scaling 16 Fillings (simple) 42 Dentures supplied (full sets) 21 Dentures supplied (upper only) 4 Dentures supplied (lower only) 8 Dentures repaired 16 Dentures remodelled 2 Dressings 12 Dentures eased 50 Impressions 66 Bites 20 Try-in 42 Paintings and applications 15 Shade of teeth 1 Fittings 4 Syringing 1 Suction disc supplied 1 Fixed in suction plate 1 Prescriptions 4 Examinations 1 Syringe socket 1 Plaster cast taken 1 Necrosed bone removed with L.A. 1 Advice 204 Letters given re Hospital Sunday Fund 9 (Note.—The first morning session was held on the 19th July, 1922.) 32 Notifiable Infectious Diseases. During 1922, under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 2,060 cases of infectious diseases (excluding Tuberculosis) were notified, including cerebro-spinal fever 1, acute poliomyelitis 4, encephalitis lethargica 2. There were also 1,781 cases notified under the Battersea (Measles and Whooping Cough) Regulations, 1922, viz., 1,496 cases of Measles and 285 Whooping Cough (vide page 56). The distribution of the cases notified in the Wards and the Sub-Districts is shown in the table on the next page. The 2,060 cases occurred in 1,793 infected houses. Of these cases, 1,550 (i.e. 75.2 per cent.) were removed to hospital and 510 (i.e., 24.8 per cent.) remained under treatment at home. Full particulars of all notifiable infectious diseases will be found in the form required by the Ministry of Health in Table II. in the Appendix. Infectious Disease Contacts. Many cases of "contacts," which were reported to the Medical Officer of Health were kept under observation in connection with various diseases, as follows:— Small-pox Plague Dysentery Malaria Cerebro-spinal fever Enteric fever. The above include civil as well as military cases. Small-pox. No case of Small-pox was notified in Battersea during 1922. Information was received of 7 persons residing or coming to reside in the Borough, who had been in contact with cases of Small-pox in London or the provinces or on infected ships or had travelled in ships from infected ports. All such cases were kept under observation. During 1922, there was a small outbreak of Small-pox in London. 70 cases being notified within the County. The majority of the cases occurred in Poplar, 51 cases. Other Boroughs in which cases occurred were Stepney 5, Fulham 2, Bermondsey 2, Shoreditch 2, Southwark 2, Finsbury 1, St. Pancras 1, Bethnal Green 1, Holborn 1, Lambeth 1, Deptford 1. 33 Notifications of Infectious Diseases, 1922, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. s. 1 2 3 4 5 6 7 8 9 E N S Small-pox - - - - - - - - - - - - - Diphtheria and Membranous Croup 93 99 117 88 85 75 20 44 49 313 223 134 670 Erysipelas 6 7 3 4 15 15 5 7 4 18 31 17 66 Scarlet Fever 119 52 67 100 107 122 21 82 80 283 270 197 750 Enteric (Typhoid) Fever 1 1 - - 1 — 1 — — 2 1 1 4 Ophthalmia Neonatorum 8 3 10 2 3 9 2 3 1 19 16 6 41 Puerperal Fever 1 1 1 - 1 4 1 2 2 2 6 5 13 Polio-mvelitis - 1 - - 1 1 - 1 — 1 2 1 4 Encephalitis Lethargica - - - 1 - - - - 1 1 - 1 2 Posterior Basic Meningitis - - - - 1 - - - - - 1 - 1 Malaria 2 2 - - - - - - 1 4 — 1 5 Dysentery — — — — — — — — — — — - — Acute Primarv Pneumonia 74 60 48 14 37 49 11 12 3 162 120 26 308 Acute Influenzal Pneumonia 24 24 22 11 16 62 16 14 7 68 89 39 196 Whooping Cough* 52 40 37 23 24 68 6 24 11 118 119 48 285 Measles* 192 260 234 143 206 228 44 139 50 689 550 252 1,496 Totals 572 550 539 386 497 633 127 328 209 1,680 1,433 728 3,841 *Notifiable in Battersea from April 24th, 1922. 34 Scarlet Fever. Scarlet fever was much less prevalent during 1922 than in the previous year, showing that the period of epidemic prevalence which began in 1919 had reached its maximum in 1921. The total number of cases notified in 1922 was 750, as compared with 1,374 in 1921, 667 in 1920 and 484 in 1919. The case-rate per 1,000 of the population was 4.4 and 13 deaths were registered from the disease, giving a death-rate of 0.07 per 1,000, as compared with 6 deaths and a mortality-rate of 0.03 in 1921. Of the cases notified, 741 (i.e., 98.8 per cent.) were removed to hospital. The 750 cases occurred in 627 infected houses. In 17 of the cases notified, the diagnosis was not confirmed at hospital. Diphtheria. The number of cases of diphtheria notified during 1922 was 670 as compared with 713 in 1921, 530 in 1920, and 229 in 1919. The number of deaths registered from the disease was 58, giving a death-rate of 0.34 as compared with 63 deaths and a death-rate of 0.37 in 1921. The following table shows— Incidence and Mortality during 1922 compared with 1921 in Wards and Sub-Districts. Ward 1 2 3 4 5 6 7 8 9 E N S Boro 1921—Cases 58 72 89 50 132 133 25 77 77 201 328 184 713 Deaths 3 7 6 4 12 17 1 8 5 16 33 14 63 Incidence per 1,000 populatn. 2.0 4.0 4.6 3.2 7.1 6.4 2.9 4.0 3.6 2.9 6.8 3.6 4.21 Deaths per 1,000 population .11 .39 .31 .25 .64 .82 .12 .42 .24 .23 .68 .28 .37 Deaths per 100 cases 5.2 9.7 6.7 8.0 9.1 12.8 4.0 10.4 6.5 8.0 10.1 7.6 8.8 1922—Cases 93 99 117 88 85 75 20 44 49 313 223 134 670 Deaths 6 11 14 4 7 9 - 4 3 27 23 8 58 Incidence per 1,000 populatn. 3.4 5.4 6.1 5.7 4.6 3.6 2.3 2.3 2.3 4.5 4.6 2.6 3.96 Deaths per 1,000 population .22 .60 .73 .26 .38 .43 - .21 .14 .38 .48 .16 .34 Deaths per 100 cases 6.5 11.1 12.0 4.5 8.2 12.0 — 9.1 6.1 8.6 10.3 6.0 8.7 The case-rate per 1,000 population was 3.96 in 1922, as com pared with 4.21 in 1921, and 3.20 in 1920. The case-mortality in 1922 was 8.7 per cent. as compared with 8.8 in 1921. The average case-mortality per cent. for the ten years 1912-1921 was 8.15. 35 The 670 cases of diphtheria occurred in 554 infected houses, 659 cases (i.e. 98.4 per cent.) were removed to hospital. The incidence of the disease was highest in Latchmere, Shaftesbury and Park Wards, these 3 Wards contributing 45 per cent. of the total cases notified. Facilities for the free bacteriological examination of swabs are available, and anti-toxin is supplied, at any hour of the day or night, free by the Council for use by medical practitioners practising in Battersea. Enteric Fever. During 1922, 9 cases of enteric fever were notified in Battersea. Of these, 5 cases were cancelled, the diagnosis not being confirmed by the hospital authorities. There was one death recorded from enteric fever. Cerebro-Spinal Fever (Posterior Basic Meningitis). During 1922, one case of cerebro-spinal fever (posterior basic meningitis) was notified in Battersea. Encephalitis Lethargica. Two cases of encephalitis lethargica were notified in Battersea during 1922, as compared with 12 cases in 1921. Both cases were removed to hospital where one subsequently died. Puerperal Fever. Thirteen cases of puerperal fever were notified in Battersea during 1922, as compared with 15 cases in 1921. There were 3 deaths from the disease, giving a case-mortality of 23.1 per cent. The number of cases per 1,000 births was 3.55 as compared with 4.01 in 1921. The fatality-rate per 1,000 births was 0.8 in 1922, as compared with 11 in 1921, 1.5 in 1920, and 1.3 in 1919. The death-rate per 1,000 population was 0.018. The deaths from puerperal fever were distributed as follows:—East Battersea, nil.; North West Battersea, 2; South West Battersea, 1; the number of cases notified in each of the sub-districts being 2, 6, and 5 respectively. Ophthalmia Neonatorum. There were 41 cases of ophthalmia neonatorum notified in Battersea during the year 1922, as compared with 61 in 1921, 105 in 1920, and 78 in 1919. The rate per 1,000 births was 11.2, as compared with 16.3 and 22.5 in 1921 and 1920 respectively. 36 The incidence of the disease and rate per 1,000 births in the sub-districts and in the Wards is shown in the following table:- Registration Sub-District. Cases. No. of Births. Rate per 1,000 births. East Battersea 19 1,616 11.8 North-West Battersea 16 1,198 13.4 South-West Battersea 6 851 7.1 Wards. No. 1. Nine Elms 9 673 13.4 „ 2. Park 2 492 4.1 „ 3. Latchmere 10 451 22.2 „ 4. Shaftesbury 2 279 7.2 „ 5. Church 3 389 7.7 „ 6. Winstanley 9 561 16.0 „ 7. St. John 2 163 12.3 „ 8. Bolingbroke 3 361 8.3 2 9. Broomwood 1 296 3.4 Borough (1922) 41 3,665 11.2 Borough (1921) 61 3,742 16.3 Borough (1920) 105 4,669 22.5 Number of cases notified- By medical practitioners 32 By midwives or nurses 9 41 Number removed to hospitals 4 All cases of ophthalmia neonatorum notified are at once visited by the Health Visitors, and steps are taken to see that they are receiving medical treatment, either at home or at hospital. The attention of all medical practitioners practising in the Borough has been drawn to the facilities for admission of these cases to the Metropolitan Asylums Board's Special Hospital (St. Margaret's Hospital). Nursing attendance is provided by the Council free where cases of ophthalmia neonatorum are being treated at home. During 1922, no permanent damage to the eyes resulted from this grave infectious eye-disease amongst the cases of infants notified. In one case, which was under treatment at Hospital, and in which the pathological report stated that the Xerosis bacillus only was found, some opacity of the cornea resulted, but the child died from bronchitis. 37 Acute Polio-Myelitis. During 1922, 4 cases of acute polio-myelitis were notified in the Borough, as compared with 2 in 1921, 1 in 1920 and 6 in 1919. Two cases were removed to hospital, one to the Infirmary, and the other was treated at home. There was one death from this disease. Erysipelas. During 1922, 66 cases of erysipelas were notified and 2 deaths were registered from the disease, as compared with 75 cases and 3 deaths in 1921. The case-mortality was 3.0 per cent., and the death-rate per 1,000 of the population was 0.012. Bacteriological Examinations. During the year 1922, the number of bacteriological examinations of specimens sent in by medical practitioners practising in the Borough of Battersea was 1.135. These specimens were examined at the Clinical Research Association's Laboratories at a cost of £144 11s. 9d., particulars of the results being set out in the following table:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 209 825 1,034 Enteric fever 2 13 15 Tuberculosis 16 70 86 Total 227 908 1,135 TUBERCULOSIS. During 1922, 411 cases of Tuberculosis (all forms) were notified in Battersea, as compared with 466 in 1921 and 498 in 1920. In the following table in shown the distribution of the notified cases arranged in the Wards and Sub-Districts of the Boroughs:- Classification. Wards. Sub-districts. The Borough. 1 2 3 4 5 6 7 8 9 E. N.W. S.W. Pulmonary 60 32 34 33 26 25 8 30 38 134 71 81 286 Non-Pulmonary 25 17 21 9 22 16 - 7 8 62 47 16 125 Totals 85 49 55 42 48 41 8 37 46 196 118 97 411 38 The following table shows the age and sex distribution of the cases of Tuberculosis notified in each Ward:— Ward. Ages: Total, all ages. Pulmonary. NonPulmonary. Grand Total. Rate per 100,000 Popuation. Under 1 yr. 1-5 5-15 15-25 25 45 45-65 65 up M. F. No. 1 1 9 18 10 29 15 3 53 32 60 25 85 309 „ 2 1 3 12 13 11 8 1 31 18 32 17 49 267 „ 3 1 1 12 14 20 7 - 26 29 34 21 55 285 „ 4 1 3 7 10 14 4 3 22 20 33 9 42 270 —5 — 2 18 10 13 4 1 25 23 26 22 48 257 „ 6 1 8 6 8 10 7 1 20 21 25 16 41 197 „ 7 — — 3 1 3 1 — 3 5 8 — 8 93 „ 8 1 1 1 8 18 6 2 18 19 30 7 37 193 „ 9 - 1 3 8 24 10 — 21 25 38 8 46 217 Borough 6 28 80 82 142 62 11 219 192 286 125 411 243 Rate per 100,000 popln. 164 254 244 ' 280 283 191 113 276 214 169 74 243 — Particulars are given in the table below of the localization of disease in the 411 cases notified during 1922. Localization of Disease. Pulmonary (287) Lungs 277 Lung and Larynx 5 Lungs and Glands 3 Lungs and Sternum 1 Lungs and Meninges 1 Glands (59) Cervical 17 Abdominal 4 Unspecified 38 Abdominal (11) Peritoneum 5 Salpinx 1 Intestines 4 Unspecified 1 Genito-Urinary (3) Epididymis 2 Genital 1 Brain (19) Meninges 19 Skin (4) Unspecified 4 Eyes (1) 1 General (8) Miliary 5 General 3 Bones and Joints (19) Spine 5 Hip 5 Spine and Hip 1 Knee 4 Fibula 1 Finger 2 Hand 1 Total 411 A copy of the official return to the Ministry of Health of the notifications on Forms A B and C, received during 1922, is set out on page 53. During 1922, there were 205 deaths from Tuberculosis registered as belonging to the Borough of Battersea. Of this number, 171 (i.e. 83.4 per cent.) were due to Phthisis (tuberculosis of the lungs), 18 to tubercular meningitis and 16 to other forms of the disease. 39 In 1921, the number of deaths from phthisis and other tubercular diseases was 216. The number of notifications received, the number of deaths and the death-rates from all forms of tuberculosis in each year since 1909 are shown in the following table:— Year 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 To. of Notifications 257 166 314 542 743 666 613 565 523 501 514 498 466 411 No. of Deaths 289 252 289 233 245 267 282 287 289 289 208 212 216 205 Death-rates per 100,000 Pop. 155.3 133.9 172.3 139.0 146.3 159.6 174.1 180.0 192.6 192.6 130.6 128.0 127.7 121.1 The death-rate from tuberculosis in 1922 is the lowest recorded during the past twenty-one years; the notifications received were also lower than during any year since 1911. The death-rates per 100,000 of the population from tuberculosis during the twenty years ended 1920, in quinquennial averages, and in 1921 and 1922 are given in the following table:— Pulmonary. NonPulmonary. Total. 1901-1905 134.8 49.2 184.0 1906-1910 116.4 41.8 158.2 1911-1915 124.2 33.8 158.0 1916-1920 134.8 30.0 164.8 Average (20 years) 127.6 38.7 166.3 1921 100.5 27.2 127.7 1922 101.0 20.1 121.1 40 In the subjoined table are given deaths from I uberculosis at various ages in each Ward during.1922:— Wards. Rate per 100,000 population. Ages:— Total, All Ages. Totals. Grand Total. Pulmon ary. NonPul ary. Under 1 yr. 1 5 5-15 15 25 25 45 45 65 65 up M. F. No. 1 171 1 4 4 12 15 8 3 23 24 38 9 47 .. 2 108 1 - 1 7 5 5 1 7 13 19 1 20 „ 3 88 - - 1 3 7 6 — 5 12 14 3 17 „ 4 103 1 1 2 2 3 5 2 12 4 13 3 16 „ 5 145 - 1 2 5 11 7 1 14 13 23 4 27 „ 6 135 2 2 - 4 10 7 3 17 11 23 5 28 „ 7 46 - - - 1 - 3 - 3 1 3 1 4 „ 8 125 1 — 1 4 8 8 2 11 13 22 2 24 „ 9 104 — — 1 6 7 8 — 9 13 16 6 22 Borough 121 6 8 12 44 66 57 12 101 104 171 34 205 Rate per 100,000 popultn. — 164 73 37 150 131 176 124 127 116 101 20 121 During 1922 there has been a marked decrease in the deathrates from all forms of Tuberculosis in East and North-West Battersea. In both these districts the housing conditions are less satisfactory and the inhabitants, for the most part, less properous than in South-West Battersea. In the latter district of the Borough on the other hand the death-rate from Tuberculosis exhibits a slight increase on the rates for previous years. District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 77 1.10 14 0.20 91 1.30 Nth.-West Battersea 51 1.05 11 0.23 62 1.28 Sth.-West Battersea 43 0.85 9 0.18 52 1.03 The Borough 171 1.01 34 0.20 205 1.21 Of the 205 deaths registered from Tuberculosis during the year, 28 were not notified until within one month before death, in 41 cases the notifications were received after death, and in 7 cases no notification was received. Of the 7 non-notified cases, 3 were recorded as tubercular after enquiry by the Coroner, 2 occurred in lunatic asylums, and 2 were certified as "probably tubercular." 41 Of the 41 cases notified after death 13 (9 pulmonary, 4 nonpulmonary) were notified by private doctors, 14 (4 pulmonary, 10 non-pulmonary) by Poor Law Institutions and 14 (2 pulmonary, 12 non-pulmonary) by hospitals or asylums. DISPENSARY TREATMENT OF TUBERCULOSIS. Battersea Tuberculosis Dispensary. The Battersea Tuberculosis Dispensary, previously under the control of a voluntary organization, was taken over by the Borough Council on the 1st May, 1921. The result of the change-over has been very satisfactory as it has brought this most important element of the Borough's Tuberculosis Scheme into close coordination with the Health Department of the Council. The work carried on at the Dispensary during 1922 has been of an extensive and useful character. The Tuberculosis Officer (Dr. G. Macdonald) reports as follows:— I beg to submit a report of the work carried out at the Battersea Tuberculosis Dispensary during the year 1922. During the year the staff has remained as it was in 1921. The work is carried on in close co-operation with the general practitioners in the Borough, and with St. Thomas's Hospital—the affiliated Hospital. During the year the lack of proper housing accommodation has militated against the work of prevention. In many cases the housing accommodation has been manifestly inadequate and in those cases it has been impossible to isolate sufficiently the tuberculous patient from the other members of the family. Wherever possible such patients have been removed to institutions but owing to the fact that the stay in institutions is only for a limited period, it will be seen that this removal to institution is only of temporary assistance as far as the prevention of the disease is concerned. The question of the employment of the Tuberculous patient especially after his return from a period of institutional treatment has been this year, as in previous years, the most difficult problem to face. Nothing has been done to attempt to solve it and so long as patients return from Sanatorium with no prospect of employment, and with the probability that the home conditions and financial circumstances of the patient are even worse than before he went away, so long will the end results of Sanatorium treatment prove disappointing. There is, unfortunately, a considerable waiting period for patients between the recommendation for, and admission to, institutions under the London County Council's Scheme. This averages roughly 28 days over the whole year. It is true that ex-service men and acute cases marked as urgent are not usually kept waiting for so long a period as this, but it follows that the others must necessarily be delayed for a longer time. This long waiting time is a distinct disadvantage in many ways. During 42 the year, 26 patients were discharged from Institutions at their own request, and two patients were dismissed for misconduct. The nett results of Sanatorium treatment appear thus far to have been somewhat better than in previous years. More patients have been discharged from the Sanatorium with their general condition much improved and fit for work. The Tuberculosis Care Committee has met 46 times during the year and much valuable work has been done by this Committee, a summary of which is summarised on page 48. During the year, assistance to the amount of £172 was given to Dispensary patients by the Emergency Help Eund of the British Red Cross Society, and for the same period, assistance to the amount of £38 by the Charity Organisation Society (Battersea C.O.S. £30, Clapham and E. Battersea £8). The amount of contributions from patients who were sent away for Institutional treatment amounted to £331 17s. This money was collected at the Dispensary and forwarded to the London County Council. New Patients. Eor the year ending 31st December, 1922, 624 new patients attended the Dispensary. Of these 624 new patients, 188 were diagnosed as tuberculous, 99, were "suspect" cases, and 337 were non-tuberculous. The percentage of definite cases was therefore 30.1. The percentage of definite cases in previous years was— 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 17.2 25.6 29.0 25.87 20.44 20.8 19.0 28.17 30.2 26.4 Of the 188 definite cases, 41 were children and 147 adults. Of the 147 adults, 102 were insured and 45 were non-insured. The number of discharged ex-service men amongst the tuberculous was 48. The following is a rough classification of the occupations of the 624 new patients:— 114 Manual Workers. 18 Factory Workers. 11 Railway, Coal and House Porters, &c. 3 Railway Guards, Collectors and Attendants. 2 Watchmen. 13 Drivers (Railway Engines, Motor Drivers, &c.). 5 Carmen and Van Boys. 23 Shopkeepers, Distributors and Shop Assistants. 1 Hawker. 8 Printers and their Assistants. 4 Laboratory Workers. 8 Waiters and Waitresses. 2 Stock-keepers. 2 Postal Workers. 43 39 Domestic Workers. 11 Dressmakers and Milliners and their Assistants. 5 Agents, Travellers and Canvassers. 40 Clerks (Varied). 5 Messengers and Errand Boys. 2 Private Teachers. 3 Theatrical Artistes and Musicians. 2 Nurses. 1 Steward. 83 Housewives. 212 School Children and Infants. 7 With no occupation. A large number of patients who were eventually discharged from the Dispensary as non-tuberculous were kept for a period under intensive observation before a definite diagnosis was arrived at. This period of observation does not in the majority of cases exceed 28 days. In doubtful cases repeated sputum examinations are undertaken and many patients are referred to St. Thomas's Hospital for X-ray examination and a further opinion before the diagnosis is definitely established. The facilities provided by St. Thomas's Hospital are fully utilised in such cases, and there is very close co-operation between the Tuberculosis Department there through the Tuberculosis Officer, and the Battersea Tuberculosis Dispensary. I have frequently laid stress upon the value of this close co-operation and wish to acknowledge now as in the past the very ready help which I have received from Dr. Hebert, the Tuberculosis Officer, in doubtful cases. " Contacts." During the past year 284 "Contacts" were examined at the Dispensary. Most of those "Contacts" were children, as it is difficult to persuade adults, who apparently are in good health, of the necessity for such examinations. The routine examination of "Contacts," is undoubtedly of great importance and the closer co-operation between the School Medical Service and the Tuberculosis Dispensaries which has come into force towards the end of the year under review, whereby the child "contacts" are kept under close observation at school, should prove of great value. "Contacts" of "open cases" ought to be kept under observation at periodic intervals. Not infrequently does one find that a patient who has been examined as a "Contact" and passed as healthy returns to the Dispensary three or four years later definitely suffering from Tuberculosis. I am of the opinion that the period of several years following school life is of very great importance and that a close supervision of "contacts" at this period would be very valuable. Unfortunately one finds that at this time of life, the individual fails to understand the necessity for medical examination. 44 Total Notifications. During the year, 40 patients in whom the diagnosis was at first doubtful, were diagnosed as definitely tuberculous, and these added to the 188 new patients make a total of 228 notified cases. Of this number, 57 had already been notified to the Medical Officer of Health, so that 171 were primary notifications from the Dispensary. Attendances. The number of old patients attending the Dispensary is 1,026. For previous years the number has been— 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 661 971 1,015 1,039 1,090 1,193 1,230. 1,250 1,474 1,570 For the year, the total number of attendances was 4,910, 1,847 attendances of insured patients, and 3,063 of non-insured patients. Patients who are insured and who are having treatment from their own doctors attend the Dispensary for observation at intervals varying from one to six months according to the necessity of the case. Home Visits. During the year, 264 visits were paid by the Tuberculosis Officer to patients in their own homes. No home treatment is undertaken but visits are paid at the request of the Ministry of Pensions, in consultation with general practitioners, and to newly notified patients who are in attendance at the Dispensary where the Dispensary Nurse finds that the home circumstances are not satisfactory on her first visit. Visits by Nurses. The visits paid by the Dispensary Nurses during the year numbered 7,048. As far as possible, the home of each notified case on the Dispensary books is visited at intervals of not more than three months. Where the home conditions, however, are found to be unsatisfactory and when a patient is in a residential institution the homes are visited more frequently. In addition to the visits paid by the Dispensary Nurses, 592 visits were made by Voluntary Visitors, including students from the Battersea Polytechnic. Sanatorium Treatment. 1. Average length of stay of patients in Sanatoria during the year 1922 16 weeks 5 days 2. The number of patients who showed improvement 65 3. The number of patients who discharged themselves 38 45 4. The number recorded of Dispensary patients who died during the year 1922 89 5. The number of patients discharged as cured in the year 1922 32 6. The number of patients recorded as having ceased to attend during 1922 118 7. The number of patients who moved out of the district in the year 1922 and were transferred to the Borough or County Medical Officers of Health of the districts to which they had moved 53 Bacteriological examinations. of sputum numbered 925. In 236 cases (25.5 per cent.) the Tubercle Bacillus was found to be present. Repeated sputum examinations in doubtful cases is of very great value and many more examinations are now carried out at the Dispensary than was formerly the case. The number of sputum examinations carried out for general practitioners during the nine months from April to December was 98. The number of examinations made for St. James's Hospital during the same period was 142. 1,205 Reports were sent to public bodies during the year. Reports to and Consultations with Practitioners. During the year consultations with practitioners at the homes of their patients, and reports to practitioners who sent patients to the Dispensary for advice numbered 625. During the year, 135 patients were sent away to Institutions under the Council's Tuberculosis Scheme. Of those, 98 were insured and 37 non.insured. 197 Patients were referred to Hospitals. 169 of these were patients in whom the diagnosis was doubtful and who were referred to St. Thomas's Hospital for X.ray examinations. The 624 new patients were recommended to attend the Dispensary by:— Practitioners 299 Came of their own accord 89 "Contacts" 60 Ministry of Pensions 53 Bacteriological Examinations. Reports on Patients. Institutional Treatment. Referred to Hospitals 46 School Medical Officer 24 Children's Welfare Centre 18 Health Visitors 15 Transfers from Hospitals 15 London County Council 8 Invalid Children's Aid Association 6 Other Dispensaries 4 Medical Officer of Health 3 Infant Life Protection Visitor 2 British Red Cross Society 1 Charity Organisation Society 2 Wandsworth Union 2 Other Patients 2 Other sources 20 Labour Exchange 1 Day Sanatorium or Open-Air School. The open-air school at Springwell House, Clapham Common North Side, receives a large number of children daily, the larger proportion (about 60 per cent.) being Battersea children. The school is housed in a large converted mansion, with a fine garden at the rear, where the children receive instruction, except in bad weather, in the open air. The school is under the administrative control of the London County Council, but with the consent of the Borough Council, the services of the Tuberculosis Officer (Dr. Macdonald) and one of the Dispensary nurses are being utilised by the County Council in medically supervising the children, the former to the extent of one half-day a week, and the latter as to three-fourths of her time, for which the County Council contribute part of these officers' salaries. The Institution is doing very useful work, the education of the children being carried on under the most favourable conditions for their recovery, and almost continuously in the open air, and suitable nourishing meals being provided at the school. The Tuberculosis Officer reports the following work carried out at the Institution during 1922:— Statistics for 1922. Number on Roll, 31st December, 1922 149 admitted during 1922 48 ,, discharged during 1922 49 Reasons for discharge:— (a) Number fit for elementary work 13 (b) „ fit for work 28 (c) ,, transferred to Hospital or torium 7 (id) ,, removed from district 1 (e) ,, transferred to Special School — (/) „ discharged for other reasons — 47 Gain or loss of weight of children who have been in the School for more than twelve months:— (a) Number of children who showed a gain in weight 107 (b) Average gain in kilos 3.07 (c) Number of children who lost weight or whose weight was stationary Nil. (d) Average loss in kilos. General Health.—Very good. Infectious Diseases.—There has been no outbreak of infectious disease at Springwell House Open Air School since the commencement in 1919. During 1922, there were six cases of infectious disease—3 of scarlet fever, 2 of diphtheria, and 1 of mumps. Vaccinations.—Forty-one children have been vaccinated during the year. Sixteen of these were primary cases. There are now 13 children at the school whose parents will not consent to vaccination. Cleanliness.—Of 107 children in the school during the year, 73 were found to be satisfactory with regard to cleanliness at the beginning of the year, and their condition remained satisfactory during the whole period. Thirty-four were not satisfactory with regard to cleanliness at the beginning of the year. Of these 34, 12 improved and their condition became satisfactory, 11 showed some improvement, and 11 showed no improvement at all. With regard to the cleanliness of the children, this appears to have improved much, and I am of the opinion that this condition is due to the regular weekly inspection of each child by the school nurse, and that if this inspection were not carried out regularly, the condition as regards cleanliness would not be so satisfactory as this. Indoor Work.—It has been found necessary to carry on the school work indoors for only two and a half days throughout the year. For half a day it was found impossible to use the platforms owing to snow and the east wind, and for two days thick fog all day prevented work being carried on outside. Discharges.—Since the opening of the school in 1919, 63 scholars over 14 years of age have been discharged as fit for work, and approximately 50 have been discharged as fit to return to an elementary school. Employment.—With regard to work, only seven children, all boys, are now on open air work. The rest of the number working seem to be equally distributed among workrooms, offices, and shops, while 20 (those leaving more recently) are out of work. 48 After-Care Committee.* The Care Committee was appointed by the Council on the taking over of the Dispensary in May, 1921, and consists of members of the Council and of representatives of other bodies engaged in health and social work in the Borough. The composition and functions of the Committee are those outlined in the Circular letter issued by the Local Government Board dated 29th April, 1915. The Committee meets weekly at the Tuberculosis Dispensary and during 1922 much valuable work was carried out which is summarised in the report of the Tuberculosis Officer below. Report of the Work of the Care Committee for the Year 1922. Number of Meetings, 46. Number of cases considered, 1,085. London County Council Cases. 110 Cases were assessed for Sanatorium. 79 Cases were re-assessed for Sanatorium. 113 Cases were reported as having had assessments accepted. 32 Cases were reported as having entered Sanatorium. 71 Cases were reported as having entered Hospital. 1 Case was Reported as having entered a Home for Advanced Cases. 47 Cases were assessed for Springwell House Holiday. 3 Cases were re-assessed for Springwell House Holiday. 28 Cases were recommended for admission to the Open-Air School. 30 Springwell House Meal Cases were considered. 1 Patient was granted the use of a shelter. Convalescent Cases. 20 Cases were referred to the Invalid Children's Aid Association for Convalescence. 13 Cases were reported as being sent away by the Invalid Children's Aid Association. In Need of Assistance. 34 Cases were referred to the Wandsworth Board of Guardians —for extra nourishment, 9; relief, 13; other forms of assistance, 12. 8 Cases were referred to the Soldiers' and Sailors' Help Society—for bed and bedding, 5 ; other assistance, 3. 5 Cases .were referred to the Soldiers' and Sailors' Families' Association—for extra nourishment, 2; other assistance 3. 7 Cases were referred to the School Care Committee—for free dinners, 6 ; other assistance, 1. 3 Cases were referred to the M.A.B.Y.S. for suitable employment. The Constitution of the Committee will be found on reference to page 4, 49 2 Cases were referred to the Battersea Trust Charities for educational grants. 3 Cases were referred to the Borough Council—for remission of rates, 2; other assistance, 1. 10 Cases were referred to other agencies for assistance. Non-Dispensary Patients. In addition to the work carried out by the staff of the Tuberculosis Dispensary, 1,818 visits to houses of notified cases of Tuberculosis were made by the Sanitary Inspectors (male and female). Women and children notified to be suffering from Tuberculosis and not attending the Tuberculosis Dispensary are visited at their homes by one of the female Sanitary Inspectors (Miss Round). During the year 1922 the number of cases of women and children not in attendance at the Dispensary notified to the Medical Officer of Health was 148. Of this number, after deducting cancelled cases, removals, &c., 138 were investigated, and the results are summarised as follows Women—73. Children—65. Married 35 Boys 31 Single 33 Girls 34 Widows 5 Total cases 138 Cases found to be dead on first visit, 32. Age and Sex Distribution. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 upwards All ages Pulmonary M. 1 4 1 1 - - - - - - - 7 F- — — 4 5 5 12 16 11 7 4 3 67 Tubercular Meningitis M. 2 3 2 1 8 F. 1 4 1 1 — — 1 — — — — 8 Other Tubercular Disease M. - 1 6 8 15 F- 1 2 12 4 4 3 3 2 2 — — 33 Total M. 3 8 9 10 - — — — - - - 30 F. 2 6 17 10 9 15 20 13 9 4 3 108 Grand Total 5 14 26 20 9 15 20 13 9 4 3 138 Home Conditions. The home conditions found on investigation showed a marked improvement compared with a similar inquiry relating to the same class of patients in 1921, in regard to the precautionary measures 50 being observed by the patients. In 30 cases the patient was found to be occupying a separate room, and in 42 cases a separate bed ; 56 of the patients were receiving institutional treatment, giving a total percentage of 92.8 in which some measure of isolation and prevention were being carried out, as compared with 68.3 per cent. in 1921. Sanitary State of Homes.—The sanitary state of the homes was found in 93 cases good, in 42 fair, and in 3 bad. Condition of Patient at First Visit.—In 12 cases good ; in 64 fair, in 30 bad ; 32 cases were found to have died. There were 646 persons living in the homes of these 138 cases, the number of rooms occupied being 447, with an average of 1.4 person per room. Treatment— Domiciliary.—36 by private doctor, 19 by panel doctor, 27 attending out.patient departments of hospitals ; 19 of these were subsequently transferred to the Tuberculosis Dispensary. Institutional.—56 were receiving hospital, sanatorium, or other forms of institutional treatment. Financial Circumstances of Patients..—41 good, 42 fair, 55 bad. Habits.—82 good, 53 fair, 3 bad. Occupation— Infants (1 to 5 years) 18 School Children (5 to 15 years) 47 Clerks 8 Domestic workers (Cooks, Charwomen, Domestic Servants, Caretakers, &c.) 11 Factory hands (including Laundry workers) 4 Housewives 40 Teacher 1 Shop Assistants and Workers (including Machinists, Dressmakers, Milliners) 5 Messenger 1 No occupation 3 138 Sputum flasks were in use in 9 cases, and 13 other patients consented to use them, and were supplied free from the Public Health Department. The total number of visits paid by the Woman Sanitary Inspector to notified cases of Tuberculosis amongst women and children during the year was 1,240. Of these 33 were in respect of home reports required in connection with Form B for the London County Council. 51 The Woman Inspector also attends regularly the meetings of the Care Committee. Of the above, 1,107 revisits were paid to old cases. The total number of these cases on the register at the end of the year was 497. Many of these cases are chronic cases, and have been on the register for years, and are not receiving medical attention. A number of them maintain they are recovered, as may probably be the case. As they refuse either to attend the Dispensary or see a doctor, though urged to do so, it is not considered desirable to lose sight of them. They are, therefore, visited very occasionally, and every effort is made to induce them, sometimes with success, to attend the Tuberculosis Dispensary for examination. Males, 1922. Married 42 Total visits paid by Male Single 31 Inspectors, 1922 578 73 Particulars unobtainable, 11 cases. Total, 84 new cases. (4 C.L.H., 1 soldier, 5 dead, 1 never resided at address given.) Age Distribution All ages. 14/16 16/20 20/25 25/30 30/35 35/4545/55 55/65 65 up Pulmonary 2 7 7 8 5 18 11 10 3 71 Tubercular Meningitis — 1 - - - - - - - 1 Other Tubercular Diseases - - - - - - - 1 - 1 Grand Total 2 8 7 8 5 18 11 11 3 73 Home Conditions. 23 occupied separate room. 58 premises in good condition 5 „ ,, bed. 8 „ fair 20 received Institutional treat- — ,, bad ,, ment. 7 no particulars obtained 12 shared room. (dead on visit). 4 not stated. 9 no information (dead). 73 73 52 Condition of Patients. 17 in good condition on 1st visit 1 particulars unobtainable. 19 ,, fair „ 21 „ bad „ „ 73 15 dead on visit. — Treatment. Domiciliary. 28 Institutional treatment. 17 Private treatment. — 23 Panel „ 73 5 O.P. Hospital. = Financial Circumstances. 23 good. 1 particulars unobtainable. 38 fair. 2 dead. 7 bad. 1 in Asylum. 73 1 ,, Infirmary. — 14 cases transferred to Dispensary. 1 case cured during 1922. Tuberculosis Dental Clinic. During the year a special weekly session for the dental treatment of Tuberculosis patients was established at the Dental Clinic, Plough Road Baths. The first session was held on the 12th July. During the last six months of the year 1922, patients recommended by the Tuberculosis Officer were treated at the Clinic. Particulars of the work carried out are set out below. No charge is made for advice, extractions or fillings, and where dentures are required the cost of them is met, if necessary, partly by the patient and partly by the Care Committee through various social or philanthropic agencies. Dental Clinic, 1922. Total attendances (July to December) 64 Total sessions 21 Average number of attendances per session 3.05 Extractions 50 Scalings 6 Fillings 7 Dentures and remodelling 8 Dressings 4 Advice given 18 Total number of operations and interviews for advice only *93 Average number of operations and interviews for advice only per session 4.43 * The number of operations for the purpose of this table i ncludes each separate extraction and filling performed. 53 Summary of Notifications during the period from the 1st January, lyzz, To lffe in the Metropolitan Borough of Battersea. Age Periods. Notifications on Form A. f Notifications on Form B. No. of Notifications on Form C. * Number of Primary Notifications. Total No. on Form A. * No. of Primary Notifications. Total No. on Form B. Poor Law Institutions Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and over. Total. Under 5 5 to 10 10 to 15 Total Primary Notifications Primary Total. Primary Total. Pulmonary— Males - 1 4 2 16 12 37 31 22 15 3 143 187 - - - - - 9 45 5 122 Females — 1 5 8 14 17 33 18 9 5 4 114 135 — — — — — 4 39 6 74 N on-Pulmonary— Males 4 13 17 12 2 4 3 - - 1 56 67 - - 1 1 3 2 2 27 Females 2 11 19 4 6 2 6 2 4 1 1 58 67 - 3 1 4 4 1 3 1 12 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (2 0) (21 ) In filling up the form the following notes should be carefully observed— Patients notified as suffering from both pulmonary and non-pulmonary disease should be included among the " pulmonary " returns only. All notifications on Form D should be disregarded in preparing this return. • Primary notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in the area to which the return relates. Any additional notification of a case which has previously been notified in the area is to be regarded as duplicate. (Note.—No primary notifications should be made on Form C.) t A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, should be included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification occurs on Form A, and all notifications on Form A, whether duplicate or not, should be included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A, or on Form B, should be included in these columns. • Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, should be included in this column. Col. 21. If the Medical Officer of Health has reason to believe that during the year the requirements of Article VII. of the Tuberculosis Regulations, 1912, have not been observed by the Medical Officer of any Sanatorium (as defined in the Regulations^ as regards any persons resident in the area, the Minister of Health should be furnished with the name of the Sanatorium concerned, the names of the patients admitted from the area and the period of treatment in each case. 54 Deaths from Zymotic Diseases. The principal zymotic diseases are small.pox, measles, scarlet fever, diphtheria (including membranous croup), whooping cough, enteric fever, and diarrhoea. The deaths from these causes in 1922 numbered 192, as compared with 173 in 1921, an increase of 11 per cent. There was a corresponding increase in the zymotic death.rate from 1 02 in 1921 to 113 in 1922. The mean death.rate from each of the principal zymotic diseases for the ten years 1902.1911 and for the ten years 1912.1921 are compared with the corresponding rates for 1921 and 1922 in the following table :— Disease. No. of Deaths. Mean Death. rate per 1,000 population. Death.rate per 1,000 population. Increase (.).) or decrease ( . ) during 1922, over 1921. 1922. 1902. 11. 1912. 21. 1921. 1922. Previous year. Prec'd'ng 10 years (average) Small Pox - - •01 - - - - - Measles 2 66 •45 •35 •012 •39 + .38 + .04 Scarlet Fever 6 13 •08 •04 •04 •08 + .04 + .04 Diphtheria 63 58 .10 •16 •37 .34 •03 + .18 WhoopingCough 30 22 •32 •22 •18 •13 •05 — .09 Enteric Fever 1 1 •04 •02 •006 •006 . — • 01 Diarrhoea and Enteritis 71 32 .68 •32 •42 •19 •23 •13 Total deaths 173 192 — — — — + 19 + 9 Total death.rate — — 1.88 1.11 1.02 1.13 + 11 + •0 2 NON.NOTIFIABLE INFECTIOUS DISEASES. Chicken.Pox. During 1922, 259 cases of Chicken.pox were reported as compared with 400 in 1921 and 615 in 1920. Influenza. There was a recrudescence of this formidable disease during 1922 and the number of deaths registered in Battersea from the disease was 110, of which 68 were certified as being due to Influenzal 55 Pneumonia, with a death-rate of 0.66, as compared with 45 deaths and a rate of 0.27 in 1921 and 57 deaths and a rate of 0.34 in 1920. There were 196 cases of Influenzal Pneumonia notified during the year as compared with 86 in 1921 and 77 in 1920. The death. rate was 0.402 as compared with 0.136 in 1921. In "other forms" of Pneumonia, the incidence and death.rate were heavier in 1922 (25 and 7.7 per cent, respectively), as compared with the previous year. The increase in the general death.rate of the Borough as compared with the two preceding years was mainly due to increased prevalence and the heavy mortality from Influenza and Influenzal Pneumonia. The following table shows a comparison of Influenzal and other Pneumonia notifications and mortality in 1922 and 1921, respectively:— Influenzal Pneumonia. Other Pneumonia. 1st quarter 1922. 1921. 1922. 1921. Cases Notified. Deaths Cases Notified. Deaths Cases Notified. Deaths Cases Notified. Deaths 132 53 31 9 115 74 80 60 2nd quarter 17 7 21 7 78 42 62 33 3rd quarter 5 - 6 — 38 18 35 16 4th quarter 42 8 28 7 77 34 72 47 Total 196 68 86 23 308 168 249 156 Notified cases per 1,000 population 1.158 •508 1 .820 1.472 Deaths per 1,000 population •402 • 136 •993 •922 Diarrhoea. Acute infective diarrhoea was less prevalent in 1922 than in any previous year, and this remarkable feature of the vital and morbid statistics of the Borough was not confined to Battersea, but characterised those for the County of London and the country generally. The total number of deaths registered from diarrhoea in Battersea during the year was 32, giving a fatality.rate of 0.19 per 1,000 as compared with 71 with a death.rate of 0.42 in 1921, and 64 with a death.rate of 0.39 in 1920. The steady decline in the incidence and mortality from infective diarrhoea which has been so marked a characteristic of the returns for the past few years has been referred to in the Annual Report 56 for 1921. The great development which has taken place in the provision of public health services, especially since the passing of the Maternity and Child Welfare Act, 1918, has no doubt been mainly responsible for this and other gratifying results of the activities of health authorities. MEASLES AND WHOOPING COUGH. Measles. Measles was so prevalent during 1922 as to assume epidemic proportions. This disease and whooping-cough, both of which are peculiarly fatal to early childhood, at the request of the Borough Council, were by Regulations issued by the Ministry of Health, dated 8th April, the Battersea (Measles and Whooping-cough) Regulations, 1922, made compulsory notifiable in Battersea. The regulations came into operation on the 24th April. During 1922, 3,060 cases were notified or otherwise reported to the Medical Officer of Health. The incidence of the disease as measured by these notified or reported cases was equivalent to a rate of 100 cases in every 1,000 of the population under 10 years of age. Of the cases notified or reported during the year, 1,496 or 49 per cent. were notified under the Regulations and 1,564 or 51 per cent. by the public elementary schools and from other sources. The deaths from measles during the year were 66, giving a total mortality-rate at all ages of 0.39, as compared with 2 deaths and a mortality rate of 0 012 per 1,000 in 1921. 21 of these deaths occurred in the first quarter, 44 in the second quarter, and 1 in the third quarter. Of the fatal cases, 62 occurred amongst children under 5 years of age, and 41 or 62 per cent. of the fatal cases were males. The precautionary measures carried out included visits by the Health Visitors to the houses of all cases notified or otherwise reported, securing of isolation so far as practicable, advice to the mothers, especially as to the importance of early medical assistance, removal to the hospitals of the Metropolitan Asylums' Board where owing to environmental conditions, this course was desirable, and the provision of nursing attendance where required. Whooping Cough. During 1922, 428 cases of whooping-cough were notified or otherwise reported to the Public Health Department. Of these, 285 were notified under the Battersea (Measles and WhoopingCough) Regulations, 1922. Twenty-two deaths were registered from whooping-cough, the death-rate being 0 13, as compared with 30 deaths and a death-rate of 0.18 in 1921, and 33 deaths and a death-rate of 0.2 in 1920. 57 Cancer. During 1922, the number of deaths registered from cancer of persons belonging to Battersea was 225 (males 110, females 115), as compared with 189 in 1921, an increase of 19 per cent. The average number of deaths from cancer during the past 4 years was 203.2. The death-rate from the disease during 1922 was 1.33 per 1,000 of the population, the corresponding deathrate in 1921 being 1.12. 58 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1922. Total Sanitary Operations 72,408 Dust receptacles provided 641 Number of house inspections 39,418 Leaky house-roofs and gutters House to house inspections 688 repaired 1,011 Bakehouse inspections 278 Houses supplied with water Bakehouse nuisances abated 25 and fittings repaired 276 Urinals—inspections 218 Houses let in lodgings registered 85 Do. altered, repaired' or No. of inspections of do. 165 water laid on 78 Water Closets provided. Intimations served under Sec.3 3,572 supplied with water or Notices served under Sec.4,&c. 910 supply disconnected from Notices served under Sees. drinking water cisterns 256 62 & 65 1,397 Cisterns covered, cleansed and Complaints received and repaired 166 attended to 3,559 Additional water supplies to Number of premises disinfected 2,257 upper floors 31 Houses supplied with dis- Keeping of animals in unfit infectants 2,089 state discontinued 36 Overcrowding abated 8 Smoke observations 130 Premises improved, cleansed Certificates of disinfection and repaired 3,075 granted 3,599 Drains tested By smoke 735 Houses inspected and certi- Do. ,, water 1,173 ficates granted (Sec. 48) 69 Drains cleansed and repaired 241 Proceedings ordered by Council Drains relaid 110 and Health Committee 3,565 Frontage drains constructed Summonses issued 66 or re-constructed 9 Magisterial Orders obtained Soil pipes and drains ventilated 112 and enforced .27 Sink and rain-water pipes Factories, Workshops, &c., disconnected or repaired 478 inspections 4,087 Water Closets cleansed and Sanitary conveniences pro- repaired 549 vided or improvements Cesspools abolished — effected in Factories and Mews and Stables drained and Workshops (Sec. 38) 142 paved 3 Underground sleeping rooms : Yards and forecourts paved Use discontinued .3 and repaired 210 Defects remedied 20 Accumulations of manure and Gipsy van inspections 59 other obnoxious matter re- Drains laid to new houses and moved or proper receptacles tenements 69 provided 4 Samples taken under the Sale of Food and Drugs Acts 1,100 Miscellaneous 2,170 59 Legal Proceedings. Legal proceedings in connection with nuisances were taken by the Council in 9 cases during 1922. Particulars with regard to each case are set out below. Legal Proceedings under the Public Health (London) Act, 1891. Nature of Offence. Result of Proceedings. Nuisances at 167 Lavender Road Nuisances having been abated, defendant to pay £2 2s. costs. Non-paving of yard at 113 Falcon Yard having been paved, summons Road withdrawn on payment of 10s. 6d. costs. Nuisances, being no water supply Orders for abatement within 7 at 51 and 57 Stainforth Road days and £2 2s. costs. Non-compliance with order to Fined £3. abate nuisance from no water supply at No. 51 Stainforth Road The like offence at 57 Stainforth Fined £3. Road Nuisance at 67 Duffield Street. Order for abatement within 14 Non-repair of yard at do. Non- days and 10s. costs on nuisance compliance with notice to abate summons. Other summonses nuisance withdrawn. Effluvia from premises No. 2 Adjourned sine die by consent on Amies Street causing a nuisance defendants, by their solicitor, undertaking to carry on the business without committing a nuisance. Do. Fined £10 10s. and £21 costs and allowed 28 days to pay. Keeping a dog and cats at No. 52 Nuisance to be abated within Brougham Street in such a seven days and defendant to pay manner as to be a nuisance 7s. costs. Nuisance at No. 20 Heaver Road Nuisance having been abated, summonses withdrawn on payment of 14s. 6d. costs. No water supply at 72 Stainforth The supply having been put on, Road defendant ordered to pay £1 Is. costs. Factory and Workshop Act. Failure to send list of outworkers Withdrawn on payment of £1 Is. on 1st February, 1922 costs. Do. Do. 60 Sale of Food and Drugs Acts. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 822 Milk 9.0% deficient in fat Fined £2 10s. in each case — £10 in all. Samples taken in course of delivery. 825 Milk 8.0% deficient in fat 826 Milk 5.0% deficient in fat 828 Milk 2.23% extraneous water and 13.71% deficient in fat j 857 Separated Milk 15.17% extraneous water First defendant fined £3. Second defendant fined 5s. 863 Milk 5.4% extraneous water Dismissed. Warranty defence. 906 Milk 8 • 1 % extraneous water C Dismissed. Samples taken in course of delivery. 907 Milk 6 0% extraneous water .j 972 Separated Milk 15.7%extraneous water Fined £2 2s. and £1 Is. costs in each case or 56 days imprisonment in default—7 days to pay. 973 Separated Milk 976 Milk 5.0% deficient in fat Dismissed. Warranty defence. 24 Milk 6.0% deficient in fat Fined £1 and £3 3s. costs on sample. No. 26. Samples taken in course of delivery. 25 Milk 12.3%deficient in fat 26 Milk 45.0% deficient in fat 236 Milk 36.0% deficient in fat First defendant ordered to pay £3 3s. costs. Second defendant fined 10s. 310 Milk 10.2% extraneous water First defendant fined £4 and £1 Is. costs. 313 Milk 14.5% extraneous water Each defendant fined 20s. and 10s. costs. 334 Milk 14*0% extraneous water Each defendant fined 10s. and 10s. 6d. costs. 344 Milk 10.0% extraneous water Fined 10s. and £1 1s. costs. 363 Milk 20.0% deficient in fat Dismissed. Warranty defence. Sample taken in course of delivery. 472 Milk 4.5% extraneous water Dismissed. Warranty defence. 485 Milk 11 % extraneous water Fined 10s. and 12s. 6d. costs. 537 Milk 6.5% extraneous water Dismissed on payment of £1 1s. costs. 610 Rice 0 • 90% of mineral matter 0.40% in excess of sug. Fined £5 and £5 5s. costs. Case against employee dismissed under the Probation of Offenders Act. 61 No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 653 Milk 9% extraneous water Ordered to pay £2 costs. Warranty pleaded. 660 Milk 42% deficient in fat Vendor ordered to paySi Is. costs. Employee fined £1 and £1 Is. costs. 688 Milk 10% deficient in fat Dismissed. Warranty defence. Milk and Dairies Amendment Act, 1922. 663 Milk Selling milk to which colouring matter, i.e., annatto, was added Summons dismissed on payment of £1 3s. costs. Public Health (Milk and Cream) Regulations, 1912. Public Health (Milk and Cream) Regulations, 1912, Amendment Order, 1917. Nature of Offence. Result of Proceedings. No label on receptacle containing preserved cream delivered to purchasers, nor on receptacle from which cream was served Ordered to pay £2 2s. costs. No labels on receptacles containing preserved cream and preserved clotted cream Ordered to pay £2 2s. costs in respect of no label on receptacle containing preserved clotted cream. Housing, Town Planning, &c., Act, 1919, Sec. 28. Nature of Offence. Result of Proceedings. A Declaration that the Council were entitled to a charge on No. 18 Arden Street under above Section for £217 12s. 2d. with interest and costs, and for an Order for sale J udgment as askecl. A Declaration that the Council were entitled to a charge on No. 20 Arden Street, under above Section for £201 10s. 7d. with interest and costs, and for an Order for sale Judgment as asked. Declarations that the Council were entitled to charges upon Nos. 52, 56, 58 and 60 Stainforth Road for expenses incurred under above Section and sale of the properties to enforce such charges Judgments as asked. 62 Summary of Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 66 cases during the year 1922:— Persons prosecuted (including employees). Convictions. Fines. Costs. Factory & Workshop Act, 1901 £ s. d. £ s. d. 4 — — 2 2 0 Milk & Dairies (Amendment) Act, 1922 1 - - 1 3 0 Public Health (Milk and Cream) Regulations, 1912, Public Health (Milk & Cream) Regulations, 1912, Amendment Order, 1917 2 - - 4 4 0 Public Health (London) Act, 1891, and the By-laws made thereunder 13 4 16 10 0 28 7 0 Sale of Food & Drugs Acts 32 23 32 19 0 23 11 6 Total 52 27 49 9 0 59 7 6 Common Lodging Houses. The following table gives a list of the common lodging houses in the Borough Premises Authorised No. of Lodgers. Whether Males or Females. 75 Falcon Road 81 Males 134 High Street 54 Males 67 Winstanley Road 66 Females Drainage Work. During the year new drains were constructed to 99 new buildings, or additions to existing buildings, and the drains of 110 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. 63 Revenue Act, 1903. During 1922, 1 application (in respect of 12 tenements) for the certificate of the Medical Officer of Health under the provisions of the Revenue Act, 1903, was received, and, after inspection by the Medical Officer of Health, 2 certificates were granted in respect of 8 tenements. Sanitary Conveniences attached to Licensed Premises. During 1922 the number of public-house urinals under inspection was 117. In 82 instances the accommodation is accessible to the general public as well as the users of the houses, and in 35 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 45 notices were served to remedy defects discovered. Smoke Nuisances. During the year 130 observations were made and 18 complaints received. Twelve preliminary and 1 statutory notice were served by the Council to abate smoke nuisances. No prosecutions were instituted. Effluvium Nuisance. A petition was received signed by 80 inhabitants of the neighbourhood complaining of nuisance from the premises of the Smith Chemical Co., No. 2a Amies Street, used for the manufacture of a dye material employed in the preparation of boot polish. The nuisance was found to be a definite nuisance under Section 21 of the Public Health (London) Act, 1891, and was reported to the Borough Council, who ordered proceedings to be taken against the firm. The summons was heard at the South-Western Police Court on the 13th January, when the case was adjourned for a month on an undertaking not to commit a nuisance in the meantime. The case came on again for hearing on the 9th March following, when an adjournment sine die was agreed to on an undertaking being given that no further nuisance should occur. This not having been observed, the summons was restored and heard on the 28th October, when the defendants were convicted and fined £10 10s. Od. and 20 guineas costs. Water Supply. During 1922, 17 applications were received for certificates of water supply in respect of 13 houses and 56 tenements in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 31 cases additional water supply to the upper floors of . tenement houses, under the provisions of Section 78 of the London County Council (General Powers) Act, 1907, and Section 48 of the Public Health (London) Act, 1891, were provided. 64 Van Dwellings. The number of van dwellings in the Borough in 1922 was 55. In the following table are set out the situations of the dwellings and number of occupants:— Situation of Vans. No. of Vans. No. Occupants. M. F. Mill's Yard, adjoining 88 Sheepcote Lane 4* 5 7 Mill's Yard, adjoining 80 Sheepcote Lane 4* 3 2 Manley's Yard, Falcon Road 8 10 8 Manley's Yard, Cabul Road 24 f 25 32 Mill's Yard, Culvert Road 15* 21 19 During the year 9 vans were found to be overcrowded, and notices were served, where necessary, to abate the nuisance. Rag Flock Act, 1911. This Act was passed to prevent the use of material known as rag flock, unless such material complies with the standard of cleanliness laid down in the Act. In Battersea the stuffing of bedding and furniture is carried on at 12 workshops. Rag flock is used at only one of these premises. The 11 remaining workshops are now using cotton flock, which is manufactured from raw cotton. Under the provisions of the Rag Flock Act one sample was taken and submitted to the Public Analyst for the purpose of analysis. This was found to comply with the requirements of the standard laid down by the Act. Rats and Mice (Destruction) Act, 1919. This Act, which became operative on the 1st January, 1920, imposes on local authorities and occupiers of premises additional responsibilities in connection with rat repression. In Battersea the Council delegated their powers under the Act to the . Health Committee, who decided to take the necessary steps to organise a scheme for rat repression in the borough. On the recommendation of the Committee the Council appointed an Officer (qualified by special training and experience) to organise the work in the district, and to act under the direction and supervision of the Medical Officer of Health. The scheme, in addition to the appointment of Rat Officer and rat catchers, included the provision of all requisite apparatus and equipment for the destruction of rats and mice, e.g., traps of various types, poisons (mainly those harmless to man and domestic animals), ferrets, dogs, etc. I he occupiers of factories, warehouses and large business premises were notified by letter of the provisions of the Act, and, * Including one shed. f Including one cottage. 65 at the same time, their attention was called to the facilities provided in the Council's scheme. A number of firms availed themselves of the scheme from the start, and made an annual payment to the Council based upon a scale charge, for the services of the Rat Officer and his staff. It was hoped that in this way the scheme would become self-supporting, but, although a considerable sum is received annually from persons using the scheme, this hope has not been realised. While the financial results have been somewhat disappointing, there can be no doubt as to the value of the work carried out under the scheme during the past three years. The small annual deficit is (many times over) compensated for in the saving in foodstuffs, and damage otherwise caused by these destructive pests. During 1922 the work carried out under the Council's Rat Repression Scheme is summarised as follows:— Premises visited 1,911 Contracts renewed 24 Poison baits used 14,545 Value of contracts £248 6 0 Dead rats found 1,815 Cash for poison bait £23 7 6 Drains were tested at 94 premises in connection with this work, and in 41 cases were found to be defective. Most of these defective drains were in private houses. As the presence of rats in houses is usually regarded as prima facie evidence of drain defects, the work of the Rat Officer therefore is carried on in close co-operation with that of the district Sanitary Inspectors. The methods employed under the Rat Repression Scheme have been described in previous Annual Reports. It is only necessary, therefore, to state that as an inspection of the summarised figures shows, the work done during the year under this head has been as satisfactory as in previous years. Personal Cleansing Station. During 1922, 4,444 children and 274 adults were cleansed at the Personal Cleansing Station, Sheepcote Lane. Of the 4,444 children attending 262 were suffering from scabies and the remainder were verminous. These children, with the exception of 7, attended from the Public Elementary Schools in the Borough by arrangement with the Education Authority, the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The treatment and cleansing of the children is carried out under the supervision of the officers of the London County Council Public Health Department, while the disinfection of the clothing and of the homes is dealt with by the Borough Council's Sanitary Staff. The building of the new Cleansing Station, the plans and specifications of which were passed by the Borough Council and app oved by the Ministry of Health, was begun towards the end of the year, and the new premises, which are being constructed on the most modern principles, are expected to be ready for use in the early summer. The new station will prove a worthy addition to the Council's Public Health activities, and the Health Committee are to be congratulated on the persistence with 66 which they have pressed forward this most necessary measure for the health and well-being of the children attending the Public Elementary Schools. When it is remembered that in most of the houses in the more crowded areas of the Borough, their amenities do not include a bathroom, facilities for the cleansing of the occupiers of such tenements become an indispensable hygienic necessity. Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1922. Premises disinfected 2,257 Rooms disinfected 3,737 Staircases disinfected 180 Schools disinfected 75 Number of articles laundered 32,172 destroyed 678 ,, verminous persons (including 4,437 schoolchildren) 4,718 infectious disease contacts 774 Library books collected 322 Total Articles. No. * Weight. Tons. cwts. qrs. lbs. Bedding, &c., disinfected 71,872 161 2 0 20 lent 1,716 4 18 2 8 Verminous clothing, &c. 6,660 2 1 2 24 Total 80,248 168 2 1 24 Mortuary. Details as to the number of bodies received into the Mortuary and as to inquests held thereat are set out in the following:— Usual Place of Residence. Total. Battersea. Want's -worth Elsewhere. Residence unknown Inquest and post-mortem held at Mortuary 82 1 6 9 91 Inquest at Mortuary ; postmortem at St. James' Hospital 7 17 3 1 28 Inquest at Mortuary ; no post-mortem 13 18 5 — 36 Total inquests held Battersea Mortuary 102 36 14 3 155 Post-mortems without inquest,Battersea Mortuary 2 - - - 2 Total post-mortems held at Battersea Mortuary 84 1 6 2 93 Bodies received for sanitary reasons 4 4 Other bodies on which no inquest held 2 — — — 2 Total bodies received 108 36 14 3 161 67  Usual Place of Residence. Total. Battersea. Wands -worth Elsewhere. Residence unknown VERDICTS AT INQUESTS HELD— Natural causes 64 6 2 — 72 Accidental Death— Asphyxia 2 — — — 2 Blow struck in self-defence 1 — — — 1 Burns and scalds 1 2 1 — 4 Coal gas poisoning 1 — — — 1 Deaths under anaesthetic — 2 — — 2 Fall 12 10 2 — 24 Overlain 1 — ■ — — 1 Railway and street accidents 7 9 4 — 20 Tetanus following scratch — 1 — — 1 Unclassified 1 — — 1 Open Verdict— Found drowned — — 1 1 2 Injuries of unknown origin — 1 — 1 2 Stillborn 1 — — — 1 Want of attention at birth 1 — — — 1 Suicide— Cut throat 2 2 — — 4 Drowning — — 2 — 2 Firearms 2 — — — 2 Poisoning—Coal gas 1 — — — 1 Drugs, etc. 3 1 2 — 6 Homicide. Careless driving (manslaughter) — 1 — — 1 Criminal Abortion (wilful murder) 1 — — — 1 Smothering and strangulation ful murder) 1 1 - 1 3 Grand Total 102 36 14 3 155 Sanitary Staff. The personnel of the Staff of the Health Department will te found fully set out on page 4. During 1922 the following changes occurred :— In November Dr. Grace Skene, M.B., B.S.(Lond.), Assistant Medical Officer (Maternity and Child Welfare) was granted four months' leave of absence for private reasons, and Dr. Constance Beach, M.R.C.S., L.R.C.P. (Lond.) was appointed as locum tenens. It is with regret that I have to record the death, after a long illness, of Colonel C. E. Cassal, F.I.C., who for a period of 34 years was Public Analyst for the old Parish and the Borough of Battersea. During Colonel Cassal's illness, and pending the filling up of the appointment, Mr. B. H. Gerrans, F.I.C., carried on the duties of Public Analyst until June, 1922, when Mr. Charles Hackman, F.I.C., was appointed to the vacant office. In October Miss O. Baggallay was appointed Health Visitor to fill the vacancy created by the resignation of Miss H. Viney. 68 Protection of the Food Supply. Unsound Food. The following is a tabulated return of unsound food seized or voluntarily surrendered during 1922: Food. Quantity. Food. Quantity. Fish. Fruit (tinned). Cod 12 stone. Melocotones 16 tins Cod's Roe 4 boxes. Peaches 2 tins. Haddock 1 trunk. Haddock Roes 1 box. Meat and Poultry Hake 1 box. Bacon 2 qrs. 7½ lbs. Herrings 2 boxes. Rabbits 133 Mackerel 1 box. Plaice 10 stone. 3 boxes. Salmon 1 tin. Skate Wings 30 lbs. 10 stone. 1 box. Fruit (fresh). Miscellaneous. Apples 14 lbs. Biscuits 2 tins. 8 ½-barrels. Meat and 2 bushel boxes. Fish pastes 153 small tins. 120 boxes. Sauce 19 doz. small Cocoanuts 400 bottles. Pears 2 bushel Suet baskets. (granulated) 3½ lbs. Tomatoes 78 bundles. Wheat 19 cwts. 1 qr. 23 lbs. 64 boxes. Cow-houses. There is only one licensed cow-house remaining in the Borough, situate at 17, Wiseton Road. Slaughterhouses. There are now only two slaughterhouses remaining in the Borough, and in only one of these is any extensive or regular slaughtering business carried on. These premises are kept under systematic inspection, and during the year 1922, 311 inspections were made by the Council's inspector. The carcases of 1,413 animals (oxen 132, calves 12, sheep 863 and pigs 406) were examined after slaughter. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1922 was 83. Two new shops were opened during the 69 year, making a total of 85 butchers' premises carrying on business at the end of the year. All butchers' shops in the Borough are systematically inspected, and, in the main, they are well kept and provided with cold storage facilities. During the year 1,170 inspections of these premises were carried out by the Council's food inspector. Sale of Food and Drugs Acts. The total number of samples taken under these Acts during 1922 was 961. Of this number 77 (i.e., 8 per cent.) were certified by the Public Analyst to be adulterated. The following table gives details of the articles of which samples were obtained for purposes of analysis:- Formal Samples taken during Whole Year. Description of Article. Total No. taken. Genuine. Adulterated. Inferior Baking Powder 5 5 - - Butter 54 52 - 2 Cheese 20 20 - — Cocoa 10 10 - - Coffee 5 5 - - Cream 1 - 1 - „ (preserved) 17 4 13 - Lard 16 16 - - Margarine 10 10 - - Milk 726 690 36 - „ (separated) 15 10 5 - Olive Oil 11 11 - - Pepper 5 4 - 1 Preserved Meats, &c. 24 22 2 - Rice 12 9 2 1 Sausages 20 2 18 - Vinegar 10 10 - - Totals 961 880 77 4 Informal Samples. In addition to the foregoing, 139 informal samples were purchased. Of this number 11 (i.e., 7.9 per cent.) were reported by the Public Analyst to be adulterated. It will be noted that there 70 is a very close correspondence in the results of analysis of informal samples and of those taken under the provisions of the Acts. Informal Samples taken.-1st July to 31st December, 1922 (6 Months). Description of Article. Total No. taken. Genuine. Adulterated. Remarks. Arrowroot 4 4 - - Borax 3 3 - - Butter 83 79 4 - Camphorated Oil 5 5 - - Cocoa 10 10 - - Coffee 6 6 - - Margarine 5 5 - Two sold in plain wrappers. Milk 10 5 5 - Mustard 4 4 - - Pepper 4 4 - - Rice 5 3 2 - Totals 139 128 11 - Of the formal samples taken the bulk were of milk, viz., whole milk 726, separated 15. Of the 726 whole milk samples, 36, or 4.9 per cent. were certified as adulterated; 5, or 33 per cent. of the separated milk samples were certified to contain extraneous water. Milk sampling was carried out on 19 Sundays during the year, and 95 samples were purchased for analysis on these occasions. Samples of milk in course of delivery to the wholesale firms or to retailers to the number of 106 were taken during the year. The bulk of these samples were taken at Clapham Junction and South Lambeth railway stations. Samples of milk to the number of 78 were taken in course of delivery to public elementary schools, hospitals, &c., in the Borough. Proceedings were taken with regard to adulteration in 28 instances (fat abstracted 12, extraneous water 13, separated milk 3), particulars relating to which will be found set out in the summarised tables on pages 60-1 Warranty as a defence was pleaded in 6 cases, and in 5 was successful. Sausages and Preserved Meats, &c. Twenty samples of sausages and 24 of preserved meats, &c., were taken during 1922 under the provisions of the Sale of Food and Drugs Acts ; 18 of the sausages and 2 of the preserved meats, &c. 71 samples were reported by the Analyst to contain preservatives in small quantity varying from 5 to 12 grains boric acid per lb., and cautionary letters were sent in one or two cases. It is interesting to note that in regard to one large wholesale firm (outside the Borough) supplying retailers in Battersea, as a result of representations made to them by their customers, following upon the cautionary letters sent by order of the Council, the wholesalers appear to have ceased to supply sausages containing preservative. A considerable number of samples taken since September to the end of the year of this wholesale firm's sausages were on analysis reported to be " genuine." Rice. Seventeen samples of rice were taken during 1922 and submitted to the Public Analvst, and 4 were reported by him to be adulterated with adventitious mineral matter to a varying extent in the respective samples. In the case of one sample, in which the amount of foreign mineral matter was reported by the Analyst to be 0.9 per cent., by order of the Health Committee proceedings were taken against the vendor. He was convicted and fined £5 with £5 5s. costs. The practice of "facing," as it is termed, rice, is done with the object of imparting to the grain a lustrous or pearly appearance. The practice can in no sense be justified, and apart from the danger to health which may be involved, it is to the prejudice of the purchaser. Any apparently improved appearance of the grain disappears on cooking, and the practice, moreover, detracts from the value of rice as an article of food. Analysts' Reports. The following tables from the reports of the Public Analysts set out in detail the analysis of the articles submitted to them:- Article. By whom taken. Result of Analysis. Observations. 1st Quarter. 152 Milk Council's Inspector Genuine. 1 artificially coloured. 15 Milk „ Adulterated as understated:- (1) 13.71% required fat deficient and 2.23 % extraneous water (2)9.0% required fat deficient (3) 8.1 % extraneous water (4) 8.0% required fat deficient (5) 6.0% extraneous water (6)5.4% extraneous water 72 Article. By whom taken. Result of Analysis. Observations. Milk-contd. Council's Inspector (7) 5.0% required fat deficient (8) 5.0% required fat deficient (9) 5.0% required fat deficient (10) 3.6% extraneous water (11) 3.0% extraneous water (12) 2.9% extraneous water (13) 2.47% extraneous water (14) 2.36% extraneous water (15) 2.0% required fat deficient 3 Butter „ Genuine. 16 Butter „ Genuine. Boric acid present, under 0.5% in each case. 2 Butter „ Inferior Actual adulteration could not be certified. Boric acid present, under 0.5% in each case. 4 Separated Milk „ Genuine. 4 Separated „ Adulterated as Milk „ stated :- (1) 15.7% extraneous water (2) 15.17% extraneous water (3) 14.9% extraneous water (4) 1.7% extraneous water 6 Luncheon Sausage „ Genuine. 5 Rice „ Genuine. 1 Rice „ Inferior. Actual adulteration could not be certified. 5 Lard „ Genuine. 5 Vinegar „ Genuine. 5 Cocoa „ Genuine. 1 Sausage „ Genuine. 4 Sausages „ Adulterated as understated :- (1) 12.53 grs. of boric acid per pound (2) 10.437 grs. of boric acid per pound (3) 10.01 grs. of boric acid per pound (4) 9.184 grs. of boric acid per pound 73 Article. By whom taken. Result of Analysis. Observations. 5 Cheese Council's Inspector Genuine. 4 White Pepper „ Genuine. 1 White Pepper „ Inferior. Actual adulteration could not be certified. 5 Coffee „ Genuine. 4 Preserved Cream „ Adulterated as understated:- (1) 26.404 grs. of boric acid per pound (2) 24.22 grs. of boric acid per pound (3) 23.80 grs. of boric acid per pound (4) 22.141 grs. of boric acid per pound 1 Breakfast Sausage „ Genuine. 1 Brawn „ Genuine. 1 Fish Paste „ Genuine. Total number of samples analysed during the quarter 250 Adulterated 27 Inferior Article. By whom taken. Result of Analysis. Observations. 2nd Quarter. 168 Milk Council's Inspector Genuine. 6 Milk „ Adulterated as understated :- (1) 45.0% required fat deficient (2) 36.0% required fat deficient (3) 12.3% required fat deficient (4) 6.0% required fat deficient (5) 3.0% required fat deficient (6)3.0% required fat deficient 17 Butter „ Genuine. Boric acid present, under 0.5% in each case. 1 Sausage „ Genuine. 9 Sausages „ Adulterated as understated :- (1) 11.690 grs. of boric acid per pound (2) 10.857 grs. of boric acid per pound (3) 9.604 grs. of boric acid per pound (4) 9.541 grs. of boric acid per pound 74 Article. By whom taken. Result of Analysis. Observations. Sausages-contd. Council's Inspector. (5) 8.764 grs. of boric acid per pound (6) 8.673 grs. of boric acid per pound (7) 7.931 grs. of boric acid per pound (8) 6.258 grs. of boric acid per pound (9) 5.005 grs. of boric acid per pound 9 Luncheon Sausage „ Genuine. 7 Preserved Cream „ Adulterated as understated :- (1) 25.41 grs. of boric acid per pound (2) 24.542 grs. of boric acid per pound (3) 23.548 grs. of boric acid per pound (4) 22.932 grs. of boric acid per pound (5) 22.435 grs. of boric acid per pound (6) 22.064 grs. of boric acid per pound (7) 18.592 grs. of boric acid per pound 5 Margarine „ Genuine. Boric acid present, under 0.5% in each case. 5 Lard „ Genuine. 5 Olive Oil „ Genuine. 5 Cheese „ Genuine. 5 Cocoa „ Genuine. 2 Separated Milk „ Genuine. 2 Clotted Preserved Cream „ Adulterated as under. (1) 23.800 grs. of boric acid per pound (2) 9.604 grs. of boric acid per pound 1 Brawn „ Genuine. 1 Liver Sausage „ Genuine. 1 Fish Paste „ Genuine. 1 Cream „ Adulterated as understated :- (1) 18.963 grs. of boric acid per pound Note. I he term "Genuine" means that the composition of the samples so described was in accordance with the scientific definitions which can at present be given to the various articles dealt with, and that adulteration could not be certified in regard to them. The term "Inferior" means that the samples so described were of low quality or of doubtful character, and that actual adulteration could not be certified in regard to them. 75 Total number of samples analysed during the quarter, two hundred and fifty (250). Total number of samples adulterated, twenty-five (25). Total number of samples inferior, none (0). Third Quarter.-By virtue of the requirements of the Sale of Food and Drugs Acts, I have to report that the total number of samples examined by me under the Acts during the quarter ended 30th September, 1922, amounted to 317. All these were submitted by the Council's Inspector, 267 of the samples being taken with the necessary formalities required by the Acts, and 50 obtained informally. The following statement shows the nature of the samples submitted and the result of the analysis, the details of drugs and "other articles " being given below:- General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Milk 221 - 221 10 10 Butter 11 42 53 0 3 3 Cheese 5 - 5 0 - 0 Margarine 5 - 5 0 - 0 Lard 6 - 6 0 - 0 Drugs - 8 8 - 0 0 Other articles 19 - 19 8 - 8 Total 267 50 317 18 3 21 Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Borax - 3 3 - 0 0 Camphorated Oil - 5 5 - 0 0 Total - 8 8 - 0 0 76 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Baking Powder 5 - 5 0 - 0 Oil, Olive 6 - 6 0 - 0 Sausage 5 - 5 5 - 5 Luncheon Sausage 2 - 2 2 - 2 Fish Paste 1 - 1 1 - 1 Total 19 - 19 8 - 8 The samples grouped under the heading "Milk" were comprised as follows:- Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Milk 218 - 218 9 - 9 Separated Milk 3 - 3 1 - 1 Total 221 - 221 10 - 10 The following table gives in detail the character of the adulteration reported:- Case No. Nature of Report. 289 (Separated) Coloured with Annatto 310 10.2% extraneous water 313 14.5% extraneous water 334 14 % extraneous water 344 10 % extraneous water 363 20 % milk fat deficient 433 1.5% extraneous water 455 4.5% extraneous water 472 4.5% extraneous water 485 11 % extraneous water The average composition, in regard to milk fat and solids-not fat, of the 209 milk samples reported as genuine proved to be:- % Milk fat 3.57 Solids-not-fat 8.83 Total milk solids 12.40 77 Fifty-three butters in all were submitted for examination. Of these 3 —all procured informally-were reported as adulterated, one as consisting entirely of margarine; one as being a mixture of margarine (at least 50 per cent.) and butter; and one as containing a slight excess of water (0.9 per cent.) over the permissible amount of 16 per cent. All butter samples were tested for the presence of preservatives, with the following results:- Number of samples containing a boron preservative 34=64.1% „ „ free from a boron preservative 19=35.9% Of the 31 samples of butter reported as genuine and which were found to contain a boron preservative, the mean content of boric acid was found to be 0.14 per cent., expressed in terms of crystallised boric acid, equivalent to 9.8 grains per lb. of butter. In no case was the percentage of boric acid found to exceed 0.5 per cent. Of the other articles submitted, 8 (or 42.1 per cent.) were reported against, the nature of the sample and its adulteration being as under Case No. Nature of Sample. Nature of Report. 493 Sausage 9.5 grains Cryst. Boric Acid per lb. 494 Sausage 6.9 grains Cryst. Boric Acid per lb. 495 Luncheon Sausage 7.7 grains Cryst. Boric Acid per lb. 496 Sausage 5.1 grains Cryst. Boric Acid per lb. 497 Fish Paste 8.6 grains Cryst. Boric Acid per lb. 498 Sausage 5.1 grains Cryst. Boric Acid per lb. 499 Sausage 7.7 grains Cryst. Boric Acid per lb. 500 Luncheon Sausage 7.7 grains Cryst. Boric Acid per lb. In conclusion, I have to report that the total adulteration during the quarter amounted to, for formal samples, 6.7 per cent.; for informal samples, 6.0 per cent.; and for all samples, 6.6 per cent. The cost of the above analyses was covered by the Analyst's salary of £600 per annum. Fourth Quarter.-By virtue of the requirements of the Sale of Food and Drugs Acts, I have to report that the total number of samples examined by me under the Acts during the quarter ended 31st December, 1922, amounted to 283. All these were submitted by the Council's Inspector, 194 of the samples being taken with the necessary formalities required by the Acts, and 89 obtained informally. 78 The following statement shows the nature of the samples submitted and the result of analysis, the details of "Other Articles" being given below:- General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Milk and Cream 173 10 183 6 5 11 Butter 5 41 46 0 3 3 Cheese 5 - 5 0 - 0 Margarine - 5 5 - 0 0 Coffee - 6 6 - 0 0 Cocoa - 10 10 - 0 0 Mustard - 4 4 - 0 0 Pepper - 4 4 - 0 0 Other articles 11 9 20 2 2 4 Total 194 89 283 8 10 18 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot - 4 4 - 0 0 Rice 6 5 11 2 2 4 Vinegar 5 - 5 0 - 0 Total 11 9 20 2 2 4 The samples grouped under the heading "Milk and Cream" were comprised as under: Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Milk 167 10 177 6 5 11 Separated Milk 2 - 2 0 - 0 Preserved Cream 4 - 4 0 - 0 Total 173 10 183 6 5 11 79 Of the 177 samples of milk submitted 11, or 6.2 per cent., were reported against, the formal samples being the following:— Case No. Nature of Report. 537 6½% extraneous water. 572 2% extraneous water. 653 9% extraneous water. 660 42% milk fat deficient. 663 Coloured with annatto. 688 10% milk fat deficient. Of the informal milk samples reported against, 4 were found to be deficient in milk fat, whilst one contained extraneous water, and, furthermore, was deficient in milk fat. The average composition, in regard to milk fat and solids-not-fat of the 166 samples of milk submitted during the quarter and reported as genuine, was as follows % Total milk solids 12.83 Milk fat 3.86 Solids-not-fat 8.97 Of the three informal butters reported against, two were found to contain margarine, whilst one contained a slight excess of boric acid. Of the 26 samples of butter examined, 24 were found to be free from any preservative other than common salt; 21 contained boric acid in quantities under 0.5 per cent. crystallised boric acid; whilst 1 contained a slight excess of this preservative, as stated above. The average content of boron preservative (in terms of crystallised boric acid) contained in the 19 samples of butter (reported as genuine) which contained this preservative, amounted to 0.19 per cent., equivalent to 13.3 grains per lb. butter. Of the 20 "Other Articles" submitted, 4, or 20 per cent., were reported against, the 2 formal samples (both of Rice) being as under:- Case No. Nature of Report. 609 0.03% excess mineral matter. 610 0.40% excess mineral matter. 80 Both informal samples of Rice reported against were also found to contain excess mineral matter. Note. By "excess mineral matter" is meant the amount of mineral matter removable from the surface of the grain in excess of the suggested limit of 0.5 per cent. In conclusion I have to report that the total adulteration during the quarter amounted to, for formal samples, 4.1 per cent.; for informal samples, 11.2 per cent.; and for all samples, 6.3 per cent. The cost of the above analyses was covered by the Analyst's salary of £600 per annum. Milk and Cream Regulations. All samples of milk are examined by the Public Analyst for the presence of preservatives, but in no case out of the 751 samples of milk taken for analysis was a preservative reported to be present. Public Health (Milk & Cream) Regulations, 1912 and 1917. The objects of these Regulations were (a) to prohibit the addition of preservatives to milk intended for human consumption and (b) to secure that cream containing preservatives shall be distinguished at all stages of sale from cream to which no preservative has been added. The 1912 Regulations prescribed the form of label to be used on all receptacles containing preserved cream, but the amount of preservation which might be added was not, however, specified. In 1917, Amending Regulations were issued by the Local Government Board fixing the maximum quantity of boron preservative which was permitted to be added to preserved cream at 0.4 per cent., or 28 grains boric acid to the pound, and requiring declaratory labels to be affixed to the receptacles containing it, stating that such cream was not suitable for infants and invalids. The Regulations, even as amended, appear to be misleading, and they seem to be regarded by the trade as implying that the addition of boric acid to cream up to 0.4 per cent. was permissible so long as the amount was declared, although the High Court has decided that the addition of boric acid to cream in quantities considerably less than 28 grains per pound was illegal. The Local Government Board, in a letter which accompanied the Order of 1917, amending the Regulations, stated that the question as to boric acid in cream was one of some difficulty, and that it had been decided to appoint a small expert committee for the purpose of enquiring further in regard thereto, and that the appointment of this Committee having been postponed in consequence of the war, Lord Rhondda, the president of the Board, 81 had decided to issue an Order as an interim measure. The Board further stated in the circular (1) that the proposed enquiry might show that the limit of boric acid in cream should be less than the maximum fixed by the regulations as amended, (2) that dealers in this article should make every effort to reduce the preservative to the smallest possible amount or even to dispense with its use entirely, and (3) that the Department must not be regarded as having decided the question as to whether the amount of boric acid specified in the amended Regulations was or was not injurious to the consumer. It is a regrettable fact that though six years have elapsed since the issue of the Order and the accompanying circular, no steps appear to have been taken to proceed with the proposed enquiry. The question of the use of preservatives in cream is, having regard to the importance of this article of food in the case of infants and invalids, a most urgent one. The Departmental Committee report on the use of preservatives and colouring matters in food recommended that the amount of boron preservative permitted in cream should not exceed .25 per cent., or slightly more than half that fixed by the Amended Regulations. The effect of these Regulations has been to embarrass and otherwise render administratively difficult the duty of Sanitary Authorities under the Sale of Food and Drugs Acts in their efforts to protect the public from the risk of injury to health from the use of preservatives in cream. The need is therefore urgent for the holding of an enquiry into the use of preservatives not only in cream but in the case of other foodstuffs as well, and the Council decided in September to support the action of Kensington Borough Council in the representations in this direction which they made to the Ministry of Health on the question of preservatives in cream. 1. Milk and cream not sold as preserved cream:- (a) (b) Number of Samples examined for the presence of a preservative. Number of Samples in which a preservative was reported to be present. Milk 751 Nil. Cream 1 1 2. Cream sold as preserved cream:- (a) Samples submitted for analysis to ascertain if the statements on the labels as to preservatives were correct :- 1. Correct statements made 17 2. Statements incorrect Nil Total 17 82 (b) Determinations made of milk fat in cream sold as preserved cream:- 1. Above 35 per cent. 17 2. Below 35 ,, Nil. Total 17 (c) Instances where (apart from analysis) the ments as to labelling or declarations of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed 3 (d) Particulars of each case in which the Regulations have not been complied with, and action taken:- 1. Sold as "Cream" with declaratory label. No verbal declaration made at time of purchase. No declaratory label was affixed to receptacle in which the cream was stored. Defendant summoned. Result, no fine, £2 2s. costs. 2. Sold as "Preserved Cream." No tory label was upon the receptacle in which the cream was stored. Other requirements were complied with. Defendants summoned. Case dismissed. Magistrate regarded the offence as an oversight on part of seller. 3. Sold as " Preserved Clotted Cream."No declaratory label was affixed to receptacle in which cream was stored. Other requirements were complied with. Defendants summoned. Result, no fine, £2 2s. costs. 3. Thickening substances:- Any evidence of their addition to cream or to preserved cream and action taken when found Nil. 4. Other observations (if any) Nil. Milk and Dairies (Amendment) Act, 1922, and the Food Control Order, 1921. 5. Action taken under Section 4 of the Milk and Dairies (Amendment) Act, 1922; and the Food Control Order, 1921:- (1) No. of samples of milk certified by Public Analyst to contain colouring matter 3 83 (2) Action taken thereon- (a) Vendors cautioned 2 (b) Vendor summoned 1 (Proceedings pending at end of year. Since determined. Summons dismissed on payment of £1 3s. costs.) Milk and Dairies (Amendment) Act, 1922. The provisions of this Act with the exception of those relating to the grading of milk came into force on the 1st September, 1922. The principal provisions of the Act are those postponing still further (until 1st September, 1925) the coming into force of the Milk and Dairies (Consolidation) Act, 1915 (Sec. 1): Power given to Sanitary Authorities under certain conditions to refuse to register or to remove from the register retail Purveyors of Milk: continues with modifications the provisions as to grading of milk which are at present contained in Orders made by the Food Controller and the Ministry of Health under the Ministry of Health (Continuance) Act, 1920, up to the 1st January, 1923, when the provisions of Section 3 will come into force. (Sec. 3.): continues and extends the provisions of an existing Order of the Food Controller and prohibits the addition of any colouring matter or water, or reconstituted milk, or skimmed or separated milk, to milk intended for sale (Sec. 4): prohibits under a heavy penalty the sale of milk of a cow suffering from tuberculosis of the udder where it is proved that the seller knew or could have ascertained by ordinary care that the cow was suffering from that disease. (Sec. 6): empowers the Ministry of Health to make Regulations prescribing standards for dried milk and condensed milk and the manner in which dried, condensed, skimmed or separated milk is to be labelled or marked. The Act, it will be noted, is a weak (temporary, it is to be hoped) substitute for the Milk and Dairies (Consolidation) Act, 1915, the operation of which is postponed for another three years. The provisions contained in Section 2, dealing with the power of Sanitary Authorities to refuse to register or to remove from the register retail purveyors of milk are, so far as London is concerned, similar to those already contained in the London County Council (General Powers) Act, 1908. The main difference between the two Acts is practically that relating to procedure. Under the General Powers Act and this Act there is an appeal by any person who thinks himself aggrieved by the decision of the Sanitary Authority to a Court of summary jurisdiction within 21 days from the date of such decision. Under the Milk and Dairies (Amendment) Act, before deciding to refuse to register or remove from the register a retail purveyor of milk, the Sanitary Authority must serve notice upon him setting out the reasons why it is proposed to remove him from the register or refuse to register him, and requiring him at not less than 7 days' notice to appear before them to show cause to the contrary. 84 The retailer may, within 21 days, appeal to a Court of summary jurisdiction against the decision of the Sanitary Authority, and either the retailer or the Sanitary Authority may further appeal to a Court of Quarter Sessions. The decision of the Sanitary Authority is not to take effect pending appeal. In the case of a proposed refusal to register, the provisions of the Order which prohibits a person from carrying on the trade of a dairyman unless he is registered are not to take effect until the appeal is finally determined. Power is also given under Sec. 2 to the Court before whom any retailer is convicted of an offence relating to milk or dairies, in addition to any other penalty, to remove him from the register for such period as the Court may think fit. The procedure under the Milk and Dairies (Amendment) Act in regard to registration in practice will be found, in my opinion, complicated and cumbersome, and will lead to delay and inconvenience to all concerned. Moreover the fact, that, pending the result of a final appeal against a proposed refusal by the Sanitary Authority to register, milk can be sold by an unregistered dairyman or milk purveyor, is an unsatisfactory feature of the Act. The provisions of Section 4 prohibiting the addition of any colouring matter or of water to milk intended for sale are useful, and will enable Sanitary Authorities to take proceedings under this Act rather than under the Sale of Food and Drugs Acts, and so avoid the warranty defence which frequently acts as a barrier to proceedings by Local Authorities for the fraudulent addition of water to milk. Ice Cream. There are 148 premises in the Borough from which ice cream is sold. Eight of these premises are occupied by Italians, all of whom carry on the sale of this article of food from street barrows. All premises, stalls and barrows are kept under systematic inspection. During 1922, 14 ice cream premises were removed from the register and 40 were added. There was, therefore, an increase of 26 in the number on the register as compared with 1921, due probably to the decrease in the price of the ingredients used in the preparation of this popular commodity. The trade appears gradually to be passing away from the Italian colony and into the hands of the English traders, a change which, on sanitary grounds, is to be welcomed. During the year 336 inspections of ice cream premises were made by the Council's inspector, and 11 notices were served to remedy defects found on inspection. In addition, during the summer season a daily inspection of the street barrows and the utensils and vessels, glasses, towels, &c., used by the owners of these vehicles was also carried out. 85 Milk Shops. The number of premises in which milk is sold in Battersea is 130. All milk shops are kept under strict inspection by the Council's inspector, and during the year 319 inspections were carried out and 10 notices were served to remedy defects found on inspection. These mainly referred to dirty or unsuitable premises and other minor defects. Three unregistered milk vendors were discovered during the year and were reported to the Health Committee, who directed cautionary letters to be sent to the offenders. Fish Shops. Fish shops in the borough in which fish, either cooked or uncooked, is sold, or in which the curing of fish intended for sale is carried on, number 63. All these premises are kept under systematic inspection. During 1922, 293 inspections were carried out, and 20 notices were served for various insanitary conditions found on inspection. In 3 fish-curing premises and one fried fish shop, the by-laws made by the London County Council regulating the conduct of these businesses were found to have been contravened. On the instructions of the Health Committee the respective owners of these businesses were cautioned. Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1922 was 90. During the year, 194 visits of inspection were made by the Council's Inspector and 10 notices were served to remedy various minor sanitary defects. Street Stalls for the Sale of Food. There are in the Borough a large number of street vendors of food stuffs of various character, viz., fruit 42, vegetables 43, fish 21, meat and rabbits 8, sweets and confectionery 6, other foods 7. These street stalls are kept under systematic inspection. The premises where the stocks are kept, from which the street stalls are supplied, are also inspected. Where these premises are, as in some instances, outside the Borough the Medical Officer of Health of the Borough is notified. During the year it was found necessary to serve 18 notices to remedy defects or insanitary conditions in premises in which food intended for sale from street stalls was found to be stored. The food sold from these stalls is generally sound and of good quality and sold at a lower price than is usually charged in the shops, and they are a boon to the poorer class of the community. Attention has been drawn in previous Annual Reports to the advantage, from the public health standpoint, of having these street vendors of food intended for human consumption registered by the Local Authority, and powers should, in my opinion, be given to enforce this provision. 86 Factories, Workshops, Workplaces and Homework. 1.-Inspections of Factories, Workshops and Workplaces (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 760 105 1 Workshops (including Workshop Laundries) 844 111 - Workplaces (other than Outworkers' premises included in the Table on page 92) 1,924 71 — Total 3,528 287 1 2. Defects found in Factories, Workshops and Workplaces. Particulars. Found on Inspection. Remedied. Referred to H.M. Inspector. Number of Prosecutions. 1 2 3 4 5 Nuisances under Public Health Act- Want of Cleanliness 70 70 - Want of Ventilation 4 4 Nil. - Overcrowding - - - Want of drainage of floors 1 1 - Other nuisances 94 94 1 Sanitary accommodation Insufficient 23 23 - Unsuitable or defective 118 118 - Not separate for the sexes 1 1 - Offences under the Factory and Workshop Act- Illegal occupation of underground bakehouse (Sec. 101) - Lack of Special Sanitary Requirements to Bakehouses (Secs. 97 to 100) 22 22 - Other Offences (excluding Offences relating to Outworkers which are included in the Table on page 92) - - - Total 333 333 - 1 87 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1922:— Bakehouses' 29 Bootmakers 31 Dressmakers 20 Laundries 5 Milliners 12 Tailors 44 Other Trades 200 Total number of workshops 341 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 17 Notified by H.M. Inspector 7 Underground Bakehouses (Section 101), in use at end of the year 27 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1922 Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Barge builder 2 28 - - - Baker 47 198 27 70 18 Bootmaker 12 23 4 - - Builder 5 106 8 - - Butter blender 1 48 24 11 10 Carpenter 1 9 - - - Chemical works 4 200 20 51 30 Chaff & Forage 4 37 - 3 - Cycle Maker 3 6 3 - - Dyer 1 30 - 24 - Engineer 28 646 31 4 - Flour mills 2 198 - 22 - Firewood cutter 11 35 3 24 - Foundry 3 72 - - - Lift maker 2 20 - - - Mason 5 349 5 - - Mineral water 2 24 - 23 - Motor repairs 17 259 7 - - Printer 18 74 19 20 - Steam laundry 17 70 18 543 97 Other Trades 83 3,934 356 1,077 481 Total 268 6,366 525 1,872 636 88 The duties of sanitary authorities in relation to the sanitation of factories are few, and are limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. Twenty-two new factory premises were added to the register during the year, dealing with— Baker 4 Carpenter 1 (Previously workshops) Engineer 3 Bootmaker 1 Firewood cutter 1 Builder 1 Other trades 11 Nineteen factories were discontinued during the year. During the year 90 preliminary and 15 Statutory notices were served under the Public Health (London) Act, 1891, for defects found on factory premises, for the most part relating to defective or insufficient sanitary accommodation, all of which were duly remedied. Workshops. The following is a list of the workshops on the register at the end of 1922:- Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 29 29 49 1 - - Blind maker 2 2 3 2 - - Bootmaker 31 31 45 2 - - Carpenter 3 4 7 1 - - Coach builder 10 12 26 2 - - Cycle maker 6 8 8 - - - Dressmaker 20 31 - - 41 10 Embroiderer 3 4 2 - 26 - Farrier & smith 14 14 33 1 - - Firewood cutter 2 2 1 - 1 - Laundry 5 10 2 - 17 - Mason 3 3 23 - - - Millinery 12 12 - - 29 12 Motor repairs 14 14 35 6 - - Piano maker 3 6 31 3 - - Photographer 3 5 6 - 3 2 Picture framer 2 2 2 - - - Rag sorter 15 16 23 6 12 - Saddler 2 2 3 - - - Tailor 44 45 48 1 62 4 Upholsterer 16 17 25 4 14 - Other Trades 102 113 246 44 62 20 Totals 341 382 618 73 267 48 89 Forty-three new workshops were added to the register, dealing with:- Boot-making 2 Builder 2 Carpenter 1 Carver 1 Coach painting 1 Cycle Maker 1 Dressmaking 3 Mason 1 Motor repairs 4 Piano-maker 1 Photographer 1 Rag sorting 1 Tailoring 5 Upholstering 4 Miscellaneous 15 Thirty-eight workshops were discontinued or became factories during the year. 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 1922 :— Trade. No. of Workshops. Protected Persons employed. Women. Young Persons. Total. Dressmaker 2 - 2 2 Farrier 1 - 1 1 Milliner 2 2 1 3 Motor Repairs 1 - 1 1 Upholsterer 1 - 1 1 Tailor 3 4 1 5 Miscellaneous 7 - 24 24 Totals 17 6 31 37 Outworkers. During 1922, 560 names and addresses of out-workers were received in 121 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 146 names and addresses of 92 out-workers, which were sent in by employers, were found to refer to other districts, and were accordingly forwarded to the Medical Officers of Health of those districts. Male. The following table shows the number of male out-workers' premises registered in the Borough, together with the trades and the number of persons employed:— 90 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaking 29 29 24 Glovemaking 1 1 1 Tailoring 40 40 59 Other Trades 3 3 6 Totals 73 73 90 Twenty-five new male out-workers (out-workers not previously registered) were registered during the year. There were 91 inspections made of male out-workers' premises during 1922, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 3 cases to remedy insanitary defects found on inspection, mainly relating to want of cleanliness of premises. Two cases of infectious disease were notified from premises occupied by male out-workers, viz., influenzal pneumonia. In each case all necessary precautionary measures were taken to prevent spread of infection. Female. The following is a list of the female out-workers registered in the Borough, together with the trades and the number of persons employed:- Trade. Number on Register. Persons Employed. Premises. Workrooms Boxmaking 9 9 9 Dressmaking 45 45 49 Embroidery 41 41 42 Fancy goods 10 10 10 Glovemaking 3 3 3 Fine needlework 9 9 11 Tailoring 38 38 43 Underclothing 4 4 5 Other trades 25 25 25 Total 184 184 197 91 Sixty-one new female out-workers (out-workers not previously registered) were registered during the year. 468 inspections of female out-workers' premises were made by the woman workshops' inspector (Miss Round). It was found necessary to serve notices under the Public Health (London) Act, 1891, to remedy defects found in 4 cases on inspection, mainly for dirty and defective condition of premises. Four cases of infectious diseases, viz., scarlet fever 1, and diphtheria 3, were notified from female out-workers' premises. In all cases special precautionary measures as required were taken to prevent spread of infection. During the year proceedings were instituted against two employers for failure to send in their lists by the 1st February, 1922. The summonses were withdrawn on payment of £1 1s. costs in each case. Bakehouses. There were 76 bakehouses on the register at the end of 1922. Of these 47 use power, and are therefore factories. Forty-nine of the bakehouses are above ground, and 27 are under ground. Three bakehouses above ground were discontinued, and 1 above and 1 below ground were re-opened during the year. 278 inspections were made during the year, and 22 intimation and 17 statutory notices were served, mainly for failure to carry out the half-yearly lime-whiting of the bakehouses within the statutory period. Warehouses and Wharves. At the end of 1922, there were 46 premises on the register, including railway yards. These premises were systematically inspected during the year, and 54 inspections were made. Two notices were served to remedy nuisances found on inspection. 92 Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Insstances. Orders made (S. 110) Prosecutions (Secs. 109, 110) Sending twice in the year. Sending once in th e year. Failing to-keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel- (1) Making 46 38 135 2 1 3 48 - 2 7 7 - 6 - - (2) Cleansingand Washing - - - - - - - - - - - - - - - Furniture and Upholstery 4 - - 1 - 1 6 - - - - - - - - Other Trades 8 - 43 2 - 40 12 - - - - - - - - Total 58 38 178 5 1 44 66 - 2 7 7 - 6 - - 93 Housing. During the year 1922, the shortage of housing accommodation in Battersea was still one of the most pressing problems of the Council. Very many cases of hardship and of serious overcrowding resulting from the lack of adequate housing accommodation to meet the needs of the Borough, have been brought to notice through the active and systematic surveys of the district, which the Housing Committee have caused to be made. The large numbers of applications registered, amounting to 2,000 during the last few years, for housing accommodation on the Council's Housing Estates, emphasise still more eloquently the seriousness of the situation. The Council have only been able to make provision for a small percentage of these applicants, the resources at their disposal for the provision of houses for the working-classes being limited owing to the lack of further available building sites within the Borough. Unfortunately, there seems to be no immediate prospect that the congestion and, even in certain areas of the Borough, the serious overcrowding, will be relieved by the provision of housing accommodation outside the Borough. The continuance of such unsatisfactory housing conditions as are now known to prevail in Battersea, in some of the lower Wards, constitutes a danger to the public health, and from the social and the moral standpoints, the situation is still further to be deplored. During the past 4 years, the Council through the Housing Committee have done what they could to provide additional housing accommodation in the Borough, and during 1922, 56 tenements on the Latchmere site and at Savona Street were completed and were occupied by 56 families consisting of 303 persons. Overcrowding. The extent to which overcrowding exists in the Borough is difficult to estimate with accuracy. There is no doubt, however, that in some of the lower Wards of the Borough there is considerable congestion, and in some areas of these Wards, serious overcrowding exists. In this connection the report of the Registrar-General on the recent census returns in relation to the Borough of Battersea is of interest. The population of the Borough as estimated by the Registrar General is 169,200. The total number of structurally separate occupied dwellings in the Borough is 27,191, containing 157,323 occupied rooms with an average of 0.96 rooms per person. The buildings are classified into five different groups, as follows:— I. Undivided private houses 21,211 II. Structurally divided houses 724 III, Flats, tenements, &c. 3,518 94 IV. Shops 2,144 V. Others, including shops, factories, workshops, wash-houses, public institutions, places of worship, amusements, &c., housing 2,778 persons 117 27,714 The number of unoccupied dwellings on the night of the Census was 523, containing 2,863 rooms. Size of dwellings.—Slightly more than half the total dwellings (15,297) contain six to eight rooms, 8,648 four to five rooms, 1,931 one to three rooms, and 1,740 have nine or more rooms. Size of families.—The average size of families is shown as 3.82 in 1921, as compared with 4.17 in 1911, the corresponding figures for the County of London being 3.79 and 4.15 respectively. The total number of private families is 42,988. The return of dwellings occupied by private families in Battersea shows that there are 11,385 (about 25 per cent.) families living in three rooms, 9,958 (22.3 per cent.) living in four rooms, (approximately half the total private families occupying three to four rooms). Twenty-five per cent. of the families occupy one or two rooms and the remaining 25 per cent. occupy five or more rooms. The Census returns further show that there has been a marked increase during the decade in the number of families occupying less than five rooms each. In 1911, 70.4 per cent. of families were living in less than five rooms each, while in 1921 the number of families occupying four rooms or less was 75.3 per cent. of the total families. The average density in Battersea as measured by the number of rooms per person is 0.96 and is exactly equal to that of the average for the County of London. The density varies as might be expected in the different Wards, ranging from .73 in Winstanley Ward to 1.4 in Broomwood. Following Winstanley, Nine Elms Ward shows next highest density (.78) and then in decreasing ratio, Church (.82), Park (.88), Latchmere (.90), Shaftesbury (.97), St. John (1.10), and Bolingbroke Ward (1.20). An examination of the figures extracted from the Census returns, shews that in relation to the Borough as a whole, the figures do not appear to suggest that actual overcrowding is prevalent. The Registrar-General in his report points out, however, that, although there has been a marked decrease in the size of families during the intercensal period 1911-1921, leading to an improvement in the unit of accommodation, this improvement has only affected the small family group of one or two persons, and that a deterioration has taken place for all other sizes of families including the larger families whose density was already approaching the region of overcrowding. 95 Moreover, in considering the index adopted by the RegistrarGeneral as a measure of "overcrowding" (i.e. number of rooms per person), it should be borne in mind that calculations based on this method afford no reliable estimate of actual overcrowding in the absence of data as to size of rooms, &c. New Houses Provided by the Council. Latchmere Estate Extension. During 1922, 52 tenements, the plans and lay-outs for which were prepared, and the construction commenced in 1921, were completed and occupied as soon as the individual dwellings were ready for occupation. These dwellings form a valuable addition to the Latchmere Estate, and appended will be found a detailed description of the Estate Extension. Description.—The accommodation in each flat consists of:— Description. Approximate area of Living room sq. ft. Bedroom sq. ft. Bedroom sq. ft. Bedroom sq. ft. Scullery sq. ft.['] Four Roomed Tenements. (a) First floor 181 153 100 651 61¾ (b) Ground floor 180 150 100 65 61¾ & 62 Three Roomed Tenements. (a) First floor 150½ 150½ 105 — 53½ (b) Ground floor 159 148 80 63 Each tenement was fitted with an Inter-oven stove (with hot water boiler) in the living room, a gas copper, bath, and a gas fire in each bedroom. Electric light has been installed. Each tenement has a separate garden, varying in size from about 14 ft. by 25 ft. to about 50 ft. by 30 ft. The cost of the buildings, roads, sewers, &c., amounted to £34,528, as compared with an estimated cost of £42,310, the amount ranking for the Ministry's subsidy being £28,968. Rent.—The exclusive rent charged for these tenements has been provisionally fixed at 9s. 3d. and 11s. 1d. for the three-roomed and four-roomed tenements respectively. Despite long negotiations 96 and many deputations, the Ministry of Health have informed the Council that they cannot approve of these rents. The matter has, therefore, been referred to the Tribunal whose decision has not yet been promulgated.* Savona Street. The four tenements in course of erection at Savona Street, referred to in the Annual Report of the Medical Officer of Health for 1921, were completed in September, 1922. These tenements, which are practically identical in plan and construction with those erected on the Latchmere Estate Extension, cost £2,695 to build (£505 below estimate). Of this sum, £1,700 will rank for subsidy, and the remainder will be borne out of General Rate. The Ministry have approved an exclusive rental of 9s. 3d. per week for these tenements, which are now occupied. . Selection of Tenants.—The selection of tenants for the new tenements on the Latchmere Estate Extension and Savona Street, was delegated to a sub-committee of the Housing Committee. 1,922 applications for accommodation on the Council's Housing Estates were considered from persons resident in the Borough, which may be summarised as follows:— About to be married 31 Two in family 221 Three „ 390 Four „ 315 Five „ 140 Six „ 68 Seven „ 17 Eight „ 14 Nine „ 9 Ten „ 2 Information not given (applicants suited, &c.) 715 1,922 The four-roomed tenements were allocated to families of not less than five in number and the 3-roomed tenements to families of not less than 4 in number. A preliminary examination of the applications shewed that 153 families were living in one room—in some cases as many as 6 in family. *The decision of the Rents Tribunal was given early in 1923, fixing the exclusive rentals for the three-roomed and the fourroomed tenements at 10s. and 11s. 6d. respectively. 97 In view of the large number of applications, and of the relatively small number of tenements to be allocated, preference was given to families living in insanitary and/or overcrowded conditions. Particulars of families housed may be summarised as follows:— (i.) In the 16 four-roomed tenements, 35 adults, 71 children (4 of these families previously lived in 1 room, 6 in 2 rooms and 6 in 3 rooms). (ii.) In the 40 3-roomed tenements, 83 adults, 114 children. (29 of these families previously lived in 1 room, 11 in 2 rooms.) The total number of persons thus accommodated is—118 adults, 185 children. Disused Fire Station—Chatham Road. The Council were approached by the London County Council in regard to the purchase of the disused fire station at Chatham Road. The Council decided to purchase this building at a cost of £8,000, to convert the lower portion into a Public Bath and to utilise the upper portion, which was arranged in tenements for the accommodation of the firemen, for housing purposes. By this means, 12 additional tenements (1 four-roomed, 9 three-roomed and 2 two-roomed) would be made available. The Ministry held a local inquiry in respect of the Baths part of the scheme and have agreed to the raising of a loan of £3,500 for this purpose. With regard to the housing portion, the Ministry having notified that this expenditure cannot rank for subsidy under the assisted Housing Scheme, application has been made to the London County Council for a loan of £4,500. This loan has now been sanctioned. It is expected that these 12 additional tenements will be ready for occupation early in 1923. New Houses Erected by Private Enterprise. During the year, thirteen houses were erected on what is known as the Battersea Rise Estate (West Side, Clapham Common and Alfriston Road). The houses in Alfriston Road were generally of the plan of houses which are now usually erected, consisting of two rooms, a combined kitchen scullery on the ground floor, and two large and one small bedroom on the first floor with bath and w.c. also on that floor. The houses on West Side are somewhat larger than those on the Alfriston Road site. Plans were submitted for 19 more houses on this estate and also for 3 houses in Roseneath Road, but these houses were not completed at the end of the year. 98 Repair of Unfit Houses. The systematic inspection of house property was actively continued during 1922, and a large number of houses, found on inspection to be more or less seriously defective or insanitary were reported to the Housing and Health Committees for action under the Housing and Town Planning, &c. Act, 1919, or the Public Health (London) Act, 1891. The policy of the Council with regard to action under the Housing Act as carried out during the past 3 years, has been continued, resulting in much valuable work being done in securing the repair of seriously unfit houses. The number of seriously insanitary houses dealt with during the year under review will be found set out in the summary on page 102. The number of insanitary houses reported for action under Section 28 was considerably below that for the preceding two years. This is due to two causes, (a) the relatively smaller number of houses found on inspection to be so seriously defective as to require action under the Housing Act, and (b) the considerable number of houses dealt with either informally or under Sec. 28 notices in 1921, the works of repair in regard to which had not been completed in that year. If the work carried out in securing the completion of the repairs to these latter houses is taken into account, it will be found that the volume of work in regard to action under Sec. 28 compares favourably with that carried out during the previous years. During 1922, it was found necessary for the Council to carry out work in default in respect of only one house, the cost incurred amounting to £84 10s. 2d. Appeals were made by the owners concerned against Notices under Sec. 28 of the Housing, Town Planning, &c., Act. 1919, requiring execution of certain works to insanitary house properties in Orville Road, Auckland Road, and Ingrave Street. The first-mentioned case referred to 9 houses numbered 1 to 17 Orville Road, the grounds of appeal being:— (i.) That the Notices had not been legally or regularly served. (ii.) That the provision of adequate light and ventilation of the staircases contained in the Notice was unnecessary and unreasonable. (iii.) The Notices were bad in law because the notices required the work to be carried out to the satisfaction of the local sanitary authority. Alternatively:— (iv.) The Notices were bad in law by reason of the inclusion of the work specified in (ii.). 99 The Ministry held a local inquiry, the result being given in favour of the Council: the formal Order of the Minister upheld the Notices, with the exception that the requirement (iii.) above should be deleted. Each party was directed to pay their own costs, and the Appellant was ordered to pay the costs incurred by the Ministry. In the next case the owner of the premises No. 22 Auckland Road appealed against the Notice served upon him under Sec. 28 on the grounds, inter alia:— (1) That the Notice had not been legally or regularly served. (2) That certain specified works in the Notice and Schedule were not necessary. A local enquiry was held on the 21st July, 1922, and the formal Order was subsequently issued by the Minister, subject to three minor amendments. The appellant was directed to pay the costs incurred by the Ministry. 13 Ingrave Street. Information was received on 4th August from the Ministry of Health, that the owner of this house had appealed against the notice re-served under Sec, 28 of the 1919 Act. Having considered the correspondence, &c., and the Council's observations, the Ministry decided in view of the circumstances of the owner to make an informal inspection in lieu of the usual local enquiry. Eventually the Ministry upheld the notice as served. Occasional difficulties, it will be noted from these appeals and in other directions as well, continue to arise in connection with administrative procedure under Sec. 28 of the 1919 Act. So far, the Council has been uniformly successful in all legal action in enforcing their powers under the Act. Unfortunately, however, while securing legal decisions in their favour for the recovery of expenditure incurred in carrying out, in default of the owner, the works of repair to render the houses concerned fit for habitation, protracted litigation, and, in some few instances even loss has resulted where the sale of the property has not yielded the cost of the works executed and the legal expenses incurred in recovery. The number of cases in which such difficulties arise is fortunately small, but may be serious in regard to the financial risks involved. While the Council's experience has been fortunate in regard to the legal action, they have found it necessary to take to enforce their claims for the reimbursement of expenditure incurred in regard to repairs carried out to insanitary properties under Sec. 28 Notices, in default of the owner, other sanitary authorities have not, in some recent instances, been equally fortunate. Legal decisions in regard to right of appeal and procedure thereon, time allowed on the notices served, recovery of costs incurred, &c., have been given which appear to have been at variance with the administrative interpretation of the section. This Section of the Act therefore requires amendment, especially in regard to provision for simplifying procedure in the recovery of expenditure incurred in default of the responsible owner. 100 Closing Orders. During 1922, on the representation of the Medical Officer of Health, acting under Sec. 17 (ii) of the Housing, &c., Act, 1909, the Council made a Closing Order in respect of the following dwelling- house:— Premises. State. Date of Order. 35 a Ascalon Street Generally dirty, damp, dilapidated and verminous throughout 19th July. The necessary works of repair having been completed and the louses made in all respects reasonably fit for habitation, Closing Orders were determined by the Council, as under:— Premises. Date Order determined. 16/17 Arden Street 25th January. Underground Dwellings. During the year, on the representation of the Medical Officer of Health under Sec. 17(vii.) of the Housing, &c., Act, 1909, the Council made Closing Orders in respect of the following underground rooms, which were illegally used for sleeping purposes:— Premises. Date of Order. 117, 119 Grant Road (back basement rooms) 24th May. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. During the year 1922, applications for the certificate of the Sanitary Authority under Section 2 of the above-mentioned Act, were received in respect of 28 premises. Of this number in 23 cases the certificates were granted and 5 applications were refused. In addition, 5* applications for the report of the Sanitary Authority under this section were received from owners. Of these, 4 were granted and one not granted. Re-Service of Notices under Sec. 28 of Housing, &c., Act, 1919. In view of the decision Rex. v. Minister of Health (ex parte Rush), in which it was held that the owner had the right of appeal *Including 2 cases under consideration at end of 1921, 101 against notices served under Sec. 28, the Ministry intimated that the form of notices to be served under this section should be amended so as to notify the owner of his right of appeal. The Council, therefore, decided, in the case of those houses where the notices already served had not been complied with, to re-serve the notices in the prescribed form. Action under Sec. 29 of Housing, &c., Act, 1919. During the year, 10 cases have been reported to the Housing Committee of owners who have collected rent in contravention of this section which prescribes that— " the name and address of the Medical Officer of Health for the district, and the name and address of the landlord or other person who is directly responsible for keeping the house in all respects reasonably fit for habitation shall be inscribed in every rent book, or where a rent book is not used, shall be delivered in writing to the tenant at the commencement of the tenancy and before any rent is demanded or collected." In each case the Committee directed that cautionary letters were to be sent to the offenders. Unhealthy Areas. No additional unhealthy areas were represented during 1922. By-Laws—Houses Let in Lodgings. Under section 94 of the Public Health (London) Act, 1891, as amended and extended by section 26 of the Housing, &c. Act, 1919, the London County Council is required to make by-laws in respect of houses intended or used for occupation by the workingclasses and let in lodgings or occupied by members of more than one family, the by-laws so made to be administered by each Metropolitan Borough Council. By-laws were made by the London County Council on the 27th July, 1920 and submitted to the Borough Councils for their observations. The draft by-laws were subsequently submitted to the Ministry of Health for approval, and, after certain alterations the Minister returned them to the County .Council with an intimation that he was prepared to approve them as amended. The by-laws, however, have not been re-submitted for the Minister's final approval. Having regard to the urgent need for improved by-laws for dealing with certain types of tenement dwellings, it is regrettable that, although a period of over two years has elapsed since the Minister intimated he was prepared to approve the amended by-laws, no steps appear to have been taken to resubmit them for this necessary formality. Insanitary Houses. The following is a list of streets in the Borough in which houses were found, on inspection, to be insanitary, and were 102 dealt with by the Council under the provisions of the Housing Act of 1919, either informally or by the service of notice under vSection 28 of the Act, during 1922:— Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Acre Street 10 Belfour Street 24 Everett Street... 1 Ascalon Street 3 Corunna Road 1 Patmore Street... 1 Savona Street 4 Total:—7 Streets; 44 houses. No. 2 District. Abercrombie St. 3 Culvert Road 1 Park Grove 2 Alexandra Aven. 1 Doddington Gr've 1 Parkside Street 1 Anerley Street 1 Frere Street 1 Rollo Street 2 Atherton Street 1 Gaines Cottages 13 Russell Street 1 Berkeley Street 1 Gladstone Terrace 1 Sheepcote Lane 45 Blondel Street 1 Kennard Street 1 Southolm Street 1 Brighton Terrace 1 Lockington Road 1 Warsill Street 1 Brougham Street 1 Oulton Street 12 Weybridge Street 19 Total 24 Streets; 113 houses. No. 3 District. Balfern Street 1 Ethelburga St. 1 Randall Street 1 B'sea Bridge Rd. 4 Frances Street 1 Rosenau Crescent 1 B'sea Park Road 2 Henry Street 34 Somerset Street 6 Bournes Place 14 High Street 3 Surrey Lane 6 Bridge Rd. West 4 Home Road 5 Spencer Street... 1 Bullen Street 4 Inworth Street 1 Winstead Street 1 Edna Street 1 Park Road 1 Total 20 Streets; 92 houses. No. 4 District. Benfield Street 1 Knox Road 1 Simpson Street 1 Currie Road 1 Lubeck Street 1 Stainforth Road 16 Duffield Street 1 Latchmere Grove 1 Shillington Street 3 Este Road 1 Lavender Road 2 Speke Road 1 Falcon Grove 1 Newman Street 18 Urswicke Road 3 Gwynne Road 1 Pearson Street 1 Winstanley Road 2 Ingrave Street 5 Total:—19 Streets; 61 houses. No. 5 District. Lavender Hill 2 Total:—1 Street; 2 houses. No. 6 District. Abyssinia Road 2 John Street 19 Strathblaine Rd. 2 Belleville Road 1 Livingstone Road 1 Usk Road 3 Eldred Place 13 St. John's Hill Gr. 1 Wayland Road 1 Field Place 1 Speke Road 1 York Road 2 Total:—12 Streets; 47 houses. 103 Summary. No. 1 District 7 streets 44 houses. „ 2 24 „ 113 „ „ 3 20 „ 92 „ 11 4 ,, 19 „ 61 „ ,, 5 „ 1 „ 2 „ ,, 6 „ *12 „ 47 „ Totals 82 „ 359 „ The following is a list of streets in the Borough in which houses were the subject of action, either informally or by the service of notice, under section 28 of the Housing Act of 1919, but the necessary works of repair had not been completed during 1921. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Aegis Grove 20 Everett Street 7 Stewarts Road 32 Ascalon Street 7 Foots Row 3 Stockdale Road 51 Bramwell Street 8 Linford Street 19 Tidemore Street 2 Corunna Terrace 7 New Road 3 Tweed Street 13 Currie Street 4 Ponton Street 15 Woodgate Street 10 Dashwood Road 39 Sterndale Road 46 Total:—286 houses. No. 2 District. Alfred Street 12 Henley Street 1 Palmerston St. 2 Arthur Street ... 5 Landseer Street 1 Roydon Street... 1 Atherton Street 3 Longhedge Street 39 Sheepcote Lane 4 Brougham Street 5 Millgrove Street 3. Weybridge Street 10 Chatham Street 21 Orkney Street 1 Total:- 108 houses. No. 3 District. Bolingbroke Road 2 Granfield Street 7 Home Road 1 Bridge Rd. West 1 Green Lane 6 Orville Road 34 Bullen Street 4 Henry Street 14 Parkham Street 3 Castle Street 1 High Street 5 Winstead Street 1 Total:—79 houses. No. 4 District. Barmore Street 4 Kambala Road 3 Rowena Crescent 1 Benfield Street 9 Khyber Road 3 Shillington Street 3 Creek Street 1 Latchmere Grove 1 Stainforth Road 12 Darien Road 1 Lavender Road 2 Thibet Street 1 Duffield Street 1 Lavender Terrace 1 Totteridge Road 1 Este Road 1 Lubeck Street 1 Urswicke Road 23 Grant Road 2 Mantua Street 1 Verona Street 6 Gwynne Road 7 Meyrick Road 7 Winstanley Road 5 Ingrave Street 7 Pearson Street 1 Yelverton Road 2 Total—107 houses. *Includes Speke Road also included in No. 4 District. 104 No. 5 District. Beaufoy Road 2 | Eland Road 1 Wickersley Road 1 Total 4 houses. No. 6 District. Auckland Road 1 Didcot Street 11 St. John's Hill Gr. 1 Britannia Place 27 Grant Road 12 Speke Road 8 Cairns Road 1 Livingstone Road 34 Winstanley Read 14 Darien Road 18 Lothair Street 9 York Road 2 Total:—138 houses. No. 7 District. Lavender Hill 1 Total :—1 house. Summary. No. 1 District 286 houses. „ 2 „ 108 „ „ 3 „ 79 „ ,, 4 „ 107 „ ,, 5 ,, 4 „ 11 6 ,, 138 „ ,, 7 ,, 1 „ Total 723 „ Statistics for the year ending 31st December, 1922. 1. General. i (a) Estimated enumerated population 169,200 (b) General death rate 13.2 per 1,000 (c) Death rate from tuberculosis 1.21 per 1,000 (d) Infantile mortality rate 69.3 per 1,000 (f) Number of premises used as habitations by all classes 27,783 (g) Estimated number of working-class dwelling-houses 24,890 (g) Number of new working-class dwellings erected 69 2. Unfit Dwelling-Houses. (a) Inspection— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,150 105 (b) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 3,584 (C) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (d) Number of dwelling-houses (exclusive of those referred to und'er the previous heading) not found to be in all respects reasonably fit for habitation 3,508 (b) Remedy of defects without service of formal notice— Number of dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 484 (C) Action under Statutory Powers— (I.) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919— (a) Number of dwelling-houses in respect of which notices were served requiring repairs 181 * (b) Number of dwelling-houses which were rendered fit— (i.) By owners 220 (ii.) By Local Authority in default of owners ... ... ... ... ... 1 (C) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (II.) Proceedings under Public Health Acts— (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied ... ... ... ... 3,149 (b) Number of houses in which defects were remedied— (i.) By owners 3,113 (ii.) By Local Authority in default of owners Nil *In addition, in view of the "Rush decision, 47 notices were re-served and are not included in above number. 106 (III.) Proceedings under Section 17 and 18 of the Housing, Town Planning, etc., Act, 1909 (a) Number of representations made with a view to the making of Closing Orders 1 (b) Number of dwelling-houses in respect of which Closing Orders were made 1 (c) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 2 (d) Number of houses in respect of which Demolition Orders were made Nil (e) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 3. Unhealthy Areas. Areas represented to the Local Authority with a View to improvement schemes under (a) Part I. or (b) Part II. of the Act of 1890:— Nil. 4. New Houses. Number of houses not complying with the building by-laws erected with the consent of the Local Authority under Section 25 of the Housing, Town Planning, etc., Act, 1919 :— 69 5. Staff. Staff engaged on Housing work, with briefly the duties of each officer:— 1. Medical Officer of Health. 2. Chief Sanitary Inspector. Housing Inspector. Seven District Sanitary Inspectors. 3. Two Clerks (mainly engaged on matters relating to Housing work). 107 TABLE I. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole District during 1922 and Previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths Net Deaths belonging to the District. Uncorrected Number. Net. 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 per 1,000 Nett Births. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1914 167,338 4,080 4,303 25.7 2,470 14.4 685 432 397 92 2,217 13.2 1915 161,945 3,604 3,820 23.6 2,992 18.5 79S 459 428 112 2,653 16.4 1916 173,432 B.† 3,523 3,774 21.8 2,502 15.7 705 424 318 84 2,221 13.9 159,402 D.† 1917 167,233 B.† 2,709 2,960 17.7 2,567 17.1 727 445 299 101 2,285 15.2 150,023 D.† 1918 168,014 B.† 2,407 2,700 16.1 3,195 21.3 857 471 267 99 2,809 18.7 149,951 D.† 1919 165,960 B.† 2,765 3,075 18.5 2,409 15.1 730 382 228 74 2,061 12.9 159,316 D.† 1920 166,093 B.† 4,218 4,669 28.1 2,393 14.4 700 386 386 83 2,079 12.5 165,664 D.† 1921 169,200 3,580 3,742 22.1 2,445 14.5 800 415 276 74 2,060 12.2 1922 169,200 3,577 3,665 21.1 2,679 15.8 864 412 254 69 2,227 13.2 *Rates calculated per 1,000 of estimated population. Area ot District in acres (land and inland water), 2,163 acres. Total population at all ages, 167,739: number of occupied separate dwellings, 27,191: average number of persons per "occupied separate dwelling, 6.17 (Census Report 1921). †Registrar General's estimated population for purposes of calculating:—(B), birth-rate; (D), death-rate. 108 TABLE II. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1922. Notifiable Disease. Cases Notified in the Borough of Battersea. Total Cases Notified in each Sub-District No. of Cases Removed to Hospital from each Sub-District. At all Ages. Under 1 year. 1 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 65 years. 65 years and upwards. E. N.W. S.W. E. N.W. S.W. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria 668 17 181 394 34 42 ... 312 222 134 311 220 126 Membranous Croup 2 ... 1 1 ... ... ... 1 1 ... 1 1 ... Erysipelas 66 1 3 4 9 36 13 18 31 17 7 6 4 Scarlet Fever 750 3 158 486 63 40 ... 283 270 197 280 269 192 Tvphus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 4 ... ... 3 ... 1 ... 2 1 1 2 1 1 Puerperal Fever 13 ... ... ... 2 11 ... 2 6 5 1 5 1 Posterior Basic Meningitis 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... Ophthalmia Neonatorum 41 41 ... ... ... ... ... 19 16 6 3 1 ... Polio-myelitis, &c. 4 1 2 1 ... ... ... 1 2 1 ... 2 1 Encephalitis Lethargica 2 ... ... ... ... 2 ... 1 ... 1 1 ... 1 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... Malaria 5 ... ... ... 1 4 ... 4 ... 1 ... ... ... Dvsentery ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Influenzal Pneu 196 11 40 15 23 93 14 68 89 39 17 14 5 Acute Primary Pneu 308 48 107 42 24 61 26 162 120 26 34 37 5 Totals 2,060 122 492 946 156 291 53 873 759 428 657 557 336 T uberculosis— ' f Pulmonary 286 ... 2 21 67 187 9 134 71 81 ... ... ... Non-Pulmonary 125 6 26 59 15 17 2 62 47 16 ... ... ... Totals (Tuberculosis) 411 6 28 80 82 204 11 196 118 97 ... ... ... Totals 2,471 128 520 1,026 238 495 64 1,069 877 525 657 557 336 Whooping Cough* 285 25 175 83 ... 2 ... 118 119 48 9 7 ... Measles* 1,496 91 785 600 15 5 ... 689 555 252 37 19 1 Grand totals 4,252 244 1,480 1,709 253 502 64 1,876 1,551 825 703 583 337 *Notifiable in Battersea from April 24th, 1922. 109 TABLE III. Causes of, and Ages at, Death during the Year 1922. CAUSES OF DEATH. Next Deaths at subjoined ages of "Residents "whether Occurring within or without the District. Total Deaths of "Residents." and "NonResidents " in Institutions in the District. AH Ages. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years upward. 1. Enteric Fever 1 ... ... ... ... ... 1 ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 66 13 28 21 4 ... ... ... ... 53 4. Scarlet Fever 13 ... 2 2 .5 1 3 ... ... ... 5. Whooping-cough 22 6 8 8 ... ... ... ... ... 19 6. Diphtheria, 58 1 10 22 24 ... 1 ... ... 2 7. Influenza 110 8 4 5 6 4 23 37 23 48 8. Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... 2 9. Meningococcal Meningitis 1 ... ... ... ... ... 1 ... ... 3 10. Tuberculosis of Respiratory System 171 ... ... ... 5 39 62 53 12 113 11. OtherTuberculous Disease 34 6 3 5 7 5 4 4 ... 28 12. Cancer 225 2 ... 1 2 24 95 101 177 13. Rheumatic Fever 13 ... ... ... 6 6 1 ... ... 5 14. Diabetes 13 ... ... ... ... 1 3 4 5 11 15. Cerebral Haemorrhage, etc. 90 ... ... ... 1 1 4 20 64 76 16. Heart Disease 365 ... ... ... 3 14 23 95 230 363 17. Arterio-Sclerosis 42 ... ... ... ... ... 1 9 32 6 18. Bronchitis 167 24 6 2 1 1 5 38 90 49 19. Pneumonia (all forms) 169 35 30 16 3 3 11 37 34 82 20. Other Respiratory Diseases 25 2 ... 1 1 ... 2 7 12 19 21. Ulcer of Stomach or Duodenum 22 ... ... ... ... ... 9 7 6 16 22. Diarrhœa, &c. 32 15 3 ... 1 ... ... 7 6 7 23. Appendicitis and Typhlitis 5 ... ... 1 ... 3 ... 1 ... 13 24. Cirrhosis of Liver 14 ... ... ... ... ... ... 10 4 9 25. Acute and Chronic Nephritis 63 ... ... 1 1 2 3 31 25 30 26. Puerperal Sepsis 3 ... ... ... ... 1 2 ... ... 5 27. Other diseases of Pregnancy 6 ... ... ... ... 1 5 ... ... 8 28. Congenital Debility and Malformation, Premature Birth 100 98 ... 1 1 ... ... ... ... 31 29. Suicide 11 ... ... ... ... 2 2 4 3 10 30. Other Deaths from Violence 63 5 3 1 10 3 8 17 16 58 31. Other Defined Diseases 322 39 6 2 13 12 38 78 134 261 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... All Causes M. 1131 131 58 52 42 41 111 330 366 781 F. 1096 123 45 37 52 58 125 225 431 723 Totals 2227 254 103 89 94 99 236 555 797 1504 110 East Battersea. TABLE IV. Infant Mortality, 1922. Net Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 2 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 3 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... ... ... 3 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 2 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Bronchitis ... ... ... ... ... 1 ... ... ... ... ... 1 3 2 1 1 ... 3 2 ... 6 7 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... ... ... 1 1 1 ... ... 2 2 1 3 4 7 Pulmonary Congestion ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Diarrhœa & Enteritis ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... 3 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 2 8 8 ... 2 ... 2 ...... 12 14 1 1 ... ... ... ... ... ... 13 15 Congenital Malformation 1 1 ... 2 1 ... ... ... ... 1 2 4 1 ... 1 1 ... ... ... ... 4 5 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 1 1 ... ... ... 5 1 Icterus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis & Asphyxia Neon. 1 1 4 ... ... 1 ... ... ... ... 5 2 ... ... ... ... ... ... ... ... 5 2 Lack of Care 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Convulsions ... ... 1 ... ... ... ... 1 ... ... 1 1 ... ... ... ... 1 ... ... ... 2 1 Homicide ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Accident ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... 1 ... ... ... 1 1 1 1 ... ... 1 2 4 3 Totals 6 6 13 10 1 6 1 3 ... 1 21 26 13 7 6 8 7 7 7 10 54 58 12 23 7 4 1 47 20 14 14 17 112 Net Births in the year. Net Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1564 52 1616 103 9 112 111 North-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1922. Net Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hrs. 1 dav-1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ...... 1 ... 1 ... 2 3 4 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ...... ... ... 1 ... 2 ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... 3 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 1 2 1 1 ... ... 4 4 Pneumonia, all forms ... ... ... ... ... ... 1 1 ... ... 1 1 3 ... 4 ... 3 2 3 ... 14 3 Pulmonary Congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 4 1 1 ... ... 3 6 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ...... ... ... ... ... 2 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 5 3 4 1 2 ... ... 2 10 11 1 3 ... ... ... ... ... ... 11 14 Congenital Malformation ... ... ... ... ... ... ... ... 2 ... 2 ... 1 ... ... ... ... ... ... ... 3 ... Congenital Debility ... ... ... ... ... ... ... 1 ... 1 ... ... 1 1 1 ... ... ... ... 2 2 Icterus Neonatorum ... ... ... 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Injury at Birth ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Atelectasis and Asphyxia Neon 1 1 ... 1 ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 2 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... 1 ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Homicide 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 2 ... 1 ... 5 ... 6 7 5 6 3 3 2 1 5 ... 21 17 8 8 15 7 8 4 8 4 60 40 Totals 13 11 6 3 5 38 16 22 12 I 12 100 Net Births in the year. Net Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1151 47 1198 91 9 100 112 South-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1922. Net Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hrs. 1 day-l week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F Small-pox ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Scarlet Fever ... ... ...... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Bronchitis ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 1 ... ... 2 1 Pneumonia, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 1 1 3 4 Pulmonary Congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ...... ... ... ... ... ... 1 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 3 1 2 ... 1 ... ... ... ... 2 6 ... 1 ... ... ... ... ... ... 2 7 Congenital Malformation ... ... 1 ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Congenital Debility 1 ... ... ... 1 ... ... ... ... 1 1 1 1 ... ... ... ... ... ... 2 2 Icterus Neonatorum ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Injury at Birth 1 1 1 ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Atelectasis & Asphyxia Neon. ... ... 1 ... ... 1 ... ... ... 1 1 2 ... ... ... ... ... ... ... ... 1 2 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... 1 ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...•... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ...-... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 5 2 1 4 1 1 ... 2 10 13 3 5 ... 2 2 3 2 2 17 25 Totals 7 7 5 2 2 23 8 2 5 4 42 • Net Births in the year. Net Deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 822 29 851 37 5 42 113 Borough of Battersea TABLE IV.—(contd.) Infant Mortality, 1921. Net Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Mont is. Total dea hs under 1 year. Percentage of Total. 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 4 5 6 7 5.12 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 1 ... 1 1 1 2 4 2.36 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... .39 Influenza ... ... ... ... ... ... ... ... ... ... ... 2 2 2 2 ... ... 6 2 3.15 Erysipelas ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... .39 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 3 3 3 2.36 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... 1 ... 1 ... 2 .79 Bronchitis ... ... ... ... 1 1 1 ... ... ... 2 1 5 3 2 3 1 5 2 12 12 9.45 Pneumonia (all forms) ... ... ... ... ... 1 1 1 ... ... 1 2 4 2 4 1 7 5 5 4 21 14 13.78 Congestion of Lungs ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... .39 Diarrhœa & Enteritis ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 2 7 1 1 1 4 11 5.91 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... .39 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... ... 1 ... 4 1 1.97 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 9 10 12 14 1 5 ... 2 2 ... 24 31 2 5 ... ... ... ... ... ... 26 36 24.41 Congenital Malformation 1 1 1 2 1 ... ... 1 2 1 5 5 2 ... 1 ... ... ... ... ... 8 6 5.51 Congenital Debility 1 ... ... ... ... 1 ... ... 1 ... 2 1 4 2 2 2 1 ... ... ... 9 5 5.51 Icterus Neonatorum ... ... ... 1 2 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 1.18 Injury at Birth 1 2 2 ... ... ... ... ... ... ... 3 2 ... ... ... ... ... ... ... ... 3 2 1.97 Atelectasis & Asphyxia Neon. 2 2 1 ... 2 ... ... ... 1 7 6 ... ... ... ... ... ... ... ... 7 6 5.12 Lack of Care ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 .39 Convulsions ... ... 3 ... ... 2 ... 1 ... ... 3 3 ... ... ... ... 1 ... ... ... 4 3 2.76 Homicide 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 .79 Overlying ... ... ... ... ... ... ... ... ... ... ... ...... 1 ... ... ... ... ... ... ... 1 .39 Accident ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 .79 Other Causes ... ... ... ... ... ... 2 ... ... ... 2 ... 1 ... 2 1 2 ... 2 2 9 3 4.73 15 17 23 18 5 13 4 5 5 3 52 56 24 20 21 17 17 14 17 16 131 123 100.00 Totals 32 41 18 9 8 108 44 38 31 33 254 — Percentage of Total 12.6 16.1 7.1 3.5 3.2 42.5 17.3 15.0 12.2 13.0 - 100.00 M. 51.6% F. 48.4% Net Births in the year. Net Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M.1,827 73 1,900 121 10 131 F. 1,710 55 1,765 110 13 123 Totals ... 3,53 7 12* 3,665 231 23 254