BAT 20 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1923 by G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. Wightman & Co., Ltd., Printers, Regency Street, Westminster, S.W. I. BAT 20 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1923 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, 1922 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. Runecklbs. As constituted 9th November, 1923. Chairman : Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor (Councillor H. Harling, j.p.) Councillor Miss E. Brown. ,, E. W. Coles. E. C. A. D. Duval. ,, W. R. Early. ,, A. P. Godfrey. „ J. Hendrick. Alderman C. W. Martin. Councillor R. Moore. Mrs. M. H. Rose. „ A. E. Samuels. „ S. C. Tarry. Maternity and Welfare Committee. 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 T. Varran. Mrs. F. Young. As constituted 9th November, 1923. Chairman : Councillor Mrs. C. S. Ganley, j.p. His Worship the Mayor " (Councillor H. Harling, j.p.) The Health Committee, as above, and the following Co-opted Members : Mrs. K. S. D. Baker. Mrs. K. Bowler. Mrs. J. Hockley. Mrs. M. T. Varran. Mrs. F. Young. Mrs. E. E. Kemp.* * Appointed 27th February, 1924. Housing Committee. 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. As constituted 9th November, 1923. Chairman : Councillor W. D. Garnsey. His Worship the Mayor (Councillor H. Harling, j.p.) Councillor J. Bruce. „ D. Carmichael. „ W. R. Early. „ W. Geard. ,, J. W. Herd. „ T. R. Jones. Alderman T. Pocock. Councillor M. J. Prior. Alderman Mrs. M. J. Robinson. Councillor E. S. Strange. ,, H. G. White. 2 Tuberculosis Committee. As constituted 9th November, 1922. The Health Committee, as above. As constituted 9th November, 1923. The Health Committee, as above. Tuberculosis Care Committee. As constituted 29th 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 lale Dispensary Committee : Mrs. Dermott. 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 Invalid Children's Aid Association. „ Representative of the War Pensions Committee. ,, Lady Almoner, St. Thomas's Hospital. ,, After-Care Sister, Victoria Hospital . ,, Tuberculosis Almoner, St. George's Hospital. I.ady Almoner, King's College Hospital. ,, Representative of the S. L. District Nursing Association. „ Representative of the London Insurance Committee. ., Lady Almoner, Brompton Hospital. As constituted 9th November, 1923. 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. Members of late Dispensary Committee : Mrs. Dermott. 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. ,, Representative of the British Red Cross Society. „ Health Visitor and Sanitary Inspector, 3 Staff of Public Health Department. (At 31st December, 1923). Tuberculosis Officer—G. MACDONALD, M.A., M b., Ch.B. Assistant Medical Officer (Maternity and Child Welfare). (Miss) M. L. HAMILTON, M.B., Ch.B., D.P.H. (appointed 28th February, 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. Miss D. Heap, H.V. Diploma (r.S.I.), San. Insp. Board's Cert. 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 Hat Officer—Mr. H. Kenham. 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. Office youth. Miss F. M. Humphreys (temporary) Maternity and Child Welfare Records. Tuberculosis Dispensary— Tuberculosis Nurses—Miss M. Schotburgh, Miss B. O'Connor, Miss 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. 4 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 1923. The vital and morbid statistics show a remarkable improvement over those of any previous year in the Parish or Borough of Battersea. The birth-rate is slightly lower than that for 1922, and it is evident that the downward trend of the birth-rate in Battersea, as in England and Wales, continues to be maintained. This is the only unsatisfactory feature of the year's statistics. The death-rate (10.8 per 1,000) shows a very considerable decrease over that for the previous year, and is no less than 2.4 per cent, lower. This is easily the lowest death-rate ever recorded in Battersea. The infant mortality rate (49 per 1,000 births) shows a very remarkable decrease as compared with that for 1922, which was up to then the lowest recorded in Battersea. The great saving in infant life which has been effected in recent years is a most gratifying feature of the Annual Reports. A comparison of the figures in the tables in that section of the Report dealing with Infant Mortality in Battersea is of interest. For the decennia 1891-1900 the Infant Mortality was 162 per 1,000 births; 1901-1910, 126 per 1,000; 1911-1920, 96 per 1,000. It is interesting to note, also, that the decline in the infant death rate has been more progressive in Battersea than in London as a whole. There are, of course, many causes assigned for this great and progressive decrease in the death-rate of infants under 1 year of age, e.g., diminished consumption of alcohol, declining birth-rate, &c., but there can be no question that the organised schemes of Municipalities for the Welfare of Women and Children have played a very important part in the results obtained. There was a decline in the incidence of all infectious diseases except whooping-cough as compared with the previous year. The death-rate from Tuberculosis (all forms) was the lowest yet recorded in Battersea. The notifications received were also lower than in any year since the disease was made compulsorily notifiable. The steady advance which has taken place in connection with the fight against Tuberculosis in the Borough should encourage the hope that more suitable premises for the Borough Tuberculosis Dispensary will, in the near future, be found for carrying on this most important work. 5 In regard to housing matters, much valuable work was accomplished under the Housing and Public Health Acts, especially in connection with the repair of unfit houses. It is, however, to be regretted that the Housing shortage is still responsible for much hardship and suffering arising from the congestion and overcrowding in several of the lower wards of the Borough. It is to be hoped that speedy relief from the evils inseparable from this unfortunate state of affairs will be found in the new Housing Bill which is promised for the year 1924. The Maternity and Child Welfare Services were carried on with undiminished activity during the year, the results of which are fully set out in the Report, and which are reflected in the remarkably low infant mortality rate, and in the improved standard of health of the women and children attending the Borough Clinics. I have again to thank the Chairmen of the Health, Maternity and Child Welfare and Housing Committees, and the Members of the Council for the consideration and support extended to me so generously; to the Chief Officers of Departments and the Staff of the Public Health Department, who, notwithstanding the heavy pressure of work, carried out their duties with zeal and efficiency, my thanks are also due for assistance always willingly rendered. G. Quin LENNANE, Town Hall, Medical Officer of Health. Lavender Hill, S.W. 6 CONTENTS. Page Births, Marriages and Deaths. Vital Statistics 8, 9, 15, 116 Birthplaces of population 10 Marriages 10 Births 10 Illegitimate Births 12 Deaths 12 „ Causes and Age Distribution 118 Comparative Table of Births, Deaths, &c. (1857-1923) 15 Infant Mortality 16,17,119-122 Illegitimate Infant Deaths 19 Notification of Births Act 19 Maternity and Child Welfare. Maternity and Child Welfare Scheme 20 Centres 20 Hospital Provision 22 Nursing Facilities 23 Health Visitors 24 Milk Order 24 Ante-Natal Work 25 V.D. 26 Maternity Hospital 28 District Midwifery Service 31 Dental Clinic 33 Infectious Diseases.—(i.) Notifiable 35 Summary of Notifications 34, 117 Bacteriological Examinations 26-28,40, 51 Contacts 35 Smallpox 35 Scarlet Fever 36 Diphtheria 37 Enteric Fever, Cerebro-Spinal Fever 38 Encephalitis Lethargica, Puerperal Fever 38 Ophthalmia Neonatorum 38 Polio-Myelitis, Erysipelas 40 Tuberculosis 41 61 Cases Notified 41,42 Localisation of Disease 42 Deaths from Tuberculosis 42 Dispensary 44 „ (Report of) 45 -55 Institutional Treatment 51,52 Open-Air School (Day Sanatorium) 53 Care Committee 53 Non-Dispensary Patients 55 Tuberculosis Dental Clinic 55 Summary Table 60,61 Zymotic Deaths 62 (ii.) Non-Notifiable Diseases 62,63 Chicken pox. Influenza 62 Diarrhœa 63 Measles 63 Whooping-Cough 64 Cancer 64 7 Page Sanitary Circumstances. Summary Table 65 Legal Proceedings 66 70 Common Lodging Houses 70 Drainage Work 70 Revenue Act. 1903 71 Licensed Premises Urinals 71 Smoke and Effluvium Nuisances 71 Water Supply 71 Van Dwellings 72 Hag Flock Act 72 Rats and Mice Destruction Act 72 Personal Cleansing Station 73 76 Disinfecting Department 76 Mortuary 76 Staff 77 Protection of the Food Supply. Unsound Food 78 Butchers' Shops 78 Cow-Houses and Slaughter-Houses 78 Sale of Food and Drugs Acts 79 81 Analysts' Reports 81 91 Milk and Cream Regulations 91 Milk and Dairies (Amendment) Act, 1922, and Food Control Order 92 Milk—Special Designations Order 92 Condensed and Dried Milk Regulations 93 Ice Cream 94 Milk Shops 94 Fish Shops 94 Restaurant Kitchens 95 Street Stalls 95 Factories. Workshops, &c.—General Tables 96 Factories 97 Workshops 98 Outworkers 99, 102 Bakehouses 101 Warehouses and Wharves 101 Housing. General 103 Overcrowding 103 New Tenements and Houses erected 104, 105 Chatham House 104 Repair of Unfit Houses 105 107 Closing Order 108 Underground Rooms 108 Increase of Rent, &c., Act 108 Housing, &c., Act, 1919—Sec. 28 111 Sec. 29 108 Insanitary Areas (Plough Road Area) 109 Houses 111 Houses Let in Lodgings—By-laws 111 Statistics 113 Appendices. Table I. Summary of Vital Statistics 116 ,, II. Infectious Disease Notifications 117 ,, III. Causes of, and Ages at, Death 118 „ IV. Infant Mortality 119 122 8 Summary of Statistics, 1923 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, 1923) 170,600 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value £1,033,153 Sum represented by a penny rate £4,235 2. Extracts i-rom Vital Statistics of the Year. Births— (Males, 1,759 ; females, 1,675) 3,434 Legitimate Births 3,319 Illegitimate Births 115 Birth-rate 20-1 Deaths— (Males, 930 ; females, 909) 1,839 Death-rate 10.8 Number of women dying in or in consequence of child-birth:— From sepsis — Other causes 10 Death rate of Infants under 1 year per 1,000 births— Legitimate 46.7 Illegitimate 130.4 49.5 Deaths from Measles (all ages) 24 „ Whooping Cough (all ages) 16 „ Diarrhoea (under 2 years of age) 26 Census, 1911— Population 167,743 Number of inhabited houses 24,321 9 Births, Marriages and Deaths. VITAL STATISTICS. Population. The population of the Borough at the Census taken on the 19th June, 1921, was 167,739. As the Census was taken in the middle of the year instead of the spring, as is usual, the Registrar-General found it necessary to make an adjustment in the figures. 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. The estimated population, according to the Registrar-General, of the Borough for the year 1923 is 170,600. The estimated population, based upon the Registrar-General's figures, for the registration sub-districts and for the nine Wards is set out in the following table:— Registration Sub-District. Estimated Mid-Year Population, 1923. Males. Females. Total. East Battersea 33,939 36,755 70,694 North-West Battersea 23,608 25,180 48,788 South-West Battersea 22,453 28,665 51,118 Total 80,000 90,600 170,600 1. Nine Elms 13,514 14,261 27,775 2. Park 8,744 9,782 18,526 3. Latch mere 9,205 10,260 19,465 4. Shaftesbury 7,575 8,096 15,671 5. Church 9,215 9,597 18,812 6. Winstanley 10,133 10,834 20,967 7. St. John 3,654 5,062 8,716 7. Bolingbroke 8,632 10,670 19,302 9. Broom wood 9,328 12,038 21,366 Total 80,000 90,600 170,600 10 Birthplaces of the Population in Battersea and London at the Census of 1921. Battersea. London. Where born. Persons. Percentage. Persons. Percentage. England 160,586 95.74 4,129,934 92.09 Wales 937 .56 28.063 .63 Scotland 1,558 .93 49,881 1.11 Ireland— Six Northern Counties 168 .10 6,564 .15 Remainder of Ireland 1,130 .67 43,299 .97 Part not defined 64 .04 2,343 .05 Isle of Man and Channel Islands 192 .11 4,918 .11 Other British Dominions, Colonies, &c. 907 .54 41,699 .93 ForeignCoun tries 1,257 .75 145,938 3.25 Born at Sea 34 .02 1,144 .03 Not stated 906 .54 30,740 .68 Total enumerated 167,739 100.00 4,484,523 100.00 Marriages. The marriages registered in Battersea during 1923 numbered 1,352. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 15.8. The steady decline which has taken place in the marriage-rate in the Borough during the past five years is shown in the following table:— Year. Marriages. Marriage-Rate. 1919 1,677 20.2 1920 1,644 19.8 1921 1,482 17.5 1922 1,404 16.6 1923 1,352 15.8 Births. The number of births registered in the Borough during 1923 was 3,415 (1,759 males, 1,656 females), an excess of 103 males. Of this number 244 were transferred out, the permanent residence of the parents being outside the Borough, and 263 births occurring elsewhere were transferred here, giving on balance a total of 3,434 births relating to Battersea residents and a corrected birth-rate of 20.1 per 1,000 of the population. 11 The births in the registration sub-districts of the Borough were as follows:— Sub-district. Males. Females. Total. East Battersea 847 779 1,626 North-West Battersea 543 529 1,072 South-West Battersea 369 367 736 The Borough 1,759 1,675 3,434 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 1923 19.7 20.2 20.1 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 1923:— Ward Estimated Population, 1923. Number of Births. Birthrate. No. 1, Nine Elms 27,775 684 24.6 No. 2, Park 18,526 471 25.4 No. 3, Latchmere 19,465 407 21.0 No. 4, Shaftesbury 15,671 291 18.6 No. 5, Church 18,812 380 20.2 No. 6, Winstanlev 20,967 494 23.6 No. 7, St. John 8,716 156 17.9 No. 8, Bolingbroke 19,302 286 14.8 No. 9, Broom wood 21,366 265 12.4 12 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1923, and during the previous decennium 1913-1922:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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 1922 21.7 23.0 24.8 16.8 Average 1913-1922 22.1 23.7 25.4 16.4 1923 20.1 23.0 22.0 14.4 Illegitimate Births. Of the total births registered as belonging to the Borough of Battersea 115 were of illegitimate children (i.e.,-3.35 per cent.), as compared with 128 or 3.49 per cent, in 1922 and 131 or 3.50 per cent, in 1921. Deaths. The number of deaths registered in the Borough during 1923 was 2,368. Of these 874 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were, on the other hand, 345 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths of persons belonging to the Borough was 1,839 (males 930, females 909). This gives a recorded death-rate of 10.8 as compared with 11.2 for London and 11.6 for England and Wales, the lowest yet recorded in Battersea. 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 1913-1922 and the year 1923 respectively:— 13 Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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. 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 1922 13.2 13.1 13.8 12.6 Average 1913-22. 14.2 14.5 15.2 12.9 1923 10.8 11.2 10.4 10.6 The death-rate per 1,000 inhabitants for each of the nine Wards is shown in the next table:— Ward. Estimated Population 1923. Number of Deaths. Deathrate. No. 1, Nine Elms 27,775 315 11.3 No. 2, Park 18,526 200 10.8 No. 3, Latchmere 19,465 205 10.5 No. 4, Shaftesbury 15,671 185 11.8 No. 5, Church 18,812 181 9.6 No. 6, Winstanley 20,967 225 10.7 No. 7, St. John 8,716 104 11.9 No. 8, Bolingbroke 19,302 211 10.9 No. 9, Broomwood 21,366 213 10.0 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1923:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65- Total. M 88 51 16 11 41 121 280 322 930 F 82 58 17 13 37 99 209 394 909 Ttls. 170 109 33 24 78 220 489 716 1,839 14 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 213 256 469 Second quarter 220 235 455 Third quarter 212 169 381 Fourth quarter 285 249 534 Deaths in Public Institutions. During 1923 the deaths of Battersea residents occurring in Public Institutions numbered 890. Of this number 604 occurred within and 286 outside the Borough. Of the total deaths in Public Institutions 596 occurred in Poor Law Institutions. Senile Mortality. During 1923 the deaths of 716 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. Total. M. F. M. F. M. F. M. F. East Battersea 74 62 34 65 9 24 117 151 268 N.W. Battersea 61 43 30 35 4 18 95 96 191 S.W. Battersea 64 58 40 64 6 25 110 147 257 Borough of Battersea 199 163 104 164 19 67 322 394 716 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 2,735 188 8 138,565 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 2,163 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 11.3 942 2,365 1911 167,765 4,381 261 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*l 59,402 — 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 — — — — *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 21.7 2,227 13.2 192 1,438 1923 170,600 3,434 201 1,839 10.8 114 1,595 * Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. †Decrease. The years marked ... were census years. 16 CHART SHOWING THE NUMBER OF DEATHS OF INFANTS IN BATTERSEA UNDER ONE YEAR OF AGE PER 1,000 BIRTHS, ANNUALLY FROM 1858 TO 1923. 17 Infant Mortality. During 1923 the deaths of 170 infants were registered as belonging to Battersea. The total number of births registered during the year was 3,434, giving an infant mortality-rate of 49.5 per 1,000 births. This is by far the lowest infant death-rate yet recorded in Battersea. There were only five Boroughs in the County of London with a lower infant mortality than 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. Battesea. 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 1923 60.4 49.5 The infant mortality-rate for the County of London for the year 1923 was 60.4 per 1,000 births. The distribution of the 170 infant deaths and the infant mortality-rates, both for the registration sub-districts and for the Wards, are shown in the following table:— 18 Registration Sub-Districts. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. M. F. TOTAL East Battersea 1,626 46 51 97 59.7 North-West Battersea 1,072 31 24 55 51.3 South-West Battersea 736 11 7 18 24.5 The Borough 3,434 88 82 170 49.5 Ward. 1. Nine Elms 684 24 21 45 65.8 2. Park 471 10 13 23 48.8 3. Latchmere 407 10 11 21 51.6 4. Shaftesbury 291 10 11 21 72.2 5. Church 380 14 4 18 47.4 6. Winstanley 494 9 15 24 48.6 7. St. John 156 2 2 4 25.6 8. Bolingbroke 286 5 3 8 28.0 9. Broomwood 265 4 2 6 22.6 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 .59 Erysipelas 2 — — — 2 1.18 Measles — — 1 4 5 2.94 Influenza — — -— 1 1 .59 Meningococcal Meningitis — 1 — — 1 .59 Whooping Cough 2 2 — 2 6 3.53 Diarrhoea and Enteritis 5 5 6 2 18 10.59 Miliary Tuberculosis — — — 1 1 .59 Tuberculous Meningitis — 1 — 2 3 1.76 Pulmonary Tuberculosis — 1 — — 1 .59 Pneumonia 2 5 4 3 14 8.24 Bronchitis 6 3 — — 9 5.29 Other Respiratory — — — — — — Diseases Nephritis 1 — — — 1 .59 Prematurity 45 — — — 45 26.47 Marasmus 3 1 3 1 9 5.29 Icterus Neonatorum 1 1 — — 2 1.18 Congenital Malformations 8 1 — 2 10 5.88 Injury at Birth 4 — — — 4 2.35 Suffocation (overlying) — — — — — Convulsions 4 — — — 4 2.35 Atelectasis & Asphyxia N. 10 — — — 10 5.88 Miscellaneous 14 4 2 3 23 13.53 Total 107 25 17 21 170 100.00 % of Total 62.9 14.7 10.0 12.4 100.0 — 19 Illegitimate Infant Deaths. The death-rate amongst illegitimate children during 1923 was 130.4 per 1,000 births, as compared with 179.7 ia 1922 and 183-2 in 1921. The corresponding death-rate of legitimate infants in 1923 was 46.7, the ratio of the mortality-rate of illegitimate infants to that of legitimate being 2.79 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 6 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 2,910 159 .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 1923 3,319 115 .035 155 15 46.7 130.4 2.79 The table shows that the ratio of births registered as illegitimate to legitimate births has remained almost stationary during the past four years, although in 1923 lower than the average for the five years 1918-22. On the other hand, the ratio of the illegitimate infant mortality-rate to that of legitimate infants has increased in the past four years, and in 1923 was 10 per cent, higher than the average ratio for the previous five years. It is apparent, therefore, that the great decrease in infant mortality during the past few years has not affected to any appreciable extent relatively the prevailing high rate of mortality amongst illegitimate children. Notification of Births Act The Notification of Births Act, 1907, was adopted in the Borough of Battersea and came into force in 1908. During 1923 the number of notifications of live births received was 3,273. The corrected number of births registered in Battersea was 3,434. The propotion of notified to registered births was 95.3 per cent. 20 The number of still-births notified during the year was 83 or 2-4 per cent, of the corrected total births registered. 191 births of infants born outside the Borough, but children of Battersea residents were notified from the district in which these births occurred. Notified births are visited and re-visited by the Council's official Health Visitors and by the Health Visitors of the voluntary organizations linked up with the Council's Maternity and Child Welfare Scheme. The mothers are invited to bring their babies to the various Welfare Centres included in the Battersea Maternity and Child Welfare Scheme. A weekly return of all births notified is sent to the London County Council in accordance with the requirements of Sec. 5, subsec. 2 of the Notification of Births Act. Maternity and Child Welfare Scheme. The Battersea 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, made useful progress during 1923. The various activities included in the Scheme— pre-natal, natal and post-natal—are now well co-ordinated, but special attention was given to the development of the pre-natal side of the work. Maternity and Child Welfare Centres. For administrative purposes the Borough is divided into six areas. In each of these areas a Maternity and Child Welfare Centre —municipal or voluntary—has been established. The Centres are situate as follows :— 1. Municipal. (а) Latchmere Baths (Burns Road). (б) All Saints' Parish Hall (Prince of Wales Road). (c) Plough Road Institution. (d) Dental Centre and Clinics (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' Parish Hall, Ponton Road, Nine Elms). In addition to the above, ancillary activities included in the Scheme comprise : (1) St. Mary's Hostel, Macaulay Road, Clapham Common, and (2) St. Margaret's Day Nursery and Resident Hostel, both of which Institutions are under voluntary control, but linked up with the Battersea Maternity and Child Welfare Scheme and in receipt of an annual grant from the Council. 21 Each Child Welfare Centre 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. The Child Welfare work at two of the voluntary associations' Centres is under the superintendence of two of the Council's Health Visitors. The work carried out at the various Municipal Infant Welfare Centres during 1923 is summarised as follows:— Summarised Statistics relating to Municipal Infants Centres, 1922-1923. Latchmere Centre. 1922. 1923. Sessions held 151 149 Attendances 12,178 11,459 First attendances 1,812 979 Average per session 80.6 76.9 Average weekly 234.1 219.2 Doctor's attendances 101 102 Babies seen by Doctor 2,711 2,306 Average daily do. do. 26.8 22.6 Weights recorded 11,062 10,053 Advice only 1,116 1,346 Plough Road Centre. Sessions held 101 101 Attendances 4,704 5,221 First attendances 769 611 Average per session 46.5 51.7 Average weekly 90.4 100.3 Doctor's attendances 51 55 Babies seen by Doctor 1,204 1,297 Average daily do. do. 23.6 23.6 Weights recorded 4,226 4,673 Advice only 478 543 East Battersea Centre. Sessions held 103 102 Attendances 4,029 4,717 First attendances 549 371 Average per session 39.1 46.2 Average weekly 77.4 90.7 Doctor's attendances 48 54 Babies seen by Doctor 1,016 1,040 Average daily do. do 21.1 19.3 Weights recorded 3,912 4,217 Advice only 117 500 22 Summary of Statistics relating to Municipal Infant Centre. 1922. 1923. Sessions held 355 351 Attendances 20,911 21,397 First attendances 3,130 1,961 Average per session 59 61 Average weekly Doctor's attendances 402 411 200 211 Babies seen by Doctor 4,931 4,643 Average number seen per session 24 22 Weights recorded 19,200 18,943 Advice only 1,711 2,389 The work carried out at the Voluntary Child Welfare Centres linked up with the Council's Maternity and Child Welfare Scheme during 1923 is summarised as follows:— Battersea School for Mothers, 55 Mundella Road. Chiselhurst (St. James's) Mission, Ponton Road Women's League of Service, 111 Bridge Road West. Total. Sessions held 95 51 67 213 Attendances 3,850 1,459 2,240 7,549 First Attendances 251 104 88 443 Average attendance per session 41 29 33 35 Average weekly 74 29 43 145 Doctor's attendance- 94 27 67 188 Babies seen by Doctor 2,670 439 1,806 4,915 Average do. per attendance 28 16 27 26 Weights recorded 3,831 1,427 2,207 7,465 Advice only 19 32 33 84 Hospital Provision. Apart from the special provision for maternity at the Borough Maternity Hospital and the District Midwifery Service, facilities for the needs of children requiring hospital treatment are provided by the Council by arrangement with the Victoria Children's Hospital, Tite Street, Chelsea. The Council contribute an annual sum to the hospital funds for this service. Women and children are occasionally referred from the Child Welfare and Ante-natal clinics to other Hospitals and Institutions. Number of cases referred to Hospitals from the Municipal Clinics during 1923: St. Thomas's Hospital 24 Victoria Hospital for Children 116 South London Hospital for Women 4 Carried forward 144 23 Brought forward 144 St. George's Hospital 1 Bolingbroke Hospital 7 Battersea General Hospital 2 St. John's Hospital (Leicester Square) 1 Infants' Hospital (Vincent Square) 1 St. James's Hospital (Balham) 7 Mothercraft Training Centre (Trebovir Road, Earls Court) 15 Borough Council T.B. Dispensary 11 Total 189 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 when required 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 diarrhoea, measles, whoopingcough and other dangerous diseases of child life, the Nursing service has proved a very effective Public Health preventive measure. During 1923, the total number of attendances made by the Nurses were as follows:— Nursing Service, 1923. Name of Disease. Age. Total. Under Over 5 years. 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 77 2,169 — — 77 2,169 Measles 28 247 8 110 33 357 Whooping Cough 17 186 — — 17 186 Diarrhoea & Vomiting 6 71 6 71 Chicken Pox 1 26 — — 1 26 Puerperal Fever — — — — — — Pneumonia 56 854 69 1,433 125 2,287 Influenza 7 91 18 232 25 323 Other Diseases — — 2 57 2 57 Totals 192 3,644 97 1,832 289 5,476 The cost of the Nursing Service, particulars of which are set out in the above table, was £182 10s. 8d. as compared with £290 7s. 4d. during 1922. 24 Health Visitors. The work carried out during 1923 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:—  Health Visitors. First Visits. Re-Visits. Total. Grand Total. C'cil. Vol'y. C'cil. Vol'y. C'cil. Vol'y. 1922. 1923 Visits to Expectant Mothers 793 129 818 175 1,611 304 1,660 1,915 Visits to Notified Births 2,806 390 5,210 960 8,016 1,350 7,685 9,366 Visits to Still Births 43 4 17 — 60 4 33 64 Visits to Children aged 1-5 years 394 3 1,000 1,456 1,394 1,459 2,059 2,853 Visits to enquire into Infant Deaths 97 25 20 7 117 32 204 149 Visits to cases of Notifiable Infectious Disease 3,173 267 1,901 87 5,074 354 6,323 5,428 Visits to cases of Non-Notifiable Infectious Disease 387 70 165 34 552 104 789 656 Visits re Summer Diarrhœa 1,713 400 — 1,713 400 2,499 2,113 Visits to Dental Cases 314 33 8 — 322 33 276 355 Visits to V.D. Cases 189 — 2 — 191 — 145 191 Other Visits 785 229 — — 785 229 1,032 1,014 Totals 10,694 1,550 9,141 2,719 19,835 4,269 22,705 24,104 Milk Order. During 1923, 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 following table gives particulars relating to the number of persons supplied, quantities distributed and cost after deducting payments made:— Year. Dried Milk. Fresh Milk. Persons Supplied. lbs. Supplied. Persons Supplied. Pints Supplied. Cost (after deducting payments made). £ 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 1923 2,231 50,110 219 25,633 3,288 25 Towards the end of 1923 arrangements were under consideration for the provision of meals for expectant and nursing mothers, which it is hoped will be completed during the current year. Ante-natal Work. The development of this side of the Borough Maternity and Child Welfare Scheme progressed during the year. In December, 1922, an additional pre-natal Clinic was opened at the East Battersea Centre. There are now five of these Clinics established in Battersea. Of these, four are under the direct supervision of the Council's Medical staff, and the fifth is under the direction of the Medical Officer of a voluntary organisation. The work of this clinic is, however, co-ordinated with that carried on at the Municipal Clinics. The importance of the work carried on at the Ante-natal Clinics cannot be over-estimated. During the past 20 years, whilst there has been a remarkable and gratifying decline in the Infant Mortality rate in England and Wales, no such decline is recorded in Maternal Mortality, which, as the Report for 1922 of the Chief Medical Officer of the Ministry of Health states, "remains now as high as it was at the beginning of the century for 'accidents' and other causes of death from childbirth." The aim, therefore, of ante-natal work is to prevent these disasters, many of which can be avoided by the provision of timely skilled professional assistance for the expectant mother. The extent to which this work has now progressed in Battersea has thrown a good deal of strain on the time of the Assistant Medical Officer (Maternity and Child Welfare), and it has become necessary, therefore, if this work is to be carried on efficiently in Battersea, to increase the medical staff. The Ante-natal Clinics are situate at the following centres : (1) Borough Maternity Hospital. This clinic is specially equipped for cases requiring more detailed examination. (2) Plough Road (West Battersea). (3) Latchmere Road, and (4) All Saints' Parish Hall (East Battersea). The Voluntary Associations' (Women's League of Service) Clinic is held at their Centre, 111 Bridge Road West. In addition to being Centres for the diagnosis of conditions which may seriously threaten the health or life of the mother or of her unborn child, they are valuable educational centres for the mothers and also for the training of midwives practising in the Borough and the pupil midwives undergoing training at the Borough Maternity Hospital and from other training Institutions. The total number of patients attending the Municipal Antenatal Clinics during 1923 was:— Central Clinic (Borough Maternity Hospital) 297 Latchmere Clinic 265 Plough Road Clinic 208 All Saints' Hall Clinic 104 874 26 Ante-natal (V.D.) Clinic. The work carried on at the Special Ante-natal Clinic at the Borough Maternity Hospital during 1923, was very satisfactory. This Clinic was opened late in 1921, and during 1922 and 1923 the attendances steadily increased. In the spring of the present year the number of cases requiring treatment became so large as to necessitate an additional afternoon session. The summarised return set out below gives the results of the work carried out during the year. Provision is made both for in-patient and out-patient treatment. During 1923 five mothers who had undergone a course of special ante-natal treatment at the Clinic were confined in the Borough Maternity Hospital. The children in all cases were full-time, apparently healthy and normal infants, only one giving a positive reaction to the blood test. These results are highly encouraging and satisfactory. It is satisfactory to record also that, although some trouble is still being experienced with defaulters, there is a distinct improvement in the regularity of attendances of patients as compared with previous years. 1. Tests carried out by Dr. Mackenzie Wallis (Pathologist). Wass. Neg. Pos. Sigma Neg. Pos. In-Patients. Maternity Home: Mothers 141 137 4 90 88 2 Babies 2 1 1 — - — Out-Patients. Clinic Cases: Mothers 90 74 26 116 92 24 Babies 36 30 6 - - — N.B.—The 63 positive blood tests were given by 24 syphilitic patients, of which 19 were mothers and 5 babies. 2. Pathological Tests carried out at the Clinics. (a) Slides from eye discharge. No evidence V.D. 28 Gonococcus found 1 Total 29 slides. (b) Slides from:— Urethra 99 Cervix 94 Total 193 slides. 27 (c) Cultures from Urethra 54 Cervix 52 Total 106 cultures. N.B.— In six cases (referring to three patients) a positive result was obtained. 3. Notified Ophthalmia Neonatorum cases seen by Medical Officers. Mothers examined 15 Babies examined 16 of which there were:— In-patients 2 Out-patients 29 Total cases seen in connection with Ophthalmia Neonatorum 31 N.B.— Of the mothers examined 3 were found to be suffering from Gonorrhoea and underwent treatment at the Clinic. One suspect case was also treated for Gonorrhoea. 4. Total number of sessions held 89 Total number of cases seen at the Clinics, 1923 233 Total number of attendances made 710 Of the 233 cases who attended:— 144 were discharged by Medical Officers having no sign of V.D. after examination. 3 were discharged cured. 2 moved from the Borough and were referred to the Medical Officer of Health of the district concerned. 31 were discharged pro tem. by the Medical Officer. 20 were transferred by the Medical Officer for treatment elsewhere. 10 ceased to attend without permission. 23 remained under treatment at the end of the year. 5. Sources from which patients were referred to the Clinic:— (a) Borough Council Maternity Home 24 (b) Municipal and Voluntary Clinics 144 (c) Practising Midwives 1 (d) Medical men 6 (e) Health Visitors 38 (f) Rescue Home 10 (g) St. Margaret's Day Nursery 3 (h) Patients who came themselves 7 Total number of cases registered from the opening of the Clinic, October, 1921 to December 31 st, 1923 341 28 Note A.— Of the seven expectant mothers treated for syphilis during the year 1923 3 mothers had healthy babies born. 1 mother had a baby born syphilitic. 3 mothers are not yet confined. Note B. — A total of seven patients were treated for Gonorrhoea during the year 1923. Of these:— 2 have been discharged cured by the Medical Officer. 1 has been transferred to St. Thomas's Hospital for inpatient treatment. 4 remain under daily treatment at the end of the year. 6. Medical Officers in Charge. Nurse. Dr. Roxburgh, Consultant. Miss Baggallay. Assistant Medical Officer (Maternity & Child Welfare). Dr. Roxburgh, M.D., M.R.C.P., Consultant to the V.D. Clinic, reports:— The work of the V.D. Ante-natal Clinic in 1923 shows a satisfactory increase over that in 1922. As regards Syphilis, although the total number of blood tests done shows a decrease, the number of positive results obtained shows a substantial increase, being 63 as compared with 19 in 1922. This seems to indicate that we are getting hold of the syphilitic patients better. As regards Gonorrhoea, although somewhat fewer slides and cultures were made and examined, gonococci were found in the same number of patients as in 1922, viz., 3. The total number of patients who attended in 1923 was 233, as against 184 in 1922, and in spite of this increase in the total numbers only 1 more ceased to attend without permission than in the previous year, viz., 10 instead of 9. The most satisfactory feature of the work has been the increase in the number of syphilitic mothers receiving ante-natal treatment and awaiting their confinements. It is to be hoped that the plan suggested by me last year and now in operation, of examining the blood of every mother who attends the ordinary ante-natal clinics will enable us to discover and treat a still larger number of syphilitic mothers at the most favourable time, namely, before the birth of the baby. This plan has already, in the few weeks it has been in operation enabled us to find out and treat several mothers with unsuspected syphilis. Maternity Hospital. The Borough Maternity Home was opened early in 1921. The Hospital is situated at 19 and 20 Bolingbroke Grove, directly overlooking Wandsworth Common. In addition to being a Lying-in Hospital, it is a recognised training Institution for PupilMidwives, and a District Midwifery Service is also run in connection with the hospital (see page 31). 29 The Central Ante-natal and Special Clinics are also held at the Out-Patients' Department of this hospital. Medical attendance, when required, is provided by a rota of local medical practitioners. The services of the Consultant to the Hospital, Dr. J. S. Fairbairn, M.D., F.R.C.S., F.R.C.P., Senior Obstetric Physician to St. Thomas's Hospital (or his deputy, Dr. A. C. Richardson, M.D., F.R.C.S.), are also available in cases of grave emergency. The staff of the hospital consists of a Matron, 1 Sister, and 4 Staff Nurses. There is also accommodation for 12 pupil-midwives. The popularity of the hospital continues to increase, as shown by the increased number of patients admitted during 1923 over the two preceding years. Particulars relating to the admissions during 1923 are set out as follows :— Total number of cases admitted 419 Average duration of stay 14 days Number of cases delivered by— (a) Midwives (nursing staff) 365 (b) Doctors (on rota) 52 Of the above 419 cases, 2 patients were admitted for ante-natal treatment prior to re-admission at a later date for confinement. Number of cases in which medical aid was sought by the midwife, with reasons for requiring assistance— (a) Ante-natal 9 Albuminaria 4 Heart disease 1 Nervous condition 1 Slight abdominal pains 1 Observation 1 Miscarriage 1 9 (b) During labour 73 a.p.h., placenta praevia 1 „ ,, internal version 1 a.p.h., accidental 1 p.p.h. 1 „ rise of t. and p. 1 Placenta retained 1 ,, not intact 1 Eclampsia, fits during third stage 1 Small round pelvis, induction 1 Contracted pelvis, induced labour 1 ,, craniotomy, rise of t. and p. 1 Funnel pelvis, delayed labour 1 Small outlet 1 Premature labour 2 Delayed labour 4 Post-mature labour 1 Delayed second stage 10 Hour-glass contractions (second stage) 1 Difficult second stage due to fibroid tumour 1 Malnutrition and dangerous varicose veins 1 Uterine inertia 2 Ruptured perineum 14 „ and fits 1 Heart disease 1 Prolapse of cord 2 Unreduced occipito position 3 Foetal distress 10 Extended breech 1 Impacted breech 1 Complicated breech 3 Brow presentation 2 73 30 (c) After labour 12 Post-partum eclampsia 2 Swelling of leg 1 Painful varicose veins 3 Pain in breast, rise of t. and p. 5 Phthisis, rise of t. and p. 1 12 (d) For infant 19 Talipes 1 Cephal-hæmatoma 1 Asphyxia 2 Prematurity 4 Mastitis 2 Discharge from ear 1 Melæna 1 Swelling in axilla 1 Fractured femur 1 Fits 1 Pneumonia 1 Illness of baby 1 Slight discharge from eyes 1 Ophthalmia 1 19 Number of cases notified as puerperal sepsis, with result of treatment 1 femoral thrombosis, transferred to Fever Hospital, 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 1 cured before leaving the Hospital. Number of foetal deaths (still-born or within 10 days of birth) and their causes 19 a.p.h., prematurity 2 „ accidental 1 Asphyxia 3 fibroid tumour 1 Foetal distress 3 Macerated foetus 1 Prolapse of cord 2 Fits 1 Pneumonia 1 Prematurity 4 19 Number of infants with discharge from the eyes however slight 11 The Medical Consultant was called in in 6 cases of grave emergency, particulars of which are set out below:— Eclampsia 2 a.p.h., placenta prævia 1 ,, accidental 1 Heart disease 1 Contracted pelvis, craniotomy 1 6 Number of maternal deaths 2 eclampsia, 1 heart disease. 1 Number of infants not entirely breast fed 3 Mother suffering from phthisis 2 Persistent cracked nipples 1 I am indebted to the courtesy of the Borough Treasurer for the following statement of the cost of the Home during the financial year ended 31st March, 1924:— 31 Maternity Hospital, 1923-1924. Total beds, 30; total cases, 382; percentage of beds occupied 49 per cent. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 325 0 8 4 Nursing 472 0 12 1 Domestic and other 464 0 11 11 Provisions 856 1 2 0 Drugs and other Medical Requisites 332 0 8 6 Heating, Lighting and Cleaning 376 0 9 8 Laundry 415 0 10 8 Repairs and Renewals Domestic 266 0 6 10 Structural 310 0 7 11 Rent, Rates, Taxes and Insurance 156 0 4 0 Loan Charges 1,458 1 17 4 Miscellaneous 185 0 4 9 Gross cost £5,615 £7 4 0 Income Pupil Midwives 306 0 7 10 Inmates' Payments 1,504 1 18 7 Other 10 0 0 3 Net cost £3,795 £4 17 4 The cost per patient has increased by 10s. 4d. per week as compared with the previous year. The main causes responsible for the increase are the increased expenditure on repairs and renewals. Decreases in the cost of heating, lighting and cleaning, and rates and taxes are outweighed by increases in the other items shown above, while the income from pupil midwives' and patients' fees is less than in 1922. District Midwifery Service. The District Midwifery Service for the attendance on maternity cases in their own homes, inaugurated at the close of 1921, continued to make progress during 1923. The service is directed from the Maternity Hospital, but accommodation has been provided for the District Midwife and her pupil at the Town Hall, which is very centrally situated for all parts of the Borough. The midwife's 32 rooms are connected with the Maternity Hospital by telephone, and persons requiring her services at night can telephone to her from the Police Stations. Particulars relating to the service during 1923 are set out below:— Total number of cases attended on the district 136 Number of cases delivered by— (а) Midwife 133 (б) Doctors 3 Number of cases where medical assistance was called for, with reasons for. requiring assistance— (a) During labour 3 In each case delayed second stage of labour. (b) After labour 7 Torn perineum 4 p.p.h. 2 Retained placenta 1 7 (c) For infant 1 Dangerous feebleness. Number of cases notified as ophthalmia neonatorum, with result of treatment 1 Attended St. Margaret's Hospital, subsequently discharged cured. Number of infants with discharge from the eyes, however slight 4 Number of maternal deaths Nil Number of infants' deaths within 10 days 3 Congenital heart disease 1 Prematurity 2 Number of still-births 1 Prematurity. Number of cases of notified sepsis Nil Number of cases in which temperature rose above 100·4 with rise of pulse Nil Number of infants not entirely breast fed 2 In each case supplemental feeds were given until breast feeding was satisfactorily established. 33 Dental Clinic. The Dental Clinic in connection with the Council's Maternity and Child Welfare Scheme was opened in August, 1920. Owing to the great increase in the work, it was found necessary in 1922 to hold a second weekly session, which was inaugurated on 19th July, 1922. The work of the Dental Clinic during 1923 is summarised as follows:— Number of sessions held (50 morning, 51 afternoon) 101 Total number of patients (women 154, children 32) 186 Total attendances (women 989, children 48) 1,037 Work carried out:— Ordinary extractions 31 Local anaesthetic extractions 244 Gas extractions 341 Scaling 44 Fillings (simple) 71 Upper dentures 22 Lower dentures 19 Repairs to dentures 13 Dressings 34 Applications 3 Prescriptions 31 Impressions 51 Bites 27 Try-in 49 Massage to gums 1 Plaster impression 1 Painting 30 Syringe socket 5 Suction disc 1 Dentures eased 32 Treatment to gums 9 Fit-indenture 1 Shade of teeth 3 Fittings 4 Polishing and cleaning 5 Advice 361 Letters given re Hospital Sunday Fund 5 34 Notifications of Infectious Diseases, 1923, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox - - - - - - - 1 - - - 1 1 Diphtheria and Membranous Croup 53 84 49 37 50 59 14 17 11 186 141 47 374 Erysipelas 13 8 10 10 16 19 1 5 2 34 42 8 84 Scarlet Fever 80 37 68 48 61 38 22 34 21 195 135 79 409 Enteric (Typhoid) Fever 2 1 1 — — — 1 1 2 3 1 4 8 Ophthalmia Neonatorum 4 7 6 4 7 11 — 2 1 17 22 3 42 Puerperal Fever — — — ' 3 1 1 — 2 — 3 2 2 7 Polio-myelitis 3 3 - - - - - - 2 6 — 2 8 Encephalitis Lethargica — — — — — 1 — 2 — — 1 2 3 Cerebro-Spinal Meningitis — — 1 1 — 1 1 — — 1 2 1 4 Malaria 1 — — — 1 - - 1 — 1 1 1 3 Dysentery — — — — -— 1 — — — — 1 — 1 Acute Primary Pneumonia 60 32 36 20 21 52 9 13 14 123 98 36 257 Acute Influenzal Pneumonia 9 11 3 3 9 23 7 5 — 23 35 12 70 Whooping Cough* 146 79 70 48 88 64 29 41 15 313 179 88 580 Measles* 108 160 194 188 156 307 59 105 42 487 599 233 1,319 Totals 479 422 438 362 410 577 143 229 110 1,392 1,259 519 3,170 * Notifiable in Battersea from April 24th, 1922. 35 Notifiable Infectious Diseases. During 1923, under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 3,170 cases of infectious diseases (excluding Tuberculosis) were notified, including cerebro-spinal fever 4, acute poliomyelitis 8, encephalitis lethargica 3. The distribution of the cases notified in the Wards and the Sub-Districts is shown in the table on the previous page. Excluding the cases of measles and whooping cough, there were 1,271 cases, which occurred in 1,082 infected houses. Of these cases, 918 (i.e., 72·2 per cent.) were removed to hospital and 353 (i.e., 27·8 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 Scarlet fever Plague Enteric fever Diphtheria The above include civil as well as military cases. Small-pox. One case of Small-pox was notified in Battersea in 1923 in the person of a man aged 53 years, who resided in South — West Battersea. Information was received on the 20th September from the Medical Officer of Health of a Northern Metropolitan Borough that a man who worked as a carman and disinfector for a firm of contractors which carried out disinfecting work for his Sanitary Authority was absent from his work through illness. He was reported to have assisted in the disinfection of a room and in the removal of bedding, &c., from a house from which a case of Small-pox was removed to hospital on the 8th September. On enquiries being made at his home in Battersea it was ascertained that this man occupied two basement rooms and lived alone. He had been at work up to the 19th September, when he consulted his doctor, 36 On the 20th September I saw the case in consultation with his medical attendant. The patient was in bed, apparently very ill. He stated that his illness began on the evening of the 16th with pains in the back, which he attributed to rheumatism. On the 19th the pain became worse, and he called at his doctor's on his way home from his work. On examination patient was evidently suffering from severe lumbar pain, and could move in bed only with difficulty. His face was flushed. There were two well-marked initial rashes present, a bright erythematous rash on neck and trunk and a very well marked petechial eruption in the groins and the upper and inner aspects of both thighs and extending upwards to the costal margins to the axillae of both sides. There were no focal lesions present. The case was diagnosed as hæmorrhagic Small-pox, and the patient was at once removed to hospital where he died next day. The patient was said to have been vaccinated in infancy, but the evidence of successful vaccination was doubtful. There appears to be no reasonable doubt but that the patient became infected while engaged in the removal of infected material from the room occupied by a previous case in the Metropolitan Borough referred to. The case is of particular interest because of the source of infection, short incubation period, clinical history and rapidly fatal issue. All precautionary measures were at once taken to prevent the spread of infection. These included vaccination or re-vaccination and daily medical inspection of all persons (two families) living in the house, in the basement of which the patient resided, and of all contacts at the works where he was employed and elsewhere. Fortunately, the particular work at which he was engaged did not bring him into immediate contact with the large number of workers employed at the firm's factory in Battersea —a matter of some importance, having regard to the fact that he continued at his work for at least the first two days of his illness. During 1923 there were 12 cases of Small-pox notified in the County of London. Scarlet Fever. Scarlet fever was much less prevalent during 1923 than in the previous year, the period of epidemic prevalence which began in 1919 having reached its maximum in 1921. The total number of cases notified in 1923 was 409, as compared with 750 in 1922, 1,374 in 1921, 667 in 1920 and 484 in 1919. The case-rate per 1,000 o f the population was 2·4 and 6 deaths were registered from the disease, giving a death-rate of 0·035 per 1,000, as compared with 13 deaths and a death-rate of 0·077 in 1922 and 6 deaths and a mortalityrate of 0·035 in 1921. Of the cases notified, 400 (i.e., 97·8 per cent.) were removed to hospital. The 409 cases occurred in 339 infected houses. 37 In 22 of the cases notified (not included in the above total), the diagnosis was not confirmed at hospital. Diphtheria. The number of cases of diphtheria notified during 1923 was 374, as compared with 670 in 1922, 713 in 1921, 530 in 1920, and 229 in 1919. The number of deaths registered from the disease was 34, giving a death-rate of 0·20, as compared with 58 deaths and a death-rate of 0·34 in 1922, and 63 deaths and a death-rate of 0·37 in 1921. The following table shows — Incidence and Mortality during 1923 compared with 1922 in Wards and Sub-Districts. Ward 1 2 3 4 5 6 7 8 9 E N S Boro 1923—Cases 53 84 49 37 50 59 14 17 11 188 139 47 374 Deaths 4 8 8 2 — 8 2 2 — 17 13 4 34 Incidence per 1,000 populatn. 1·9 4·6 2·5 2·4 2·7 2·8 1·6 0·9 0·5 2·7 2·9 ·9 2·19 Deaths per 1,000 population •15 •44 ·41 •13 - •38 •23 •10 - •24 •27 •08 •20 Deaths per 100 cases 7·5 9·5 16·3 5·4 — 13·6 14·3 11·8 — 9·0 9·4 8·5 9·1 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 2·19 in 1923, as compared with 3·96 in 1922, 4·21 in 1921, and 3·20 in 1920. The case-mortality in 1923 was 9·1 per cent. as compared with 8·7 in 1922. The average case-mortality per cent. for the ten years 1913— 1922 was 8·24. The 374 cases of diphtheria occurred in 308 infected houses, 366 cases (i.e. 97·9 per cent.) were removed to hospital. The incidence of the disease was highest in Park, Winstanley and Church Wards, these 3 Wards contributing 51·6 per cent. of the total cases notified. In 53 cases notified (not included in above total) the diagnosis of diphtheria was not confirmed. 38 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 1923, 12 cases of typhoid or enteric fever were notified in Battersea. Of these 4 cases were cancelled, the diagnosis not being confirmed at hospital. Two of the remaining cases were paratyphoid fever. One death was recorded from typhoid fever in 1923. In most of the cases the source of infection was difficult to trace with any degree of certainty. In one case the patient was a nurse and had been engaged in nursing a typhoid patient, and it is probable that she was infected in the course of her duties. Another case there is reason to believe was infected by eating cockles whilst staying at a south-coast town. In the remaining cases, including the fatal case, no definite evidence as to the source of infection was obtainable. Cerebro-Spinal Fever (Posterior Basic Meningitis). During 1923, 4 cases of cerebro-spinal fever were notified in Battersea. Two deaths occurred from this disease during the year. Encephalitis Lethargica. Three cases of encephalitis lethargica were notified in Battersea during 1923, as compared with 2 cases in 1922 and 12 cases in 1921. Two cases were removed to hospital, both of which were fatal. Puerperal Fever. Seven cases of puerperal fever were notified in Battersea during 1923, as compared with 13 cases in 1922 and 15 cases in 1921. There were no deaths from this cause in 1923. The number of cases per 1,000 births was 2·04, as compared with 3•55 in 1922. The notified cases were distributed as follows : East Battersea 3, North-West Battersea 2, South-West Battersea 2. Ophthalmia Neonatorum. There were 42 cases of ophthalmia neonatorum notified in Battersea during the year 1923, as compared with 41 in 1922, 61 in 1921, 105 in 1920, and 78 in 1919. The rate per 1,000 births was 12·2, as compared with 11·2, 16·3 and 22·5 in 1922, 1921 and 1920 respectively. 39 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 17 1,626 10·5 North-West Battersea 22 1,072 20·5 South-West Battersea 3 736 4·1 Wards. No. 1. Nine Elms 4 684 5·8 „ 2. Park 7 471 14·9 „ 3. Latchmere 6 407 14·7 ,, 4. Shaftesburv 4 291 13·7 ,, 5. Church 7 380 18·4 ,, 6. Winstanley 11 494 22·3 ,, 7. St. John — 156 — ,, 8. Bolingbroke 2 286 7·0 ,, 9. Broom wood 1 265 3·8 Borough (1923) 42 3,434 12·2 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 34 By midwives or nurses 8 42 Number removed to hospitals 6 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 gratuitously where cases of ophthalmia neonatorum are being treated at home. Two cases occurred of permanent damage to the eyes from ophthalmia neonatorum, in one case leading to total loss of sight and in the other to impaired vision resulting from damage to the right cornea. In the first case, owing to delay on the part of the midwife in attendance in notifying the Medical Officer of Health the case was not removed to hospital until three days after the onset of the disease. The case was removed to St. Margaret's 40 Hospital, Metropolitan Asylums Board within an hour of receipt of the notification,and was discharged four months later with permanent loss of vision in both eyes. The conduct of the midwife was reported to the Central Midwives Board for investigation. The Board subsequently referred the case to the Local Supervising Authority—the London County Council—for disciplinary action. In view of the action taken by these Authorities, the Borough Council did not take proceedings against the Midwife for breach of Art. VI. of the Public Health (Ophthalmia Neonatorum) Regulations, 1915, but directed that a cautionary letter be sent to her as to her future conduct in this respect. In the other case the child was born in a hospital outside the Borough, and developed the disease while in hospital, and was not discharged from there until after six weeks. In spite of every care, however, permanent damage to the right eye resulted. Acute Polio-Myelitis. During 1923, 8 cases of acute polio-myelitis were notified in the Borough, as compared with 4 in 1922, 2 in 1921, 1 in 1920 and 6 in 1919. Seven cases were removed to hospital, the other being treated at home. There was no death from this disease in 1923, as compared with 1 death in 1922. Erysipelas. During 1923, 84 cases of erysipelas were notified and 3 deaths were registered from the disease, as compared with 66 cases and 2 deaths in 1922 and 75 cases and 3 deaths in 1921. The case-mortality was 3·6 per cent., and the death-rate per 1,000 of the population was 0·018. Bacteriological Examinations. During the year 1923, the number of bacteriological examinations of specimens sent in by medical practitioners practising in the Borough of Battersea was 1,048. These specimens were examined at the Clinical Research Association's Laboratories at a cost of £135 15s. 2d., particulars of the results being set out in the following table:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 146 890 1,036 Enteric fever 2 8 10 Tuberculosis — 1 1 Other — 1 1 Total 148 900 1,048 41 TUBERCULOSIS. During 1923, 364 cases of Tuberculosis (all forms) were notified in Battersea, as compared with 411 cases in 1922, 466 in 1921 and 498 in 1920. In the following table is shown the distribution of the notified cases arranged in the Wards and Sub-Districts of the Borough:— Classification. Wards. Sub-districts. 1 2 3 4 5 6 7 8 9 E. N.W. S.W. Pulmonary 50 30 26 24 14 25 10 35 34 117 49 82 NonPulmonary 27 13 17 8 17 18 2 6 8 57 43 16 Totals 77 43 43 32 31 43 12 41 42 174 92 98 The Borough Pulmonary 248 Non-Pulmonary 116 Total 364 The following table shows the age and sex distribution of the ca6es of Tuberculosis notified in each Ward during 1923:— Ward. Ages: Total, all ages. Grand Total. Rate per 100,000 population. Under l yr. 1-5 5-15 15-25 25-45 45-65 65 up M. F. 1 1 7 14 16 25 11 3 46 31 77 277 2 1 2 8 12 11 8 1 29 14 43 232 3 1 3 12 5 15 6 1 29 14 43 221 4 - 2 2 5 13 9 1 21 11 32 204 5 - 4 9 7 6 5 - 18 13 31 165 6 1 3 9 12 11 6 1 23 20 43 205 7 - 1 2 - 7 2 - 6 6 12 138 8 1 1 5 6 22 4 2 20 21 41 212 9 - 2 8 8 17 5 2 22 20 42 197 5 25 69 71 127 56 11 214 150 364 213 Rate per 10 0,000 population in each age group 135 225 208 240 251 171 112 267 166 213 — 42 Particulars are given in the table below of the localization of disease in the 364 cases notified during 1923. Localization of Disease. Pulmonary (248) Abdominal (4) General (5) Lungs 234 Peritoneum 4 Miliary 2 Lungs and Larynx 4 Genito- Urinary (1) General 3 Lungs and Hip 1 Testes 1 Lungs and Abdomen 1 Bones and Joints (26) Lungs and Glands 3 Brain (13) Spine 8 Lungs and Rib 1 Meninges 13 Hip and Hip Joint 8 Lungs and Finger 1 Skin (6) Rib 1 Lungs and Miliary 1 Knee 1 Scalp, Face and Chest 1 Lungs and Meninges 2 Humerus 1 Foot and Ankle 4 Face 3 Glands (59) Elbow 1 Hands and Arm 1 Cervical 34 Pelvis 1 Unspecified 1 Abdominal 2 Os Calcis 1 Unspecified 23 Neck (2) Abscess 2 Total 364 A copy of the official return to the Ministry of Health of the notifications on Forms A B and C, received during 1923, is set out on pages 60 and 61. During 1923, there were 175 deaths from Tuberculosis registered as belonging to the Borough of Battersea. Of this number, 139 (i.e. 79·4 per cent.) were due to Phthisis (tuberculosis of the lungs), 13 (7·4 per cent.) to tubercular meningitis and 23 (13·2 per cent.) to other forms of the disease. In 1922, the number of deaths from phthisis and other tubercular diseases was 205. 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. Primary Notifications. No. of Deaths. Death-rate per 100,000 Population. 1909 257 289 155·3 1910 166 252 133·9 1911 314 289 172·3 1912 542 233 139·0 1913 743 245 146·3 1914 666 267 159·6 1915 613 282 174·1 1916 565 287 180·0 1917 523 289 192·6 1918 501 289 192·6 1919 514 208 130·6 1920 498 212 128·0 1921 466 216 127·7 1922 411 205 121·1 1923 364 175 102·6 Aver. 1909-23 476 249 150·4 43 The death-rate from tuberculosis in 1923 is the lowest yet recorded in Battersea; the notifications received were also lower than during any year since compulsory notification came into force. The death-rates per 100,000 of the population from tuberculosis during the twenty years ended 1920, in quinquennial averages, and in 1921, 1922 and 1923 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 1923 81·5 21·1 102·6 In the subjoined table are given deaths from Tuberculosis at various ages in each Ward during 1923:— Wards. Rate per 100,000 population. Ages:— Total, All Ages. Totals. Grand Total. Pulmon ary. NonPul monary. Under l yr. 1-5 5-15 15-25 25-45 45-65 65 up M. F. No. 1 130 1 1 2 6 14 11 1 22 14 31 5 36 „ 2 86 1 2 - 6 3 4 — 10 6 11 5 16 „ 3 82 1 1 - 6 6 2 - 12 4 14 2 16 „ 4 134 - 1 2 6 7 5 - 13 8 17 4 21 „ 5 90 - 2 1 4 8 2 - 7 10 13 4 17 „ 6 110 1 1 - 5 5 8 2 10 13 19 4 23 „ 7 69 - 1 1 1 3 1 - 4 2 5 1 6 „ 8 104 1 — 3 1 8 5 2 13 7 14 6 20 „ 9 94 - 1 2 2 11 3 1 12 8 15 5 20 Borough 103 5 10 11 37 65 41 6 103 72 139 36 175 Rate per 100,000 popultn. — 135 90 33 125 128 125 61 130 80 82 21 103 44 During 1923 there has been a decrease in the death rate from all forms of Tuberculosis, more marked in East and North West Battersea than in South West Battersea. District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 62 0·88 14 0·20 76 1·08 Nth.-West Battersea 40 0·82 10 0·20 50 1·02 Sth.-West Battersea 37 0·72 12 0·24 49 0·96 The Borough 139 0·82 36 0·21 175 1·03 Of the 175 deaths registered from Tuberculosis during the year, 22 were not notified until within one month before death, in 33 cases the notifications were received after death, and in 3 cases no notification was received. Of the 3 non-notified cases, 2 were recorded as tubercular after enquiry by the Coroner, and 1 occurred in a lunatic asylum. Of the 33 cases notified after death 7 (5 pulmonary, 2 nonpulmonary) were notified by private doctors, 13 (7 pulmonary, 6 non-pulmonary) by Poor Law Institutions and 13 (4 pulmonary, 9 non-pulmonary) by hospitals or asylums. In 1922, 28 cases were not notified until one month before death, in 41 cases the notification was received after death, while in 7 cases no notification was received. DISPENSARY TREATMENT OF TUBERCULOSIS. Battersea Tuberculosis Dispensary. The work of the Tuberculosis Dispensary during 1923 has been of a satisfactory and progressive character. The premises, an adapted private dwelling-house, in which this highly important health service is carried on, are, however, inadequate, structurally unfitted and inconveniently situated for the purpose, and it is to be hoped that an at early date a more suitable building will be provided. The Dispensary is the more important of the two administrative units of the scheme for dealing with tuberculosis, serving as it does inter alia as a receiving-house and centre of diagnosis and a clearinghouse and centre for observation. In a large working-class district such as Battersea it is essential that a structurally suitable building should be provided, and that it should be centrally situated so as to be easy of access to the working-class population. It cannot 45 be said that either of these conditions is fulfilled by the existing Dispensary, and it is therefore urgently desirable that more suitable provision should be made for carrying out the work of a modern Tuberculosis Dispensary. The Tuberculosis Medical 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 1923. During this year no change has taken place in the staff of the Dispensary. As in previous years, 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. The visiting of the homes of patients attending the Dispensary is carried out by the Dispensary nurses, and unsatisfactory and insanitary home conditions found to be present on inspection are reported to the Medical Officer of Health in order that such conditions may be dealt with by him. An endeavour is made to induce all notified cases of tuberculosis to attend the Dispensary, but for various reasons it is impossible to persuade all to attend. Efforts in this direction, however, have proved more successful this vear than during any year in the past, owing to the close co-operation between the Public Health Department at the Town Hall and the Tuberculosis Dispensary. Many patients are notified for the first time to the Medical Officer of Health from Institutions, where such patients are inmates at the time, and it is only on their discharge that they are able to attend the Dispensary. On notification of discharge of such patients from Institutions, visits are paid to the home with a view to attendance at the Dispensary, the object being to get in touch with those suffering from the disease in order to see that each receives the appropriate treatment, and in order that steps may be taken to prevent, as far as possible, the spread of infection to others. There is still, unfortunately, a considerable waiting period for patients between the recommendation for, and admission to, Institutions under the London County Council's Tuberculosis Scheme. This waiting period varies throughout the year, and is more marked during the spring and summer months, but on an average over the whole year it works out at 29 days. The long waiting period has a bad effect on many patients, both on their physical and mental conditions, and I am of the opinion that much good would result if the waiting period could be reduced to a week or 10 days. Institutional accommodation is limited, and this accounts for the long waiting period and also for the premature discharge of patients from Institutions in order that beds may be found for those on the waiting list. All countries, apparently, suffer from the inadequate number of sanatorium beds with the exception of the United States of America, where 50 per cent. of such beds are unoccupied. In many parts of London much difficulty has apparently been experienced in finding Institutional accommodation for advanced cases of tuberculosis, but in Battersea this difficulty has not been felt to any great 46 extent. This may in great part be due to the fact that very many of the advanced cases in the Borough are with little difficulty persuaded to enter the local Poor Law hospital, where the conditions are very good. One patient during the year discharged himself from one of the London County Council Institutions in order to re-enter St. James' Hospital because he found the conditions more to his liking in the latter Institution. The London County Council provides Institutional treatment for advanced cases of ex-service men, pensioners for tuberculosis, and besides making use of St. James' Hospital, several advanced cases have been sent to St. Luke's Home, Pembridge Villas, and also to St. Joseph's Hospice, Hackney. Many advanced cases, however, are unwilling to go away to any Institution, and prefer to remain at home, and, unfortunately, in several of those cases the home conditions have been very unsatisfactory. In such cases it seems desirable that powers should be given for compulsory removal to hospital and detention there in order to prevent the spread of infection. No Tuberculosis Dispensary service is complete and no Tuberculosis Officer can carry out his duties satisfactorily without the assistance of a Care Committee. The Care Committee of this Dispensary meets weekly on a Friday at 3 p.m., and much valuable work has been done in the way of assisting patients and their families who are in need of assistance in various ways. Close cooperation is effected by this Committee with the various voluntary and other agencies in the Borough, the Charity Organisation Society, the Invalid Children's Aid Association, with the Board of Guardians, the Emergency Help Fund of the British Red Cross Society, the United Services Fund, the Soldiers' and Sailors' Families Association, and with the Local War Pensions Committee. All these different bodies are represented on the Dispensary Care Committee, and in this way co-operation is close and effective. Much help for our patients has been obtained through all those various agencies. It is realised that patients are unlikely to derive the full benefit from sanatorium or any other form of treatment if they are worried with regard to the financial condition of their families whilst they are undergoing Institutional treatment, and the efforts of the Care Committee are directed to make such provision for the family as is necessary before the patient goes away. In the main such efforts have been eminently successful. In the finding of employment for patients discharged from sanatorium, however, the services of the Care Committee have not been so successful, and in this connection no help whatever has been given by any public body or any Government Department, and the Labour Exchanges have been unable to place any of our patients, although many have been referred to them. Anything that has been done in this direction has been accomplished by private enterprise. This inability to find suitable employment for discharged sanatorium patients is the greatest defect in our tuberculosis service, and no success is likely to be achieved until such time as the State realises its obligation in this way. A summary of the work of the Care Committee during the year is given below. 47 Many children who attend the Dispensary, and who are not found to be suffering from tuberculosis but are debilitated from various causes, are sent away for convalescent treatment through the agency of the Invalid Children's Aid Association. Much good work is done in this way. The value of complete convalescence after, for example, a severe attack of measles complicated with broncho-pneumonia, cannot be doubted, and the assistance of the Invalid Children's Aid Association in sending to a convalescent home in the country or at the seaside children who have recovered from an acute illness or who are not thriving and in need of a change is frequently asked for children who attend the Dispensary. The London County Council also has an agreement with the Association whereby tuberculous children who are not in need of sanatorium treatment, but who may benefit from a period of treatment in a convalescent home may be sent away. The Tuberculosis Dental Clinic, which was established during the latter half of the previous year, has been in operation during the whole of the year under review. It has proved to be of very great benefit to the patients who attend the Dispensary, and who are found to be in need of dental treatment. No difficulty is experienced in persuading patients to attend the Clinic. In fact, patients are only too willing to avail themselves of the opportunity which the Clinic affords. 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. Grants in aid are also frequently forthcoming, if the patient is insured, from the patient's Approved Society. Since the coming into force of the London County Council's Scheme, indicated in last year's Report, closer co-operation has been secured between the School Medical Service and the Tuberculosis Dispensary Service. This scheme aims at reducing the number of children not definitely tuberculous in attendance at the Dispensary, and securing the supervision of such children by the School Medical Officer during the child's attendance at School. A special card provided for the purpose, on which the Tuberculosis Officer gives such particulars as the name of the child, date of birth, address, school attended, together with a short history of the case and the result of examination, is sent to the Divisional School Medical Officer for transmission to the School Medical Officer concerned. The following are the classes of cases transferred:— Class 1.—All "unsatisfactory children," whether "contacts" or not, who, after a period of observation at the Dispensary, are considered to be probably non-tuberculous, but who require supervision. Class 2.—All "contacts" who, on first examination, are found to be apparently healthy. 48 Class 3.—All other "contacts" attending school whom, for one reason or another, it has been found impossible to examine. The circular issued by the Medical Officer of Health of the London County Council lays down the procedure to be followed at the School. Class 1 shall be— (a) Examined by the School Medical Officer quarterly and referred back to the Dispensary if, at any time, in his opinion the child should be regarded as probably tuberculous. (b) Weighed approximately monthly and the weight recorded on the chart. Class 2 shall be— (a) Examined once a year. (b) Weighed quarterly. Class 3 shall be examined as soon after reference as possible, classified by the School Medical Officer, and dealt with as Class 1 or Class 2, as the case may be. The system has not been in operation sufficiently long to judge of the results, but it certainly appears to be of value in preventing congestion at the Tuberculosis Dispensary, and at the same time exercising supervision over the "unsatisfactory" and "contact" child. The "contact" child, especially of the "open" case, living at home, should be kept under supervision during the whole of school life, but it appears that the large number of such cases referred from the different Dispensaries will make such supervision on the lines indicated impossible. If this turns out to be so, the value of the scheme will be correspondingly reduced. New Patients. For the year ending 31st December, 1923, 662 new patients attended the Dispensary, an increase of 38 over the preceding year. Of these 662 new patients 202 were diagnosed as tuberculous, 142 were "suspect" cases, and 318 were, considered non-tuberculous. The percentage of definite cases was therefore 30·5. The percentage of definite cases in previous years was:- 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 17·2 25·6 29·0 25·87 29·44 29·8 19·0 28·17 30·2 26·4 80·1 Of the 202 definite cases 43 were children and 159 adults. Of the 159 adults 102 were insured and 57 were non-insured. The number of discharged ex-service men amongst the tuberculous was 42, 6 less than in the preceding year. 49 The following is a rough classification of the occupations of the 202 new patients who were found to be definitely tuberculous:— 27 Housewives. 6 Domestic Servants, Charwomen and Office Cleaners. 43 Schoolchildren and Infants. 18 Clerks (varied). 11 Drivers, Conductors and Carmen. 15 Labourers, Fitters, Painters, Toolmakers, Engineers and Plasterers. 3 Post Office Workers. 16 Dealers and Shop Assistants. 2 Confectioners. 8 Printers and Assistants. 3 Storekeepers. 15 Factory, Workshop and workroom Assistants. 3 Musicians. 5 Railway Workers. 2 Waiters and Waitresses. 6 Messengers and Caretakers. 1 Boot Repairer. 3 Tailors and Assistants. 1 Horsekeeper. I Woodchopper. 1 Fireman. 2 Instrument Makers. 1 Mannequin. 1 Assistant Librarian. 1 Photographer. 1 French Polisher. 1 Police Constable. 5 With no occupation. As in previous years, 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. Endeavours are made to make this period as short as possible, both for the sake of the patient and in order to prevent congestion at the Dispensary. In exceptional cases only does the period of observation exceed one month, but in some patients with a bad family history and somewhat indefinite signs and symptoms, it is found advisable to prolong the period of observation, the patient being kept under observation at somewhat long intervals after the preliminary intensive period. In doubtful cases repeated sputum examinations are undertaken, and several patients are referred to St. Thomas' Hospital for X-ray examination and a further opinion before a definite diagnosis is arrived at. The facilities provided at St. Thomas' Hospital are fully utilised in such cases, and close co-operation exists between the Tuberculosis Department of the Hospital through the Tuberculosis Officer and the Battersea Tuberculosis Dispensary. I wish again to acknowledge 50 the very ready help which I have this year, as in the past, received from Dr. Hebert, the Medical Officer in charge of the Tuberculosis Department of St. Thomas' Hospital. Such help I have always found of the greatest value. "Contacts." During the past year 290 "contacts" were examined at the Dispensary. Of the " contacts " examined 90 were adults and 200 children. The value of a single examination of a "contact" child is apt to be exaggerated, and supervision over a period of years is required to make this part of the Tuberculosis Scheme really worth while. It has to be remembered that the infection in childhood is frequently a latent infection which may light up at any time, more frequently, perhaps, after some acute illness or other debilitating influence. A single examination, therefore, when no clinical evidence of disease is found, may give a false sense of security. Reference of " contact " children to the School Medical Officer, if systematically carried out, will provide for the continued supervision of those children. In addition, the Dispensary Nurses, on their periodic visits to the homes of Dispensary patients, make enquiries concerning the other members of the family, and, when their enquiries lead them to suspect that a further examination of one or more members may be advisable, they endeavour to persuade them to return to the Dispensary for re-examination. The prolonged supervision of "contacts" becomes increasingly more difficult, and it may become necessary in the future to concentrate on special families where the history re tuberculosis is a bad one, or where the home conditions are particularly unsatisfactory. Total Notifications. During the year 17 patients in whom the diagnosis was at first doubtful were diagnosed as definitely tuberculous, and these, added to the 202 new patients, make a total of 219 notified cases. Of this number 99 had already been notified to the Medical Officer of Health, so that 120 were primary notifications from the Dispensary. Attendances. The number of old patients attending the Dispensary during the year was 942. For previous years the number has been:— 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 661 971 1,015 1,039 1,090 1,193 1,230 1,250 1,474 1,570 1,026 For the year, the total number of attendances was 5,436, compared with 4,910 in the previous year. Of those, 1,791 were attendances of insured patients, and 3,645 of non-insured patients. No treatment of insured patients is given at the Dispensary save in exceptional circumstances, but such patients attend the Dispensary for observation at intervals varying according to the necessity of the case. 51 Home Visits. During the year 188 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 to ex-service men, pensioners for tuberculosis, who are unable to attend the Dispensary, in consultation with general practitioners, and in cases where the home conditions on the report of the Nurse or otherwise appear to require a special visit. It has been found impossible to visit the home of every notified patient. Visits by Nurses. The home visits paid by the Dispensary Nurses during the year numbered 6,942. As far as possible the home of each notified case on the Dispensary books is visited at intervals of three months, and notes of such visits are entered by the Nurses on a special card. Each week the Tuberculosis Officer goes over the week's cards with the Nurses, who call his attention to any special circumstance which may require his attention. Where the home conditions are found to be unsatisfactory and when a Dispensary patient is in a residential Institution, home visits by the Nurses are paid more frequently. In addition to the visits paid by the Dispensary Nurses, 136 visits were made by students from the Battersea Polytechnic. Sanatorium Treatment. 1. Average length of stay of patients in sanatoria during the vear 1923 14 weeks 3 davs. 2. The number of patients who showed improvement 43 3. The number of patients who discharged themselves 16 1. The number recorded of Dispensary patients who died during the year 1923 85 2. The number of patients discharged as cured or disease arrested during 1923 38 3. The number of patients recorded as having ceased to attend during 1923 27 4. The number of patients who moved out of the district in the year 1923 and who were transferred to the Borough or County Medical Officer of Health 32 Bacteriological Examinations. The number of sputum examinations increased from 925 last year to 1,132. In 302 (26·7 per cent.) cases the Tubercle Bacillus was found to be present. In doubtful cases repeated sputum examinations are carried out. This part of the work increases from 52 year to year. The number of sputum examinations carried out for general practitioners in the Borough during the year was 253. The number of examinations made for St. James' Hospital during the same period was 168. Reports on Patients. 1,332 reports were sent to public bodies during the year 1923. Reports to and Consultations with Practitioners. The relationship between the local general practitioners and the Dispensary continues to be cordial, and the percentage of new cases referred by them for an opinion remains high. In addition to the number of new cases sent by practitioners to the Dispensary, as shown in the table, many old patients are referred back during the year for a further opinion with regard to treatment. Many progress reports on insured patients also are submitted to the Tuberculosis Officer at three-monthly intervals by the doctor. During the year consultations with practitioners at the homes of their patients and reports to practitioners on patients sent to the Dispensary numbered 574. Institutional Treatment. During the year 112 patients were sent away to Institutions under the London County Council's Tuberculosis Scheme. Of these 85 were insured and 27 non-insured. Referred to Hospitals. 104 patients were referred to hospitals. 80 of those were patients in whom the diagnosis was doubtful and who were referred to St. Thomas' Hospital for X-ray examination. The 662 new patients were recommended to attend the Dispensary by— Practitioners 272 Came of their own accord 130 Contacts 63 Patients asked to call 53 Health Visitors 33 Transfers from Hospitals 25 Ministry of Pensions 23 Children's Welfare Centre 12 School Medical Officer 11 Members of Committee 8 Other Dispensaries 6 Wandsworth Union 5 School Nurses 5 London County Council 4 Invalid Children's Aid Association 2 Other Patients 2 Sanitary Inspectors 2 Other Sources 6 53 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: suitable nourishing meals being provided at the school. Details of the Medical supervision of the children during 1923 is summarised as follows::— Number on Roll 31st December, 1923 143 „ admitted during 1923 48 „ discharged during 1923 56 Reasons for discharge:— (a) Fit for elementary school 16 (b) Fit for work 31 (c) Transferred to Hospital or Sanatorium 3 (d) Removed from district 5 (e) Transferred to Special School — (J) Discharged for other reasons 1 (invalid) Gain or loss in weight of children who have been in the School for more than twelve months:— (a) Children who gained weight 103 (b) Average gain in kilos. 3.1 (c) Children who lost weight or whose weight was stationary 1 (d) Average loss in kilos. 1 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 Constitution of the Committee will be found on reference to page 2. 54 The Committee meets weekly at the Tuberculosis Dispensary and during 1923 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 1923. Number of meetings, 45. Number of cases considered, 1,093. London County Council Cases. 99 Cases were assessed for Institutional treatment. 138 Cases were re-assessed for Institutional treatment. 115 Cases were reported as having had assessments accepted. 38 Cases were reported as having entered Sanatoria. 37 Cases were reported as having entered Hospitals. 52 Cases were assessed for Springwell House Holiday. 28 Cases were recommended for admission to the Open-Air School. Convalescent Cases. 23 Cases were referred to the Invalid Children's Aid tion for convalescence. 14 Cases were reported as having been sent away by the Invalid Children's Aid Association. 9 Cases were referred to the Charity Organisation Society for convalescence. 3 Cases were reported as having been sent away by the Charity Organisation Society. 1 Case was referred to the Guardians for convalescence. In Need of Assistance. 39 Cases were referred to the Wandsworth Board of Guardians for: extra nourishment, 20; relief, 10; other forms of assistance, 9. 68 Cases were granted extra nourishment through the Borough Council. 2 Patients were granted dentures from the Borough Council. 24 Cases were referred to the Charity Organisation Society for: Financial assistance, 4; dentures, 9; bed and bedding, 9; other assistance, 2. 22 Cases were referred to the British Red Cross Society for: Financial assistance, 8; clothing, 6; nourishment, 4; bed and bedding, 4. 2 Cases were referred to the School Care Committee for: Milk at school, 1; dinners, 1. 7 Cases were referred to other agencies for assistance. Training and Employment. 10 Cases were referred to appropriate agencies for ment. 4 Patients were placed in suitable posts. 55 1 Case education grant obtained from Battersea Trust Charities. 1 Case referred to the Baron Bouck Relief Fund for educational grant. The amount of contributions from patients who were sent away for Institutional treatment amounted to £410 16s. 10d. This money was collected at the Dispensary and forwarded to the London County Council. Tuberculosis Dental Clinic. During 1922 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, 1922. During the year 1923, 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, 1923. Total attendances 402 Total sessions 51 Average number of attendances per session 8 Extractions 100 Scalings 18 Fillings 36 Dentures and remodelling 19 Repairing dentures 1 Dressings 20 Advice given 113 Total number of operations and interviews for advice only 307* Average number of operations and interviews for advice only per session 6 NON-DISPENSARY PATIENTS. In addition to the work carried out by the staff of the Tuberculosis Dispensary, 1,838 visits to houses of notified cases of Tuberculosis were made by the Sanitary Inspectors (male and female). Females and Children under 16. 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). * The number of operations for the purpose of this table includes each separate extraction and filling performed. 56 During the year 1923 the number of cases of women and children not in attendance at the Dispensary notified to the Medical Officer of Health was 132. Of this number, after deducting cancelled cases, removals, &c., 122 were investigated, and the results are summarised as follows:- Women—54. Married 19 Single 26 Widows 9 Children— 68 Boys 36 Girls 32 Total cases 122 Cases found to be dead on first visit, 23. Age and Sex Distribution. 0-1 1-5 5-10 10-15 15-20 1 20-25 25-35 35-45 45-55 55-65 65 upwards All ages Pulmonary M. - 2 1 1 - - - - - - - 4 F. 1 2 2 2 4 14 10 6 6 3 3 53 Tubercular Meningitis M. - - 1 - - - - - - - - 1 F. 1 7 - 1 1 - - - - - - 10 Other Tubercular Disease M. — 5 11 7 1 - - - - - - 24 F. - 5 9 7 2 2 2 2 - 1 - 30 Total M. - 7 13 8 1 - - - - - - 29 F. 2 14 11 10 7 16 12 8 6 4 3 93 Grand Total 2 21 24 18 8 16 12 8 6 4 3 122 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 1922, in regard to the precautionary measures being observed by the patients. In 20 cases the patient was found to be occupying a separate room, and in 43 cases a separate bed; 56 of the patients received institutional treatment, giving a total percentage of 97-54 in which some measure of isolation and prevention was being carried out, as compared with 92-8 per cent, in 1922. Sanitary State of Homes.—The sanitary state of the homes was found in 74 cases good, in 40 fair, and in 8 bad. Condition of Patient at First Visit.—In 14 cases good, in 71 fair, in 14 bad; 23 cases were found to have died. There were 481 persons living in the homes of these 122 cases, the number of rooms occupied being 384, with an average of 1.25 person per room. 57 Treatment— Domiciliary.—32 by private doctor, 8 by panel doctor, 26 attending out-patient departments of hospitals. 30 of these were subsequently transferred to the Tuberculosis Dispensary. Institutional.—56 were receiving hospital, sanatorium, or other forms of institutional treatment during the year. Financial Circumstances of Patients.—25 good, 42 fair, 55 bad. Habits.—86 good, 29 fair, 7 bad. Occupation— Infants (1 to 5 years) 23 School Children (5 to 15 years) 45 Clerks 4 Domestic workers (Cooks, Charwomen, Domestic Servants, Caretakers, &c.) 9 Factory hands (including Laundry workers) 7 Housewives 29 Teacher 1 Librarian's Assistant 1 Pianist at Cinema 1 No occupation (including 1 inmate of asylum) 2 122 Sputum flasks were in use in 9 cases, and 7 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 1,157. Of these 11 were in respect of home reports required in connection with Form B for the London County Council. The Woman Inspector also attends regularly the meetings of the Tuberculosis Care Committee. Of the above, 1,029 revisits were paid to new and old cases. The total number of cases on the register at the end of the year was 557. Many of these cases are chronic, and have been on the register for years, and are not receiving medical attention. As, however, they refuse either to attend the Dispensary or see a doctor, though urged to do so, they are kept under supervision and visited occasionally, and every effort is made to induce them, sometimes with success, to attend the Tuberculosis Dispensary for periodical examination. 58 Adult Males, 1923 (New Cases). Married 72 Total visits paid by Male Inspectors, 1923— Single 25 Widowers 3 New Cases 111 Not stated 11 Re-inspections 570 111 681 Age Distribution. All ages. 16/20 20/25 25/30 30/35 35/45 45/55 55/65 65 up Pulmonary 5 7 9 12 22 25 8 8 96 Tubercular Meningitis — 1 — — — — — — 1 Other Tubercular Diseases 4 4 1 1 3 — 1 — 14 Grand Total 9 12 10 13 25 25 9 8 111 Occupations. Bakers and confectioners 4 Porters, packers and messengers 9 Builders, carpenters, &c. 8 Clerks, draughtsmen, &c. 9 Railway workers 2 Carmen and drivers 6 Shop assistants, &c. 5 Costers and general dealers 2 Stone workers 3 Engineers, fitters, &c. 11 Tailoring 4 Labourers 20 Unoccupied 6 Musicians 2 Vagrant 2 Naval and Military 3 Miscellaneous 8 Not stated 7 111 Home Conditions. 26 occupied separate room. 79 premises in good condition 5 „ ,, bed. 17 „ fair „ 23 received Institutional treatment. 1 „ bad „ 14 no particulars obtained (dead on visit). 41 shared room. 2 not stated. 111 14 no information (dead). 1ll 59 Condition of Patients. 16 in good condition on 1st visit 10 particulars not known. 41 „ fair „ „ 111 30 „ bad „ „ 14 dead on visit. Treatment. Domiciliary. 48 Institutional treatment (including 4 asylum cases) 22 Private treatment. 27 Panel ,, 5 not stated. 9 O.P. Hospital. 111 Financial Circumstances. 7 good. 7 not stated. 69 fair. 111 14 bad. 14 dead on visit. 33 cases transferred to Dispensary. 3 cases discharged as cured during 1923. 09 Summary of Notifications during the period from the 31st December, 1922, to the 29th December, 1923, in the Metropolitan Borough of Battersea. Age Periods. Notifications on Form A. † 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 1 3 6 16 35 32 29 11 7 141 179 — — — — — 1 54 2 114 Females 1 2 3 4 8 22 27 17 8 4 4 100 127 — — — — 1 1 39 1 55 N on-Pulmonary— Males 1 12 27 9 3 7 4 3 - 1 - 67 77 — — — — — — 1 1 22 Females 3 10 15 6 3 4 2 3 - 1 - 47 53 — — 1 — 1 — — — 17 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (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.) † 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 in the case of any institution belonging to the Council, formal notifications on Form C have not been made, the totals of the weekly admissions during the year of patients proper for notification on Form C should be shewn (according to the classification in Column 1) in brackets in Column 21. 61 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 31st December, 1922, to the 29th December, 1923, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. Age Periods 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 upwards Total Cases. Pulmonary Males - - - - - - 2 2 1 - 1 6 „ Females - - - - - 1 - - 1 - - 2 Non-pulmonary Males - - - - 1 - - - - - - 1 „ Females - - - - - - - - - - - - (These 9 cases are comprised of:—Notified on Form C—6; on Form D—2; Discovered on post-mortem—1.) 62 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 1923 numbered 114, as compared with 192 in 1922, a decrease of 41 per cent. There was a corresponding decrease in the zymotic death-rate from 113 in 1922 to .67 in 1923. The mean death-rate from each of the principal zymotic diseases for the ten years 1903-1912 and for the ten years 1913-1922 are compared with the corresponding rates for 1922 and 1923 in the following table:— Disease. No. of Deaths. Mean Deathrate per 1,000 population. Death-rate per 1,000 population. Increase ( + ) or decrease ( - ) during 1923, over 1923. 1922. 190312. 191322. 1923. 1922. Previous year. Prec'd'ng 10 years (average) Small Pox 1 ... ... ... .006 — + .006 + .006 Measles 24 66 .450 .360 .141 .390 — .249 — .219 Scarlet Fever 6 13 .072 .047 .035 .077 — .042 — .012 Diphtheria 34 58 .109 .206 .199 .343 .144 — .007 WhoopingCough 16 22 .306 .219 .094 .130 — .036 — .125 Enteric Fever 1 1 .004 .019 .006 .006 ... — .013 Diarrhoea and Enteritis 32 32 .544 .352 .188 .189 — .001 — .164 Total deaths 114 192 ... ... ... ... — 78 — 74 Total death-rate ... ... 1.485 1.203 .669 1.135 — .466 — .534 NON-NOTIFIABLE INFECTIOUS DISEASES. Chicken-Pox. During 1923, 617 cases of chicken-pox were reported as compared with 259 in 1922 and 400 in 1921. Influenza. Influenza was less prevalent in 1923. The number of deaths registered in Battersea from this disease was 31 ,as compared with 110 in 1922, giving a mortality-rate of 0.18. 63 There were 70 cases of influenzal pneumonia notified during the year as compared with 196 in 1922 and 86 in 1921. The death-rate was 0.10 as compared with 0.40 in 1922. Diarrhœa. The great decline which has taken place in recent years in the prevalence of acute infective diarrhoea was again evident in 1923. The total number of deaths registered from diarrhoea in Battersea in 1923 was 32, giving a fatality-rate of 0.19 per 1,000 of the population. The factors concerned in the great decrease in mortality from acute infective enteritis or summer diarrhoea of infants have been discussed in previous Annual Reports. It is satisfactory to note, however, that the decrease has been maintained. MEASLES AND WHOOPING-COUGH. Measles. There was a considerable decline in the incidence of measles during 1923 as compared with the preceding year. This disease and whooping-cough continue to remain compulsorily notifiable in the Borough under Regulations issued by the Ministry of Health dated 8th April, 1922, the Battersea (Measles and Whooping Cough) Regulations, 1922. During 1923, 1,688 cases were notified or otherwise reported to the Medical Officer of Health. The incidence of the disease as measured by these notified and reported cases was equivalent to a rate of 55 cases in every 1,000 of the population under 10 years of age. In the previous year 3,060 cases were notified or otherwise reported. Of the cases notified or reported during 1923, 1,319, or 78 per cent, were notified under the Regulations, as compared with 1,496 cases, or 49 per cent, in 1922. It will be noted, therefore, that the obligation of notification is being observed. There were 369 cases or 22 per cent, of the total cases reported from the public elementary schools and other sources. The deaths from measles during the year were 24, giving a total mortality-rate at all ages of 0.14, as compared with 66 deaths and a mortality-rate of 0.39 in 1922. The disease was most prevalent during the fourth quarter, 22 of the 24 deaths occurring in that period of the year. The fatal cases occurred amongst children under 5 years. The special precautionary measures carried out included visits by the Health Visitors to the homes of all cases notified; securing of such isolation as is practicable; advice to the mothers as to the 64 importance of early medical attention; removal to the Metropolitan Asylums Board's hospital where the home conditions of the patient are unsatisfactory.. During 1923,91 cases were removed to hospital. Whooping-Cough. During 1923, 580 cases of whooping-cough were notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health. There were 16 deaths registered from the disease, the death-rate being 0-095, as compared with 22 deaths and a mortality-rate of 0.13 in 1922 and 30 deaths and a death-rate of 0.18 in 1921. Cancer. During 1923, the number of deaths registered from cancer of persons belonging to Battersea was 242 (males 124, females 118), as compared with 225 in 1922 and 189 in 1921. The average number of deaths from cancer during the past 5 years was 211. The death-rate from the disease per 1,000 of the population, was 142 in 1923, as compared with 133 in 1922 and 112 in 1921. The following table shows comparative average death-rates from cancer for quinquennial periods since 1901:— Period. Total Cancer Deaths. Mean Annual Death-rate. 1901-05 744 .88 1906-10 802 .95 1911-15 921 1.11 1916-20 1,005 1.28 Average. 1901-20 174 1.05 1921 189 1.12 1922 225 1.33 1923 244 1.42 65 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1923. Total Sanitary Operations 68,283 Dust receptacles provided 641 Number of house inspections 36,930 Leaky house-roofs and gutters repaired 946 House to house inspections 1.051 Bakehouse inspections 298 Houses supplied with water and fittings repaired 284 Bakehouse nuisances abated 41 Urinals—inspections 149 Houses let in lodgings registered 85 Do. altered, repaired or water laid on 73 No. of inspections of do. Water Closets provided, 255 Intimations served under Sec.3 3,648 supplied with water or supply disconnected from drinking water cisterns 225 Notices served under Sec.4,&c. 974 Notices served under Sees. 62 & 65 866 Cisterns covered, cleansed and repaired 91 Complaints received and attended to 3,476 Additional water supplies to upper floors 29 Number of premises disinfected 1,752 Houses supplied with disinfectants 1,685 Keeping of animals in unfit state discontinued 19 Overcrowding abated 13 Smoke observations 178 Premises improved, cleansed and repaired 2,883 Certificates of disinfection granted 2,251 Drains tested By smoke Do. „ water 540 1,153 Houses inspected and certificates granted (Sec. 48) 48 Drains cleansed and repaired 280 Proceedings ordered by Council and Health Committee 3,725 Drains relaid 118 Frontage drains constructed or re-constructed 34 Summonses issued 80 Magisterial Orders obtained and enforced 27 Soil pipes and drains ventilated 117 Sink and rain-water pipes disconnected or repaired 473 Factories, Workshops, &c., inspections 4,083 Water Closets cleansed and repaired 502 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 136 Cesspools abolished — Mews and Stables drained and paved — Underground sleeping rooms: Yards and forecourts paved and repaired 229 Use discontinued — Defects remedied — Accumulations of manure and other obnoxious matter removed or proper receptacles provided 19 Gipsy van inspections 46 Drains laid to new houses and tenements 48 Samples taken under the Sale of Food and Drugs Acts 1.200 Miscellaneous 1,703 66 Legal Proceedings. Legal proceedings in connection with nuisances were taken by the Council in 11 cases during 1923. 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. Nuisance at No. 11 Knox Road Nuisance having been abated, defendant ordered to pay £1 ls.Od. costs Exposure without proper precautions in public street while suffering from Scarlet Fever Fined £2 2s. 0d. Want of paving to forecourts of 20 and 22 Verona Street Paving having been done and costs 10/- paid, summonses withdrawn. Nuisance at 32 Harbut Road Nuisance having been abated and costs 14/6 paid, summonses withdrawn. A number of dogs kept on premises, 49 John Street, in such manner as to be a nuisance Order to abate nuisance within 7 days, with 7/- costs. Stable at rear of 146 Lavender Road used for sleeping purposes Order prohibiting use for sleeping purposes to be obeyed within 14 days. Shed at rear of 146 Lavender Road used for human habitation and in such a state as to be injurious or dangerous to health Closing Order. Nuisance from black smoke Defendants undertaking to use their best endeavours to prevent a nuisance in future, and paying £3 3s. Od. costs, summonses withdrawn. Do. Defendants undertaking to use their best endeavours to prevent a nuisance, and to pay £7 7s. Od. costs, summonses withdrawn. Nuisance at 109 Wickersley Road Order for abatement in 7 days with 11/- costs. Nuisance at 112 Wycliffe^Road The like ordei in 14 days with 8/costs. Order not having been complied with, further hearing adjourned sine die to enable the Council to enter and abate nuisance. 67 Sale of Food and Drugs Acts. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 746 Milk 13-0% extraneous water Pined 10s. 772 Milk 5-0% extraneous water Defendant deceased. Withdrawn on payment of £1 Is. 0d. costs. Samples taken in course of delivery. 773 Milk 6-0% extraneous water 826 Milk 13-0% extraneous water Fined £2. 829 Margarine Selling margarine by retail and delivering it to the purchaser in a plain wrapper. Fined £2. 839 Milk 10% extraneous water Dismissed on payment of £1 5s. 0d. costs. 867 Medicine Selling a compounded drug 17-0% deficient in potassium iodide Fined 40s. and £3 3s. 0d. costs. 912 Vinegar 7-0% deficient in acetic acid Dismissed on payment of 23s. costs. 930 Milk 7-0% extraneous water Fined £2 and £2 2s. 0d. costs. Second defendant bound over in the sum of 40s. 9 Milk 4-0% deficient in fat Dismissed—warranty defence. 26 Milk 15 • 0% extraneous water C Fined £5 on each of the four summonses — 14 days in which to pay. Summons against other defendant withdrawn. 27 Milk 14-0%extraneous water 28 Milk 14 -0%extraneous water I 29 Milk 14-0%extraneous water 49 Separated Milk 10-5% extraneous water Fined £2 and £3 3s. Od. costs. 78 Milk 26-0% deficient in fat Summonses withdrawn, the defendants' warrantor having been convicted of selling milk deficient in fat in proceedings by the Wandsworth Borough Council. 135 Milk 10-0% deficient in fat Withdrawn on payment of £3 3s. 0d. costs. Sample taken in course of delivery. 179 Milk (a) 9% extraneous water (a) Dismissed, Warranty defence. (6) Name & address not on barrow (6) Fined £1. 185 Milk 10-5% extraneous water Fined £2 and 12s. 6d. costs. 209 Milk 25% deficient in fat Fined £2 and £1 Is. 0d. costs. Sample taken in course of delivery. 309 Cream of Tartar 21-5% of maize starch Withdrawn by order of the Health Committee on payment of 23s. costs. 68 No. of Sample Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 310 Cream of Tartar 8-0% bicarbonate of soda Withdrawn by order of the Health Committee on payment of 23s. costs. 321 Milk 2-0% extraneous water & 6.0% deficient in fat Withdrawn on payment of £3 3s. Od. costs. Sample taken in course of delivery. 367 Milk 16-0%deficient in fat Summonses dismissed on payment of 25s. costs in all, having regard to defendant's previous good record. Samples taken in course of dedelivery. 369 Milk 17-0% deficient in fat 374 Milk 10-0% deficient in fat Summons dismissed on payment of 17/6 costs, having regard to defendant's previous good record. Sample taken in course of delivery. 476 Milk 18% extraneous water Fined 40s. 601 Sponge Cake The equivalent of 23-8 grains of crystallised boric acid per lb. Fined 40s. and £1 Is. 0d. costs. 618 Milk 2% deficient in fat Dismissed on payment of £1 Is. Od. costs. 634 Milk 11J% extraneous water and at least 32£% deficient in milk fat Fined £10. Name to be removed from the register of milk purveyors in the borough for a period of 12 months. Milk and Dairies Amendment Act, 1922. 813 Milk Selling milk to which a colouring matter, viz., Annatto, had been added Summons against vendor dismissed under Probation of Offenders Act, on payment of £2 2s. Od. costs; case against employee withdrawn. 911 Milk Do. Fined 25s. 120 Milk Do. Dismissed on payment of £1 Is. 0d. costs. 383 Milk •Do. Dismissed on payment of 10s. 6d. costs. 406 Milk Selling milk to which colouring matter had been added Dismissed on payment of £1 Is. 0d. costs. * Also contained 2% extraneous water. 69 No. of Sample. Article. Nature of Offence. Adulteration, &c. Result of Proceedings. 466 Milk 14% extraneous water Fined 40s. Summons against employee withdrawn. 574 Milk 7|% extraneous water Fined 20s. and 21s. costs. Summons against employee withdrawn. 579 Milk 7% extraneous water First defendant who took responsibility fined £1 10s. Od. and case against second defendant withdrawn. 594 Separated Milk Selling separated milk to which colouring matter had been added Dismissed on payment of £1 Is. Od. costs. 604 Milk 7% extraneous water Dismissed on payment of £2 2s. Od. cost-,-. 605 Milk 10% extraneous water Fined £5. Summons against second defendant withdrawn on first defendant taking responsibility. 673 Milk 10% extraneous water Dismissed on payment of £1 Is. 0d. costs. Public Health (Milk and Cream) Regulations, 1912. Public Health (Milk and Cream) Regulations, 1912, Amendment Order, 1917. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 924 Preserved Cream No label on receptacle delivered to purchaser Summons dismissed on vendor, who took responsibility, paying 925 Preserved Cream Do. Summons dismissed on vendors, who took responsibility, paying £1 Is. 0d. costs. Housing, Town Planning, &c.. Acts 1919, Sec. 28. Nature of Offence. Result of Proceedings. 35a Ascalon Street—as occupier failing to obey closing order made on 19th July, 1922 Ordered to quit within one month. 70 Summary of Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 56 cases during the year 1923:— Persons prosecuted (including employees). Convictions. Fines. Costs. £ s. d. £ s. d. Factory & Workshop Act, 1901 — — — — Milk & Dairies (Amendment) Act, 1922 18 6 10 15 0 9 19 6 Public Health (Milk and Cream) Regulations, 1912, Amendment Order, 1917 5 — — 2 2 0 Public Health (London) Act, 1891, and the Bylaws made thereunder 11 6 2 2 0 14 1 6 Sale of Food and Drugs Acts 31 14 49 10 0 26 7 0 Housing Acts 1 1 — — Total 66 27 62 7 0 52 10 0 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 72 new buildings, or additions to existing buildings, and the drains of 118 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. 71 The drains of the following premises, being "sewers" in respect of the maintenance of which liability was recognised by the Council, were repaired or reconstructed during 1923 at the cost of the Council:— Battersea Park Road, 371 (with 369) Etruria Street, 9, 11, 13. Falcon Road, 61, 63, 65. Hibbert Street, 20 (with 14 to 24). John Street, 47, 48, 49. Russell St., the "Earl Russell"; 28 & 30. Speke Rd„ 28,30, 32; 66, & 68; 69 & 71. The expenditure incurred on these "sewers" amounted to £449 15s. It is satisfactory to note that in October, 1923, the London County Council gave notice of intention to include in their General Powers Bill a clause to extend to all the Metropolitan Borough Councils the protection already obtained by the Woolwich Council in their Act of 1905 against liability for the maintenance of unauthorised combined drains. Revenue Act, 1903. During 1923 no application for the certificate of the Medical Officer of Health under the provisions of the Revenue Act, 1903, was received. Sanitary Conveniences attached to Licensed Premises. During 1923 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, 27 notices were served to remedy defects discovered. Smoke Nuisances. During the year 178 observations were made and 47 complaints received. Thirty preliminary and 5 statutory notices were served by the Council to abate smoke nuisances. Proceedings were instituted against two firms, the summonses being withdrawn on payment of 3 guineas and 7 guineas costs, respectively, the defendants by their solicitors undertaking to use the best practical steps to prevent further nuisances arising. Effluvium Nuisance. During 1923 no complaint of effluvium was established. Water Supply. During 1923, 48 applications were received for certificates of water supply in respect of 48 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 29 cases additional water supply to the upper floors o 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. 72 Van Dwellings. The number of van dwellings in the Borough in 1923 was 58. 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 3 4 4 Mill's Yard, adjoining 80 Sheepcote Lane 4 3 5 Gray's Yard, 481, Battersea Park Road 2 2 4 Manley's Yard, Falcon Road 7 9 6 Manley's Yard, Cabul Road 24† 24 23 Mill's Yard, Culvert Road 18* 23 26 During the year 8 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. Rag flock is no longer being used in Battersea for stuffing bedding and furniture. Cotton flock appears now to have been substituted for the purpose. 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. During 1923 the work carried out under the Council's Rat Repression Scheme is summarised as follows:— Premises visited 1,744 Contracts renewed 13 Poison baits used 44,050 Value of contracts £178 0 0 Dead rats found 1,727 Cash for poison bait £27 3 6 Drains were tested at 94 premises in connection with this work, and in 52 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. * Including one shed. † Including one cottage. 73 Personal Cleansing Station. The new Establishment Laundry and Personal Cleansing Station were opened by the Mayoress, Mrs. F. C. R. Douglas, M.A., on the 3rd November. The new building containing these two institutions has been erected on part of the land belonging to the Latchmere Public Baths. It is a composite building, the ground storey being occupied by the new Establishment Laundry and a disinfecting plant for the use of the Cleansing Station. The upper storey is occupied by the new Personal Cleansing Station. The new station on the first floor is approached from Sheepcote Lane by an entrance door and concrete staircase 3 ft. 6 ins. wide, the wall being in part lined with green glazed tiles. The Station contains separate accommodation for males and females. Each division contains two bath cubicles, one of which is fitted with a head-cleaning apparatus in addition to the bath, a douche compartment, undressing and dressing cubicles, two waiting rooms, one for persons awaiting cleansing and one for persons waiting while their clothing is being disinfected, a room for the nurse and attendant, sanitary accommodation, &c. The station is lighted by two lantern lights, and by windows on three sides. The walls are lined with white glazed bricks throughout. The division forming the cubicles and dressing boxes are of "Shipwood" glazed partition bricks. Special attention has been given to the cubicle doors to avoid joints and crevices which would harbour vermin. Heating is provided by five grilled radiators, each with 150 ft. of heating surface. They are supplied with steam from a boiler in the disinfectant chamber on the ground floor. The disinfestation of the verminous clothing of the persons cleansed is carried out by means of a gas-heated steam disinfecting plant fitted into the brick wall which divides the room into two compartments, each of which is thereby separated from the other. There is therefore a clean side and an infested side. Lifts convey the clothing from either of these compartments to or from the station above. At the official opening by the Mayoress the following memorandum was prepared on the instructions of the Health Committee showing the statutory powers and duties of the Council under the Cleansing of Persons Act and the work which had been accomplished since these powers were adopted in Battersea in 1906:— Memorandum from the Medical Officer of Health. The Cleansing of Persons Act, 1897, permits local authorities to provide cleansing and disinfection for those requiring such facilities, and for this purpose “Any local authority shall have the power when in their discretion they shall see fit to permit any person who shall apply to the said authority . . . to have the use, free of charge, of the apparatus (if any) which the authority possesses for cleansing the person 74 and his clothing . . . . the use of such apparatus shall not be considered to be parochial relief or charitable allowance to the person using the same or to the parent of such person, and no such person or parent shall by reason thereof be deprived of any right or privilege or be subject to any disqualification or disability. Local authorities may expend any reasonable sum on buildings, appliances and attendants that may be required for the carrying out of this Act, and any expenses for this purpose may be defrayed out of any rate or fund applicable by the authority for general sanitary purposes or for the relief of the poor." Notwith tanding the existence of these very valuable powers, not much use appears to have been made of them, probably because the Act was permissive—there be'ng no statutory obligation on a local authority to administer the Act, nor, should the authority decide to administer the Act, is there any power to compel any person to avail himself of its provisions. In 1906 in Battersea the Borough Council decided to make use of the powers contained in the Act. A temporary Personal Cleansing Station was established, one of the Reception Shelters at Sheepcote Lane being utilised for the purpose. The station was opened for the reception of persons requiring the use of the facilities provided by the Council on the 25th July, 1906. At first comparatively little use was made of the station, but as its influence began to be felt the numbers steadily increased. The common lodging houses, Salvation Army shelters, and vagrants at first supplied the majority of the applicants, but in course of time the advantages of the station attracted a wider class. The grateful and comforting experience derived by the less fortunate class of inhabitant of being able to obtain a warm bath amid clean and comfortable surroundings and without loss of their indopendence and self-respect was responsible, no doubt, for the rapid increase in the popularity of the station. In 1911 the London County Council, in compliance with the statutory duty imposed upon them as the Education Authority for London, finding it necessary to make provision for the cleansing of school children attending the public elementary schools, entered into a contract upon terms agreed upon with the Council for the use of the station for the cleansing of Battersea children. The greatly increased numbers of persons using the station made it necessary to utilise another shelter. It soon became evident, however, that these buildings were structurally and otherwise unsuitable for the purpose, and from time to time the difficulties arising in carrying out this valuable work were brought to the notice of the Council. Unfortunately, the war inhibited public health activities, and it was not until December, 1919, that the Council decided to build a suitable station, and in February, 1920, plans, &c., were prepared and submitted to the Ministry of Health, who approved of them after some alterations and amendments were agreed to by the Council. The estimated cost of the new station was £3,300, but this estimate was later increased to £3,665. The pressure of other work on the Works Department of the Council caused some unavoidable delay in the erection of the new building, but a start Was made late in 1922, and the station was completed and ready for use in July, 1923. The new station is very centrally situated and is built in conjunction with the new Establishment Laundry on the spare land beside the Latchmere Baths, with its frontage to Sheepcote Lane. It is a well-lighted, airy building,, with tiled walls and impermeable floors, and is provided with all necessary modern equipment, e.g., baths, douches, sprays, sterilising apparatus for clothing, &c. It is anticipated that it will be capable of dealing with at least double the present annual number of persons. Appended will be found particulars of the numbers of persons cleansed, and the cost annually since the station was established in July, 1906. 75 These figures clearly show the extent to which the facilities provided by the Council, inadequate and unsuitable as they were, have been availed of. It is gratifying to find that new, more commodious, better adapted and equipped premises for carrying on this important health service are at length an accomplished fact. Moreover, it should not be overlooked that the work carried out at the Station forms a very important link with that carried out by the Council in the cleansing and disinfection of houses under the provisions of the Public Health (London) Act, 1891, and other statutes. It should also be remembered that certain dangerous infectious diseases are known to be spread by the agency of vermin, and that probably the list of diseases so transmitted—if the causative organisms could be discovered and isolated—would be found to be extended. Finally, the provision of a service like this is a valuable educational factor in the promotion of personal hygiene. In working-class districts like Battersea there is, unfortunately, a large proportion of dwellinghouses where the opportunity for securing personal cleanliness is restricted or lacking. In the circumstances, the provision of public facilities such as those which the municipality can provide is not only justifiable but indispensable, and an important adjunct to their other public health services. Number of Baths, &c. Adults Children. Cost of Station. Amount Contributed. Verminous. Verminous and Scabies. £ £ 1906 141 2 29 — 1907 504 113 42 — 1908 1,011 656 82 1909 1.373 321 91 — 1910 1,583 341 88 1911 1,459 191 93 13 1912 1,351 841 237 65 1913 1,323 1,090 118 69 1914 1,050 1,602 132 78 1915 648 1,273 125 78 1916 475 1,773 143 94 1917 320 2,620 169 140 1918 291 3,179 237 187 1919 366 3,214 287 169 1920 419 4,213 456 331 1921 340 4,607 561 400 1922 274 4,444 584 400 12,928 30,480 £3,474 £2,024 The new station provides greatly improved accommodation and equipment to that hitherto available for carrying out this useful public health work. During 1923, 4,949 children and 212 adults were cleansed at the Personal Cleansing Station. Of the 4,949 children attending, 184 were suffering from scabies and the remainder were verminous. The children attended from the public elementary schools in Battersea 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 76 vision of officers of the London County Council Public Health Department, whilst the disinfection of the clothing and the homes is dealt with by the Borough Council's sanitary staff. Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1923. Premises disinfected 1,752 Rooms disinfected 2,840 Staircases disinfected 171 Schools disinfected 59 Number of articles laundered 28,405 „ „ destroyed 901 „ verminous persons (including 4,949 school children) 5,161 „ infectious disease contacts 535 ,, Library books collected 204 Total Articles. No. Weight. Tons. cwts. qrs lbs. Bedding, &c., disinfected 51,846 118 16 1 6 ,, lent 1,116 3 6 1 20 Verminous clothing, &c. 4,619 1 9 3 22 Articles from Welfare Centres 5,405 (not weighed) Total 62,986 123 12 2 20 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. Wands -worth Elsewhere. Residence unknown Inquest and post-mortem held at Mortuary 75 5 11 5 96 Inquest at Mortuary; post-mortem at St. James's Hospital 9 19 4 1 33 Inquest at Mortuary; no post-mortem 7 19 6 — 32 Total inquests held Battersea Mortuary 91 43 21 6 161 Post-mortems without inquest, Battersea Mortuary 3 1 1 5 Total post-mortems held at Battersea Mortuary 78 6 12 5 101 Bodies received for sanitary reasons Other bodies on which no inquest held 6 — — — 6 Total bodies received 100 44 22 6 172 77  Usual Place of Residence. 1 Total. Batter, sea. Wands -worth Elsewhere. Residence unknown VERDICTS AT INQUESTS HELD— Natural causes 58 11 4 — 73 Accidental Death— Asphyxia 3 — 1 — 4 Burns and scalds 1 3 1 — 5 Coal gas poisoning — — — .— — Deaths under anaesthetic 2 — — — 2 Drowning — 1 1 — 2 Fall 7 10 3 — 20 Heat Stroke 1 — — — 1 Railway and street accidents 4 14 4 — 22 Tetanus following injury — — — 1 1 Septicaemia„ 1 — — — 1 Open Verdict— Found drowned — — 2 1 3 Injuries of unknown origin — — — "—.* Stillborn — — ' — 2 2 Want of attention at birth 1 — — 2 3 Suicide— Cut throat 1 1 — — 2 Drowning — 1 3 — 4 Firearms 2 — — — 2 Hanging 2 — — — 2 Poisoning—Coal gas 4 — — — 4 Drugs, etc. 4 — 2 — 6 Homicide. Careless driving (manslaughter) — 1 — — 1 Criminal Abortion (wilful murder) — 1 — — 1 Smothering and strangulation (wilful murder) — — — — — Grand Total 91 43 21 6 161 Sanitary Staff. The personnel of the staff of the Health Department will be found fully set out on page 3. During 1923 the following changes occurred :— 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. At the end of this period she found that she was unable to resume her duties, and resigned her appointment. The vacancy was filled up by the appointment of Dr. Martha L. Hamilton, M.B., B.Ch.(Edin.), D.P.H. In September Miss D. Heap was appointed an additional Health Visitor. 78 Protection of the Food Supply. Unsound Food. The following is a tabulated return of unsound food seized or voluntarily surrendered during 1923:— Food. Quantity. Food. Quantity. Fish Fruit & Vegetables (fresh). Dabs 6 stone. Apples 100 cases. Hake 1 box. 2 bushels. Herrings 2 boxes. Brussels tops 20 ½-bags. Kippers 8 boxes. Strawberries 56 3-lb. baskets Mussels 1 bag. Tomatoes 11 bundles. 1 sack. 8 boxes. Plaice 3½ stone. 1 case. 21 lbs. Miscellaneous. Skate 2 boxes. Wheat 5 38/496qrs. 2 stone. 488 lbs. Whelks 1 bag. Whiting 6 stone. 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. These premises are kept under systematic inspection, and during the year 1923, 303 inspections were made by the Council's inspector. The carcases of 991 animals (oxen 89, calves 15, sheep 552 and pigs 335) were examined after slaughter. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1923 was 85. Three new shops were opened during the year, making a total of 88 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 1,169 inspections of these premises were carried out by the Council's food inspector. 79 Sale of Food and Drugs Acts. The total number of samples taken under these Acts during 1923 was 902. Of this number 65 (i.e., 7-2 per cent.) were certified by the Public Analyst to be adulterated. In addition to the foregoing, 298 informal samples were purchased, of which 22 (i.e., 7.4 per cent.) were reported by the Public Analyst as adulterated or not up to standard. The following table gives details of the articles of which samples were obtained for purposes of analysis :— Examined. Adulterated. Formal Informal Total Formal Informal Total Arrowroot — 12 12 — 0 0 Bread — 3 3 — 0 0 Butter 22 125 147 0 4 4 Cake—Jam Sandwich — 2 2 — 1 1 „ Sponge 5 15 20 1 3 4 „ Madeira — 10 10 — 9 9 Camphorated Oil — 9 9 — 0 0 Cheese 21 — 21 0 — 0 Cocoa 6 17 23 0 0 0 Coffee 20 — 20 0 — 0 Cream 3 — 3 2 — 2 , Preserved 9 2 11 0 0 0 „ of Tartar 12 7 19 6 2 8 Honey 4 10 14 0 0 0 Lard 16 6 22 0 0 0 Margarine 12 17 29 0 0 0 Milk 702 — 702 43 — 43 „ (separated) 10 — 10 2 — 2 Mustard — 8 8 — 0 0 Olive Oil 5 5 10 0 0 0 Pepper — 7 7 — 0 0 Prescriptions 10 6 16 1 0 1 Preserved Meats, &c. 9 5 14 4 3 7 Rice 5 18 23 0 0 0 Sago — 4 4 — 0 0 Sausages 16 — 16 5 — 5 Sugar — 4 4 — 0 0 Vinegar 15 6 21 1 0 1 902 298 1,200 65 22 87 With regard to the 87 samples certified to be adulterated legal proceedings were instituted in 42 instances, and cautionary letters were addressed to the vendors in 9 cases by direction of the Health Committee. 80 Milk. Of the whole-milk samples 43, or 6.1 per cent., were certified as adulterated, whilst of the 10 samples of separated milk 2, or 20 per cent., were reported against. The average composition of the 659 samples reported as genuine proved to be as under :— Total milk solids 12.5 % Milk fat 3.64% Solids not fat 8.86% The content of milk fat in these 659 samples ranged as follows: 4.0 per cent, and over 90 samples or 13.7 per cent. 3.9 ,, ,, 40 ,, 6.1 ,, 3.8 ,, ,, 68 ,, 10.3 ,, 3.7 „ ,, 84 ,, 12.7 ,, 3.6 „ ,, 81 ,, 12.3 ,, 3.5 „ ,, 77 ,, 11.7 ,, 3.4 ,, ,, 90 ,, 13.7 ,, 3.3 ,, ,, 57 ,, 8.6 ,, 3.2 ,, ,, 36 ,, 5.5 ,, 31 ,, ,, 21 ,, 3.2 ,, 3.0 ,, ,, 15 ,, 2.3 ,, All samples were systematically tested for the presence of preservatives, but in none of the 712 samples examined was a preservative found. Milk sampling was carried out on 17 Sundays during the year and 85 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 94 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 81 were taken in course of delivery to public elementary schools, hospitals, &c., in the Borough. Proceedings were taken with regard to adulteration in 36 instances (fat abstracted 8, extraneous water 19, both fat abstracted and added water 2, added colouring matter 5 and separated milk 2), particulars relating to which will be found set out in the summarised tables on pages 67 to 70. Warranty as a defence was pleaded in 2 cases, and in both the plea was successful. Sausages and Preserved Meats, &c. Sixteen samples of sausages and 9 of preserved meats, &c., were procured in the form prescribed by the Acts, and submitted to the Public Analyst. Five of the sausages and 7 of the preserved meats. 81 &c., were reported to contain a boron preservative expressed in terms of crystallised boric acid ranging from 5 to 12 grains per pound of these foodstuffs. Rice. Twenty-three samples of rice were purchased for submission to the Public Analyst, 5 being procured formally and 18 informally. All these samples were reported as genuine. Prescriptions. Sixteen samples of compounded medicines were procured for submission to the Public Analyst. Of the 16 samples 10 were taken in the form prescribed by the Acts and 6 informally. Of the former 1 sample, a mixture containing iodide of potash, was reported by the Public Analyst to be deficient to the extent of 17 per cent. of this drug. Proceedings were taken against the chemist from whom this sample was purchased. He was convicted and fined £2 0s. Od. and £3 3s. Od. costs. Butter. During the year 147 samples of butter were submitted for examination, 22 samples being taken in the form prescribed by the Acts, whilst 125 were purchased informally. Of these latter 4 were reported against by the Public Analyst, 3 as containing margarine, and 1 as containing an excess of boric acid over the maximum permissible limit of 0.5 per cent. Of the 147 samples submitted 41, or 27.9 per cent. contained no preservative other than salt, whilst 106, or 72.1 per cent., contained a boron preservative. Excluding the 4 informal samples reported as adulterated, the average content of boron preservative expressed in terms of crystallised boric acid proved to be 0.25 per cent., equivalent to 17.5 grains per pound of butter. Margarine. Twenty-nine samples of margarine were purchased for submission to the Public Analyst, 12 being procured formally and 17 informally, and all were reported as genuine. A boron preservative was present in each of the 29 samples, the average quantity for all samples expressed as boric acid amounting to 0.26 per cent., equivalent to 18.2 grains per pound of margarine. Analyst's Reports. The following reports of the Public Analyst set out in detail the results of the analysis of the articles submitted to him. 82 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 March, 1923, amounted to 300. All these were submitted by the Council's Inspector, 220 of the samples being taken with the necessary formalities required by the Acts, and 80 obtained informally. First Quarter.—The following statement shews the nature of the samples submitted, and the result of analysis, the details of Drugs and Other Articles being given below:— General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Butter 15 17 32 0 0 0 Cheese 6 — 6 0 — 0 Cocoa — 5 5 — 0 0 Cream 3 — 3 2 — 2 Cream (Preserved) 1 — 1 0 — 0 Margarine 6 5 11 0 0 0 Milk 157 — 157 10 — 10 Milk, Separated 1 — 1 0 — 0 Mustard — 5 5 — 0 0 Vinegar 5 6 11 1 0 1 Drugs 10 11 21 1 0 1 Other Articles 16 31 47 2 0 2 Total 220 80 300 16 0 16 Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Camphorated Oil — 5 5 — 0 0 Prescriptions 10 6 16 1 0 1 Total 10 11 21 1 0 1 83 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot — 4 4 — 0 0 Brawn 1 — 1 0 — 0 Coffee 6 — 6 0 — 0 Fish Paste 1 — 1 1 — 1 Honey — 6 6 — 0 0 Lard — 6 6 — 0 0 Olive Oil — 5 5 — 0 0 Pepper, White — 4 4 — 0 0 Rice — 6 6 — 0 0 Sausages 6 — 6 1 — 1 Sausage (Breakfast) 1 — 1 0 — 0 Sausage (Luncheon) 1 — 1 0 — 0 Total 16 31 47 2 0 2 Of the 32 samples of butter examined, 13 were found to be free from any preservative other than common salt, whilst 19 contained a boron preservative in quantities under 0.5 per cent. 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 0.27 per cent., equivalent to 18.9 grains per lb. Of the 3 samples of cream examined 2 were reported against as containing a boron preservative expressed as crystallised boric acid in quantities as follows:— Case No. Percentage of Boric Acid. 924 0.36 925 0.33 Of the 157 samples of milk examined, 10 were reported against, as follows:— Case No. Nature of Report. Case No. Nature of Report. 746 13% extraneous water. 813 Coloured with Annatto. 749 3% extraneous water. 826 13% extraneous water. 764 4% milk fat deficient. 839 10% extraneous water. 772 5% extraneous water. 911 Coloured with Annatto. 773 6% extraneous water. 930 7 % extraneous water. The average composition of the 147 samples of Milk returned as genuine was as under:— Total milk solids % 12.48 Milk fat 3.64 Solids not fat 8.84 84 One sample of vinegar was reported against as under:— Case No. Nature of Report. 912 7% deficient in acetic acid One prescription was reported against, as follows:— Case No. Nature of Report. 867 17% deficient in potassium iodide. The 2 samples reported against under the heading Other Articles " were as follows:— Case No. Nature of Sample. Nature of Report. 893 Fish Paste 10.0 grains of Boric Acid per lb. 894 Sausages 12.2 „ „ In conclusion I have to report that the total adulteration during the quarter amounted, for formal samples, to 7.2 per cent.; for informal samples, to 0.0 per cent.; and for all samples, to 5.3 per cent. Second Quarter.—The following statement shews the nature of the samples submitted, and the result of analysis, the details of Drugs and " Other Articles " being given below:— General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Butter 4 38 42 0 1 1 Cheese 10 — 10 0 — 0 Cocoa 6 — 6 0 — 0 Margarine 6 — 6 0 — 0 Milk 182 — 182 15 — 15 Milk (Separated) 4 — 4 1 — 1 Drugs 5 4 9 3 2 5 Other Articles 29 26 55 0 9 9 Total 246 68 314 19 12 31 Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Cream of Tartar 5 4 9 3 2 5 Total 5 4 9 3 2 5 85 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot — 4 4 — 0 0 Cake (Madeira) — 10 10 — 9 9 Coffee 9 — 9 0 — 0 Honey 4 — 4 0 — 0 Lard 11 — 11 0 — 0 Rice — 8 8 — 0 0 Sausages 4 — 4 0 — 0 Sausage (Breakfast) 1 — 1 0 — 0 Sponge Cake — 2 2 — 0 0 Sponge fingers — 2 2 — 0 0 Total 29 26 55 0 9 9 Of the 182 samples of milk submitted, 15, or 8.2 per cent. were reported against, as under:— Case No. Nature of Report. Case No. Nature of Report. 9 4% milk fat deficient. 131 2% milk fat deficient. 26 15% extraneous water. 135 10% milk fat deficient. 27 14% extraneous water. 179 9% extraneous water. 28 14% extraneous water. 185 10½% extraneous water. 29 14% extraneous water. 209 25% milk fat deficient. 71 2½% extraneous water. 211 3% milk fat deficient. 78 26% milk fat deficient. 214 2% milk fat deficient. 120 Coloured with Annatto. The average composition, in regard to milk fat and solids-notfat, of the 167 samples of milk submitted during the quarter and reported as genuine was as follows:- Total solids % 12.38 Milk fat 3.49 Solids not fat 8.89 Of the 4 samples of separated milk submitted, 1 was reported against, as under:— Case No. Nature of Report. 49 10½% extraneous water Of the 5 formal samples of drugs submitted, 3 were reported against, as follows:— Case No. Nature of Sample. . Nature of Report. 243 Cream of Tartar 4 parts per million excess Arsenic 244 ,, ,, 21.5% Maize Starch 245 ,, ,, 8.0% Bicarbonate of Soda 86 The one informal sample of butter reported against was found to contain a slight excess of boric acid. Of the 42 samples of butter examined, 15 were found to be free from any preservative other than common salt; 26 contained a boron preservative in quantities under 0.5 per cent., expressed in terms of crystallised boric acid, whilst 1 contained a slight excess of this preservative, as stated above. The average content of boron preservative (expressed in terms of crystallised boric acid) contained in the 26 samples of butter reported as genuine, and which contained this preservative, amounted to 0.23 per cent., equivalent to 16.1 grains per lb. butter. The 6 samples of margarine were all found to contain a boron preservative in quantities under 0.5 per cent., the average for the six samples amounting to 0.27 per cent. or 18.9 grains per lb. margarine, expressed in terms of crystallised boric acid. Of the 2 informal samples of cream of tartar reported against, 1 was found to contain an excess of arsenic, whilst the other contained cornflour. The 9 informal samples of cake (Madeira) reported against were found to contain a boron preservative, in varying quantities. In conclusion, I have to report that the total adulteration during the quarter was, for formal samples, 7.7 per cent.; for informal samples, 17.6 per cent. ; and for all samples, 9.8 per cent. Third Quarter.—The following statement shows the nature of the samples submitted, and the result of analysis, the details of Drugs and "Other Articles" being given below:— General Statement. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Butter — 33 33 — 1 1 Cheese 5 — 5 0 — 0 Cocoa — 4 4 — 0 0 Cream, Preserved 4 2 6 0 0 0 Margarine — 8 8 — 0 0 Milk 192 — 192 7 — 7 Mustard — 3 3 — 0 0 Vinegar 10 — 10 0 — 0 Drugs 7 3 10 3 0 3 Other Articles 5 20 25 4 4 8 Total 223 73 296 14 5 19 87 Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Cream of Tartar 7 3 10 3 0 3 Total 7 3 10 3 0 3 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Cake, Jam Sandwich — 2 2 — 1 1 Cake, Sponge — 2 2 — 0 0 Fish Paste — 2 2 — 2 2 Pepper — 3 3 — 0 0 Rice — 4 4 — 0 0 Sago — 4 4 — 0 0 Sausage, Breakfast 1 3 4 1 1 2 Sausage, Luncheon 2 — 2 1 — 1 Sausages 2 — 2 2 — 2 Total 5 20 25 4 4 8 Of the 192 samples of milk submitted 7, or 3.6 per cent., were reported against, as under:— Case No. Nature of Report. Case No. Nature of Report. 321 2% extraneous water and 6% milk fat deficient. 383 2% extraneous water and coloured with Annatto. 367 16% milk fat deficient. 406 Coloured with Annatto. 369 17% milk fat deficient. 466 14% extraneous water. 374 10% milk fat deficient. The average composition, in regard to milk fat and solids-notfat, of the 185 samples of milk submitted during the quarter and reported as genuine was as follows:- Total milk solids % 12.38 Milk fat 3.61 Solids-not-fat 8.77 88 Thirty-three butters in all were submitted for examination during the quarter. All of these were informal samples, and one was reported as being a mixture of margarine (at least 50 per cent.) and butter. All butter samples were tested for the presence of preservatives, with the following results:— Number of samples containing a boron preservative 26=78.8% „ „ free from a boron preservative 7=21.2% Of the 25 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 0.25 per cent., expressed in terms of crystallised boric acid, equivalent to 17.5 grains per pound of butter. In no case was the percentage of boric acid found to exceed 0.5 per cent. The 8 informal samples of margarine all contained a boron preservative, but in no case did the amount exceed 0.5 per cent., expressed in terms of crystallised boric acid. Of the 10 samples of cream of tartar examined, 3, or 30 per cent., were reported against, namely:— Case No. Nature of Report. 308 6 parts of arsenic per million 309 21.5% maize starch 310 8% bicarbonate of soda Of the "Other Articles" submitted, 8, or 32 per cent., were reported against, the 4 formal samples being as under:— Case No. Nature of Sample. Nature of Report. 356 Sausages 5.6 grains Crystallised Boric Acid per lb. 358 ,, 6.02 ,, ,, 359 Luncheon Sausage 6.93 ,, ,, 360 Breakfast Sausage 7.77 ,, ,, Of the informal "Other Articles" reported against, 1 sample of jam sandwich, 2 of fish paste, and 1 of breakfast sausage were found to contain a boron preservative. In conclusion, I have to report that the total adulteration during the quarter amounted to, for formal samples, 6.2 per cent.; for informal samples, 6.8 per cent. ; and for all samples, 6.4 per cent. Fourth Quarter.—The following statement shows the nature of the samples submitted, and the result of analysis, the details of Drugs and "Other Articles" being given below. 89 General Statement. Examined. Adulterated Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread — 3 3 — 0 0 Butter 3 37 40 0 2 2 Cocoa — 8 8 — 0 0 Cream, Preserved 4 — 4 0 — 0 Margarine — 4 4 — 0 0 Milk 171 — 171 11 — 11 Milk, Separated 5 — 5 1 — 1 Sugar — 4 4 — 0 0 Drugs — 4 4 — 0 0 Other Articles 30 17 47 4 3 7 Total 213 77 290 16 5 21 Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Camphorated Oil — 4 4 — 0 0 Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot — 4 4 — 0 0 Cakes, Sponge 5 9 14 1 3 4 Coffee 5 — 5 0 — 0 Fish Paste 1 — 1 1 — 1 Honey — 4 4 — 0 0 Lard 5 — 5 0 — 0 Olive Oil 5 — 5 0 — 0 Rice 5 — 5 0 — 0 Sausages 4 — 4 2 — 2 Total 30 17 47 4 3 7 90 Of the 171 samples of milk submitted, 11, or 6.4 per cent., were reported against, as under:— Case No. Nature of Report. Case No. Nature of Report. 476 18% extraneous water. 634 11½% extraneous water and 32½% milk fat deficient. 544 5% milk fat deficient. 574 7½% extraneous water. 579 7% extraneous water. 643 2½% extraneous water. 604 7% extraneous water. 663 3% milk fat deficient. 605 10% extraneous water. 673 10% extraneous water. 618 2% milk fat deficient. The average composition, in regard to milk fat and solids-not-fat, of the 160 samples of milk submitted during the quarter and reported as genuine was as follows:— Total milk solids % 12.80 Milk fat 3.84 Solids-not-fat 8.96 One sample of separated milk was reported against, namely:— Case No. Nature of Report. 594 Coloured with annatto Of the 47 " Other Articles" examined, 7, or 14.9 per cent., were reported against, the formal samples being the following:- Case No. Nature of Sample. Nature of Report. 500 Sausages 6.02 grains Crystallised Boric Acid per 1b. 502 ,, 6.02 ,, ,, 504 Fish Paste 8.19 ,, ,, 601 Sponge Cakes 23.8 ,, ,, The 3 informal samples of sponge cakes reported against were found to contain a boron preservative in varying quantities. Of the 40 samples of butter submitted, 2 informal samples were reported against as containing margarine. Of the 40 samples of butter examined, 6 were found to be free from any preservative other than common salt, whilst 34 contained a boron preservative in quantities not exceeding 0.5 per cent. The average content of boron preservative expressed in terms of crystallised boric acid contained in the 32 samples of butter reported as genuine, and as containing this preservative, amounted to 0.24 per cent., equivalent to 16.8 grains per lb. The 4 informal samples of margarine all contained a boron preservative, but in no case did the amount exceed 0.5 per cent. (expressed in terms of crystallised boric acid), the average content being 0.33 per cent., equivalent to 23.1 grains per lb. 91 In conclusion, I have to report that the total adulteration during the quarter amounted to, for formal samples, 7.5 per cent.; for informal samples, 6.5 per cent.; and for all samples, 7.2 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 712 samples of milk taken for analysis was a preservative reported to be present. 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 712 Nil. Cream 3 2 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 11* 2. Statements incorrect Nil. Total 11 (b) Determinations made of milk fat in cream sold as preserved cream:— 1. Above 35 per cent 11 2. Below 35 „ Nil. Total 11 (c) Instances where (apart from analysis) the requirements 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 2 * Two of these were informal samples. 92 (d) Particulars of each case in which the Regulations have not been complied with, and action taken:— 1. Sold as "Cream" without a declaratory label. No verbal declaration was made at time of purchase. A declaratory label was affixed to receptacle in which the "cream" was stored. Defendant summoned. Result, summons dismissed on defendant paying £1 1s. costs. 2. Sold as "Cream" without a declaratory label. No verbal declaration was made at time of purchase. A declaratory label was affixed to receptacle in which the "cream" was stored. Defendant summoned. Result, summons dismissed on defendant paying £1 1s. 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 6 (2) Action taken thereon— Vendor summoned 6 1st case No fine. £2 2s. costs. 2nd „ Fined 25s. No „ 3rd „ No fine. £1 1s. „ †4th „ „ „ 10s. 6d. 5th „ „ „ £1 1s. „ 6th „ „ „ £1 1s. „ Milk (Special Designations) Order. Orders were made by the Minister of Health under Sec. 3 of the Milk & Dairies (Amendment) Act, 1922, dated December 9th and 18th, 1922. These Orders were repealed by an Order made on 25th May, 1923. The Orders prescribed the procedure as to licences * For other proceedings under this Act see pages 68-69. † Also certified to contain 2 per cent. of extraneous water. 93 to sell milk under the designations "Certified" "Grade A (Tuberculin tested)," "Grade A," and "Pasteurised," and the fees to be paid for such licences and the standard of cleanliness to be observed in each grade of milk. During 1923, 18 licences were granted to local milk retailers, including "supplementary" licences. Two samples were taken during the year, and were submitted to the Clinical Research Association for examination. Condensed Milk. Regulations made under Sec. 8, Milk & Dairies (Amendment) Act, 1922, for controlling the standard of quality of condensed milk were issued by the Ministry of Health in May, 1923, to come into operation on 1st October following,and the date was later postponed to 1st January, 1924. The Regulations are to be enforced by the Local Authority as regards sale in this country and as regards importation by the Commissioners of Customs and Excise. Two grades of condensed milk are recognised by the Regulations—" full cream "and" skimmed or machine skimmed," either of which may be "sweetened" or "unsweetened." It is prescribed by the Regulations that "full cream" shall contain not less than 9 per cent. of milk fat and 31 per cent. of milk solids (including fat); for "skimmed milk" a standard of not less than 20 per cent. (26 per cent. if unsweetened) of milk solids including fat. It is further prescribed that special forms of labels as to size of letters, wording, &c., shall be used, and, further, the equivalents (in pints) of the milk (of the same grade as the condensed milk) which can be made from the contents of the tins is to be stated on the labels. Skimmed milks are to be clearly marked on the prescribed label, "Unfit for babies." Dried Milk. Regulations were made under Sec. 8 of the Milk & Dairies (Amendment) Act, 1922. The Public Health (Dried Milk) Regulations, 1923, were issued by the Minister of Health in November, 1923, to come into force on 1st May, 1924. The Regulations prescribe that dried milk may be sold as "Dried Full Cream Milk," containing not less than 26 per cent, of milk fat; "Dried three-quarter cream milk," not less than 20 per cent.; "Dried half-cream milk," not less than 14 per cent.; and "Dried quarter-cream milk," not less than 8 per cent.; and skimmed milk, containing not less than 9 per cent. of milk solids other than milk fat. Packets for sale are to disclose the equivalent quantity (in pints) of full, part cream, &c., which the contents of the packets represent. The labels of packets must state, in the case of partly skimmed milks, that such milk "should not be used for babies except under medical advice," and in the case of skimmed milk that such milk is "unfit for babies." In regard to dried milks to which sugar or some other substance has been added, to the labels 94 on the tins or other receptacles, the word "sweetened," "modified" or "compounded" must be added to the other printed conditions, including size of lettering, &c. Each label is, in addition, to contain the name and address of the manufacturer of dried milk, and, in the case of imported milk, the name and address of the dealer or merchant for whom such milk has been manufactured. The Regulations are to be enforced by local authorities and their officers in the manner prescribed by the Regulations. Ice Cream. There are 162 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 1923, 14 ice cream premises were removed from the register and 28 were added. There was, therefore, an increase of 14 in the number on the register as compared with 1922. During the year 331 inspections of ice cream premises were made by the Council's inspector, and 13 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. 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 563 inspections were carried out and 13 notices were served to remedy defects found on inspection. These mainly referred to dirty or unsuitable premises and other minor defects. One unregistered milk vendor was discovered during the year and reported to the Health Committee, who directed a cautionary letter to be sent to the offender. Thirteen cases occurred during 1923, in which a milk business changed hands, the register of milk purveyors being amended accordingly. In 4 cases new vendors were registered in respect of premises not previously used for the purpose, and in 4 cases the sale of milk was discontinued. 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 1923, 325 inspections were carried out, and 12 notices were served for various insanitary conditions found on inspection. 95 Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1923 was 91. During the year, 284 visits of inspection were made by the Council's Inspector and 8 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 7, bacon 1, other foods 7, total 129. 96 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) 615 119 _ Workshops (including Workshop Laundries) 726 98 _ Workplaces (other than Outworkers' premises included in the Table on page 102) 2,258 77 _ Total 3,599 294 _ 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 25 25 - Want of Ventilation 1 1 - Overcrowding 2 2 - Want of drainage of floors - - - Other nuisances 72 72 - Sanitary accommodation Insufficient 12 12 - Unsuitable or defective 112 112 - Not separate for the sexes 15 15 - Offences under the Factory and Workshop Act— Nil. Illegal occupation of underground bakehouse (Sec. 101) - - - Lack of Special Sanitary Requirements to Bakehouses (Secs. 97 to 100) 41 41 - Other Offences (excluding Offences relating to Outworkers which are included in the Table on page 102) - - - Total 280 280 - - 97 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1923 :— Bakehouses 29 Bootmakers 31 Dressmakers 17 Laundries 5 Milliners 9 Tailors 42 Other Trades 198 Total number of workshops 331 4.—other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 13 Notified by H.M. Inspector 8 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 1923:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Barge builder 2 26 4 — — Baker 47 208 22 125 17 Bootmaker 14 27 3 — — Builder 5 103 4 — — Butter blender 1 49 24 11 12 Carpenter 1 9 — — — Chemical works 4 227 5 62 14 Chaff & Forage 4 39 1 9 — Coach 3 26 2 — — Cycle Maker 3 4 5 — — Dyer 1 40 — 23 — Engineer 30 677 33 — — Flour mills 2 100 — 15 — Firewood cutter 10 30 4 22 1 Foundry 2 30 1 — — Lift maker 2 16 4 — — Mason 5 346 2 — — Mineral water 2 25 — 24 — Motor repairs 17 179 8 — — Printer 18 92 18 20 7 Steam laundry 17 68 18 535 74 Other Trades 83 3,791 367 898 581 Total 273 6,112 525 1,744 706 98 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. Eighteen new factory premises were added to the register during the year, dealing with— Bootmaker 2 Printer 1 Motor 3 Other trades 9 Engineer 3 Thirteen factories were discontinued during the year. During the year 103 preliminary and 16 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 complied with. Workshops. The following is a list of the workshops on the register at the end of 1923:— 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 4 4 9 1 — — Coach builder 10 12 32 2 — — Cycle maker 7 8 8 — — — Dressmaker 17 19 1 — 52 6 Embroiderer 2 4 — — 23 — Farrier & smith 14 14 33 — — — Firewood cutter 2 2 1 2 — — Laundry 5 10 4 — 18 — Mason 3 3 23 — — — Milliner 9 9 — — 26 4 Motor repairs 11 11 25 1 — — Piano maker 3 6 31 3 — — Photographer 3 5 6 — 3 2 Picture framer 3 3 3 1 — — Rag sorter 13 13 18 5 4 — Saddler 2 2 3 — — — Tailor 42 49 53 3 39 5 Upholsterer 16 18 25 4 14 2 Other Trades 103 110 234 31 57 11 Totals 331 364 606 58 236 30 99 Twenty-seven new workshops were added to the register, dealing with:— Boot-making 1 Motor repairs 1 Carpentry 1 Picture frames 1 Coach painting 1 Tailoring 1 Cycle Making 1 Upholstering 1 Dressmaking 2 Miscellaneous 17 Thirty-seven 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 1923:— Trade. No. of Workshops. Protected Persons employed. Women. Young Persons. Total. Baker 1 — 1 1 Boot Repairer 1 — 1 1 Corsetmaker 1 — 1 1 Dressmaker 3 — 7 7 Engineer 1 — 1 1 Fine Needlework 1 — 3 3 Tailor 2 1 3 4 Miscellaneous 3 — 4 4 Totals 13 1 21 22 Outworkers. During 1923, 550 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. 155 names and addresses of 114 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:— 100 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaking 31 31 31 Glovemaking 1 1 1 Tailoring 45 45 73 Other Trades 3 3 6 Totals 80 80 111 Twelve new male out-workers (out-workers not previously registered) were registered during the year, and five were removed from the register. There were 111 inspections made of male out-workers' premises during 1923, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 9 cases to remedy nuisances found on inspection, mainly relating to want of cleanliness of premises. One case of infectious disease, viz., diphtheria, was notified from premises occupied by male outworkers. All necessary precautions 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 or Register. Persons Employed. Premises. Workrooms Boxmaking 4 4 4 Dressmaking 51 52 51 Embroidery 35 35 37 Fancy goods 7 7 7 Glovemaking 3 3 3 Knitting and crochet 15 15 16 Millinery 3 3 3 Needlework 17 17 17 Tailoring 49 49 49 Underclothing 8 8 10 Other trades 14 14 14 Total 206 207 211 101 Forty-seven new female out-workers (out-workers not previously registered) were registered during the year. 373 inspections of female out-workers' premises were made by the woman workshops' inspector (Miss Round). It was found necessary to serve one notice under the Public Health (London) Act, 1891, for dirty condition of premises found on inspection. Bakehouses. There were 76 bakehouses on the register at the end of 1923. Of these 47 use mechanical power, and are therefore factories. 49 of the bakehouses are above ground, and 27 are under ground. 298 inspections were made during the year, and 42 intimation and 10 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 1923, there were 46 premises on the register, including railway yards. These premises were systematically inspected during the year, and 60 inspections were made. Six notices were served to remedy nuisances found on inspection. 102 Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Prems ec. 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. Instances. Orders made (S. 110) Prosecutions (Secs. 109, 110) Sending twice in the year. Sending once in the 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 54 35 146 2 — 53 59 — — 10 10 — l — — (2) Cleansingand Washing — — — — — — — — — — — — — — — Furniture and Upholstery 2 — 2 — — — 2 — — — — — — — — Other Trades 4 — 8 2 — 12 8 — — — — — — — — Total 60 35 156 4 — 65 69 — — 10 10 — l — — 103 Housing. The housing question in Battersea, so far as it relates, at least, to working-class dwellings, is still acute, and numerous cases of overcrowding continued to come to the notice of the Department during the year. In some of the lower wards congestion and even serious overcrowding exist to an extent that is a menace to health. The reports of the Health Visitors working in these areas refer to the overcrowding existing in many houses visited systematically during the epidemic prevalence of measles in the last quarter of the year as a contributory cause of the spread of this and other diseases of child life. In fact, one Health Visitor, working in one of the most densely populated districts of the Borough, probably correctly, attributes the unduly high mortality from measles and respiratory complications amongst the younger children-not to lack of care on the part of the mothers who, she finds, are on the whole excellent nurses—but to the serious lack of air-space in these homes, leading to reduced resistance to infection and to a rapidly fatal issue. There can, of course, be no question that the mortality from measles, whooping-cough and other common infections of childhood tends to increase under insanitary housing conditions and the vitiated atmosphere of overcrowded rooms. In the present unhappy circumstances when the housing shortage is so universally prevalent, it is of necessity impracticable to put into force the statutory powers of the Council for the prevention of overcrowding. It is to be hoped, therefore, that the new Housing Bill which is promised in the coming year will be found to contain adequate provision for the erection of working-class dwellings to an extent which will with reasonable expedition be capable of remedying the present unfortunate position. In Battersea there is, as pointed out in previous annual reports, no ground available for building houses, and relief, therefore, from the sanitary and social evils resulting from the housing shortage, so far as this borough is concerned, can only be secured by the adequate provision of working-class dwellings elsewhere in the County of London, the rents charged for such dwellings to be within the means of the persons requiring them. During 1923 the Council by the acquisition of the disused Chatham Road Fire Station, provided 12 additional tenements for working-class families, and these were occupied immediately on the completion of the repairs, &c., required to fit them for habitation. Overcrowding. The extent of the overcrowding prevailing in Battersea was discussed in last year's Annual Report. It is only necessary to state, therefore, that there is no sensible diminution in the congestion, and, in some of the lower wards of the Borough, even serious overcrowding referred to in previous reports. 104 New Houses Provided by the Council. Chatham Road. The disused Fire Station at Chatham Road was purchased at a cost of £8,000 by the Council from the London County Council in the previous year. The Council decided to convert the lower portion into public swimming and slipper, &c., baths, and to utilise the upper portion of the building, which was arranged in tenements for the firemen, for housing accommodation. In this way 12 tenements were placed at the disposal of the Housing Committee and, on the necessary repairs and redecoration being completed, were occupied by 12 working-class families. The Housing Committee considered 80 applications in connection with the allocation of the tenements at Chatham House, which may be summarised as follows:— 56 cases of families living in 1 room. 13 „ „ 2 rooms. 6 „ „ 3 rooms. 5 cases of families unable all to live together owing to insufficient accommodation. In no case was an application considered from a person resident outside the Borough. Particulars of the families housed may be summarised as follows:— (i.) In the 2 2-roomed tenements—4 adults, 2 children. (1 of these families previously lived in 1 room and the other in 2 rooms.) (ii.) In the 8 3-roomed tenements—16 adults, 27 children. (3 of these families previously lived in 1 room, 4 in 2 rooms, and 1 in 3 rooms.) (iii.) In the 2 4-roomed tenements—4 adults, 11 children. (1 of these families previously lived in 1 room and the other in 2 rooms.) The total number of persons thus accommodated is 24 adults and 40 children. The Council approved the proposal of the Housing Committee that the rents be as follows:— First floor—1 4-roomed tenement 15s. 0d. per week. 1 3-roomed do. 13s. 0d. do. 1 2-roomed do. 9s. 0d. do. Second do.—1 4-roomed do. 14s. 6d. do. 1 3-roomed do. 12s. 6d. do. 1 2-roomed do. 9s. 0d. do. Third do.— 3 3-roomed do. 12s. 0d. do. (each). Fourth do.—3 3-roomed do. 11s. 6d. do. ( do. ). 105 New Houses Erected by Private Enterprise. During 1923, 41 new houses were erected by private enterprise on the remaining sites of what is known as the Battersea Rise Estate (Broomwood Road, Chatto Road, Wisley Road). In addition to these three houses were erected in Sudbrooke Road and three in Roseneath Road in the same district of the Borough, and one house was erected in Ethelburga Street in East Battersea. The houses erected on the Battersea Rise Estate were similar in design and construction to those built on the same estate in previous years, each containing two living-rooms and 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 this floor. Eight more houses on the Battersea Rise Estate (Chatto Road) were in course of erection, but were not completed at the end of the year. Repair of Unfit Houses. During 1924 the systematic inspection of house property was actively pursued, 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 practice of dealing with the more seriously unfit houses under the provisions of Sec. 28 of the Housing Town Planning, &c., Act, 1919, has been carried out since the Act came into force towards the latter end of 1919, and valuable results have been obtained. It is the routine procedure authorised by the Housing Committee to communicate, in the first instance, with the owner of the property concerned, drawing his attention to the state of premises, and requesting him to put forward for the consideration of the Housing Committee his proposals for the repair of the property. As a general rule owners avail themselves readily of this informal procedure, and in the great majority of instances specifications of the necessary repairs required to render the premises in all respects fit for habitation are submitted for the approval of the Committee and the work is executed by the owner without the service of notice. In this way during the past five years a very large proportion of seriously unfit houses have been repaired to the satisfaction of the Council by the owners concerned. In a relatively small minority of cases it has been found necessary to serve notices under Sec. 28 upon the owners concerned, and with the notices schedules of repairs required to render the premises fit for habitation. In most of these cases the requirements of the notices are complied with, but in a few instances.it is found necessary to enforce the powers of the Council and for this purpose for the Council to enter and carry out necessary repairs in default of the owner. 106 During 1923 the number of cases in which it was found necessary for the Council to exercise their powers in default was 34 and the total expenditure incurred was £6,407 6s. 1d. It unfortunately happens that it is in the case of the more seriously defective property that difficulty is experienced in getting the owner to comply with the requirements of the Sec. 28 notice. In some of these cases the property is so old, worn out, or otherwise defective, as to be incapable of being made fit. In normal circumstances such properties would be represented by the Medical Officer of Health for Closing Orders under the Housing Act. Owing to the impracticability of finding alternative accommodation for the tenants there is no course open but for the service and enforcement of the notice under Sec. 28. The work required to put into even temporary state of fitness for habitation this type of house is frequently so considerable as to make it impossible to recover the whole of the expenditure incurred by the Council in carrying out the necessary repairs in default of the owner. While it is inevitable-, in view of the acuteness of the Housing shortage, that an increasing liability must fall on the Borough Council in regard to the repairs of such properties, it would be desirable and prudent to restrict the works of repair in such worn out houses to the minimum requirements necessary to render them temporarily fit for habitation. The process of recovery of the expenses incurred by the Housing Authority in carrying out repairs in default of owners is in practice found to be far from expeditious, or otherwise unsatisfactory. Moreover, administrative and legal difficulties not infrequently arise, notwithstanding the amending procedure provided in Sec. 10 of the Housing Act, 1923, leading to delay, confusion and sometimes to costly litigation in the enforcement of the powers under Sec. 28. It is satisfactory to note, however, that in Battersea, on the whole, having regard to the extent to which the powers under this Section of the 1919 Act have been applied, comparatively few difficulties have been met. It has to be remembered, however, that while these difficult cases are relatively few in number the cost incurred in carrying out the repairs in default of the owners may be formidable. The need for further amendment of Sec. 28 in order to simplify administrative and legal procedure was brought to the notice of the Metropolitan Boroughs Standing Joint Committee by the Borough Council, and the following amendments to Clause 10 (Repair of Houses) of the Housing (No. 2) Bill were proposed for their consideration. Suggested Amendment to Clause 10 (Repair of Houses):— (i.) To add after paragraph (a)- When such a notice is served the local authority shall notify the service to the person from whom the 107 owner holds the promises, so far as such person can after reasonable enquiries be ascertained and if the owner or any other person having any estate or interest in the premises when requested by the local authority to state the name and address of the person from whom he holds refuses or wilfully omits to disclose or misstates the same he shall be liable on summary conviction to a fine not exceeding £5. (ii.) To add after paragraph (c)- The local authority shall for the recovery of their expenses with interest have all the same powers and remedies under the Conveyancing Acts, 1881 to 1911 and otherwise as if they were the mortgagees having powers of sale and lease of accepting surrenders of leases and of appointing a receiver. The Standing Joint Committee decided to support these amendments and they were eventually embodied with modifications in the Amended Housing (No. 2) Bill as the Housing Act, 1923. The main effects of the first Amendment will be (1) by notifying those holding superior interests in the property to enable them to make use of their powers under Sec. 30 of the 1919 Act, to protect their interests, and (2) the local authority can often secure by such warning notice to the superior owner or owners the execution of the necessary repairs. The second Amendment is designed to place the local authority in regard to the recovery of expenditure in a similar position as mortgagees under the Conveyancing Acts with powers of sale of lease, of accepting surrenders of leases and of appointing a Receiver for the receiving of the expenses incurred by them including any expenditure under Sec. 28. These Amendments are an improvement, and may serve to simplify procedure under Sec. 28. The work carried out under Sec. 28 during 1923 compares favourably with that of the past four years and the details will be found summarised at the end of this report. The repair of unfit houses is the most satisfactory feature of the Council's Housing work. A considerably higher standard of repair has been obtainable under the powers conferred under Sec. 28, and while it has not been possible to abate overcrowding, many of the ill-effects of the congestion arising from the housing shortage have been, to some extent at least, mitigated by the improved state of fitness for habitation systematically enforced under the Housing and Public Health Acts. 108 Closing Orders. During 1923, 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 dwellinghouse:— Premises. State. Date of Order. Nil. The Closing Order made in respect of No. 35a Ascalon Street was determined on the 5th October, 1923. The premises were, however, on structural grounds, found to be incapable of being rendered fit for further use as a dwelling house. Underground Dwellings. No underground rooms were represented for Closing Orders under Sec. 17 (7) of the Housing, Town Planning, &c., Act, 1909, during the year. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. During the year 1923, applications for the certificate of the Sanitary Authority under Section 2 of the Act of 1920 were received in respect of 21 premises. Of this number in 15* cases the certificates were granted and 6 applications were refused. In addition, 4 applications for the report of the Sanitary Authority under this section were received from owners, all of which were granted. The main provision of the amending Act of 1923 is to require particulars of the necessary repairs to accompany the certificate of the Sanitary Authority. Action under Sec. 29 of Housing, &c., Act, 1919, During the year, 15 cases, relating to 32 houses, 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 *Including 2 cases in which the certificate was not issued, the necessary repairs having been completed. 109 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. Insanitary Areas. No additional insanitary areas were represented during 1923. With reference to the Plough Road Insanitary Area, in June, 1922, the Ministry of Health stated that they could not at the time regard the Council's Improvement Schemes as schemes that could be approved for purposes of financial assistance, and the matter was not then proceeded with further. Subsequently, in January, 1923, the Council again approached the Ministry, who agreed to permit the Council to go on with the Plough Road Scheme, it being understood that the Council would only proceed with a limited part of the area, and that the Ministry would be prepared to contribute half of the annual loss up to a limit of £350, if the scheme was proceeded with at once. The Council, in February, decided to proceed, at the moment, with the limited part of the area originally represented and asked the Ministry to hold a Local Enquiry. On the 4th April, 1923, a Local Enquiry was held on behalf of the Ministry by Mr. Harry Stewart at the Town Hall. Before issuing their formal order the Ministry enquired as to the alternative accommodation which would be necessary for the persons displaced by the scheme. The Housing Committee were of the opinion that re-housing should be effected on the site in buildings not exceeding two storeys, in accordance with the usual practice of the Council, but that if this was adopted for the Plough Road Scheme additional accommodation would be required outside the area of the site. There being no land available for development in the Borough an effort was made by the Council to obtain the St. Peter's Hospital site then for sale, which is just outside the boundaries of the Borough. The London County Council, however, acquired this site and they were subsequently approached by the Council with a view to providing the additional accommodation required to re-house the surplus displaced tenants not capable of being re-housed on the site. The County Council assented to this, but attached certain conditions with which the Council were unable to agree. The Council again approached the Ministry on the subject, and it was eventually decided that the only feasible way of complying with the conditions laid down was to provide alternative accommodation for all displaced tenants on the site itself. This course meant a revision of the two-storey principle, and eventually the Council reluctantly decided, as the only practicable solution, to submit detailed plans and estimates for the erection of three-storey dwellings on the site. no The formal order of the Minister of Health was made on the 7th January, 1924, and it is hoped that the improvement scheme will be proceeded with during that year. It is regrettable, however, that the sanction of the original scheme was not given by the Ministry. This would have enabled the Council to have carried out a really useful improvement scheme in this most congested area of the Borough, its density being 231 persons per acre, as compared with 42.2 persons per acre in the Broomwood Ward. The limited area which the Ministry are prepared to sanction will, at least, have the effect of disposing of some of the worst of the old and worn out insanitary dwellings in the Borough. The modified scheme will involve the demolition of 64 houses in Britannia Place, Field Place and York Road, inhabited by, approximately, 395 persons, and the cost of the improvement scheme is estimated to be £55,610, and to involve an average nett loss of about £15 per tenement per annum to the Council or £1,050 per annum on the whole scheme. The following draft balance sheet prepared by the Borough Treasurer will show that these estimates are approximately correct so far as can at present be foreseen:— RECEIPTS. £ s. d. PAYMENTS. £ s. d. Rents, 66 tenements* at 12s l0d. each per week 2,202 4 0 Average loan charges (Instalment svstem), £55 61 Of for 60 years at Less empties, &c. 82 14 0 4'½%. 2,199 0 0 2,119 10 0 Rates at 12s. 4d. (Rateable value £12) 488 8 0 Average annual deficit 1,271 0 0 Insurance ... 231 (1 0 Water 59 8 0 Repairs, £5 per tenement per annum 330 0 0 Collection and supervision 82 14 0 £3,390 10 0 £3,390 10 0 A vcrage annual dencit per tenement, *.19 os. 2d. Loans are calculated on the instalment system (equal instalments of principal, with interest on balance outstanding). The first year's deficit will, in fact on this system, be £2,501. This sum will be reduced £42 annually. * Three-roomed tenements built and rented as at Savona Street. \Made up as follows :— £ Site 5,000 Costs 100 Clearing site 2,000 Erection of 66 tenements at £.700 each 46,200 Contingencies, 5% 2,310 £55,610 Deducting the Ministry's grant from £19 5s. 2d. will leave £14 nett average deficit per tenement per annum to be borne by the Council, or £924 per annum for the whole scheme. It will be noted that, following the Council's usual procedure, the balance sheet anticipates that the loan will be taken up on the instalment system. If, however, the loan were taken up on the annuity system, although the annual deficits on the earlier years would be smaller, the annual average nett deficit during the loan period of 60 years would be increased (owing to this more expensive loan method) from £14 to £21 per tenement per annum. Ill By-Laws—Houses Let in Lodgings. Reference was made in the Annual Report last year to the Bylaws which the London County Council were required to make under section 94 of the Public Health (London) Act, 1891, as amended and extended by section 26 of the Housing, Town Planning, &c., Act, 1919. By-laws were made by the London County Council in 1920 for confirmation by the Ministry of Health, but have not yet been confirmed. The County Council, however, gave notice that they were seeking powers under the Housing Bill (No. 2), 1923, to amend section 26 of the 1919 Housing Act under which these bylaws were required to be made, before completing the revision of the draft by-laws. The matter was referred by the Borough Council, on the recommendation of the Housing Committee, to the Ministry of Health, the Members of Parliament for the Borough, and the Metropolitan Boroughs Standing Joint Committee, with a view to hastening the issue of the by-laws. Insanitary Houses. The following is a list of streets in the Borough in which houses were found, on inspection, to be insanitary, and were dealt with by the Council under the provisions of the Housing Act of 1919, either informally or by the service of notice under Section 28 of the Act, during 1923 :— Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Ascalon Street 4 Everett Street ... 2 Sterndale Road 3 B'sea Park Road 2 Linford Street ... 1 Stewarts Road 4 Ceylon Street ... 1 New Road 1 Wadhurst Road i Currie Street 5 Savon a Street ... 1 Woodgate Street 6 Total :—12 streets, 31 houses. No. 2 District. Anerley Street ... j 2 GladstoneTerrace 1 Palmerston Street 9 Arthur Street 2 Henley Street ... 6 Park Grove 1 B'sea Park Road 2 Kennard Street 1 Rollo Street 1 Cambridge Road 1 Kilton Street 1 Roydon Street 1 Culvert Road 12 Latchmere Road 1 Russell Street ... 3 Brougham Street 1 Lockington Road 1 Weybridge Street 5 Total :—18 streets, 51 houses No. 3 District. B'sea Bridge Road[ 2 Frances Street 1 l'arkham Street 6 Bullen Street ... 2 Freeland Street 1 Orville Road ... 1 Castle Street 2 Green Lane 6 Randall Street... 3 Church Road ... 1 3 Total :—10 streets, 27 houses. 112 No. 4 District. Barmore Street ... 3 Ingrave Street... 2 Meyrick Road ... 4 Benfield Street ... 1 Knox Road 1 Musjid Road ... 1 Currie Road 1 Khvber Road ... 1 Newcomen Road 1 Este Road 1 Latchraere Grove 1 ShillingtonStreet 2 Falcon Road 3 Lavender Road 4 Stainforth Road 5 Gwynne Road ... 2 Lubeck Street ... 1 Winstanley Road 2 Heaver Road 3 Total :—19 streets, 39 houses. No. 5 District. Gideon Road 1 Glycena Road ... 1 Wickersley Road 3 Total :—3 streets, 5 houses. No. 6 District. Abyssinia Road ... 2 Maysoule Road 1 Shelgate Road ... 1 Aliwal Road 1 Mendip Road ... 1 Tritton Street ... 16 Chivalry Road ... 1 Northcote Road 1 Usk Road 1 Linda Street 1 Plough Road ... 1 Way land Road... 8 Livingstone Road 6 Total :—13 streets, 41 houses. Summary. No. 1 District .. 12 streets 31 houses. .. 2 18* „ 51 „ » 3 „ 10 ... 27 „ 4 19 ... 39 ^ »» • • 3 5 „ 6 13 ... 41 Totals ... 74* streets ... 194 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 1922. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Aegis Grove 1 Dashwood Road 20 Stewarts Road 13 Ascalon Street ... 6 New Road 1 Stockdale Road 25 Belfour Street ... 24 Patmore Street 1 Tweed Street ... 13 Corunna Road ... 1 Sterndale Road 31 Woodgate Street 10 Corunna Terrace 7 Total :—13 streets, 153 houses. No. 2 District. Abercrombie St 2 Brougham Street 4 Parkside Street 1 Alfred Street 7 Millgrove Street 2 Sheepcote Lane 18 Atherton Street... 2 Orkney Street ... 1 Weybridge Street 12 Berkeley Street ... 1 Park Grove 1 Total :—11 streets, 51 houses. * Battersea Park Road also included in No. 1 District. 113 No. 3 District. B'sea Bridge Rd.. 2 Henry Street ... 1 Orville Road ... 23 Bullen Street 1 High Street 1 Som rset Street 4 Edna Street 1 Home Road 1 Surrey Lane 4 Frances Street 1 Total :—10 streets, 39 houses. No. 4 District. Benfield Street ... 2 Lavender Road 3 Simpson Street... 1 Currie Road 1 Lubeck Street ... 1 Stainforth Road 29 Darien Road 1 Meyrick Road ... 1 Urswicke Road... 16 Gwynne Road ... 5 Newman Street 8 Verona Street ... 2 Ingrave Street ... 10 Pearson Street 1 Winstanley Road 1 Knox Road 1 Shillington Street 1 Total :—17 streets, 84 houses. No. 6 District. Auckland Road ... 1 Eldred Place ... 6 Speke Road 6 Belleville Road ... 1 Grant Road 2 Usk Road 3 Britannia Place 1 8 J ohn Street 13 Winstanley Road 3 Darien Road 1 3 Livingstone Road 6 Total :—11 streets, 52 houses. No. 7 District. Lavender Hill ... 1 Total :—1 street, 1 house. Summary. No. 1 District ... 13 streets 153 houses. 2 11 51 *i 3 i, ... 10 39 „ 4 17 84 „ 6 11* „ 52 „ 7 1 street 1 house 61* streets 380 houses Statistics for the Year ending 31st December, 1923. 1. General. (a) Estimated enumerated population 170,600 (b) General death rate 10-8 per 1,000 (c) Death rate from tuberculosis ... 1 03 per 1,000 (d) Infantile mortality rate 49-5 per 1,000 (ie) Number of premises used as habitations by all classes 27,831 (/) Estimated number of working-class dwellinghouses ... 24,938 (g) Number of new working-class dwellings erected ... 48 * Darien Road and Winstanley Road also included in No. 4 District. 114 2. Unfit Dwelling-Houses. (a) Inspection— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,413 (b) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910... 3,834 (c) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (id) Number of dwelling-houses (exclusive of those referred to under the previous heading) not found to be in all respects reasonably fit for habitation 3,565 (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 158 (c) Action under Statutory Powers— (I.) Proceedings under Section 28 of the Housing, Town Planping, etc., Act, 1919 • (a) Number of dwelling-houses in respect of which notices were served requiring repairs 66* (b) Number of dwelling-houses which were rendered fit— (i.) By owners 80 (ii.) Bv Local Authority in default of owners ... 34 (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 3,371 (b) Number of houses in which defects were remedied — (i.) By owners 3,144 (ii.) By Local Authority in default of owners ... Nil * In addition, in view of the " Rush " decision or for other reasons, 51 notices were re-served and are not included in above number. 115 (III.) Proceedings under Sections 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 Nil (b) Number of dwelling-houses in respect of which Closing Orders were made Nil (c) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit... 1 (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 :— 48 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). 116 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 1923 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. * Number Rate per 1,000 Net Births. 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 18-5 798 459 428 112 2,653 16-4 1916 ^ 173,432 B.f 159,402 D.f | 3,523 3,774 21-8 2,502 15-7 705 424 318 84 2,221 13-9 1917 167,233 B.f 150,023 D.f | 2,709 2,960 17-7 2,567 171 727 445 299 101 2,285 15-2 19181 168,014 B.f 149,951 D.t j. 2,407 2,700 16-1 3,195 21-3 857 471 267 99 2,809 18-7 1919 ^ 165,960 B.f 159,316D.f j. 2,765 3,075 18-5 2,409 15-1 730 382 228 74 2,061 12-9 1920 | 166,093 B.f 165,664 D.f | 4,218 4,669 28-1 2,393 14-4 700 386 386 83 2,079 12-5 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 3,665 211 2,679 15-8 864 412 254 69 2,227 13-2 1923 170,600 3,415 3,434 20-1 2,368 140 874 345 170 49 1,839 10 8 Area of 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). • Rates calculated per 1,000 of estimated population. t Registrar General's estimated population for purposes of calculating:—(B), birth-rate ; (D), death-rate. 117 {Required by the Ministry of Health to be used in the A nnual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1923. 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 1 1 1 1 Cholera ... Diphtheria 374 5 127 197 26 19 188 139 47 185 138 43 Membranous Croup Erysipelas 84 •i 4 6 13 43 14 34 42 8 12 10 2 Scarlet Fever ... 409 2 100 242 49 16 195 135 79 194 133 73 Typhus Fever ... Enteric Fever ... 8 1 4 3 3 1 4 2 1 4 Puerperal Fever 7 ... 1 6 3 2 2 3 2 2 Cerebro-Spinal Fever ... 4 2 1 1 1 2 1 1 1 1 Ophthalmia Neonatorum 42 42 17 22 3 2 4 Polio-myelitis, &c. 8 6 2 6 2 5 2 Encephalitis Lethargica 3 i 2 1 o 1 1 Polio-encephalitis Malaria ... 3 I 2 i 1 1 Dysentery 1 1 1 Acute Influenzal Pneu.... 70 2 9 6 8 39 6 23 35 12 6 7 2 Acute Primary Pneu. 257 18 73 43 23 79 21 123 98 36 42 25 15 Totals 1,271 75 319 498 127 211 41 594 479 198 452 322 146 Tuberculosis— Pulmonary ... 248 1 3 11 53 169 11 118 49 81 Non-Pulmonary 116 4 22 58 18 14 57 43 16 Totals (Tuberculosis) 364 5 25 69 71 183 11 175 92 97 Totals 1,635 .80 344 567 198 394 52 769 571 295 452 322 146 Whooping Cough* 580 60 346 167 1 6 313 179 88 5 5 4 Measles* ... 1,319 73 717 512 12 5 487 599 233 41 44 4 Grand totals ... 3,534 213 1,407 1,246 211 405 52 1,569 1,349 616 498 371 154 * Notifiable in Battersea from April 24th, 1922. 118 TABLE III Causes of, and Ages at, Death during the Year 1923. causes of death. Nett Deaths at subjoined ages of "Residents" whether Occurring within or without the District. Total Deaths of " Residents " and " NonResidents " in Institutions in the District. A!! 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 1 2. Small-pox 1 1 3. Measles ... 24 5 10 9 13 4. Scarlet Fever ... 6 2 3 1 5. Whooping-cough 16 6 6 2 2 11 6. Diphtheria 34 1 6 19 8 7. Influenza 31 1 1 2 6 12 9 q 8. Encephalitis Lethargica ... 2 1 1 3 9. Meningococcal Meningitis 2 1 1 10. Tuberculosis of Respiratory System ... 139 1 1 6 30 59 36 6 109 11. OtherTuberculous Disease ... 36 4 1 8 5 7 6 5 42 12. Cancer ... 242 1 2 24 119 96 207 13. Rheumatic Fever 6 4 1 1 1 14. Diabetes... 10 3 2 5 8 15. Cerebral Haemorrhage, etc. ... 91 2 30 59 7K 16. Heart Disease ... 334 1 6 5 20 86 216 350 17. Arterio-Sclerosis 35 1 8 18 18. Bronchitis 133 9 2 3 3 29 87 45 19. Pneumonia (all forms) ... 100 14 12 3 6 2 14 24 25 57 20. Other Respiratory Diseases 22 1 1 2 5 5 8 8 21. Ulcer of Stomach or Duodenum ... 23 9 10 4 16 22. Diarrhoea, &c. ... 32 18 8 1 1 1 3 31 23. Appendicitis and Typhlitis 8 1 3 2 2 20 24. Cirrhosis of Liver 8 s 3 11 25. Acute and Chronic Nephritis 55 1 2 3 3 19 27 51 26. Puerperal Sepsis 3 27. Other diseases of Pregnancy 10 1 9 12 28. Congenital Debility and Malformation, Premature Birth 72 70 2 39 29. Suicide ... 21 3 a 8 9 ft 30. Other Deaths from Violence 43 1 2 3 5 3 9 16 4 48 31. Other Defined Diseases... 302 38 2 3 10 11 34 68 136 245 32. Causes ill-defined or unknown All Causes /m. 930 88 29 23 27 40 121 280 322 734 IF- 909 82 24 34 30 37 99 209 394 710 Totals 1839 170 53 57 57 77 220 489 716 1444 119 East Battersea. TABLE IV. Infant Mortality, 1923. Net Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-fi 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 i Scarlet Fever Whooping Cough 1 2 1 3 1 Diphtheria & Croup... 1 1 Influenza 1 1 Erysipelas 1 1 Meningococcal Meningitis Pulmonary tuberculosis 1 1 Tuberculous Meningitis 1 1 Other Tuberculous Disease ... Bronchitis 1 1 1 3 2 2 5 Pneumonia (all forms) 2 1 3 9 1 1 6 4 Pulmonary Congestion Diarrhoea & Enteritis 2 2 2 2 2 1 1 7 5 Gastritis 1 1 Syphilis 1 i Rickets Nephritis 1 1 1 Premature Birth 4 8 2 4 1 2 7 14 1 8 14 Congenital Malformation 1 2 1 1 3 1 1 2 4 Congenital Debility ... 3 1 1 4 1 Icterus Neonatorum 1 1 1 Injury at Birth 1 1 1 Atelectasis & Asphyxia Neonatorum 1 1 2 1 1 4 2 4 2 Lack of Care 1 1 1 i 1 I Convulsions ... 1 i 1 1 1 1 Homicide Overlying Accident Other Causes 1 l 1 1 1 1 1 2 3 4 7 11 4 7 3 2 3 2 2 17 24 10 10 5 9 5 7 9 1 46 51 Totals 11 3 1 1 5 5 4 1 2 ) 1 4 1 2 0 97 • Net Births in the year. Net Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1581 45 1626 89 8 97 120 North-west Battersea. TABLE IV.—(contd.) Infant Mortality, 1923. 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. r. M. F. M. F M. F. Small-pox Chicken-pox ... Measles 1 1 2 2 Scarlet Fever Whooping-cough 1 1 1 2 Influenza Meningococcal Meningitis 1 1 Tuberculous Meningitis 1 1 Other T uberculous Disease 1 1 Bronchitis 1 1 1 1 Pneumonia, all forms i 1 1 1 •I. 7 Pulmonary Congestion Diarrhoea & Enteritis 1 2 1 1 1 3 3 Gastritis Syphilis 1 1 Rickets Nephritis Premature Birth 8 1 1 ? 1 9 4 1 10 4 Congenital Malformation 1 1 1 1 1 o Congenital Debility ... 1 1 1 1 3 Icterus Neonatorum i 1 Injury at Birth 1 i 1 Atelectasis and Asphyxia Neonatorum 1 1 1 i 2 1 2 Lack of Care 1 i 1 Convulsions ... 1 1 Homicide Overlying Accident 1 1 Other Causes... 1 1 1 1 1 4 1 Totals ... 9 3 2 3 2 1 1 1 1 15 8 5 2 4 6 3 2 4 6 31 24 12 5 3 2 1 23 7 10 5 10 55 Net Births in the year. I Net Deaths in the year (Infants under 1 year)! Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1031 41 1072 49 6 55 121 South-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1923. Net Deaths from stated causes at various ages under 1 year: causes of death. age periods. Under 24 hrs. 1 day-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 Scarlet Fever Whooping-cough Diphtheria & Croup... Influenza Erysipelas 1 1 1 Meningococcal Meningitis Tuberculous Meningitis 1 1 Other Tuberculous Disease Bronchitis Pneumonia, all forms Pulmonary Congestion Diarrhoea & Enteritis Gastritis Syphilis Rickets Nephritis Premature Birth ] 1 3 2 1 4 1 5 4 Congenital Malformation 1 i Congenital Debility... 1 1 Icterus Neonatorum... Injury at Birth 1 1 2 2 Atelectasis & Asphyxia Neonatorum 1 1 1 Lack of Care... Convulsions ... 1 1 Homicide Overlying Accident Other Causes 1 1 Totals 2 1 1 4 2 3 8 5 2 1 1 1 11 7 3 5 2 3 13 3 1 1 18 Net Births in the year. Net Deaths in the year(Infants under 1 year)! Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total 707 29 736 17 1 18 122 tsorough of Uattersea. TABLE IV.—{contd.) Infant Mortality, 1923. 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 dea'hs under ye r. Percentage of Total. 1-2 2-3 3-4 1-3 3-6 j 6-3 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F IM. F. M. F. M. F. Small-pox Chicken-pox... Measles 1 2 2 3 2 2-94 Scarlet Fever Whooping-cough 1 1 1 2 2 5 1 3-53 Diphtheria and Croup I 1 -59 Influenza 1 1 •59 Erysipelas 1 1 1 1 i 1-18 Meningococcal Meningitis 1 1 •59 Pulmonary Tuberculosis 1 1 •59 Tuberculous Meningitis 1 1 1 1 2 1-76 Other Tuberculous disease 1 . • • 1 •59 Bronchitis 1 1 1 4 1 2 3 6 5 • 29 Pneumonia (all forms) 2 1 4 3 1 2 1 8 6 8-24 Pulmonary Congestion ... Diarrhoea & Enteritis 2 3 4 1 3 3 1 1 HI 8 1(1-59 Gastritis 1 2 1 2 1-76 Syphilis 1 1 1 1 2 l-7fl Rickets Nephritis 1 1 1 •59 Premature Birth 12 10 4 9 3 1 1 2 20 22 3 23 22 26-47 Congenital Malformation ... 3 2 1 1 5 ■1 1 1 1 4 7 6-47 Congenital Debility... 3 1 1 2 1 5 3 4-71 Icterus Neonatorum ... 1 1 1 2 1-18 Injury at Birth 1 1 1 1 3 1 3 1 2-35 Atelectasis & phyxia Neonatorum 2 1 3 2 ... 1 1 6 4 6 4 5-88 Lack of Care 2 1 2 1 2 1 1 -76 Convulsions ... 1 1 ... 1 I 2 1 2 2 2-35 ... Overlying 1 1 ■58 Other Causes 9 1 1 3 1 2 1 2 1 3 7 1; 7-65 18 15 7 14 7 3 7 3 1 2 40 37 17 13 9 16 8 9 14 7 88 82 100 00 Totals ... 33 21 10 10 3 77 30 25 17 21 170 — 1 Percentage of Total ... 19-4 12-4! 5-9 5-9 1 -7 45-3 17-el 14-7 10-0 12-4 100 00 M. 51-8% F. 48-2o/0 Net Births in the ye; j. Net Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M. ... 1,696 63 1,759 79 9 88 F. ... 1,623 52 1,675 76 6 82 Totals ... 3,319 I 115 3,434 155 15 170