AC 4386 BAT 25 Metropolitan Borough of Battersea. REPORT ON THE HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1927. BY G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. Wightman & Co., Ltd., Printers, 104, Regency Street, S.W. 1. 68602 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1927. 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 and 24th November, 1926. Chairman: Councillor J. Hendrick. His Worship the Mayor. (Councillor W. H. Humphreys, j.p.) Councillor Mrs. T. Amphlett. Alderman J. R. Archer Councillor J. A. Biss. „ H. W. Carpenter. „ E. W Coles. „ C. S. King. „ G. H. Lawther. „ R. Moore. „ J. Morgan. Alderman Mrs. M. J. Robinson. Councillor Mrs. M. H. Rose. As constituted 9th November, 1927 Chairman: Councillor J. Hendrick. His Worship the Mayor. (Alderman J. F. Lane, j.p.) Councillor Mrs. T. Amphlett. Alderman J. R. Archer. Councillor H. W. Carpenter. „ E. W. Coles. Alderman G. Fineran. Councillor G. H. Lawther. „ R. Moore. „ J. Morgan. „ N. G. M. Prichard. Alderman Mrs. M. J. Robinson. Councillor Mrs. M. H. Rose. Maternity and Child Welfare Committee. As constituted 9th and 24th November, 1926. Chairman: Councillor Mrs. M. H. Rose. His Worship the Mayor. (Councillor W. H. Humphreys, j.p.) The Health Committee, as above, and the following Co-opted Members: Mrs. K. S. D. Baker. Mrs. H. Bowler. Mrs. M. F. Douglas. Mrs. E. E. Kemp. Mrs. H. E. Mellor Mrs. F. Young. As constituted 9th November, 1927. Chairman: Councillor Mrs. M. H. Rose. His Worship the Mayor. (Alderman J. F. Lane, j.p.) The Health Committee, as above, and the following Co-opted Members: Mrs. K. S. D. Baker. Mrs. H. Bowler. Mrs. M. F. Douglas. Mrs. E. E. Kemp. Mrs. H. E. Mellor. Mrs. F. Young. Housing Committee. As constituted 9th November, 1926. Chairman: Councillor H. Harling. His Worship the Mayor. (Councillor W. H. Humphreys, j.p.) Councillor Mrs. T. Amphlett. „ C. Barrington. „ J. Bruce. „ C. S. Cooper. Alderman G. Fineran. Councillor W. Geard. ,, W. J. McIver. Alderman C. J. Powell. „ Mrs. M. J. Robinson Councillor E. S. Strange, j.p. „ H. G. White. As constituted 9th November, 1927. Chairman: Councillor H. Harling. His Worship the Mayor. (Alderman J. F. Lane, j.p.) Councillor Mrs. T. Amphlett. „ C. Barrington. „ J. Bruce. Councillor W. Geard. „ W. J. McIver. „ J. Morgan. Alderman C. J. Powell. Councillor N. G. M. Prichard. Alderman Mrs. M. J. Robinson. Councillor E. S. Strange, j.p. „ H. G. White. 2 Committee to issue certificates and reports under the Rent and Mortgage Interest Restrictions Acts, 1920 and 1925, as to the condition of dwelling Houses. As constituted 9th November, 1926. Chairman: Councillor H. Harling. His Worship the Mayor. (Councillor W. H. Humphreys, j.p.) Alderman G. Fineran. Councillor W. Geard. „ E. S. Strange, j.p. „ H. G. White. As constituted 9th November, 1927. Chairman: Councillor H. Harling. His Worship the Mayor. (Alderman J. F. Lane, j.p.) Alderman G. Fineran. Councillor W. Geard. „ E. S. Strange, j.p. „ H. G. White. Tuberculosis Committee. As constituted 9th November, 1926. The Health Committee, as above. As constituted 9th November, 1927. The Health Committee, as above. Tuberculosis Care Committee. As constituted 9th November, 1926. Chairman: Alderman J. R. Archer. Alderman G. Fineran. Councillor J. Hendrick. „ R. Moore. „ Rev. A. G. Prichard. „ E. S. Strange, j.p. Other Member: Mrs. E. W. Coles. Members of the late Dispensary Committee: Mrs. Dermott. Mr. G. J. W. Gilder. Mr. B. R. Thorne. Members of the late Voluntary Care Committee: Mrs. Causton. Miss B. Home. Miss Morris. Consultative Members: L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Representative of the Invalid Children's Aid Association. Representative of the War Pensions Committee (Mr. F. H. Richardson). Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, St. Thomas's Hospital (Miss Cummins). After-Care Sister, Victoria Hospital (Miss Underwood). Representative of the London Insurance Committee (Mr. R. A. Hanson). Representative of the S.L. District Nursing Association (Miss A. M. Stanford). Representative of the British Red Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector (Miss J. Round), As constituted 9th November, 1927. Chairman—Alderman J R. Archer Alderman G. Fineran. Councillor J. Hendrick. „ R. Moore. „ E. S. Strange, j.p. „ C. H. Young. Other Member: Mrs. E. W. Coles. Members of the late Dispensary Committee: Mrs. Dermott. Mr. G. J. W. Gilder. Mr. B. R. Thorne. Members of the late Voluntary Care Committee: Mrs. Causton. Miss B. Home. Miss Morris. Consultative Members: L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Representative of the War Pensions Committee (Mr. F. H. Richardson). Representative of the Invalid Children's Aid Association. Lady Almoner, St. Thomas's Hospital (Miss Cummins) After-Care Sister, Victoria Hospital (Miss Underwood). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, King's College Hospital (Miss Edmonds). Representative of the S.L. District Nursing Association (Miss A. M. Stanford). Representative of the London Insurance Committee (Mr. R. A. Hanson). Lady Almoner, Brompton Hospital (Miss Marx). Representative of the British Red Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector (Miss J. Round). 3 Staff of Public Health) Department. (At 31st December, 1927). Tuberculosis Officer—G. MACDONALD, M.A., M.B., Ch.B., D.P.H. Assistant Medical Officer (Maternity and Child Welfare)— (Miss) M. L. HAMILTON, M.B., Ch.B., D.P.H. Do. (part-time)— (Miss) ALICE BLOOMFIELD, M.D., F.R.C.S. Resident Medical Officer, Borough Maternity Hospital— Miss JOYCE PEAKE, M.R.C.S., L.R.C.P. Medical Officer, Diphtheria Immunisation Clinic— Dr. MABEL BRODIE, M.B., Ch.B., D.P.H. Public Analvst—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 A. Bannerman, H.V. Cert., 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. Diploma, 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, San. Insp. Board's Cert. Miss F. B. Goodall. H.V. Diploma, Cert. C.M.B., San. Insp. Board's Cert. Miss M. McEwan (Temporary), H.V. Cert. (R.S.I.), Cert. C.M.B. Sanitary Inspectors— Mr. J. Lawrence, Cert. San. Inst, and Meat Insp. Cert. (Sen. Insp.) 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. H. H. May, Cert. San. Inst. 4. Mr. F. H. Chuter, San. Insp. Board's Cert. & Meat Insp. Cert. 5. Mr. J. R. Holloway, San. Insp. Board's Cert. 6. Mr. C. Binding, San. Insp. Board's Cert. and Meat Insp. Cert. 8. Mr. J. T. Baxter, Cert. San. Inst. Mr. H. E. Wheeler (Housing) San. Insp. Board's Cert., and Meat Insp. Cert. Food Inspector—Mr. A. Chuter, Cert. San. Inst., and Meat Insp. Cert. Workshops Inspector—Mr. W. E. Benjamin, Cert. San. Inst. Organising Rat Officer—Mr. H. Renham. Clerical Staff— Chief Clerk—Mr. F. E. Ward. Mr. J. W. Brown (Statistical). Mr. E. Cole. Mr. W. Halstead. Mr. H. C. Godfrey. Mr. R. Graham. Miss G. Newton. Mr. W. C. Turner Miss R. Dove. Office youth. Miss M. A. Weller (M. & C.W. Records). Maternity Home — Matron—Miss J. Gibson, Cert. C.M.B. 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. Clerks—Miss C. Turner. Miss Brown. Disinfecting Station—Superintendent—C. Woodhouse. Mortuary—Keeper—W. Newman. 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Batter sea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit for your information my Annual Report on the health and sanitary state of the Borough of Battersea for the year 1927. The Vital and Morbid Statistics for the year have been on the whole satisfactory and indicate that the Borough continues to maintain its position as one of the healthiest in the County of London. The birth-rate (i.e., 16.6 per 1,000) is the lowest recorded in Battersea except during the War year, 1918. This steady decrease in the birth-rate is the most unsatisfactory feature of the Vital and Morbid Statistics of the Borough. The decline in the birth-rate is common to the whole country, the corresponding rates for the County of London and for England and Wales being 16.1 and 16.7 respectively. The general death-rate is slightly higher than that for 1926 and is about equal to that for the County of London. On the other hand it is gratifying to record that there has been a considerable decline in the Infant mortality-rate (53 per 1,000 births as compared with the previous year, 62 per 1,000 births) which, except that for 1923, is the lowest Infant death-rate recorded in the Borough. The Zymotic death-rate decreased from 0.69 in 1926 to 0.33 in 1927. The Maternity and Child welfare activities of the Council are reflected in the decline in Infant mortality and Maternal mortality during the year. The development of the Ante-natal side of the work during the past four or five years has no doubt contributed to this satisfactory result, and, as will be noted in the Section of the Report dealing with Ante-natal progress, the increase in the number of attendances at the Central Ante-natal clinic at the Borough Maternity Hospital will render it necessary for the Council to consider the question of increasing the existing accommodation by the erection of an out-patient block adjoining the main hospital buildings. 5 It is regrettable again to have to allude to the serious and even dangerous overcrowding which exists in some of the lower Wards of the Borough. The fact that, in numerous instances, families of 5, 6, 7, 8 and even 9 persons are living in a single room in Battersea, and that hundreds of families are compelled to live under such distressing conditions of housing inadequacy as still prevail in the less prosperous areas of the Borough, is a matter of grave public health concern. It is to be hoped that steps will be taken by those responsible to speed up the provision of dwellings at rentals within the reach of those most in need of adequate housing accommodation. The establishment by the Council, at one of the Maternity and Child Welfare Centres, of a Clinic for preventive inoculation against diphtheria is a notable feature of the year's public health preventive measures and, from experience elsewhere, should prove a valuable aid in the reduction of the incidence of, and mortality from, this fatal infectious disease, especially amongst children. The calamity which, early in January of 1928, occurred to many of the riverside Boroughs, owing to the serious flooding of dwelling-houses resulting from an abnormally high tide, affected many hundreds of houses in North Battersea. Fortunately in Battersea there was no loss of life, but much distress and hardship were occasioned by the flood. A brief summary of the incident, and of the steps taken for the relief of sufferers, appears on page 74 of the Annual Report. In conclusion, it is my privilege to acknowledge the support and assistance so generously accorded to me by the Mayor, the Chairmen of the various Committees, and the Members of the Council. To my colleagues, the Chief Officers of Departments, and to the Staff of the Health Department, my thanks are also due for the valuable assistance always willingly rendered. G. Quin Lennane, Medical Officer of Health. Town Hall, Battersea, S.W. 11. 6 CONTENTS. General. Page. Constitution of Committees 1-2 Staff of Public Health Department 3 Introduction 4-5 Summary of Statistics 8 Births, Marriages and Deaths. Vital Statistics 9,108 Population 9 Marriages 10 Births and Birth-rates in Wards and Sub-districts 10- 11 Illegitimate Births 11 Deaths in Borough 11-12 Death-rates in Sub-districts 13 Deaths in Public Institutions and Senile Mortality 13-14 Causes and Age Distribution 110 Comparative Table of Births, Deaths, &c. (1857-1927) 18 Infant Mortality 14-16, 19, 111-114 Illegitimate Infant Deaths 17 Comparative Statistics, Metropolitan Boroughs 17 Notification of Births Act and Still-births Registration 20 Maternity and Child Welfare. Maternity and Child Welfare Scheme 21 Centres 21-22 Hospital Provision 23 Southwark Diocesan Homes 23 Nursing Facilities 24 Health Visitors 24-25 Test-feeding (St. Thomas's Cornwall Babies' Hostel) 25 Milk and Dinners for necessitous persons 26 Convalescent Homes 26-27 Ante-Natal Work 27-29 Visiting Work for Hospitals 29 V.D 29-31 Maternal Mortality 31-32 Maternity Hospital 32-35 „ ,, Out-Patients Department27, 32 District Midwifery Service 35-36 Dental Clinic 36-37 Infectious Diseases—(i.) Notifiable 38 Summary of Notifications 39, 109 Bacteriological Examinations 52,61 Contacts 38, 51 Small-pox 40 Scarlet Fever 40 Diphtheria and Diphtheria Prophylaxis 40-42 Enteric Fever, Cerebro-Spinal Fever 43 Puerperal Fever and Puerperal Pyrexia 43 Encephalitis Lethargica 43-44 Polio-Myelitis and Polio-Encephalitis 42-43 Ophthalmia Neonatorum 44 Erysipelas 45 Measles and Whooping Cough 45 Tuberculosis 45 58,115-117 Cases Notified 45-47 Localisation of Disease 47 Non-notification 47 Deaths from Tuberculosis 47-49 Public Health (Tuberculosis) Regs. 1924 (Requirement of Notification) 47 „ „ „1925 56 Dispensary 49 „ (Report of) 50-54 Sputum Examination, X-Ray Examination 52 Institutional Treatment 51 Open-Air School (Day Sanatorium) 52 Tuberculosis Dental Clinic 53 Care Committee 53 Training and Employment 53 Non-Dispensary Patients 54-56 Summary Table of Notifications 57, 58 ,, „ Tuberculosis Scheme (Dispensary) 115-117 7 Infectious Diseases—continued. Page Zymotic Deaths 59 (ii.) Non-Notifiable Diseases 59 Chicken-pox 59 Diarrhoea 60 Influenza 60 Cancer 60 Sanitary Circumstances. Sanitary Inspection 62 Summary Table 62 Legal Proceedings 63-68 Common Lodging Houses 68 Drainage Work 69-70 Licensed Premises (Sanitary Conveniences) 70 Smoke and Effluvium Nuisances 70 Water Supply 70 Van Dwellings 71 Rag Flock Act 71 Rats and Mice Destruction Act 71-72 Fouling of Footways by Dogs 72 Personal Cleansing Station 72-73 Disinfecting Department 73 Coroner's Court and Mortuary 75 Staff 76 Thames Flooding 74 Protection of the Food Supply. Inspection and Supervision 77 Unsound Food 77 Cow-Houses and Slaughter-Houses 77 Butchers' Shops 78 Public Health (Meat) Regulations, 1924 78 Sale of Food and Drugs Acts 78 Analyst's Reports 78-83 Ice-Cream Vendors 83 Milk and Cream Regulations, 1912-17 84 Milk and Dairies (Amendment) Act, 1922 85 Milk and Dairies Order, 1926 85 Milk and Dairies (Consolidation) Act, 1915 85 Milk (Special Designations) Order, 1923 86 Public Health (Condensed and Dried Milk) Regulations 86 Milk Shops 86 Public Health (Preservatives, &c., in Food) Regulations, 1925 87 Fish Shops, Restaurant Kitchens, Street Stalls 87 Factories, Workshops, &c.—General Tables 88 Factories 89 Workshops 90 Outworkers 91-93, 94 Bakehouses 93 Warehouses and Wharves 93 Housing. General 95 New Tenements and Houses erected 95 Repair of Unfit Houses 96 Closing Orders 96 Underground Rooms 97 Increase of Rent, &c„ Acts 97 Action under Section 5, Housing Act, 1925 97 Insanitary Areas 97 Overcrowding 97 98 Insanitary Houses 98-100 Statistics 101 Summary of Housing Work 101-102 Staff 102 Appendices. Diphtheria—Report of M.O.H. on Schick Test 103-107 Table I. Summary of Vital Statisti 108 „ II. Infectious Disease Notifications 109 „ III. Causes of, and Ages at. Death 110 „ IV. Infant Mortality 111-114 Tuberculosis Scheme of the Borough Council— Return of Work of the Dispensary 115 -117 8 Summary of Statistics, 1927. 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 1927) 169,000 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value £1,131,429 Sum represented by a penny rate £4,679 2. Extracts from Vital Statistics of the Year. Births— (Males, 1,382; females, 1,419) 2,801 Legitimate births (1,338 males, 1,374 females) 2,712 Illegitimate „ (44 males, 45 females) 89 Birth-rate 16.6 Deaths— (Males, 1,012, females, 1,053) 2,065 Death-rate 12.2 Number of women dying in or in consequence of childbirth— From sepsis 1 Other causes 5 Death-rate of infants under 1 year per 1,000 births. Legitimate 52.4 Illegitimate 89.9 53.5 Deaths from Measles (all ages) 1 „ Whooping-cough (all ages) 15 „ Diarrhœa (under 2 years of age) 7 Census, 1911— Population 167,743 Number of inhabited houses 24,321 9 Births, Marriages and Deaths. VITAL STATISTICS. Population. The population of the Borough of Battersea estimated to the middle of 1927 is 169,000. This figure shows a decrease as compared with 1926 and is the result of a revision by the RegistrarGeneral based, it is understood, upon information as to migration. It is probable that the figures given by the Registrar-General will be found an under-estimate. The estimated population based upon the Registrar-General's figures, for the registration Sub-districts and for the nine Wards into which the Borough is divided, is set out in the following Table Registration Sub-Districts. Estimated Mid-Year Population, 1927. Males. Females. Total. East Battersea 33,621 36,410 70,031 North-West Battersea 23,386 24,945 48,331 South-West Battersea 22,243 28,395 50,638 Total 79,250 89,750 169,000 Wards. No. 1. Nine Elms 13,387 14,127 27,514 No. 2. Park 8,662 9,690 18,352 No. 3. Latchmere 9,120 10,164 19,284 No. 4. Shaftesbury 7,504 8,020 15,524 No. 5. Church 9,128 9,507 18,635 No. 6. Winstanley 10,038 10,734 20,772 No. 7. St. John 3,620 5,014 8,634 No. 8. Bolingbroke 8,550 10,569 19,119 No. 9. Broomwood 9,241 11,925 21,166 Total 79,250 89,750 169,000 10 MARRIAGES. The marriages registered in Battersea during 1927 numbered 1,428. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 16.9. Year. Marriages. Marriage-Rate. 1922 1,404 16.6 1923 1,352 15.8 1924 1,367 16.0 1925 1,382 16.1 1926 1,304 15.2 Mean, 1922-26 1361.8 15.9 1927 1,428 16.9 BIRTHS. The number of births registered in the Borough during 1927 was 3,099 (1,561 males, 1,538 females), an excess of 23 males. Of this number, 587 were transferred out, the permanent residence of the parents being outside the Borough, and 289 were transferred here, giving on balance a total of 2,801 births relating to Battersea residents, and a corrected birth-rate of 16 6 per 1,000 of the population. The following table gives the distribution of the births and the birth-rate per 1,000 of the population in the Sub-districts and in the Wards for the year 1927. Sub Districts. Estimated Population, 1927. Number of Births. Birthrate. East Battersea 70,031 1,251 17.9 North-West Battersea 48,331 915 18.9 South-West Battersea 50,638 635 12.5 Wards. No. 1, Nine Elms 27,514 515 18.7 No. 2, Park 18,352 373 20.3 No. 3, Latchmere 19,284 337 17.5 No. 4, Shaftesbury 15,524 222 14.3 No. 5, Church 18,635 328 17.6 No. 6, Winstanley 20,772 421 20.3 No. 7, St. John 8,634 123 14.2 No. 8, Bolingbroke 19,119 258 13.5 No. 9, Broomwood 21,166 224 10.6 11 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1927, and during the previous decennium 1917-1926:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea.. 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 1923 20.1 23.0 22.0 14.4 1924 18.4 19.9 21.9 12.8 1925 18.5 20.6 20.6 13.6 1926 17.3 18.9 20.6 11.9 Average 1917-1926 19.9 21.5 22.7 14.8 1927 16.6 17.9 18.9 12.5 This is the lowest birth-rate recorded in Battersea with the exception of the year 1918. The birth-rate shows a decline in four of the Wards of the Borough. The decline has been most marked in Latchmere, Nine Elms and Shaftesbury Wards. The birth-rate in Battersea is 3.25 per 1,000 lower than the average for the previous decennium 1917-1926. The birth-rate for the County of London was 16.1 per 1,000 of the population, and for England and Wales the rate was 16.7. Illegitimate births numbered 89 or 3T8 per cent. of the total births. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of stillbirths was made compulsory. During the six months the Act has been in operation, 46 stillbirths were registered in Battersea. The total number of stillbirths notified during the year was 79. DEATHS. The number of deaths registered in the Borough during 1927 was 2,773. Of these 1,102 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 394 deaths of Battersea residents 12 registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 2,065 (males 1,012, females 1,053). This gives a recorded death-rate of 12.2 compared with 11.9 for London, and 12.3 for England and Wales. According to the factor supplied by the Registrar-General, for correction of death-rate in reference to age and sex distribution, the corrected death-rate for Battersea during 1927 was 11.8. The distribution of the deaths and the death-rate per 1,000 inhabitants for each of the nine Wards is shown in the following Table. Ward. Estimated Populationl927. Number of Deaths. Deathrate. No. 1, Nine Elms 27,514 318 11.6 No. 2, Park 18,352 229 12.5 No. 3, Latchmere 19,284 219 11.4 No. 4, Shaftesbury 15,524 191 12.3 No. 5, Church 18,635 244 13.1 No. 6, Winstanley 20,772 264 12.7 No. 7, St. John 8,634 92 10.7 No. 8, Bolingbroke 19,119 241 12.6 No. 9, Broomwood 21,166 267 12.6 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1927:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 88 41 11 13 52 110 318 379 1,012 F 62 40 16 10 53 114 261 497 1,053 Ttls. 150 81 27 23 105 224 579 876 2,065 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 320 383 703 Second quarter 222 229 451 Third quarter 206 174 380 Fourth quarter 264 267 531 1,012 1,053 2,065 13 The increase in the death-rate (11.4 to 12.2 as compared with 1926) has been slight and is accounted for by the increased deathrate in the first quarter of the year from respiratory disease and influenza. The death-rate was lowest in the St. John Ward (10.7), and highest in Church Ward (13.1). The deaths of persons over 65 years numbered 876 or 42.4 per cent. of the total deaths. The average age at death was 53.4 years, as compared with 50.3 in 1926. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1917 15.2 15.4 16.3 14.0 1918 18.7 19.2 20.2 16.6 1919 12.9 12.4 12.7 13.7 1920 12.5 12.8 12.4 12.3 1921 12.2 12.3 12.7 11.5 1922 13.2 13.1 13.8 12.6 1923 10.8 11.2 10.4 10.6 1924 11.8 11.9 12.5 11.0 1925 10.5 10.5 11.0 10.0 1926 11.4 11.5 11.4 11.3 Average 1917-26. 12.9 13.0 13.3 12.4 1927 12.2 12.0 12.6 12.1 The natural increase of population (that is the excess of births over deaths) was 736 in 1927, the lowest figure yet reached except in the War years 1917 and 1918. There was an adverse balance of 109 in 1918, and in 1917 the natural increase was 675. Deaths in Public Institutions. During 1927 the deaths of Battersea residents occurring in Public Institutions numbered 1,019. Of this number 682 occurred within and 337 outside the Borough. Of the total deaths in Public Institutions 645 occurred in Poor Law Institutions. 14 Senile Mortality. During 1927 the deaths of 876 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 79 73 52 83 10 24 141 180 321 N.W. Battersea 63 58 46 50 5 17 114 125 239 S.W. Battersea 54 70 55 80 15 42 124 192 316 Borough of Battersea 196 201 153 213 30 83 379 497 876 Births and Deaths Registration Act, 1926. The Births and Deaths Registration Act, 1926, came into force on 1st July, 1927. The Act amends the law relating to Certification of Deaths and the disposal of the dead. A certificate of death can be given only by a registered Medical Practitioner in the prescribed form and must be delivered by the Practitioner himself to the Registrar. Other changes of importance relate to the particulars of the cause of death, a new form of certificate is provided for the use of Medical Practitioners, which was drawn up after consultation between the Registrar-General and representatives of the medical profession, in order to secure more accurate records of the causes of death. This should be found to assist Medical Officers of Health in compiling the Statistics for their Annual Reports. Infant Mortality. During 1927 the deaths of 150 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,801 giving an infant mortality rate of 53.5 per 1,000 births, as compared with 61.6 in 1926. It will be noted that the infant mortality-rate was considerably lower during 1927 than in the previous year. The main cause of the decline was a fall in the mortality from respiratory and intestinal diseases. The distribution of the 150 infant deaths and the infant mortality-rates for the registration sub-districts and the Wards, are shown in the following table:— 15 Registration Sub-District. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. M. F. total. East Battersea 1,251 46 25 71 56.8 North-West Battersea 915 29 19 48 52.5 South-West Battersea 635 13 18 31 48.8 The Borough 2,801 88 62 150 53.5 Ward. 1. Nine Elms 515 27 14 41 79.6 2. Park 373 13 5 18 48.3 3. Latchmere 337 5 — 5 14.8 4. Shaftesbury 222 3 6 9 40.5 5. Church 328 11 6 17 51.8 6. Winstanley 421 16 13 29 68.9 7. St. John 123 2 2 4 32.5 8. Bolingbroke 258 8 9 17 65.9 9. Broomwood 224 3 7 10 44.6 It will be noted that in the sub-districts the rate was highest in East Battersea (56.8) and lowest in South-West Battersea (48.8). In the Wards, Nine Elms showed the highest rate (79.6) and Latchmere the lowest (14.8). The infant mortality rate in the County of London and in England and Wales during 1927 was 59 and 69 respectively. The number of infant deaths and the infant mortality in each quarter of the year was as follows:— Births registered. Infant deaths. Infant Mortality Rate. First quarter 727 51 70.2 Second quarter 704 37 52.6 Third quarter 701 25 35.7 Fourth quarter 669 37 55.3 During the last 9 months of the year the infant death-rate was 47.7. But for the relatively high mortality of the first two quarters the rate would have been equal to or even lower than in 1923, the record year. There were 80 deaths of infants during the first four weeks of life (or 53.3 per cent. of the total infant deaths) as compared with 81 deaths (or 44.3 per cent.) in 1926 and a percentage for the quinquennium 1922-1926 of 43.7. 16 Measles accounted for 1 infant death during the year. The deaths from developmental diseases were 74 as compared with 72 in 1926. The next tables show the incidence of mortality from the chief diseases of infancy in the first four weeks and during the four trimesters:— Table showing Deaths of Infants under 1 day, under 1 week and under 4 weeks from 1922 to 1927. Year. Under 24 hrs. 1 to 7 days. 1 to 4 weeks. Total under 4 weeks. 1922 32 41 35 108 1923 33 21 23 77 1924 21 29 27 77 1925 25 29 35 89 1926 20 38 23 81 Total 1922-26 131 158 143 432 Mean do. 26.2 31.6 28.6 86.4 1927 29 29 22 80 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Enceph. Lethargica — — 1 — 1 0.66 Measles — 1 — — 1 0.67 Influenza 1 — — — 1 0.67 Dysentery — — 1 — 1 0.67 Whooping Cough — 2 2 — 4 2.67 Diarrhœa and Enteritis 3 3 — 1 7 4.67 General Tuberculosis — 2 — — 2 1.33 Tuberculous Meningitis — — — 1 1 0.67 Pulmonary Tuberculosis — — — — — — Pneumonia 3 3 8 9 23 15.33 Bronchitis 2 1 — — 3 2.00 Other Respiratory Diseases — — — — — — Sarcoma — 1 — — 1 0.67 Prematurity 57 — — — 57 38.00 Marasmus 4 — 1 — 5 3.33 Icterus Neonatorum — 1 — — 1 0.67 Congenital Malformations 8 — 1 — 9 6.00 Injury at Birth 2 — — — 2 1.33 Suffocation (overlying) — — — — — — Convulsions 3 — 1 1 5 3.33 Atelectasis &Asphyxia N. 5 — — — 5 3.33 Lack of Care 3 — — — 3 2.00 Syphilis — 2 — — 2 1.33 Accident and Homicide 1 — — 2 3 2.00 Miscellaneous 4 2 7 — 13 8.67 Total 96 18 22 14 150 100.0 Percentage of Total 64.0 12.0 14.7 9.3 — 100.0 17 Illegitimate Infant Deaths. The death-rate amongst illegitimate children during 1927 was 89.9 per 1,000 births, as compared with 162.2 per 1,000 births in 1926, 113.2 in 1925, 148.1 in 1924 and 179.7 in 1923. The corresponding death-rate of legitimate children in 1927 was 52.4, the ratio of the mortality-rate of illegitimate infants to that of legitimate being 1.7 to 1. Comparative Statistics, Metropolitan Boroughs. Table showing the birth-rates, death-rates and infant mortalityrates in the 29 Metropolitan Cities and Boroughs for the year 1927:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 Births. 1. Shoreditch 20.6 1. Woolwich 10.6 1. Holborn 38 2. Poplar 19.8 2. Greenwich 10.8 2. Woolwich 42 3. Bethnal Green 19.6 3. Lewisham 11.0 3. Lewisham 46 4. Finsbury 19.2 4. Bethnal Green 11.1 4. Finsbury 50 5. Southwark 19.0 5. Fulham 11.3 5. Lambeth 50 6. Bermondsey 18.5 6. St. Marylebone 11.3 6. Hampstead 51 7. Islington 18.3 7. Wandsworth 11.3 7. Wandsworth 51 8. Stepney 18.1 8. Camberwell 11.4 8. Camberwell 52 9. Deptford 16.8 9. Deptford 11.5 9. Battersea 53 10. Battersea 16.6 10. City of London 11.5 10. Greenwich 53 11. Greenwich 16.2 11. Hackney 11.6 11. Islington 53 12. Lambeth 16.2 12. Stepney 11.6 12. Bethnal Green 57 13. Woolwich 15.9 13. Poplar 11.8 13. Deptford 58 14. Hackney 15.7 14. Battersea 12.2 14. St. Marylebone 59 15. Hammersmith 15.6 15. Hampstead 12.2 15. Hammersmith 61 16. Camberwell 15.6 16. S. Newington 12.2 16. Southwark 61 17. Paddington 15.5 17. City of Westminster 12.3 17. St. Pancras 62 18. St. Pancras 15.5 18. Hackney 64 19. Lewisham 15.1 18. St. Pancras 12.3 19. Fulham 66 20. Fulham 15.1 19. Islington 12.3 20. Kensington 66 21. Kensington 15.0 20. Lambeth 12.4 21. Poplar 66 22. S. Newington 14.0 21. Holborn 12.5 22. S. Newington 66 23. Wandsworth 13.5 22. Shoreditch 12.6 23. Bermondsey 67 24. Chelsea 13.4 23. Bermondsey 12.9 24. Stepney 68 25. St. Marylebone 13.2 24. Hammersmith 13.0 25. City of Westminster 68 26. Holborn 12.0 25. Finsbury 13.4 27. Hampstead 11.9 26. South wark 13.4 26. Shoreditch 74 28. City of Westminster 10.0 27. Paddington 13.5 27. Chelsea 76 28. Kensington 13.8 28. Paddington 79 29. City of London 8.7 29. Chelsea 14.1 29. City of London 105 London County 16.1 11.9 59 England and Wales 16.7 12.3 69 18 COMPARATIVE STATISTICS OF BIRTHS, MORTALITY, &c. Year. Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.4 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 291 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.8 669 22.1 129 471 1865 33,688 1,357 40.3 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 5,237 34.7 2,697 17.9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16.1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2,303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31.7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901 169,100 5,025 29.7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 375 2,282 1906 179,622 4,654 25.9 2,384 13.2 338 2,270 1907 181,736 4,574 25.1 2,406 13.2 255 2,168 1908 183,873 4,629 25.1 2,272 12.3 238 2,357 1909 186,036 4,450 23.9 2,417 12.9 283 2,033 1910 188,222 4,489 23.7 2,124 11.3 242 2,365 1911 167,765 4,381 26.1 2,404 14.3 836 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 — — — — 1917 D*159,402 — — 2,221 13.9 160 1,553 B*167,233 2,960 17.7 — — — — 1918 D*150,023 — — 2,285 15.2 185 675 B*168,014 2,700 16.1 — — — — 1919 D*149,951 — — 2,809 18.7 204 -109† B*165,960 3,075 18.5 — — — — 1920 D*159,316 — — 2,061 12.9 95 1,014 B*166,093 4,669 28.1 — — — 1921 D*165,664 — — 2,079 12.5 188 2,590 169,200 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 20.1 1,839 10.8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,805 10.5 64 1,379 1926 171,900 2,969 17.3 1,960 11.4 119 1,009 1927 169,000 2,801 16.6 2,065 12.2 57 736 * Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. † Decrease. Census years in heavy type. 19 Chart Showing Birth, Death and Infant Mortality Rates in Battersea from 1858 to 1927. 20 Notification of Births Act. During 1927 the number of notifications of live births received was 2,709. The corrected number of births registered during the year in Battersea was 2,801. The proportion of notified to registered births was, therefore, 96.7 per cent. The number of still births notified during the year was 79 or 2.8 of the total live births. 197 living and 4 still-births of Battersea children born in other districts were notified from the districts in which these births occurred. The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926, on 1st July, 1927. From this date to 31st December, 59 still-births were registered in Battersea, of which 13 were of non-resident, and 46 of Battersea parents. 46 still-births (or 100 per cent.) were notified during the same period. Notified births are visited and revisited by the Council's official Health Visitors and the visitors of the Voluntary organisations included in the Council's Maternity and Child Welfare Scheme. A weekly return of all births notified is forwarded to the London County Council, in accordance with the requirements of Sec. 5, Sub-Sec. 2, of the Notification of Births Act. 21 MATERNITY AND CHILD WELFARE SCHEME. The Maternity and Child Welfare Scheme of the Council includes Municipal and Voluntary effort and the activities of both are fully co-ordinated. In order to enable the Voluntary Associations to keep their work efficient and in uniformity with that of the Municipal Centres and Clinics they receive, in addition to the grants from the Ministry of Health, an annual contribution from the Council. Maternity and Child Welfare Centres. The Centres, Municipal and Voluntary, are situate as follows:— 1. Municipal. (a) Latchmere Baths (Burns Road Entrance). (b) All Saints Parish Hall (Prince of Wales Road). (c) Plough Road Baths. (d) Chatham Hall (Chatham Road). (e) Dental Centre and Clinic (Plough Road Baths). 2. Voluntary. (a) Battersea School for Mothers (55 Mundella Road). (b) Women's League of Service (111 Bridge Road West). (c) Chislehurst Mission (St. James' Hall, Ponton Road, Nine Elms). Other ancillary services included in the Scheme are:— (1) St. Mary's Hostel, Macaulay Road, Clapham Common. (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road. At each of the Centres a clinic is held, a woman Medical Officer and a nurse being in attendance. Each centre is under the supervision of a trained Health Visitor and Voluntary Helpers assist in the work of these centres. The Voluntary Centres are managed on similar lines to those of the Municipal Centres. The following table gives a summary of the work carried out at the Centres in 1927:— 22 Summarised Statistics Relating to Infant Centres, 1927: Municipal. Voluntary. Grand Total. Latchmere Centre. Plough Road Centre. East Battersea Centre. Chatham Road Centre. Total Battersea School for Mothers. Chislehurst (St .James's) Mission. Women's League of Service. Total Municipal and Voluntary. Sessions held 146 100 98 148 492 86 51 72 209 701 Attendances 5,933 3,862 4,306 5,376 19,477 3,380 1,283 1,745 6,408 25,885 First attendances 402 310 354 314 1,380 212 56 70 338 1,718 Average attendances per session 40 39 44 36 40 39 25 24 31 37 Average ditto weekly 114 74 83 103 375 65 25 34 123 499 Doctor's attendances 96 46 46 51 239 86 26 66 178 417 Babies seen by Doctor 2,027 999 1,224 1,064 5,314 2,506 314 1,305 4,125 9,439 Average ditto per attendance 21 22 27 21 22 29 12 20 23 23 Weights recorded 5,067 3,281 3,894 4,729 16,971 3,354 1,190 1,623 6,167 23,138 Advice only 866 581 412 647 2,506 26 93 122 241 2,747 23 Hospital Provision. In addition to the provision of Midwifery Services, Hospital and District, the Council have provided facilities for the needs of children requiring special Hospital treatment by arrangement with the Victoria Children's Hospital, Chelsea, and the Fulham Babies' Hospital (chronic debility and wasting diseases). The Council contribute an annual sum in the case of the former, and a per capita payment to the latter Institution in respect of these facilities. Women and children where necessary are referred from the AnteNatal and Child Welfare Centres to other appropriate Institutions. Number of cases referred to Hospitals and Institutions from the Maternity and Child Welfare Clinics during 1927:— St. Thomas's Hospital 39 Victoria Hospital, Chelsea 303 St. James's Hospital 14 Bolingbroke Hospital 12 Borough Tuberculosis Dispensary 18 Fulham Babies' Hospital 8 St. Thomas's Cornwall Babies' Hostel 120 Chelsea Hospital for Women 1 Infants' Hospital, Vincent Square 1 Guy's Hospital 1 Moorfields Hospital 2 519 Southwark Diocesan Homes. For some years past the Council has contributed towards the cost of the maintenance during the period following confinement of unmarried mothers resident in their district and their children, by the Southwark Diocesan Association for Preventive and Rescue work, in St. Mary's House, Macaulay Road, Wandsworth, which is an Institution affiliated to the Council's Maternity and Child Welfare Scheme. During the year under report, a request was received from the Association that the Council should contribute to the cost of Battersea unmarried mothers who were received into other homes maintained by the Association, and with the sanction of the Ministry of Health, the Council agreed to contribute on a per capita basis a sum not exceeding £65 per annum for this object. 24 Nursing Facilities. During 1927 the total number of attendances made by the District Nursing Service in connection with the Council's Scheme was:— Nursing Service, 1927. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 118 2,829 — — 118 2,829 Measles — — 4 19 4 19 Whooping Cough 16 181 1 4 17 185 Diarrhoea & Vomiting 5 21 — — 5 21 Chicken Pox — — 2 13 2 13 Pemphigus Neonatorum 2 38 — — 2 38 Puerperal Pyrexia — — 1 5 1 5 Pneumonia 53 985 88 1,885 141 2,870 Influenza 13 147 34 401 47 548 Erysipelas — — 5 65 5 65 Encephalitis Lethargica — — 2 24 2 24 Totals 207 4,201 137 2,416 344 6,617 The cost of the Nursing Service in 1927 was £220 l1s. 4d. as compared with £227 16s. 0d., in the previous year. Health Visitors. The Health Visiting Staff consists of 9 full time Health Visitors. two of whom are partly employed as Women Sanitary Inspectors. Facilities are granted by the Council to students of recognised Training Bodies for practical instruction and training as Health Visitors. During the year a number of students from the Hygiene Department, Battersea Polytechnic, Bedford College and the College of Nursing received a course of training under the Council's Maternity and Child Welfare Scheme. By arrangement with the Authorities of Bedford College for the practical training of their students under the Council's Maternity and Child Welfare Scheme, the services of one of the permanent Health Visitors, Miss O. Baggallay, were largely utilised for this purpose. To maintain the establishment staff, Miss M. McEwan was appointed as temporary Health Visitor for a period of one year, the expenditure incurred bv the Council being borne by Bedford College. The work carried out during 1927 by the Council's Health Visitors and those of the voluntary organisations included in the Borough Maternity and Child Welfare Scheme is summarised in the following table :— 25  C'cl. Vol. Total. Visits to Expectant Mothers 2,173 366 2,539 Visits to Notified Births 8,466 1,481 9,947 Visits to Still Births 63 8 71 Visits to children aged 1-5 years 2,702 2,091 4,793 Visits to enquire into Infant Deaths 156 32 188 Visits to cases of Notifiable Infectious Disease 3,240 249 3,489 Visits to cases of Non-Notifiable Disease 438 137 575 Visits re prevention of Diphtheria 80 20 100 Visits re Summer Diarrhœa 788 435 1,223 Visits to Dental Cases 406 72 478 Visits to V.D. Cases 29 1 30 Other Visits 1,156 846 2,002 19,697 5,738 25,435 St. Thomas's Cornwall Babies' Hostel. The arrangements temporarily made in the previous year with St. Thomas's Cornwall Babies' Hostel, with the sanction of the Ministry of Health, for the provision of facilities for cases sent from the Borough Maternity and Child Welfare Clinics for test feeding and the encouragement of breast feeding amongst Battersea mothers, were continued during 1927. The results of the year's work have been very promising and are summarised below A. Test Feeds. Number of cases, 108, comprising: Mothers, 108; babies, 109. Number of attendances, 125. 10 of these cases received in-patient treatment. B. In-Patient Treatment. 34 Battersea cases received, made up of— 12 mothers and 13 babies sent by Council. 1 mother and 8 babies sent from other sources. Period of stay. 25 cases sent by Council— 12 mothers and 13 babies, 290 days Average 24.1days 9 other cases— 1 mother and babe, 62 days; Average babies, 418days. 60.2 days. A contribution of £100 was made by the Council towards the cost of this work, which is included in the estimates of the Maternity and Child Welfare Scheme. 26 Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, milk is provided by the Council for 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 by those able in part to contribute:— Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons supplied. lbs. supplied. Persons supplied. Pints supplied. 1920 1,473 15,588 233 31,894 £ 3,330 1921 2,391 49,020 301 27,254 5,011 1922 2,469 61,511 260 23,879 5,279 1923 2,231 50,110 219 25,633 3,288 1924 1,840 51,837 178 17,654 2,533 1925 1,620 44,805 222 26,079 2,631 1926 609 30,762 699* 89,435 3,262 1927 111 2,912 1,381† 206,717 3,438 * Of these 469 also received dried milk. †,, ,, 53 „ ,, ,, ,, The Ministry of Health, on the 19th April, notified the Council that various deductions would be made from the Council's estimates of expenditure on their Maternity and Child Welfare Scheme for the financial year 1927-28, including a reduction of £760 from the amount provided for Milk and Milk Administration (£4,560). The Ministry suggested the revision of the scale of income upon which the payments to be made by the applicants for the supply of milk at reduced rates or free are assessed, but the Council decided to adhere to their existing scale. By the exercise of rigid supervision the expenditure on milk, as will be seen from the table, has been kept substantially within the reduced amount allowed by the Ministry. As stated in last year's report, in place of dried milk formerly supplied under this service, Grade A (Tuberculin Tested) milk only is now given, except in a few cases where, for medical reasons, dried milk is ordered. In addition to the above, dinners to the number of 693 were supplied during 1927 to necessitous mothers and children at a cost of £19 18s. 9d. Convalescent Homes. During 1927, accommodation was provided for 25 mothers and 24 children attending the various Maternity and Child Welfare 27 Clinics in St. Mary's Convalescent Home, Birchington, and the Burnett Cottage Home, Heme Bay, through the Council's Maternity and Child Welfare Scheme. The average stay was 2 weeks and the cost amounted to £99 6s. 2d. The Council contributed £60 18s. 0d., and the remainder was provided by a voluntary Association working in the district and by the patients themselves. An extension of this useful work is under consideration. Ante-Natal Work. The work of the Ante-Natal Clinics which has been fully described in previous Annual Reports, was carried on with unabated activity during 1927. This work is under the direction of Miss Alice Bloomfield, M.D., F.R.C.S., who attends four sessions weekly, three at the Borough Maternity Hospital Out-patients Department, and one at the Latchmere Baths Centre, and who reports as follows:— Tuesday Afternoon, Special Clinic.—This has been very well attended, the average attendance at each Session—about 13— having increased from the previous year: 712 new patients and 77 old patients were seen in all, making a total of 789. The majority of them attended for blood tests, of which 12 were positive, but 102 patients were seen for other causes, including vaginal discharge during pregnancy, &c. Wednesday and Thursday Mornings at Borough Maternity Hospital.—These Clinics have been extremely well attended, a large proportion of the patients being primiparse. The expectant mothers are, on the whole, tending to come up at an earlier date in pregnancy, i.e., 3rd, 4th and 5th months to book for their confinements. I consider this should be encouraged as it allows for a thorough general and special examination of the patient at a period in pregnancy when the diagnosis and treatment of organic disease in the mother—24 cases of cardiac disease and 7 cases of Tuberculosis were seen at the Ante-Natal Clinics in 1927—and the prophylaxis of ill-health in the later months of pregnancy by attention to details of hygiene, care of teeth, etc., can be expected to have good results. Friday Morning, Latchmere Baths.—This clinic continues to be well attended. New cases here preponderate both because they are numerous and also for the reason that in the later months of pregnancy cases who are to be confined in the Borough Maternity Hospital are transferred to the Maternity Home clinics. Many patients who have engaged the Borough Midwife attended this clinic, where they derive the considerable advantage of being examined by myself and the Borough Midwife on the same occasion, with benefit to both nurse and patient. 28 Gratifying features of the work as a whole are:— (1) The return of patients in a subsequent pregnancy to the the Borough Maternity Clinics—who have previously been confined in the Borough Maternity Hospital or by the Borough Midwife on the District Midwifery Service— showing the recognition by the patients of the benefit to be derived from the regular ante-natal treatment and skilled care during their confinements. (2) Cases referred to the Clinics for an opinion by private doctors and midwives. While these are relatively few in number they are to be encouraged as they reveal a desirable co-operation between outside doctors and nurses and the Borough Clinics and increase the scope and usefulness of the Ante-Natal Scheme. During the year 1927, a resident medical officer has been appointed to the Borough Maternity Hospital. While this appointment is as yet possibly on its trial its usefulness and desirability has, I think, been well demonstrated. The Resident Medical Officer attends the two main ante-natal and the Special Clinics and her co-operation with myself and her skilled treatment of cases whose admission to the hospital for ante-natal treatment has been recommended, has greatly facilitated and improved the working of the Ante-Natal Scheme. Moreover, she forms a liaison between the Ante-Natal Clinics and the in-patients' department and is ready to carry out suggested treatment and to give accurate information, as to the course of subsequent labour in an ante-natal patient, all of which improves the efficiency of the ante-natal scheme and increases its scope. I am adding below a table with a few figures which serve I think to indicate the usefulness of the Ante-Natal work. The induction figures are, I think, particularly creditable, 13 inductions having been done with no bad results to the mothers no still-births and only two neo-natal deaths (one from albuminuria). Forceps.—High, none ; Low, 26. Results—(a) Mother—good; (6) Infant—still-born (albuminuria) 1 ; no neo-natal deaths, no permanent injury. Inductions.—Total 13. Results—(a) Mother—good; (b) Infant—no still-births; neo-natal deaths 2 (one albuminuria). Albuminuria.—Cases treated in the Borough Maternity Hospital 10. Results—(a) Mother—albuminuria when discharged 3; (b) Infant—Macerated foetus 3, still-birth 1, neo-natal death 1. Eclampsia—no case. Toxcemia. No. of cases 2. Results—(a) Mother—good; (b) Infant—neo-natal death 1 (induction). 29 Breech Cases.—Number delivered as Breeches 10, of whom only 2 were undiagnosed at term. In the others version failed, premature labour supervened, etc. Results—(a) Mother—good ; (6) Infant—still-birth 1 (Hydro-cephalus), neo-natal deaths 2. Caesarian Section.—1 Result good. Craniotomy.—Result. Mother—satisfactory (at the request of mother, case recommended for Caesarian Section). The total number of patients attending the Ante-Natal Clinics during 1927 was :— Central Clinic (Borough Maternity Hospital) 606 Latchmere Clinic 243 All Saints (East Battersea) 137 Plough Road (West Battersea) 154 1,140 I he numbers show a decrease of 68 patients as compared with 1926. In addition to the Ante-natal work carried out under the Maternity and Child Welfare Scheme, a considerable amount of visiting and reporting of cases is done for the Obstetric and Gynaecological Departments of the larger Hospitals in connection with Battersea patients attending these Institutions. The following is a summarised statement showing the Hospital and the visiting work carried out for them during 1927:— Ante-natal and postnatal. Other. Total. St. Thomas' Hospital 306 397 703 General Lying-in Hospital 199 — 199 King's College Hospital 6 — 6 St. George's Hospital 32 — 32 Westminster Hospital 7 — 7 Victoria Hospital, Chelsea — 89 89 Gt. Ormond Street Hospital — 3 3 St. James' Hospital Battersea General Hospital — 15 1 15 1 Bolingbroke Hospital — 1 1 Infants' Hospital, Vincent Square — 1 1 Other Philanthropic Societies — 2 2 550 509 1,059 Ante-Natal (V,D.) Clinic. This Special treatment clinic was established in connection with the Ante-natal Out-patient Department at the Borough Maternity Hospital at the end of 1921. The Clinic is fully equipped with all modern requisites for diagnosis and treatment and is directed by Dr. A. C. Roxburgh, the Consultant Medical Specialist. The work carried out during 1927 is summarised in the table on page 30. 30 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results. Year. Number of expectant mothers tested by w.r. Number giving positive w.r. Per cent. Number of expectant mothers with positive w.r. treated during pregnancy. Babies. Healthy Neg. w.r. Healthy looking Not yet tested. Positive w.r. Still-born. 1922 — — — 1 1 0 0 0 1923 — — — 8 5 2 1 0 1924 517 18 3.5 15 11 3 0 1* 1925 653 14 2.1 8 7 1 0 0 1926 658 10 1.5 9 7 2 0 0 1927 674 12 1.7 12 6 4 2 0 * Not syphilitic. 31 Dr. Roxburgh reports:—"Compared with 1926, there was an increase of 16 in the number of Wasserman tests carried out on pregnant women attending the Clinics, viz. : 674 as against 658. Of these 12, i.e., 1.7 per cent. were found positive as against 1.5 per cent last year. All twelve had anti-syphilitic treatment during the remainder of their pregnancies. Unfortunately the average period of pregnancy at which these mothers came to the ante-natal clinics was a month later than last year, viz., 6½ months : in fact half of them were more than 7 months pregnant at their first attendance. This hardly gives treatment a fair chance and its results may be reflected in the fact that two of the babies had positive Wasserman tests. As usual an unsatisfactory feature is that some of the women will not bring their babies up for test in spite of energetic persuasion by the Health Visitor, four this year are defaulters in this respect, as against the usual 2. I very much regret the loss to the Clinic occasioned by the departure of Miss Olive Baggallay who for some years has kept the notes and statistics of the Clinic in a most efficient way and has been most energetic in her attempts to get the patients to attend regularly, an uphill task." Maternal Mortality. During 1927, there were 6 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 2.14 per 1,000 births. Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1922. 1923. 1924. 1925. 1926. 1927. Deaths from Puerperal Sepsis 3 4 3 3 1 Deaths from other causes connected with child-birth 6 10 5 3 7 5 Total Maternal Deaths connected with child-birth 9 10 9 6 10 6 Rate t>er 1.000 births— Puerperal Sepsis 0.82 — 1.27 0.94 1.01 .36 Other Maternal deaths 1.64 2.91 1.59 0.94 2.36 1.78 Rate per 1,000 births all Maternal deaths in child-birth 2.46 2.91 2.86 1.88 3.37 2.14 Rate per 1,000 population— Puerperal Sepsis .018 — .023 .017 .017 .006 Other Maternal deaths .035 .059 .029 .017 .041 .030 Rate per 1,000 population all Maternal deaths in childbirth .053 .059 .052 .034 .058 .036 32 Four of these deaths occurred in St. James' Hospital and 2 at home. The causes of death were certified as being— Puerperal sepsis 1 Haemorrhage 2 Ruptured ectopic gestation 1 Toxaemia of pregnancy 1 Pulmonary embolism 1 It is satisfactory to be able to record a decline in Maternal Mortality during 1927, and an inspection of the above table shows on the whole a relatively fairly satisfactory record for the Borough. Borough Maternity Hospital. The Borough Maternity Hospital was opened for the reception of Maternity patients in February, 1921. The Hospital is situate at 19 and 20 Bolingbroke Grove, overlooking Wandsworth Common. Accommodation is provided for 30 patients at one time. The Hospital is also a recognised training Institution for pupil-midwives and a district midwifery service for the attendance of the District Midwife on patients in their own homes is directed from the Borough Maternity Hospital. The Central Ante-Natal and Special Treatment Clinics are held at the Out-patient Department of the Hospital. The Nursing Staff of the Hospital consists of a matron, sister and 4 staff nurses. There is accommodation in the Hospital for 12 pupil midwives undergoing training. During 1927, the Council on the recommendation of the Maternity and Child Welfare and Staff Committees decided to appoint a Resident Medical Officer for a period of 12 months, renewable for another year. The main reasons for this appointment were, the great increase in the number of patients admitted, difficulty of obtaining local medical assistance when required, number of difficult and dangerous cases admitted from Ante-Natal Clinics requiring Medical supervision while in Hospital, necessity for co-ordinating work of Hospital with Ante-Natal Centres and for the proper keeping of records and case papers, ensuring that the services of the Consultant Obstetrician to the Hospital are available with the least possible delay in cases of grave emergency, and provision for a post-natal clinic for the periodical examination of patients subsequent to their discharge from the Hospital after confinement. The results of the first few months working of the new appointment have fully justified the action of the Council. It has increased the efficiency of the Clinical work of the Hospital and has provided greater security for the patients, a matter of vital importance having regard to the number of difficult and dangerous cases admitted, many of them requiring serious surgical operations to be carried out without delay. 33 During 1927, 634 cases were admitted to the Hospital as compared with 625 cases in 1926, 560 cases in 1925 and 400 cases in 1924. The services of the Consultant Obstetrician to the Hospital, Dr. J. S. Fairbairn, M.D., F.R.C.S., F.R.C.P., Senior Obstetric Physician to St. Thomas' Hospital (or his deputy, Dr. A. H. Richardson, F.R.C.S.) are also available in cases of grave emergency. It was found necessary to call in the services of the Consultant Obstetrician in 12 cases during the year as compared with 10 cases in 1926. Particulars relating to the admissions during 1927 are set out as follows:— Total number of cases admitted 634 Average duration of stay 14 days Number of cases delivered by midwives 583 Number of cases delivered by doctors 44 Of the above cases, 7 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. Accidental hemorrhage 2 Placenta previa 2 Albuminuria 3 Uterine inertia 1 Ante-partum hemorrhage 1 — Contracted pelvis 3 30 Induction 14 Malpresentation 4 (b) During Labour. Adherent placenta 5 Retained placenta and Foetal distress 3 hemorrhage 2 Heart disease 1 Ruptured perineum 28 Prolapse of cord 2 — Prolonged labour 23 64 (c) After Labour. Rupture of perineum 12 Painful V.V 2 Influenza 3 Abdominal pain 1 Rise of temperature 3 Pain in breast 2 Boil on buttock 1 Pain in groin 1 Engorged breasts 3 B. coli in urin. 1 Eclamptic fits 1 — Pain in limb 2 33 Pain in bladder 1 Vesical pain 1 34 (d) For Infant. Prematurity 7 Imperforate anus 1 Feebleness 10 Stillbirth 1 Blisters 2 Discharge from eyes 43 Asphyxia 2 Unknown illness 1 Cyanosis 2 73 Peeling 3 Skin eruption 1 = Number of maternal deaths 0 Number of cases in which temperature rose above 100.4° F. for 24 hours with rise of pulse rate 15 Number of cases notified as Ophthalmia neonatorum with result of treatment 3 (All cured. No permanent damage to eyes. 2 transferred to St. Margaret's Hospital for treatment.) Number of cases with discharge from eyes however slight 43 Number of infants not entirely breast fed 7 Anaemia of mother 1 Phthisis of mother 1 Prematurity and deficiency 2 Mastitis 1 Rheumatism and heart disease 1 Chronic albuminuria 1 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia (5 recovered, 1 died from tuberculosis) 6 Number of foetal deaths (still-born or within 14 days of birth) and their causes 23 Haemorrhage 1 Drugs (macerated) 1 Complicated breech 1 Purpura 1 Shortness of cord 1 Prematurity 6 Prematurity and pernicious 1 ■/ x vomiting 1 Asphyxa 1 Hydrocephalus 1 Albuminuria in mother Head injury—craniotomy 1 (macerated )5 Anencephalus 1 Causes unknown 2 The Consultant Obstetrician was called in in 12 cases of grave emergency, particulars of which are set out below:— A.P.H. (accidental) 1 Appendicitis 1 Cæsarean section 1 Severe anaemia after P.P.H. Ruptured urethra after forceps and adherent placenta 1 delivery 1 B. coli in urine 1 Contracted pelvis 1 Central placenta prasvia 1 Hyperemesis gravidarum 1 Induction 1 Purulent discharge, absorption Chronic nephritis and rise of &c. 1 temperature 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, 1928:— 35 Maternity Hospital, 1927-1928. Total beds, 30; total cases, 602; percentage of beds occupied 77.2 per cent. Statement showing expenditure for the year ended 31st March, 1928, in respect of the Maternity Hospital. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 322 0 5 4 Nursing 598 0 9 11 Domestic and other 513 0 8 6 Provisions 1,251 1 0 9 Drugs and other Medical Requisites 301 0 5 0 Heating and Lighting 519 0 8 7 Laundry 402 0 6 8 Repairs and renewals Domestic 544 0 9 1 Structural 362 0 6 0 Taxes and Insurance 82 0 1 5 Loan Charges 1,316 1 1 10 Miscellaneous 259 0 4 4 Gross cost £6,469 £5 7 5 Income Pupil Midwives 300 0 5 0 Patients' Payments 2,532 2 2 0 Other 20 0 0 4 Net cost £3,617 £3 0 1 District Midwifery Service. During 1927 there were 157 cases attended in their own homes by the District Midwife as compared with 152 in the previous year, an increase of 5 cases. Particulars relating to this Service during the year are set out below:— Total number of cases attended in the district 157 Average number of visits to each case 18 Number of cases delivered by:— (a) Midwife 155 (b) Doctors 2 Number of cases where medical assistance was called for, with reasons for requiring assistanc:— (a) Ante-Natal. Nil. 38 (b) During Labour. Adherent placenta 1 (c) After Labour. Ruptured perineum 4 Varicose veins 3 Puerperal pyrexia 2 Influenza 1 Severe chill 1 11 (d) For Infant. Prematurity 6 Spots on face 1 7 Number of cases of— Puerperal sepsis — Maternal deaths — Stillbirths — Death within 10 days — Infants not entirely breast-fed — Inflammation of eyes (slight) 3 Ophthalmia neonatorum 2 (1 removed to St. Margarets (M.A.B.) Hospital; both cured). Dental Clinic. During 1927 the work carried out at the Dental Clinic was satisfactory. The Clinic was established as an integral part of the Council's Scheme for Maternity and Child Welfare for providing facilities for the treatment of expectant and nursing mothers and children under 5 years of age. The additional session for children which was referred to in my annual report for 1926 was opened in March, 1927. The Dental Clinics are also available for patients recommended by the Medical Officers of the Maternity and Child Welfare Clinics of the Voluntary Associations linked up with the Council's Scheme. The work of the Dental Clinic during 1927 is summarised as follows:— Women. Children. Sessions held 149 33 No. of patients treated 310 92 No. of new patients 155 47 No. of patients referred to hospital . 22 12 Total attendances 2,048 339 37 Work carried out:— Women. Children. Extractions— Ordinary 2 5 With local anaesthetic 106 18 „ general anaesthetic .241 11 Total 349 34 No. of teeth extracted 1,135 70 Scaling and polishing 39 2 Fillings 64 60 Upper dentures 72 — Lower dentures 69 — Denture visits 655 — Dressings and treatment to gums 69 16 Repairs to dentures 36 — Advice 752 216 The estimated cost of dental treatment (Maternity and Child Welfare) in the financial year 1927-8 was £610 10s. 6d. This sum includes £260 10s. 6d. paid for dentures supplied, the cost of which was distributed as under:— £ s. d. Contributed by patients 148 7 11 Grants from British Dental Hospital 15 15 0 Grants from Saturday and Sunday Hospital Funds 46 7 0 Grants from other philanthropic agencies 1 5 0 Grant by Guardians 2 0 0 Health Insurance 22 15 1 Contribution by the Council 24 £260 0 10 6 6 The net cost of this service during 1927-8 was £374 0s. 6d. 38 Notifiable Infectious Diseases. During 1927 under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 2,440 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 6, acute poliomyelitis 7, encephalitis lethargica 4, acute polio-encephalitis 1. The following is a list of the diseases compulsorily notifiable in Battersea:— Small-pox. Acute polio-myelitis. Cholera. Acute polio-encephalitis. Diphtheria. Glanders. Membranous croup. Anthrax. Erysipelas. Hydrophobia Scarlet fever. Acute influenzal pneumonia. Typhus fever Acute primary pneumonia. Typhoid or enteric fever. * Trench fever. Relapsing fever. Malaria. Continued fever. Dysentery. Puerperal fever. Plague. Puerperal pyrexia Acute encephalitis lethargica. Ophthalmia neonatorum. Measles. Cerebro-spinal fever. Whooping cough. The Infectious Diseases (London) Regulations, 1927, were issued by the Ministry of Health in December. The effect of the regulations was to remove (as from 1st January, 1928) trench fever from the list of compulsorily notifiable infectious diseases and to provide that cases of malaria occurring in Institutions where infection had been induced for therapeutic purposes, should not be notified, except that at least four days before the discharge of such a patient from the Institution, the Medical Officer who had charge of the patient should notify the Medical Officer of Health of the district in which the patient proposes to reside. The distribution of the cases notified in the registration subdistricts and the wards is shown in the table on p. 39. Excluding measles and whooping cough, there were 1,668 cases which occurred in 1,392 houses. Of these cases 1.328, or 79.5 per cent., were removed to the Isolation Hospitals of the Metropolitan Asylums Board or to other Institutions and 340, or 20.5 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 (Table II.) in the Appendix. Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. * Not notifiable after 31st December, 1927. 39 Notifications of Infectious Diseases, 1927, in Wards and Sub-Districts. Notification Diseases. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox — — — — — — — — — — — — — Diphtheria 202 85 95 38 55 137 14 21 33 354 256 70 680 Erysipelas 17 9 10 5 10 13 3 6 5 37 27 14 78 Scarlet Fever 61 39 51 47 48 53 11 31 35 151 140 85 376 Enteric (Typhoid) Fever 2 — — — 2 — — — — 2 2 — 4 Ophthalmia Neonatorum 10 7 6 3 3 13 1 3 2 22 20 6 48 Puerperal Fever 1 2 2 — 1 1 — — 2 5 2 2 9 Puerperal Pyrexia 3 6 1 1 1 5 1 5 2 11 6 8 25 Polio-myelitis ... 2 1 1 — 2 1 — — — 4 3 — 7 Polio-encephalitis 1 — — — — — — — 1 — — 1 Encephalitis Lethargica — — 2 — — 2 — — — 1 3 — 4 Cerebro-Spinal Meningitis — 1 — 2 1 2 — — — 2 3 1 6 Malaria — — 1 — — 1 — — — — 2 — 2 Dysentery — — — — — 1 — — — — 1 — 1 Trench Fever — — — — — — — — — — — — — Acute Primary Pneumonia 56 34 40 20 25 56 4 23 5 126 104 33 263 Acute Influenzal Pneumoni 22 20 18 14 21 32 8 21 8 65 62 37 164 * Whooping Cough 100 70 81 36 88 74 14 30 14 239 209 59 507 *Measles 42 28 58 49 28 24 11 22 3 162 61 42 265 Totals 518 303 366 215 285 415 67 162 109 1,182 901 357 2,440 * Notifiable in Battersea from 24th April, 1922. 40 Small-Pox. No case of small-pox occurred in Battersea during 1927. During the year 5 cases of this disease were recorded in London, 3 in Hackney, and 1 each in Hampstead and Poplar. In England and Wales, 14,769 cases of small-pox were notified during 1927. Scarlet Fever. The incidence of Scarlet Fever was relatively low in 1927, 376 cases being notified as compared with 581 in the previous year. The case-rate per 1,000 of the population was 2 . 2 and 3 deaths were registered from the disease giving a death-rate of 0.018 per 1,000 as compared with 2 deaths and a death-rate of 0.012 in 1926. Of the cases notified 371 or 98.7 per cent. were removed to hospital. The infected houses numbered 328. In 42 of the notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at Hospital. Diphtheria. The number of cases of Diphtheria notified in Battersea during 1927 was 680 as compared with 540 in 1926, 396 in 1925, 372 in 1924, 374 in 1923 and 670 in 1922. The number of deaths registered from the disease was 25, giving a death-rate of 0.148 as compared with 20 deaths and a death-rate of 0.116 in 1926. Of the 680 cases notified 675 or 99.3 per cent. were removed to hospital. The infected houses numbered 568. In 73 cases notified (not included in the above total) the diagnosis of Diphtheria was not confirmed at hospital. The case-rate per 1,000 population was 4.02 as compared with 3.14 in 1926, 2.30 in 1925, 2.18 in 1924, 2.19 in 1923, and 3.96 in 1922. The case-mortality was 3.68 as compared with 3.70 in 1926, 2.53 in 1925, 6.72 in 1924, and 9.09 in 1923. The incidence of the disease was highest in the Nine Elms, Winstanley and Latchmere Wards. 41 The following table shows the incidence and mortality of diphtheria during 1927 in the Borough, the sub-districts and the wards:— Ward. Cases. Deaths. Cases per 1,000 Popltn. Deaths per 1,000 Popltn. Percentage Case Mortality. 1 202 6 7.34 .22 2.97 2 85 5 4.63 .27 5.88 3 95 2 4.93 .10 2.11 4 38 — 2.45 — — 5 55 2 2.95 .11 3.64 6 137 5 6.60 .24 3.65 7 14 — 1.62 — — 8 21 1 110 .05 4.76 9 33 4 1.56 .19 12.12 E. 354 12 5.05 .17 3.39 N.W. 256 8 5.30 .17 3.13 s.w. 70 5 1.38 .10 7.14 Boro' 680 25 4.02 .148 3.68 Incidence and Mortality, 1895-1927. Period. Mean Quinquennial Rates. Case mortality per cent. Mean No.of cases per annum. Mean case rate. Mean No. of deaths per annum. Mean death- rate. 1895-1899 569.6 3.43 93.4 .564 17.02 1900-1904 265.2 1.57 22.6 .134 8.34 1905-1909 267.4 1 .58 222 .131 8.18 1910-1914 224.4 1.34 17.4 .104 7.74 1915-1919 261.0 1.66 22.4 .143 8.56 1920-1924 531.8 3.15 43.4 .257 8.06 Year 1925 396 2.30 10 .058 2.53 „ 1926 540 3.14 20 .116 3.70 „ 1927 680 4.02 25 .148 3.68 Diphtheria Prophylaxis. The Council on the recommendation of the Health Committee decided to establish a Schick Clinic in the Borough and Dr. Mabel Brodie was appointed as part time Specialist Medical Officer in charge. The Clinic was opened towards the end of 1927 at the 42 Maternity and Child Welfare Centre, Latchmere Baths. The Medical Officer attends one afternoon weekly from 2 to 4, and one of the Health Visitors who has received instruction in this work is also in attendance. The report of the Medical Officer of Health on which the above recommendation was made to the Council will be found in the Appendix. The following table shows the number of cases dealt with from the date of the opening of the Clinic (5th October, 1927) to the end of the year :— No. of Patients 95 No. Positive 18* Attendances ... 266 No. receiving prophylactic treatment 52 Tests made 39 Acute Polio-Myelitis. There were 7 cases of acute Polio-Myelitis notified in Battersea during 1927. There was 1 death from the disease. The following table gives particulars of the cases of Poliomyelitis notified in Battersea during the year:— Identification. Age & Sex. Date Notified. Result. G.S 11 M. 19 Jan. In receipt of out-patient treatment weekly at St. Thomas's Hospital. S.C. 6 F. 5 Feb. Fit to attend school. M.B. 2 F. 8 Mar. Fatal, 25 Mar. E.F 2 F. 4 Apl. Appears well. S.E. 2 M. 24 May In receipt of treatment at St. Thomas's Hospital. G.B. 1 M. 22 Aug. Admitted Carshalton Hospital, 16 Nov. P.F. 1 F. 27 Sept. Right leg affected, condition improving. At the end of the year there were still under observation 29 ases, including 21 notified prior to 1927, of which 23 were of children mder 5 years of age when notified. All these cases were carefully enquired into and kept under observation during the year. Of the 23 cases still under observation in addition to the cases notified during the year, 11 were * Immunity had not been completed in any of these cases by the end of the year. 43 undergoing out-patient treatment at the end of 1927, 4 cases were still in hospital, 1 case awaiting admission, 2 were under convalescent treatment, 1 being attended by own doctor and improving, 2 were reported well and the 2 remaining cases were still wearing instruments. Acute Polio-Encephalitis. One case of this disease was notified during 1927. There were 2 deaths from the disease including the notified case, the unnotified case being originally notified as one of bronchopneumonia. This case was treated at St. Thomas's Hospital and the death certified as due to above disease after post-mortem examination. Puerperal Fever and Puerperal Pyrexia. There were 9 cases of Puerperal Fever notified in Battersea during 1927, as compared with 12 cases in 1926, 6 cases in 1925 and 15 cases in 1924. There was 1 death from the disease. The number of cases per 1,000 births was 3.21, as compared with 4 • 04 in 1926, and 1,88 in 1925. The notified cases were distributed as follows:—East Battersea, 5; North West Battersea, 2; South West Battersea, 2. The case mortality was 11.1 per cent., and the death-rate per 1,000 births was 0.36. The number of cases of puerperal pyrexia notified during 1927 was 25, and the incidence per 1,000 births was 8.93. Enteric Fever. During 1927 eight cases of enteric fever (including one of Paratyphoid Fever) were notified in Battersea. Of these 4 cases were cancelled, the diagnosis not being confirmed at hospital. There was no death from this disease during 1927. Cerebro-Spinal Fever. During 1927 seven cases of this disease were notified in Battersea, one of which was subsequently cancelled. Three deaths were recorded from this disease. Encephalitis Lethargica. Nine cases of Encephalitis Lethargica (sleepy sickness) were notified in Battersea during 1927, as compared with 8 in 1926, 8 in 1925 and 14 in 1924. In 5 of the cases the diagnosis was not confirmed. Two deaths were recorded from the disease (one being of an un-notified case in an infants' hospital)* giving a death-rate of 0.012 for the year. * This death was certified as due to Encephalitis Lethargica following a post-mortem examination. 44 The following table gives particulars of the cases notified during 1927:— Identification. Age and Sex. Date notified. Date of Death. Progress. C.D 5, M. 4 Feb. Mild case T.S 59, M. 27 May — Attending hospital, doing light work. H.L 55, M. 12 Aug. — Well: at work. H.S. 29,F. 19 Aug. - Progressing ably In 1927 the number of notified cases of this disease in England and Wales was 1,617, and in London 149. Ophthalmia Neonatorum. There were 48 cases of Ophthalmia Neonatorum notified in Battersea during 1927 as compared with 35 cases in 1926, 32 cases in 1925, 41 cases in 1924 and 42 cases in 1923. The rate per 1,000 births was 17.1, as compared with 11.8 in 1926, 10.0, 13.1 and 12.2 in 1925, 1924 and 1923 respectively. The disease was most prevalent in the less prosperous districts of the Borough, East Battersea and North West Battersea contributing 87.5 per cent. of the total cases notified. During 1927 the number of visits paid by nurses supplied by the Borough Council in cases of Ophthalmia Neonatorum or other inflammatory condition of the eyes of the newly-born, was 2,829. In addition 134 visits of enquiry and supervision were made by Health Visitors. There were 9 severe cases amongst the 48 notified, all of which were removed to St. Margaret's (M.A.B.) Hospital for treatment. No permanent damage to the eyes of infants suffering from Ophthalmia Neonatorum or other inflammatory condition of the eves was recorded during the year. The following table shews the distribution of the cases notified:— Sub-Districts. Ward. Cases. Births. Rate per 1,000 Births. Year. Cases. Births. Hate per 1,000 Births. E. Battersea 22 1,251 17.6 1922 41 3,665 11.2 N.W. Battersea 20 915 21.9 S.W. Battersea 6 635 9.4 1923 42 3,434 12.2 1. Nine Elms 10 515 19.4 1924 41 3,139 13.1 2. Park 7 373 18.8 1925 32 3,184. 10.0 3. Latchmere 6 337 17.8 4 Shaftesbury 3 222 13.5 1926 35 2,969 11.8 5. Church 3 328 9.1 6. Winstanley 13 421 30.9 Mean 1922.7 38.2 3,278 11.7 7. St. John 1 123 8.1 8. Bolingbroke 3 258 11.6 9. Broomwood 2 224 8.9 Borough 48 2,801 17.1 1927 48 2,801 171 45 Erysipelas. There were 78 cases of Erysipelas notified and 2 deaths were recorded from the disease during 1927 in Battersea. The casemortality was 2.56 per cent. and the death-rate per 1,000 population was 0.012. Measles. The number of cases of Measles notified or otherwise reported in 1927 was 312 and there was one death recorded from the disease. Of the 312 cases 265 were notified by medical practitioners under the Regulations—The Battersea (Measles and Whooping Cough) Regulations, 1922—and the remaining 47 cases were reported by the public elementary schools or by the parents, etc. Whooping-Cough. During 1927 there were 507 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922 to the Medical Officer of Health and 242 additional cases were reported from the public elementary schools and other sources. There were 15 deaths registered from this disease, the deathrate being 0.089, as compared with 13 deaths and a death rate of 0.076 in 1926, 20 deaths and a death-rate of 0.116 in 1925, 17 deaths and a death-rate of 0.099 in 1924, 16 deaths and a death-rate of 0.095 in 1923 and 22 deaths and a death-rate of 0.13 in 1922. The total number of cases notified or otherwise reported during 1927 was 749 as compared with 1,210 in 1926, 1,320 in 1925, 816 in 1924 and 1,024 in 1923, the decrease in 1927 compared with 1926 being 38.1 per cent. The disease, with measles, was made compulsorily notifiable in Battersea in 1922, and the precautionary measures taken against the disease are similar to those in connection with the latter disease, in view of the danger to life in the younger children. TUBERCULOSIS. During 1927 there were 308 cases of Tuberculosis (all forms) notified in Battersea as compared with 344 in 1926 and 335 in 1925. 46 In the following table is shown the distribution of the notified cases in the Sub-Districts and Wards of the Borough:— Classification. Wards. Sub-districts. 1 2 3 4 5 6 7 8 9 E. N.W. S.W. Pulmonary 39 30 29 25 24 18 10 27 31 104 57 72 NonPulmonary 12 12 6 12 6 11 5 10 1 37 21 17 Totals 51 42 35 37 30 29 15 37 32 141 78 89 The Borough: Pulmonary 233 Non-Pulmonary 75 Total 308 The following table shows the age and sex distribution of the cases of Tuberculosis notified in each Ward and in the Registration Sub-Districts during 1927:— Ward. Ages: Total, all ages. Grand Total. Rate per 100,000 population. Under lyr. 1-5 5-15 15-25 25-45 45-65 65 up M. F. 1 1 1 3 17 20 8 1 31 20 51 185 2 2 4 7 12 10 6 1 24 18 42 229 3 1 1 1 12 14 5 1 20 15 35 187 4 - - 6 8 15 7 1 16 21 37 238 5 - 1 3 13 6 7 - 19 11 30 161 6 1 2 6 10 4 4 2 17 12 29 140 7 - - 6 2 5 2 - 8 7 15 174 8 1 2 4 8 15 7 - 20 17 37 194 9 - - 1 8 16 6 1 17 15 32 151 Boro' 6 11 37 90 105 52 7 172 136 308 178 E. 3 6 14 40 51 22 4 77 63 140 200 N.W. 2 3 9 31 16 15 2 48 30 78 161 S.W. 1 2 14 19 38 15 1 47 43 90 178 Rate per 10 0,000 population in each age group Boro' 164 100 113 307 209 160 72 217 152 182 - In the table on pp. 57-58 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 308 cases notified in 1927 is summarised below:— Localisation of Disease. Pulmonary (233) Bones and Joints (17) Genito-urinary (3) Lungs 229 Ankle 2 Kidney 2 Larynx 2 Elbow 1 Testicle 1 Lungs and Peritoneum 1 Hip and Elbow 1 Eye (left) 1 Knee 3 Lungs and Hips 1 Spine 7 Brain (8) Meninges 8 Wrist 3 Abdominal (7) Peritoneum 4 Skin (4) Ear (left) i Glands (34) Cervical 18 Peritoneum and Cervical glands 1 Lips and Gums 1 Unspecified 2 Abdominal 2 Ileum 1 Generalised 1 Unspecified and Various 14 Unspecified 1 The following table gives particulars in regard to non-notification of Tuberculosis for the 6 years 1922-1927:— Non-Notification of Tuberculosis. Year. Not notified (dead). Notified after Death. Primarily Notified on Form C or D. (Form A not received). Reported from Other Sources Total. 1922 7 41 35 3 86 1923 3 33 8 — 44 1924 6 30 3 7 46 1925 19 18 4 4 45 1926 13 10 4 7 34 1927 12 14 — — 26 From an examination of the above table giving particulars of non-notification of the disease, it will be noted that there has been an improvement in 1927 as compared with previous years. In accordance with the suggestions contained in the Circular letter of the Ministry of Health, dated 22nd December, 1924, with reference to the requirements of notification, in all cases where the obligation of notification is not complied with the attention of the Medical Practitioner concerned is drawn to the omission, and an explanation requested. It was not found necessary to take any legal action during 1927. Deaths from Tuberculosis. The death-rate from Tuberculosis was slightly higher in 1927 than in the previous year, being 103.6 per 100,000 population. The lowest death-rate hitherto recorded from the disease was in 1926, when it was 96.6 per 100,000 population. 47 48 In the subjoined table are given deaths from Tuberculosis at various ages in each Ward and the registration sub-districts during 1927:- Wards. Rate per 100,000 population. Ages:— Total, All Ages. Totals. Grand Total. Pulmon ary. NonPul monary. 0-1 1-5 5-15 15-25 25-45 45-65 65- M. F. 1 98 1 1 — 7 13 4 1 13 14 24 3 27 2 174 1 3 1 9 10 7 1 17 15 26 6 32 3 88 — - — 6 4 5 2 12 5 16 1 17 4 103 1 _ — 7 3 4 1 7 9 13 3 16 5 75 — - - 5 2 5 2 5 9 14 — 14 6 116 — 1 2 7 7 7 — 15 9 21 3 24 7 104 — 1 1 3 4 — — 5 4 7 2 9 8 94 — 2 — 6 8 2 — 10 8 14 4 18 9 85 — — — 3 6 8 1 8 10 16 2 18 E. 114 3 4 1 25 28 16 3 39 41 67 13 80 N. 101 — 1 2 15 11 16 4 30 19 46 3 49 S. 91 — 3 1 13 18 10 1 23 23 38 8 46 — 104 3 8 4 53 57 42 8 92 83 151 24 175 Rate per 100.000 popultn. 82 73 12 181 114 129 82 116 92 89.4 14.2 104 The death-rates per 100,000 of the population during the 25 years ended 1925 in quinquennial averages and in individual years from 1921 to 1927 are given in the following table:— Years. 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 1921-1925 92.6 23.0 115.6 Average (25 years) 120.5 35.6 156.1 1921 100.5 27.2 127.7 1922 101.0 20.1 121.1 1923 81.5 21.1 102.6 1924 89.5 21.6 111.1 1925 90.6 25.0 115.6 1926 82.0 14.6 96.6 1927 89.4 14.2 103.6 49 During 1927 there were 175 deaths from Tuberculosis registered as belonging to the Borough of Battersea. Of this number 151 (i.e. 86.3 per cent.) were due to pulmonary tuberculosis, 14 (i.e. 8.0 per cent.) to tubercular meningitis and 10 (i.e. 5.7 per cent.) to other forms of the disease. In 1926 the number of deaths from tubercular diseases was 166. Of the 175 deaths registered from Tuberculosis during the year 24 cases were not notified until one month before death; in 13 cases the notifications were received after death, and in 12 cases no notification was received. Of the 12 cases in respect of which no primary notification was received 11 (6 pulmonary, 5 non-pulmonary) were patients who died in hospitals, infirmaries or nursing homes. The remaining case was under treatment by a private medical practitioner. Of the 13 cases notified after death 2 (1 pulmonary, 1 nonpulmonary) were notified by private medical practitioners, 7 (3 pulmonary, 4 non-pulmonary) from Poor Law Institutions and 4 (2 pulmonary and 2 non-pulmonary) by hospitals or asylums. In a further case notified after death (Pulmonary), the death, being due to accidental causes, was not ascribed to Tuberculosis. Tuberculosis Dispensary. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1927. It is expected that the Dispensary which will be removed to Southlands, to that part of the buildings which is being converted and adapted for the purpose, will be ready by the middle of 1928. The staff of the Dispensary consists of a Tuberculosis Medical Officer, 3 Nurses, Secretary, Dispenser and two Junior Clerks. There are also Caretakers (man and wife) living on the premises. The Dispensary treatment of school children is carried on in close co-operation with the School Medical Service, and the Springwell House Open Air School on Clapham Common North Side, has, in this connection, carried on useful work during the year, particulars of which will be found on p. 52. The Tuberculosis Care Committee, the composition of which will be found on p. 2, met weekly at the Tuberculosis Dispensary during the year, and details of the work of the Committee will be found set out on p. 53. 50 Dental facilities for tuberculosis patients were provided by the Council in 1922. A weekly session is held at the Dental Centre, Plough Road, and patients requiring treatment or the provision of dentures are referred to the Clinic by the Tuberculosis Medical Officer. Institutional treatment is provided by the London County Council for Battersea patients, this form of treatment being arranged for in the majority of cases through the Tuberculosis Dispensary. Dr. Macdonald, Tuberculosis Medical Officer, reports:— The shortage of suitable and adequate housing accommodation has made the segregation of the Tuberculous patient in his own home in many cases an impossibility, so that unless the patient is willing to be removed to an institution and the authorities are willing to keep the patient in an institution for an indefinite period, there is great risk of the spread of infection to other members of the family. During the past year the home conditions under which 182 patients were living at the time of the Dispensary nurses' first visit were good in 80 cases, fair in 70 and bad in the remaining 32. The following table shows the changes which resulted in the home conditions as a result of the visits of the Dispensary nurses:— Patient having own room. Own bed sharing room. Sharing bed and room. At time of first visit 55 30 97 At end of 1927 67 33 82 Where husband and wife, having their own bedroom, share the same bed, and either is the patient, the home conditions are considered to be good according to the London County Council's classification of home conditions. It is evident from the foregoing figures that the home conditions of Tuberculous patients residing in the Borough are far from satisfactory. The number of new patients attending the Dispensary during the year was 16 fewer than in the previous year, and the number of "contacts" examined 13 less than in 1926. Fewer attendances were made at the Dispensary by patients, the number being 4,180 as against 4,686 in 1926. The Dispensary is, in the main, a centre for diagnosis and observation rather than an out-patient department for treatment. As far as possible it is desirable that the treatment of the patient should be undertaken by his own doctor and not through the Dispensary. In many cases, however, the nature and chronicity of the disease, necessitating treatment over 51 a long period, makes Dispensary treatment unavoidable because the patient, unless he be insured, is unable to afford the cost of private medical treatment. During 1927, 155 patients received institutional treatment under the London County Council's Tuberculosis Scheme, being 24 more than in the previous year. The average length of stay was 41 days more than in 1926 and the average period of waiting between the recommendation and admission to an institution was the same. Definite improvement, as a result of institutional treatment, was shown by more patients. On the other hand, 20 more patients took their own discharge from institutions than in 1926. The Tuberculosis Care Committee met weekly at the Dispensary. Much useful assistance is given to patients and their families through this agency. During 1927, 644 new patients attended the Dispensary for examination. In addition 12 patients were transferred from other areas and attended the Dispensary for the first time during the year. Of the 644 patients 434 were adults and 210 were children. The "Contacts" examined at the Dispensary numbered 199, 75 adults and 124 children. Of the new patients and "Contacts" 199 were found to be suffering from Tuberculosis, 172 adults and 27 children. During the year 7 patients in whom the diagnosis was at first doubtful were found to be suffering from Tuberculosis, and these added to the 199 new cases and the 12 transfers, made a total of 218 notified cases. Of this number 105 had already been notified to the Medical Officer of Health, so that 113 were primary notifications from the Dispensary. The total number of attendances at the Dispensary during 1927 was 4,180. During the year 186. visits were paid to the homes of patients by the Tuberculosis Officer and 5,434 by the Dispensary Nursing Staff. During 1927, 155 patients received institutional treatment under the London County Council's Tuberculosis Scheme. The average stay of patients in institutions was 145 days, and the average period of waiting between recommendation and admission was 19 days. Of the number admitted 93 had definitely improved as a result of institutional treatment—51 patients discharged themselves. 52 In addition to admissions to institutions provided by the London County Council 45 patients were admitted to St. James' Hospital. Number of Dispensary patients who died during 1927 111 Number of Dispensary patients discharged 18 Number of Dispensary patients who ceased to attend 41 Number of Dispensary patients removed to other districts (and transferred to the Medical Officer of Health of the districts concerned) 38 The number of sputum examinations at the Tuberculosis Dispensary during 1927 was 1,435, 390 (27.2 per cent.) of which were positive. Of the total number of specimens examined 510 were sent by medical practitioners and 390 specimens were examined for St. James' Hospital. The number of reports sent to public bodies during 1927 was 1,041. Consultations with Medical practitioners at the homes of their patients and reports on their patients sent to the Dispensary numbered 965. The number of reports received during the year in respect of insured persons was:— (a) Form G.P. 17 5 (6) Form G.P. 36 219 One hundred and thirty-four patients were referred to hospitals, 115 of which were sent to St. Thomas's Hospital for X-ray examination. Open Air School. The particulars relating to the work carried out during 1927 at Springwell House Open-Air School are summarised as follows:— Number on roll, 31st December, 1927 141 Number admitted during 1927 42 Number discharged during 1927 49 Reasons for Discharge— (a) Fit for Elementary School 5 (b) Fit for work 30 (c) Transferred to Hospital or Sanatorium 7 (d) Removed from district 4 (e) Transferred to Special School 1 (f) Discharged for other reasons 2 53 Gain or loss in weight of children who have been in the School for more than 12 months:— Children who have gained weight 106 Average gain in kilos 3.5 Children who lost weight or whose weight was stationary Nil Tuberculosis Dental Treatment. Total attendances 297 Sessions held 49 Average attendance per session 61 Extractions 133; scalings, 9; fillings, 25; dentures supplied—whole sets 10, partial sets 5; repairs to dentures, 5; dressings, 39; advice, 80 (average per session, 6.2) 306 In the Appendix (pages 115 to 117) will be found Form T. 53, which contains the returns required by the Ministry of Health of the work of the Dispensary during the year 1927, and Form T. 56, which shows in a summarised form the condition of all patients whose case records were in possession of the Dispensary at the end of 1927, arranged according to the years (from 1921 to 1927) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. The Tuberculosis Care Committee. The Care Committee met weekly during 1927, and the following is a summary of the work carried out by the Committee:— Battersea Borough Council,—extra nourishment, 124; housing, 3 127 Wandsworth Board of Guardians—financial assistance, 10; dentures, 2; clothing, 13; other assistance, 15 40 British Red Cross Society—financial assistance, 1 1 United Services Fund—financial assistance, 14; clothing, 10; other assistance, 1 25 Charity Organisation Society—dentures, 10; financial assistance, 5; clothing, 7; other assistance, 3 25 Other Agencies 2 Training and Employment. London County Council 1 Labour Exchange 2 Battersea Borough Council 2 Farming Colony 1 54 The contributions of patients who were sent away for appropriate institutional treatment, collected by the Dispensary and remitted to the London County Council, amounted to £640 5s. 7d. NON-DISPENSARY CASES. The following particulars relate to notified cases of Tuberculosis not on the roll of patients attending the Tuberculosis Dispensary, some of whom were subsequently transferred to the Dispensary. These cases are systematically visited by the male and female Sanitary Inspectors. Women and Children. During 1927 the number of new cases notified and not attending the Tuberculosis Dispensary was 104 (women 65, children 39). Of this number, after correction and adjustment of the figures as to cases not traced, transferred to the Dispensary and to other districts, and cases in regard to which no information could be obtained, the following particulars are given:— There were 19 deaths recorded amongst these 104 cases. In 8 cases death had occurred prior to the first visit and 11 deaths were subsequently recorded during the year. In addition there were 10 deaths of unnotified cases, not included in the above 104 cases. The following table gives the age and sex distribution of the 104 women and children non-dispensary cases notified to be suffering from Tuberculosis (all forms) during 1927:— Age and Sex Distribution. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 upwards All ages Pulmonary M — — 1 2 — — — — — — — 3 F. — — — 3 12 7 13 6 6 4 1 52 Tubercular Meningitis M. 1 4 — — 2 — — — — — — 7 F. — — 2 — — 1 — — — — — 3 Other Forms M. 7 4 4 4 — — — — — — — 19 F. — 3 3 1 1 4 4 1 1 1 1 20 Total M 8 8 5 6 2 - - - - - - 29 F. — 3 5 4 13 12 17 7 7 5 2 75 Grand Total 8 11 10 10 15 12 17 7 7 5 2 104 55 The home conditions of these 104 cases were investigated. In the majority of cases the sanitary state of the home was found to be satisfactory, the average number of persons per room being 1.4. In 9 cases, however, the conditions were found to be unsatisfactory, the patient's family occupying only a single room. As compared with the years 1926 and 1925, however, there is a distinct improvement—when 18 and 19 families respectively were found to be occupying a single room. During the year 70 of these 104 cases were receiving hospital, sanatorium or other institutional treatment. At the end of 1927 there were 425 women and children nondispensary patients (a decrease of 39 as compared with 1926) including new cases notified during the year on the register, and 1,089 visits were paid by the female Sanitary Inspector (Miss J. Round) to the homes of these patients. Efforts are made, in as many cases as possible, to induce nondispensary patients to attend the Tuberculosis Dispensary, and during 1927, 41 cases were transferred, 27 of these being new cases. Subsequently 7 of these transferred cases were removed from the register, "Disease cured." It is satisfactory to record that the efforts to secure protection against infection of other members of the family have met with considerable success, e.g., separate room or bed was found to be in use in 40 per cent. of the cases; and 68 patients consented during the year to avail themselves of institutional treatment. Adult Male Patients. There were 287 adult male patients not on the Dispensary roll on the register at the end of 1926, and 76 were new cases notified during 1927. Of these new cases 10 died during the year. The following table gives particulars of the non-dispensary new cases notified in 1927:— Age Distribution. All ages. 16-20 20-25 25-35 35 -45 45-55 55-65 65 up Pulmonary 4 12 14 11 10 6 5 62 Tubercular Meningitis — — — — — — — — Other tubercular Diseases 4 6 1 2 — 1 — 14 Total 8 18 15 13 10 7 5 76 56 The homes of all these patients were systematically visited during the year by the District Sanitary Inspectors, and 534 visits, including 76 first visits to new cases were paid. Six of the new cases notified were found to have died on the first visit. Of the new cases 44 received institutional treatment and 30 were transferred to the Dispensary. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action during the year under report in regard to the provisions of these Regulations. 57 Summary of Notifications during the period from the 2nd January, 1927, to the 31st December, 1927, 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 Pulmonary— Males — — 2 3 10 24 27 25 25 11 5 132 180 — — — — — 34 123 Females — 1 1 6 24 14 27 15 8 4 1 101 134 — — — — — 40 68 Non-Pulmonary— Males 6 6 4 8 4 7 2 2 — 1 — 40 46 — — — — — — 17 Females — 4 9 4 2 5 6 1 1 2 1 35 41 — — — — — 1 18 (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. In the case of an institution belonging to the Council of a County Borough, formal notifications on Form C may not be made to the Medical Officer of Health in respect of patients from the County Borough. If such is the case, the totals of the weekly admissions of such patients during the year should be shewn in brackets in column 21 (according to the classification in column 1) and these figures should be regarded as additional to the figures showing the number of formal notifications on Form C in this column. 58 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 2nd January, 1927, to the 31st December, 1927, 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 — — 1 — — — 1 1 1 3 7 „ Females — — 1 — — 1 2 3 7 Non-pulmonary Males 1 2 1 — 2 — — — — — — 6 „ Females — 2 — — — 3 — — 1 — — 6 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death Returns 14† cases notified after death—12 unnotified 9 4 "Inward" Transfers (Death returns only) 5 8 Other Sources, viz.: — — * Note.—New cases first coming to knowledge otherwise than by formal notification may in some instances afterwards be formally notified on Form A or Form B. Such cases should be included in the appropriate columns of the Summary of Notifications overleaf and not in the Supplemental Return, unless the formal notification in any of such cases was improperly made, e.g., after death of the person, in which event the case should appear in the Supplemental Return. No case should be included both in the Summary of Notifications and in the Supplemental Return. † Includes 1 case not classified to Tuberculosis (accidental death). 59 Deaths from Zymotic Diseases. The principal zymotic diseases are small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping-cough, enteric fever and diarrhœa. The deaths from these causes in 1927 numbered 57, as compared with 119 in 1926, a decrease of 52.1 percent. There was a corresponding decrease in the zymotic death-rate from 0.692 in 1926 to 0.338 in 1927. The number of deaths from these diseases is lower than in any year since 1857. The mean death-rate from each of the principal zymotic diseases for the ten years 1907-1916, and for the ten years 19171926, are compared with the corresponding rates for 1926 and 1927 in the following table:— Zymotic Diseases. Number of Deaths from each of the principal Zymotic Diseases in 1926 and 1927, with corresponding Death Rates for those years and for the 10 years 1907-16 and 1917-1926. Small Pox No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase (+) or Decrease (—), 1927 over 1927. 1926. 1927. 1926. 19071916. 19171926. Previous year. 19171926. — — — — — .001 — -.001 Measles 1 43 .006 .250 .462 .237 -.244 -.231 Scarlet Fever 3 2 .018 .012 .062 .034 +.006 -.016 Diphtheria 25 20 .148 .116 .135 .182 +.032 -.034 Whooping-cough 15 13 .089 .076 .263 .154 +.013 -.065 Enteric fever — 1 — .006 .028 .011 -.006 -.011 Diarrhoea and enteritis 13 40 .077 .232 .692 .273 -.155 -.196 Total 57 119 .338 .692 1.642 .892 -.354 -.554 NON-NOTIFIABLE INFECTIOUS DISEASES. Chicken-Pox. During 1927 there were 671 cases of chicken-pox reported, as compared with 375 in 1926, 853 in 1925, 541 in 1924, 617 in 1923, 259 in 1922, and 400 in 1921. 60 Diarrhœa. During 1927 the total number of deaths from diarrhoea of children under 2 years of age was 7, and was equivalent to a fatality-rate of .04. In 1926 there were 28 deaths and a fatalityrate of 0.16. Influenza. There were 83 deaths due to Influenza during 1927, as against 25 in 1926, 36 in 1925, 84 in 1924, 31 in 1923 and 110 in 1922. The mortality-rate was .49 as compared with .15 in 1926, .21 in 1925, .49 in 1924, .18 in 1923 and .66 in 1922. Influenzal Pneumonia was much more prevalent in 1927 than in the previous year, 164 cases being notified as against 76 in 1926. The death-rate was 0.24 per 1,000 of the population, as compared with 0.07 in 1926, and 0.09 in 1925. Cancer. During 1927 the number of deaths of Battersea residents from Cancer was 252 (males 126, females 126) as compared with 263 in 1926, 236 in 1925, 231 in 1924, 242 in 1923, and 225 in 1922. The death-rate from the disease per 1,000 of the population was 1.49 as compared with 1.53 in 1926, 1.37 in 1925, 1.35 in 1924, 1.42 in 1923 and 1.33 in 1922. The following gives the comparative average death-rates from Cancer in Battersea for quinquennial periods since 1896:— 1896-1900 0.52 1916-20 1.28 1901-5 0.88 1921-25 1.33 1906-10 0.95 1926 1.53 1911-15 1.11 1927 1.49 The following table shews the localisation of the disease in the case of the 252 deaths recorded in 1927. Localisation. No. of deaths. Total. % of Total. Male Female Buccal cavity 16 4 20 7.94 Stomach, liver, etc 46 36 82 32.54 Peritoneum, intestines and rectum 29 25 54 21.43 Female genital organs — 25 25 9.92 Breast — 21 21 8.33 Skin — — — — Other and unspecified organs 35 15 50 19.84 Total 126 126 252 100.00 61 Bacteriological Examinations. During 1927 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 2,641. This number is exclusive of the Tuberculosis specimens, the examination of which was carried out at the Tuberculosis Dispensary. The following table gives particulars of the bacteriological examinations carried out during the year:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 393 2,236 2,629 Enteric fever — 10 10 Puerperal Pyrexia — 2 2 Total 393 2,248 2,641 The cost of these examinations amounted to £344 11s. 0d., and is borne by the Council. 62 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1927. Total Sanitary Operations 66,775 Dust receptacles provided 455 Number of house inspections 35,314 Leaky house-roofs and gutters repaired 795 House to house inspections 1,058 Bakehouse inspections 232 Houses supplied with water and fittings repaired 115 Bakehouse nuisances abated 103 Urinals—inspections 82 Houses let in lodgings registered 85 Do. altered, repaired or water laid on 45 No. of inspections of do. 125 Water Closets provided, supplied with water or supply disconnected from drinking water cisterns 144 Intimations served under Sec.3 3,607 Notices served under Sec.4,&c. 952 Notices served under Sees. 62 & 65 2,431 Cisterns covered, cleansed and repaired 89 Complaints received and attended to 3,605 Additional water supplies to upper floors 20 Number of premises disinfected 2,145 Houses supplied with disinfectants 957 Keeping of animals in unfit state discontinued 17 Overcrowding abated 7 Smoke observations 11 Premises improved, cleansed and repaired 2,573 Certificates of disinfection granted 3,636 Drains tested By smoke 752 Houses inspected and certificates granted (Sec. 48) 90 Do. „ water 1,280 Drains cleansed and repaired 275 Proceedings ordered by Council and Health Committee 3.716 Drains relaid 116 Frontage drains constructed or re-constructed 35 Summonses issued 54 Magisterial Orders obtained and enforced 23 Soil pipes and drains ventilated 105 Sink and rain-water pipes disconnected or repaired 383 Factories, Workshops, &c., inspections 4,827 Water Closets cleansed and repaired 526 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 58 Cesspools abolished — Mews and Stables drained and paved — Underground sleeping rooms: Use discontinued 1 Yards and forecourts paved and repaired 328 Defects remedied 4 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 7 Gipsy van inspections 30 Drains laid to new houses and tenements 90 Samples taken under the Sale of Food and Drugs Acts 1,200 Miscellaneous 1,417 63 Legal Proceedings. Legal proceedings in connection with nuisances were taken by the Council in 18 cases during 1927. Particulars with regard to each case are set out below. Legal Proceedings under the Public Health (London) Act, 1891. Nature of Offence or Claim. Result of Proceedings. Nuisances at Nos. 15, 16 and 18 Woodgate Street, and failure to provide proper dust-bins at Nos. 14, 15, 17 and 18 Woodgate Street. (Seven summonses.) Necessary dust-bins having been provided, the nuisance at 18 abated, and works being in hand to abate the nuisances at 15 and 16, five of the summonses dismissed on payment of £1 Is. costs in each case. The remaining two adjourned. At adjourned hearing, remaining works having been completed, summonses dismissed on payment of £1 1s. costs in each case. Nuisance at 135 Speke Road Works required to abate the nuisance having been completed, summons dismissed on payment of £1 1s. costs. Nuisance at 103 Harbut Road The like. Nuisance at 1 Gwynne Road Order made for nuisance to be abated within twenty-one days. Failure to comply with the Order of the Court to abate a nuisance at 1 Gwynne Road. Fined 21s. and £3 3s. costs. Nuisance at 13 Brougham Street Order made for nuisance to be abated within seven days. Nuisance at 141 York Road Terms having been come to out of Court for the nuisance to be abated by the Council, and the defendant having paid the required contribution summons withdrawn. Nuisance at 143 York Road The like. (1) Nuisance at 36 Belleville Road (1) Order made for nuisance to be abated within seven days. (2) Absence of water supply, etc., to W.C. at same premises (2) Fined 20s. and £3 3s. costs. Nuisance at 167 St. John's Hill. Order made for abatement of nuisance within fourteen days and for payment of £2 2s. costs. Nuisance at 4 Basnett Road Terms having been come to out of Court for the nuisance to be abated by the Council, and the defendant having paid the required contribution, summons withdrawn. 64 London County Council (General Powers) Act, 1907. Nature of Offence or Claim. Result of Proceedings. Nuisance at 160 Stewarts Road Defendant having completed most of the works necessary to abate the nuisance, and undertaken to complete the remainder immediately, fined 1s. and £3 3s. costs. Sale of Food and Drugs Acts. No. of Sample Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 808 Vinegar 18% deficient in acetic acid Fined 5s. and £1 1s. costs. 868 Milk 16% deficient in milk fat Fined 10s. and£l 1s. costs. 984 Milk 5% deficient in milk fat Dismissed, defendant (the farmer) satisfying the Court that the milk as sold was the actual product of the cow. (Samples taken at place of delivery.) 986 Milk 3% deficient in milk fat 987 Milk 10% deficient in milk fat 988 Milk 3% deficient in milk fat 989 Milk 3% deficient in milk fat 131 Milk 7% deficient in milk fat Summons dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. costs. 176 Milk 6% deficient in milk fat Dismissed; defendant (the farmer) satisfying the Court that the milk as sold was the actual product of the cow. (Samples taken at place of delivery.) 177 Milk 6% deficient in milk fat 178 Milk 6% deficient in milk fat 179 Milk 7% deficient in milk fat 180 Milk 7% deficient in milk fat 181 Milk 7% deficient in milk fat 182 Milk 4% deficient in milk fat 183 Milk 7% deficient in milk fat 187 Milk 22% deficient in milk fat Fined 25s. and £2 2s. costs. 248 Milk 14% deficient in milk fat Fined 20s. and £1 1s. costs. Summons against employee withdrawn. (Notice of Warranty given, but no previous application made for sample to be taken.) 300 Milk 10% deficient in milk fat Summons dismissed on payment of £2 2s. costs. That against employee withdrawn. 65 Sale of Food and Drugs Acts—continued. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 612 Vinegar 5% deficient in acetic acid Defendants having paid £1 1s. costs, summons withdrawn on instructions of Health Committee. 615 Vinegar 28% deficient in acetic acid Fined £5. 621 Milk 9% deficient in milk fat Defendant having accepted responsibility, summons against second defendant withdrawn. Summons dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. costs. Milk and Dairies (Amendment) Act, 1922. No. of Sample Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 960 Milk 12½% added water First defendant fined £4 and £3 3s. costs. Summons against second defendant withdrawn. 961 Milk 10½% added water Summons against vendor dismissed under Probation of Offenders Act, 1907, and defendant ordered to pay £1 1s. costs. Summons against second defendant withdrawn. 314 Milk 1½% added water 4s., cost of summonses, having been paid, summonses withdrawn on instructions of Health Committee. 342 Milk 8% added water Dismissed under Probation of Offenders Act, 1907. 448 Milk Containing an added colouring matter Fined 40s. and £l 1s. costs. Summons against employee withdrawn. 449 Milk Containing an added colouring matter Fined 5s. Summons against second defendant withdrawn. 508 Milk Containing an added colouring matter Fined 20s. and £1 1s. costs. Summons against employee dismissed. 66 Milk and Dairies (Consolidation) Act, 1915. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. — Milk Not having name and address on milk barrow Fined 40s. (Maximum penalty.) — Milk Not having name and address conspicuously inscribed on milk barrow Fined 20s. on each of two summonses. Public Health (Preservatives, etc. in Food) Regulations, 1925. Nature of Offence. Result of Proceedings. Selling sausages which contained preservatives without label or notice to that effect Both summonses dealt with together and dismissed on payment of £2 2s. costs. Metropolis Management Acts, 1855. Nature of Offence or Claim. Result of Proceedings. Balance of cost of reconstructing frontage drain serving 98/100 Latchmere Road Debt and 3s., cost of summons, having been paid before hearing, summons withdrawn. Failure to deposit plans, &c., in connection with reconstruction of drains at 175 High Street Plans, &c., having been deposited, summons dismissed on payment of £2 2s. costs. Housing Acts. Nature of Offence or Claim. Result of Proceedings. A declaration that the Council are entitled to a first charge on the premises, 47, 48 and 49 John Street for £200 17s. 10d., £261 8s. l0d. and £295 0s. 2d. respectively, plus interest at Five per cent. per annum from 16th April, 1926, in each case; an Order for Sale and other relief Judgment for the Council (with costs) in accordance with claim. 67 Housing Acts—Continued. Nature of Offence or Claim. Result of Proceedings. Failure to have name and address of landlord and of Medical Officer of Health in rent book of 218a Queens Road Fined 2s. 6d. For determination of leases of 171 Ingrave Street on failure by one of the defendants to comply with the Council's notice to repair the premises. (Council joined as defendants.) The other defendants having handed over to the plaintiffs the deeds relating to the property, and the plaintiffs having complied with the Council's notice, order made by consent in terms of claim and for the other defendants to pay the plaintiffs' costs, including those of the Council, which were to be paid by the plaintiffs in the first instance. Possession of the premises, 229 York Road, and mesne profits at 14s. 2d. per week from 21st February, 1927 Order in terms of claim, but to be suspended for two months. Default in payment of £28 4s. 6d., arrears due under an Order of the Council, dated 23rd July, 1924, for work done by them at 27 Darien Road Debt and 3s., cost of summons, having been paid before hearing case withdrawn. Possession of the premises, 16 Field Place, and arrears of rent and mesne profits Judgment for the Council (with costs) for £10 1s. 10d., and for possession to be given in twentyeight days, to be suspended to 31st December, 1927 (but no longer) if current rent of 8s. 9d. a week be paid and 1s. 3d. a week off the arrears. Possession of two rooms, at 16 Britannia Place Order made for possession to be given within twenty-eight days. 68 Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 48 cases during 1927. Acts and Regulations under which Proceedings taken. Persons Prosecuted including employees. Convictions Fines. Costs. Public Health (London) Act, 1891, and the by- laws made thereunder 10 6 £ s. d. £ s. d. 2 1 0 17 17 0 London County Council (General Powers) Act, 1907 1 1 0 1 0 3 3 0 Sale of Food and Drugs Acts 15 5 8 0 0 12 12 0 Milk and Dairies(Consolidation) Act, 1915 2 2 4 0 0 Milk and Dairies (Amendment) Act, 1922 12 4 7 5 0 6 10 0 Public Health (Preservatives in Food, etc.) Regulations 2 — — 2 2 0 Housing Acts 10 4 0 2 6 0 3 0 Metropolis Management Act, 1855 2 — — 2 5 0 Total 54 22 21 9 6* 44 12 0* * The disproportion between the fines and costs imposed is accounted for by the fact that the Court in some instances dealt with defendants under the Probation of Offenders Act, discharging them on payment of costs. 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 69 Drainage Work. During the year new drains were constructed to 140 new buildings, or additions to existing buildings, and the drains of 116 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. The drains of the following premises, being combined drains for the maintenance of which liability was recognised by the Council, were repaired or reconstructed during 1927 at the cost of the Council:— Nos. 5 & 7 Afghan Road; Nos. 1 to 9 Church Road; Nos. 56 & 58 Knowsley Road; Nos. 9 & 10 Pountney Road; Nos. 56 & 58 Speke Road. The expenditure incurred by the Council under this head amounted to £231 4s. 8d., towards which a contribution of £20 was made by the owners of Nos. 9 and 10 Pountney Road. In the case of No. 39 Bolingbroke Grove, it was found on inspection of the drains serving these premises that the gulleys of adjoining houses, Nos. 40 & 41, had been improperly connected to the drains of No. 39, contrary to the Order of the late Wandsworth District Board of Works. The owner thereupon raised the question that the Council were liable for the combined portion of the drain. It was found impossible, owing to the financial circumstances of the builder responsible (upon whom notice under the Metropolis Management Acts was served), to enforce the carrying out of the original order. After negotiations with the owner of No. 39 the Council agreed, subject to the owner, when re-constructing the system of drainage serving that house, giving access for the gulleys in question to continue to discharge into the system, to reconstruct the frontage drain at their own cost. The total number of plans of proposed drainage work deposited during 1927, as compared with 1926, was as under:— 1927 1926 Re-construction or repair of existing drains 85 64 New buildings or additions to existing buildings 72 43 157 107 In three cases, drainage work was found to have been carried out in contravention of the provisions of the drainage by-laws, as under:— 1. Water waste preventer fixed without notice. 2. W.C. pan fixed without notice. 3. Plans of works executed not deposited within specified period. 70 In the first two cases, a cautionary letter was addressed to the offender, and in the third case, legal proceedings were instituted, and, the plans having been deposited, the summons was dismissed on payment of £2 2s. costs. During the year 1927, 752 drains were tested by smoke of which 124 were found defective. The water test was applied on 1,280 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 105 instances. Water closets were provided, or existing closets repaired, in 144 cases. The total number of drains relaid during the year was 116. Those cleansed and repaired numbered 275. Sanitary Conveniences attached to Licensed Premises. During 1927 the number of public-house urinals under inspection was 116. In 78 instances the accommodation is accessible to the general public as well as the users of the houses, and in 38 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 36 notices were served to remedy defects discovered. Smoke Nuisances. During the year 11 observations were made and 11 complaints received. Seven preliminary notices were served by the Council to abate smoke nuisances, which were duly complied with. Effluvium Nuisance. Five complaints of effluvium nuisance were received during 1927, but in only three cases were nuisances established. The nuisances being immediately abated, it was not necessary to institute legal proceedings in any case. Water Supply. During 1927 applications were received for certificates of water supply in respect of 90 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 20 cases additional water supply was provided to the upper floors of tenement houses, as required by the Borough Council 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. 71 Van Dwellings. The number of van dwellings in the Borough in 1927 was 65. 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. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 4 Mills' Yard, adjoining 80 Sheepcote Lane 5 7 7 Haines' Yard, Falcon Road 8 9 8 Manley's Yard, Cabul Road 30† 30 28 Mills' Yard, Culvert Road 18* 18 26 Van dwellings are frequently inspected, and during the year only one van was found to be slightly overcrowded. Five vans were unoccupied. 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. No proceedings were taken under the Act in Battersea during 1927. 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 1927 the work carried out under the Council's Rat Repression Scheme is summarised as follows:— Premises visited 1,739 Contracts renewed 12 Poison bats used 34,000 Value of contracts £163 0 0 Dead rats found 2,405 Cash for poison bait £19 11 0 Total expenditure (financial year 1927-8) £538 19 8 Income (financial year 1927-8) £150 12 0 Drains were tested at 78 premises in connection with this work, and in 47 cases were found to be defective. Most of these defective drains were in private houses. As the presence of rats * Including one shed. † Including one cottage. 72 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. Fouling of Footways by Dogs. The Council, on the recommendation of the Health Committee, decided to make the following By-law with regard to the fouling of public footways by dogs:— "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this By-law shall be liable to a penalty not exceeding 40s. This By-law shall cease to be in force after the 30th June, 1929, unless a By-law confirming and continuing its provisions has been duly made and come into force before that date." The By-law came into force in June, 1927. No proceedings were taken under this By-law during the year. Personal Cleansing Station. During the year 1927, there were 4,360 children and 256 adults cleansed and treated at the station. Of the 4,360 children attending, 321 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 4,323 attended from the Public Elementary Schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of Officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's Sanitary staff. There has been a slight increase in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. 73 Number of Baths, &c. Year. Adults. Children. Expenditure. Amount Contributed. Verminous and Scabies. 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 1923 212 4,949 779 487 1924 311 5,394 912 488 1925 261 4,724 879 459 1926 229 4,371 916 425 1927 256 4,360 960 418 14,197 54,278 £7,920 £4,301 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1927. Total Premises disinfected 2,145 Rooms disinfected 3,197 Staircases disinfected 210 Schools disinfected 53 Number of articles laundered 27,983 „ „ destroyed 897 „ verminous, etc., persons (including 4,323 school chidren) 4,616 ,, infectious disease contacts 1,158 ,, Library books collected 280 Total Articles. No. Weight. Tons. cwts. qrs lbs. Bedding, &c., disinfected 71,579 139 0 1 4 „ lent 1,359 4 5 3 12 Verminous clothing, &c. 4,576 2 5 2 22 Articles from Welfare Centres 2,565 (not weighed) Total 80,079 145 11 3 10 74 Thames Flooding. On the night of the 6th and 7th January, 1928, serious flooding occurred due to the overflowing of an abnormally high tide which affected more or less seriously all the riparian Metropolitan Boroughs and occasioned serious loss of life in some places. Fortunately, no loss of life occurred in Battersea, but much hardship and distress were occasioned in the lower parts of the Borough by the flooding of the basements and ground floors of hundreds of houses. On the instructions of the Mayor, who personally visited the affected areas, immediate steps were taken by the Health Department to render all possible assistance, and immediate relief was given in urgent cases by the provision of coal for the drying of houses, the pumping out and cleansing of cellars, and the drying and disinfection of clothing, bedding etc. A full report upon the flooding will be included in the next Annual Report. No. of houses affected (approximately) 420 Premises supplied with disinfectants (approximately) 350 Coal tickets issued 948 Floor covering, furniture, etc., replaced (cases) 390 75 Coroner's Court and Mortuary. Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1927 are set out in the following table :— Usual Place of Residence. Total Battersea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court; postmortem at Mortuary 60 33 11 4 108 Inquest at Coroner's Court; postmortem elsewhere 24 47 17 1 89 Inquest at Coroner's Court; no postmortem 13 13 7 — 33 Total inquests at Coroner's Court 97 93 35 5 230 Post-mortem at Mortuary, inquest elsewhere 11 1 - - 12 Post-mortem at Mortuary; no inquest (Coroner's Certificate) 38 2 - 1 41 Total post-mortems at Mortuary 109 36 11 5 161 Bodies received for sanitary reasons 2 — — — 2 Other bodies received on which no inquest held at Mortuary 5 9 1 — 15 Total bodies received 153 105 36 6 300 VERDICTS AT INQUESTS HELD— Natural causes 39 28 4 — 71 Accidental Death— Asphyxia 1 1 2 — 4 Burns and scalds 6 3 — — 9 Coal Gas poisoning — 2 — — 2 Deaths under anaesthetic 2 2 1 — 5 Drowning — — 2 — 2 Fall 14 18 3 — 35 Railway and street accidents 14 22 13 — 49 Septicæmia following injury — — — — — Tetanus following injury — 1 — — 1 Other accidents 3 2 — — 5 Open Verdict— Abortion — 1 — — 1 Found drowned — — 2 2 4 Potassium bromide poisoning — 1 — — 1 Stillborn 3 1 — — 4 Want of attention at birth — 1 — 1 2 Suicide— Asphyxia — — 1 — 1 Cut throat 3 1 1 — 5 Drowning 1 1 5 — 7 Firearms 1 — — — 1 Hanging 2 1 — — 3 Poisoning—Coal gas 3 3 — — 6 „ Drugs, etc 3 4 1 1 9 Homicide. Abortion 2 — — — 2 Infanticide — — — 1 1 Grand Total 97 93 35 5 230 76 Staff of Public Health Department. The personnel of the staff of the Health Department will be found fully set out on page 3. Several changes occurred in the staff of the Department during the year. Dr. Joyce Peake, M.R.C.S., L.R.C.P., was appointed Resident Medical Officer of the Borough Maternity Hospital in September, 1927. Dr. Mabel Brodie, M.B., Ch.B., D.P.H., was appointed parttime Medical Officer in charge of the Diphtheria Immunisation (Schick) Clinic. Mr. H. Marrable, District Sanitary Inspector. No. 6 District, retired owing to ill-health after 33 years' service in May, and Mr. C. Binding was appointed District Sanitary Inspector to fill the vacancy. Miss C. P. Armitage, Health Visitor, resigned her appointment in February, and Miss A. Bannerman was appointed to fill the vacancy. Miss M. McEwan was appointed temporary Health Visitor for a period of 1 year in March. (Vide p. 24). Miss R. Dove was appointed Shorthand typist in February to fill a vacancy in the Clerical staff resulting from the transfer of Mr. J. Holloway to the Inspectorial Staff. Miss C. Dickson, Matron of the Borough Maternity Hospital, resigned her appointment in September, 1927, and Miss J. Gibson was appointed to fill the vacancy. 77 Protection of the Food Supply. INSPECTION AND SUPERVISION OF FOOD. Unsound Food. The following is a tabulated return of unsound foods which, under the provisions of Section 47(8) of the Public Health (London) Act, 1891, were brought to the notice of the Sanitary Inspectors and voluntarily surrendered during 1927:— Food. Quantity. Food. Quantity. Fish. Fruit & Vegetables (fresh). Dog Fish 3 boxes Currants 20 boats. Haddock 3 boxes. Potatoes 10 bags. Do. dried 5 trunks. Tomatoes 17 bundles. Herrings, fresh 1 box. Kippers 5 boxes. Meat & Poultry. Mackerel 1 box. Bacon 28 lbs. Mixed Fish 1 trunk. Do. (green) 58 lbs. Mussels 2 bags. Rabbits (wild) 72 Shrimps 4 galls. 16 lbs. Miscellaneous. Skate wings 3 boxes. Cucumbers (pickled) 1 barrel. Winkles 3 bags. Sweetmeats 40 lbs. Cow-houses. There is now no licensed cow-house remaining in the Borough, the use of that situate at 17 Wiseton Road having been discontinued during the year. Slaughter-houses. There are only two slaughterhouses remaining in the Borough. These premises are kept under systematic inspection, and during the year 1927, 288 inspections were made by the Council's inspector. The carcases of 98 animals (calves 4, goats 1, sheep 53, and pigs 40) were examined after slaughter. 78 The provisions of the Public Health (Meat) Regulations, 1924, have been brought to the notice of the occupiers of these slaughterhouses, and no contravention of the Regulations in regard to slaughterhouses were reported during the year. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1927 was 95. Four new shops were opened during the year and one closed, making a total of 98 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 1,294 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. During the year contraventions of the provisions of the above named Regulations, mainly relating to the failure to protect meat exposed for sale from contamination by dust, etc., were reported in 11 cases. In only 1 of these was it found necessary to institute legal proceedings to enforce the requirements of the Regulations and in that case the proceedings were not complete at the end of the year. Sale of Food and Drugs Acts. The total number of samples taken under the Acts during 1927 was 950, of which 43 or 4.5 per cent. were certified by the Public Analyst to be adulterated. In addition to the foregoing, 250 informal samples were procured, of which 2 (or 0.8 per cent.) were reported by the Public Analyst as containing preservative. The percentage of samples reported by the Public Analyst to be adulterated during the 5 years 1922-26, and in 1927, was as follows:— Year. Formal Samples. Informal Samples. 1922 8.0% 7.9% 1923 7.2% 7.4% 1924 3.9% 11.5% 1925 4.4% 2.8% 1926 4.3% 3.7% Mean 5.6% 6.7% 1927 4.5% 0.8% 79 The following tables give details of the articles of which samples were obtained for the purpose of analysis:— Main Statement. TABLE I. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread — 7 7 — 0 0 Butter 24 64 88 0 0 0 Cheese 21 — 21 0 — 0 Cocoa 21 — 21 0 — 0 Coffee 22 — 22 0 — 0 Confectionery (Sweets) — 4 4 — 0 0 Cream 6 — 6 0 — 0 Cream, Preserved 14 — 14 0 — 0 Flour, Self-raising 1 12 13 1 1 2 Jam 1 7 8 0 0 0 Margarine — 24 24 — 0 0 Milk 696 — 696 37 — 37 ,, Skimmed 1 — 1 0 — 0 „ Condensed (Full Cream) — 9 9 — 0 0 „ „ (Machine Skimmed) — 4 4 — 0 0 „ Dried — 4 4 — 0 0 Mustard — 12 12 — 1 1 Sugar — 7 7 — 0 0 Vinegar 33 — 33 3 — 3 Drugs — 24 24 — 0 0 Other Articles 110 72 182 2 0 2 Total 950 250 1200 43 2 45 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bicarbonate of Soda — 5 5 — 0 0 Camphorated Oil — 7 7 — 0 0 Cream of Tartar — 5 5 — 0 0 Milk of Sulphur — 3 3 — 0 0 Paregoric — 2 2 — 0 0 Tincture of Iodine — 2 2 — 0 0 Total — 24 24 — 0 0 80 TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot — 12 12 — 0 0 Baking Powder — 12 12 — 0 0 Brawn 2 — 2 0 — 0 Custard Powder — 8 8 — 0 0 Dripping 6 4 10 0 0 0 Fruits (dried) — 8 8 — 0 0 Honey 15 — 15 0 — 0 Lard 21 — 21 0 — 0 Meats & Fish (potted) 12 — 12 0 — 0 Meats (other) 7 — 7 0 — 0 Olive Oil 10 — 10 0 — 0 Pepper — 9 9 — 0 0 Rice 5 8 13 0 0 0 Sausages 20 — 20 2 — 2 „ preserved 4 — 4 0 — 0 „ breakfast 2 — 2 0 — 0 „ luncheon 6 — 6 0 — 0 Sponge Cake — 11 11 — 0 0 Total 110 72 182 2 0 2 Milk. Of the 697 formal samples (including one of skimmed milk) 37 or 5.3 per cent were certified as adulterated. Twenty-eight samples were reported against as being deficient in milk fat, 6 as containing extraneous water, and 3 as containing colouring matter. The greatest deficiency in milk fat amounted to 22 per cent., and the highest percentage of extraneous water was 12.5 per cent. In the 5 years 1922-26 and in 1927, the percentage of adulterated formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1922 726 36 4.9 1923 702 43 6.1 1924 721 25 3.4 1925 808 40 4.9 1926 738 32 4.3 Mean 739 35 4.7 1927 696 37 5.3 81 The present year shews a slight increase over the average of the preceding five years in the number of adulterated samples. The average composition of the 659 samples reported as genuine proved to be as under:— Total milk solids 12.42% Milk fat 3.63% Non-fatty solids 8.79% The content of fat in these 659 samples ranged as follows:— 4.0% and over 82 samples or 12.4% Between 3.9 and 4.0% 27 „ 4.1% 3.8 „ 3.9% 45 „ „ 6.8% 3.7 „ 3.8% 63 „ 9.6% 3.6 „ 3.7% 89 „ 13.5% 3.5 „ 3.6% 105 „ 15.9% „ 3.4 „ 3.5% 77 „ 11.7% 3.3 „ 3.4% 84 „ 12.8% 3.2 „ 3.3% 50 „ 7.6% 3.1 „ 3.2% 27 „ 4.1% 3.0 „ 3.1% 10 „ 1.5% Under 3.0% — „ - 659 100.0% All samples were systematically tested for the presence of preservatives. In no case, however, was a positive result obtained. Milk sampling was carried out on 16 Sundays during the year, and 96 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 82 were taken during the year. The bulk of these samples was taken at Clapham Junction or South Lambeth Railway Stations. Samples of milk to the number of 74 were taken in course of delivery to elementary schools in the borough. Five samples were also taken in course of delivery at the request of the Medical Officers of Health of neighbouring boroughs under the provisions of the Milk and Dairies (Consolidation) Act, 1915, which permits the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. Proceedings with regard to adulteration were taken in 26 instances—fat abstraction, 19; extraneous water, 4; added colouring matter 3—particulars relating to which will be found set out in the tables on pages 64 to 65. Warranty was pleaded in defence in one case, but the requirements of the Milk and Dairies (Consolidation) Act, 1915, had not been complied with by the vendor. 82 Sponge Cakes, Fairy Cakes, &c. During the year 11 samples of sponge cakes were submitted to the Public Analyst. All these samples were procured informally, and were found to be genuine. Butter. During the year 88 samples of butter were submitted for examination. Of these 24 were taken in the form prescribed by the Acts, and the remaining 64 samples were purchased informally. Of the 88 samples reported as genuine, 33 contained no preservative other than common salt, whilst 55, or 62.5 per cent., contained a boron preservative.* The maximum quantity of this preservative which was permitted in butter was 0.5 per cent. or 35 grains to the lb., but in no case was a greater quantity found present, the average amount contained in the 55 samples amounting to 0.23 per cent. or 16.1 grains to the lb. of butter, expressed in terms of crystallised boric acid. The average moisture content for all the samples (88) was found to be 14.0 per cent. Margarine. Twenty-four samples of margarine were purchased and submitted to the Public Analyst for examination, all of which were procured informally. The provisions of the Public Health (Preservatives, etc., in Food) Regulations, came into force at the beginning of the year in regard to this article, and it is satisfactory to record that all these 24 samples were reported as being free from preservative. Reference to former annual reports indicates that previously it was exceptional to find a sample of margarine which did not contain a boron preservative. The average water content of these 24 samples was 14.2 per cent. Sausages, Preserved Meats, &c. Ten formal samples of potted fish and fish paste; 9 formal samples of preserved and potted meats; 28 formal samples of sausages (including 6 of luncheon sausage, and 2 of breakfast sausage), and 4 formal samples labelled "Preserved Sausage" were submitted to the Public Analyst during the year. These were reported to be genuine with the exception of 2 samples of sausages which contained respectively 262 and 326 parts per million of Sulphur Dioxide. * The addition of preservatives, other than common salt, to butter, is prohibited by the Public Health (Preservatives in Foods) Regulations, from the 1st January, 1928. 83 The public Health (Preservatives, etc., in Food) Regulations, permit the presence of Sulphur Dioxide in sausages to an amount not exceeding 450 parts per million, but the presence of preservative must be indicated on the label. These two samples were, therefore, found not to comply with the requirements as to disclosure. Summonses were issued in respect of this offence but were dismissed on payment of two guineas costs (vide p. 66). Flour. In the early part of the year, an informal sample of Self-Raising Flour was reported upon adversely by the Public Analyst as containing dried soda alum as an acid constituent of the leavening mixture. A formal sample from the same source was similarly reported upon. A subsequent investigation showed that Baking Powder of an American origin had been mixed with flour in the preparation of this article. The attention of the retailer was called to the matter and he agreed to discontinue the sale of the article. It is satisfactory to record that the use of alum for the purpose in this country has long been discontinued. Eleven further samples of Self-Raising flour were reported as genuine. Rice. Thirteen samples of rice (5 formal and 8 informal) were procured and submitted to the Public Analyst and all were reported as genuine. Of these, one formal and one informal sample proved to be polished with the aid of talc, the coating in the first case amounting to 0.22 per cent. and in the second to 0.20 per cent. Vinegar. Thirty-three samples of vinegar were procured formally and submitted to the Public Analyst. Three of these were reported to be deficient in acetic acid to the extent of 18 per cent., 5 per cent. and 28 per cent. respectively. The result of the legal proceedings in respect of these samples is shewn on pp. 64 and 65. Ice Cream Vendors. There are 149 premises in the borough from which ice cream is sold, 21 of these being occupied by Italian vendors by whom this article of food is sold. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under daily inspection during the season. During 1927, 4 of the ice cream premises were removed from the register and 5 were added. There was, therefore, an increase of 1 in the number of premises compared with 1926. During the year 514 inspections were made and 21 notices were served to remedy defects found on inspection. In addition, during the summer season a daily inspection of street barrows and the utensils, glasses, towels, &c., used thereon was carried out. The improvement in the manner in which this commodity is now sold, referred to in previous annual reports, is being maintained. 84 Milk and Cream Regulations, 1912-17. 1. Milk and cream not sold as preserved cream :— (a) Number of Samples examined for the presence of a preservative. (b) Number of Samples in which a preservative was reported to be present. Milk 697* Nil. Cream 6 Nil. 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 14 2. Statements incorrect — Total 14 (b) Determinations made of milk fat in cream sold as preserved cream:— 1. Above 35 per cent 14 2. Below 35 „ Nil. Total 14 (c) Instances where (apart from analysis) the ments as to labelling or declarations of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken. Nil. 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 * One of these was a sample of skimmed milk. 85 Milk and Dairies (Amendment) Act, 1922. (Vide Circular 360 of the Ministry of Health.) 5. Action taken under Section 4 of the Milk and Dairies (Amendment) Act, 1922:— (a) (1) Number of samples of milk certified by the Public Analyst to contain colouring matter 3 (2) Action taken thereon— Three cases—Vendors summoned. Fined respectively £2 and £1 1s. costs; 5s. (no costs); and £1 with £1 1s. costs. (b) (1) Number of samples of milk certified by Public Analyst to contain extraneous water 6 (2) Action taken thereon— Vendor summoned 4 Convictions (fines with or without costs) 1 Dismissed on payment of costs 2 Dismissed without costs 1 Vendor cautioned 2 Milk and Dairies (Consolidation) Act, 1915. Under the Milk and Dairies (Consolidation) Act, 1915, 2 proceedings were taken against a milk vendor for selling milk without having his name and address conspicuously inscribed on the vehicle, (vide p. 66). Advantage was taken of Section 9 and the Third Schedule of this Act by milk purveyors in 19 cases relating to 27 samples of milk. Of these, 18 were reported by the Public Analyst to be genuine. In the case of the remaining 9 samples which were certified to be adulterated and which were the subject of legal proceedings, 8 of these were taken in course of delivery from the producer, at whose subsequent request eight further samples were taken at his farm. Of these, 6 were certified to be genuine, and 2 to be deficient in milk fat to the extent of 2 per cent. and 9 per cent. respectively. The Magistrate dismissed the summonses issued in respect of the 8 original samples. In the case of the ninth sample the requirement of the vendor was not delivered within the time prescribed by the Act. The summons in this case was dismissed on payment of two guineas costs. Milk and Dairies Order, 1926. The provisions of the above-named Order, which had already been brought to the notice of milk purveyors in the Borough and which are referred to in detail in the Annual Report for 1926 of the Medical Officer of Health, were enforced by the Council's Officers during the year under report. It was unnecessary, however, to take any legal action during the year for breaches of the Order. 86 Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to issue licences to others than producers (i.e., persons producing milk for sale from herds over which they have control). The licences so granted are available for a period up to the end of the year in which they were issued. There is a scale of fees payable to the Licensing Authority by applicants for licences. During 1927 licences were issued as follows:— Certified milk (including 1 supplemental licence) 20 Grade A (Tuberculin tested) milk (3 supplemental) 59 Grade A milk (supplemental) 1 Grade A, Pasteurised (1 supplemental) 9 Pasteurised milk (2 supplemental) 13 Two licences to bottle Grade A (TT) milk and one Pasteuriser's licence were granted and are included in the above figures. In December, 1926, the attention of the Council was drawn to the use by a firm trading in Battersea of the title "Grade A Dairy." Steps were taken to deal with the matter, and the firm in question agreed to discontinue the use of this title or any other designation which might be regarded as an infringement of the Order. Public Health (Condensed Milk) Amendment Regulations. and Public Health (Dried Milk) Amendment Regulations. In November, the Ministry of Health issued Regulations amending the Regulations of 1923 dealing with condensed and dried milk. The amending Regulations relate mainly to the wording of the labels and the size of the printing type to be used thereon. Milk Shops. The number of premises registered in Battersea for the sale of milk is 131. One new premises was registered during the year for the sale of milk, and in one case the sale of milk from registered premises was discontinued. In 6 cases registration was transferred on account of change of proprietorship. All milk shops are kept under inspection and during the year 492 inspections were carried out and 18 notices were served to remedy defects found on inspection. These mainly referred to dirty and unsuitable premises and other minor defects. 87 In addition to the above there are 41 persons registered in respect of premises in which sterilised milk in sealed bottles only is sold. 14 vendors whose licensed premises are without the borough were registered as purveyors within Battersea, and 5 premises used for the wholesale distribution of milk are registered by the Council. The Public Health (Preservatives, &c., in Food) Regulations, 1925. The Public Health (Preservatives, etc., in Food) Amendment Regulations, 1927, were issued by the Ministry of Health in June. The main effect of the Regulations was to postpone the action of the principal Regulations as regards pearl barley until the 1st January, 1928, to add lactic acid to the list of permitted preservatives, and to include in the schedule of articles in which certain specified preservatives are permitted the following items:— Parts per Food. Preservative. million. 8. Sugar (including solid glucose) and cane syrups Sulphur dioxide 70 8a. Cornflour (maize starch) and other prepared starches Sulphur dioxide 100 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 67. All these premises are kept under systematic inspection. During 1927, 312 inspections were made and 19 notices were served for various defects found on inspection. Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1927 was 99, the same number as in 1926, one new premises replacing one closed. During the year 239 inspections were carried out, and in 12 cases it was found necessary to serve notices to remedy defects which were mainly of a minor character. Street Stalls for the Sale of Food. There are in the Borough 242 street stalls for the sale of foodstuffs of varied character, namely—coffee, 8; vegetables and fruit, 173; fish and poultry, 26; meat and rabbits, 4; sweets, 12; other foods, 19. Nine notices were served for defective and insanitary conditions of premises used by the street vendors for the storage of their stock. 88 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) 962 105 - Workshops (including Workshop Laundries) 1,034 94 - Workplaces (other than Outworkers' premises included in the Table on page 94) 2,337 83 - Total 4,333 282 - 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 156 155 Nil. - Want of Ventilation 9 9 - Overcrowding 1 1 - Want of drainage of floors 4 4 - Other nuisances 132 129 - Sanitary accommodation Insufficient 4 4 - Unsuitable or defective 49 47 - Not separate for the sexes 7 7 — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (Sec. 101) - - _ Other Offences (excluding Offences relating to Outworkers which are included in the Table on page 94) - - - Total 362 356 - - 89 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1927 :— Bakehouses 22 Bootmakers 36 Dressmakers 24 Laundries 4 Milliners 14 Tailors 35 Other Trades 220 Total number of workshops 355 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 7 Notified by H.M. Inspector 2 Underground Bakehouses (Section 101), in use at end of the year 26 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1927:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Barge builder 2 26 1 - - Baker 52 223 22 20 20 Bootmaker 15 28 3 - - Builder 4 95 - - - Butter blender 1 36 43 - 14 Chemical works 4 210 5 65 12 Chaff & forage 4 55 - 8 - Coach 2 22 - - - Cycle maker 3 4 5 - - Dyer 2 44 — 24 - Engineer 29 677 14 - - Flour mills 2 150 - 10 - Firewood cutter 10 47 6 22 - Foundry 1 30 — - - Lift maker 2 16 - - - Mason 6 330 2 - - Mineral water 2 25 - 23 - Motor repairs 15 212 1 2 - Printer 18 92 7 15 - Steam laundry 17 69 6 530 62 Other trades 81 3,607 283 1,171 365 Total 272 5,998 398 1,890 473 90 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. Seven new factory premises were added to the register during the year, dealing with various trades, and 8 were removed. During the year 101 preliminary and 4 Statutory notices were served under the Public Health (London) Act, 1891, for defects found on factory premises, for the most part relating to defective or insufficient sanitary accommodation, all of which were duly remedied. Workshops. The following is a list of the workshops on the register at the end of 1927:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 22 31 35 1 — — Blind maker 2 3 3 2 — — Bootmaker 36 36 56 1 — — Carpenter 4 5 8 — — — Coach builder 7 12 26 — — — Cycle maker 8 12 10 1 5 — Dressmaker 24 28 — — 52 8 Embroiderer 1 2 — — 8 3 Farrier & smith 13 13 30 — — Firewood cutter 4 4 3 1 2 Laundry 4 16 3 — 15 — Mason 4 5 7 — — — Milliner 14 17 1 — 39 1 Motor repairs 15 15 45 1 1 — Musical instrument 3 6 45 1 — — Photographer 2 2 3 — 1 — Picture framer 4 5 6 1 — — Rag sorter 17 18 28 3 5 — Saddler 2 2 3 — — — Tailor 35 46 54 3 60 1 Upholsterer 17 22 32 4 9 3 Other trades 117 130 286 33 95 15 Totals 355 430 684 52 292 31 91 In certain of these trades in which female labour is mainly used, the inspection of the workshops is carried out by a female sanitary inspector, and during 1927 the number of inspections amounted to 43. Eighty-six intimation and 8 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 3 intimation notices were served by the female inspector. Thirty-seven new workshops were added to the register, dealing with the following trades:— Bootmaker 2 Photographer 1 Coachbuilder 1 Picture framer 1 Dressmaker 5 Rag Sorter 3 Firewood cutter 1 Tailor 1 Mason 1 Other Trades 18 Motor repairer 3 The following table gives particulars relating to workshops in which "protected persons" were employed, notices of which were duly sent to H.M. Inspector during 1927:— Trade. No. of Workshops. Protected Persons employed. Women. Young Persons. Total. Dressmaker 5 8 2 10 Knitted Garments 1 — 4 4 Milliner 1 7 — 7 Totals 7 15 6 21 Outworkers. During 1927, 568 names and addresses of outworkers were received in 109 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 173 names and addresses relating to 119 outworkers, 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:— 92 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaking 34 34 35 Glovemaking 1 1 1 Tailoring 56 56 86 Other Trades 4 4 4 Totals 95 95 126 Ten new male outworkers (outworkers not previously registered) were registered during the year, and 9 were removed from the register. There were 194 inspections made of male outworkers' premises during 1927, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 4 cases to remedy sanitary defects found on inspection, as follows:— Want of cleansing; defective w.c.; accumulation of rubbish. No case of infectious disease was notified during 1927 from premises occupied by male outworkers. Female. The following is a list of the female outworkers registerec in the Borough, together with the trades and the number of persons employed:— Trade. Number on Register. Persons Employed. Premises. Workrooms Blousemaking 5 7 16 Boxmaking 9 9 9 Dressmaking 24 25 50 Embroidery 40 40 44 Fancy goods 8 8 8 Fine needlework 3 3 3 Glovemaking 2 2 2 Knitting and crochet 3 3 3 Tailoring 33 34 51 Underclothing 16 16 24 Other trades 8 8 8 Total 151 155 218 93 The number of new female outworkers (outworkers not previously registered) registered during the year was 57. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 300. It was found necessary in one case to serve a notice under the Public Health (London) Act, 1891, to remedy defects. One case of infectious disease, viz.: diphtheria, was notified from female outworkers' premises. Such precautionary measures as were required were taken to prevent spread of infection in this case. Bakehouses. There were 74 bakehouses on the register at the end of 1927. Of these 52 use power, and are therefore factories. Forty-eight of the bakehouses are above ground, and 26 are under ground. One above ground bakehouse was reopened during the year, and three bakehouses were removed from the register, the premises being used for other purposes. Inspections made during the year were 232, and 39 intimation and 2 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 1927, there were 44 premises on the register, including railway yards. These premises were systematically inspected during the year, and 91 inspections were made. Five intimation notices were served to remedy nuisances found on inspection. 94 Home Work, 1927. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. 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. Workers. Contractors. Workers. Wearing Apparel- (1) Making 52 6 150 5 l 16 58 — — 5 5 - l - -— (2) Cleansing & Washing 2 — 2 - - - 2 - - - - - - - - Furniture and Upholstery 2 - 1 - - - 2 - - - - - - - - Other Trades 4 - 6 - - - 4 - - - - - - - - Total 60 6 159 5 l 16 66 - - 5 5 — l - - Note.—Of the 182 names included in this table, only 52 were of work people residing in Battersea, the remaining names being those of workers residing outside the Borough. The names of 158 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were therefore 210 Battersea home-workers named in the lists. 95 Housing. The housing conditions in Battersea, so far as adequate housing accommodation is concerned, are still very unsatisfactory, and during the year 1927 hundreds of cases of congestion and overcrowding have been brought to the notice of the Housing Committee. For reasons which have been fully referred to in previous Annual Reports it has been impossible, except to a very limited extent, to remedy these insanitary and otherwise undesirable conditions. Some slight alleviation of this distressing situation has been effected through the additional dwellings provided by the Borough Council, and by the quota allocated to Battersea by the London County Council on their various Housing Estates in cases of special hardship, &c. Unfortunately, however, there is still a large number of families in Battersea living under conditions which are, on sanitary and social grounds, a reproach to civilisation. New Houses. It has been pointed out in previous Reports that the Borough Council have had very limited opportunities of relieving the congestion and overcrowding resulting from the housing inadequacy in Battersea, practically the whole of the available area of the Borough being built upon. Such few opportunities as have arisen have been seized by them to erect working class dwellings. During 1927, apart from the Plough Road Improvement Scheme, 18 tenements were erected in Latchmere Road, on the site reserved for the building of the new Maternity and Child Welfare Centre and Tuberculosis Dispensary, the acquisition of Southlands College and grounds enabling the Council to utilise these premises for the proposed buildings. The new tenements were erected by the Council's Works Department, each containing three rooms and scullery, and provided with bath, electric light, hot water supply, &c. These dwellings accommodate 18 families, comprising 37 adults and 50 children. The Council applied for, and were successful in obtaining, the subsidy of £9 per tenement per annum for 40 years. The Principal's House at Southlands College was utilised for working-class dwellings.—five tenements—one of three rooms, three of four rooms, and one of five rooms—having been provided by the conversion and adaptation of this building. Fifty-four houses were erected by private enterprise almost entirely in South Battersea. These additional new houses unfortunately have little effect upon the inadequacy of the housing 96 accommodation in the working-class congested areas of the Borough, and are situate as follows:— Battersea Park Road 1 Beechholme Estate (Nightingale Lane) 47 Queens Road 1 Sudbrooke Road 4 Thurleigh Road 1 Total 54 Repair of Unfit Houses. A good deal of useful work in the repair and re-conditioning of unfit houses was carried out during the year under the provisions of the Housing and Public Health Acts, details of which will be found summarised on pp. 98-102. The work of the Council in this direction has been fully described in previous Annual Reports, so that it is unnecessary to say more than that the policy of the Council in using the powers of Housing Act, 1925, in securing the re-conditioning of serious defective house property continues to be fully justified. It is satisfactory to record that during 1927 the right of appeal by owners against notices under Section 3 of the Housing Act, 1925, was not exercised. The appeal against the notice served by the Council under Section 3 in respect of No. 58 Winstanley Road, which was made in 1926, was the subject of a local inquiry by the Minister of Health early in 1927. In this case the owner objected to a requirement in the notice to remove the unsuitable material used to repair a ceiling in one of the rooms of this house, and to provide approved materials and carry out the repairs in a durable and workmanlike manner. The appeal was dismissed. Considerable progress has been made in the re-conditioning of houses in regard to the provision of adequate light and ventilation to the staircases and landings. A large proportion of the older working-class houses in the Borough have been found on inspection to be lacking in these essentials, and the owners have been called upon to remedy the defect, either by the provision of a small window made to open (if sufficient wall space is available) or alternatively by means of a suitable ventilated skylight. Many hundreds of houses have been dealt with in this manner during the past years, and in 1927 in the case of a large estate of some 800 houses the owners, after negotiation, asked for a period of five years in which to carry out the work, and eventually the Housing Committee agreed to a period of four years. During the year 229 houses on this estate were provided with windows, made to open, on the staircase. Closing Orders. No Closing Orders under Section 11 (1) of tne Housing Act, 1925, were made by the Council during 1927. 97 Underground Rooms. During 1927 the Council made a Closing Order in respect of the underground room at No. 23 Tyneham Road, which was habitually used for sleeping purposes. The room was duly vacated. Increase of Rent, &e., Acts. During 1927, 9 applications were received from tenants for the certificate, and 3 from owners for the report of the Sanitary Authority under the above-mentioned Acts. The application for a Certificate was refused in 1 case, those for reports were granted in 2 cases, the remaining case being under consideration at the end of the year. Action under Section 5 of the Housing Act, 1925. During 1927, 52 cases relating to 70 houses were reported to the Housing Committee for contraventions of Section 5 of the Housing Act, 1925, which requires the rent book (if such is provided) to be kept in the prescribed form. In 51 cases satisfactory explanations having been received and the requirements of the section subsequently complied with, the Committee directed that cautionary letters were to be sent to the offenders and in the other case that proceedings be taken. Insanitary Areas. No additional insanitary areas were represented to the Council during 1927. During the year considerable progress was made with the Plough Road Improvement Scheme. The fifth, sixth and seventh blocks were completed, and the eighth nearly completed by the end of the year. With a view to rendering this scheme more effective the Council decided to acquire by purchase cottages in Holtby Place adjoining, and by the purchase and demolition of factory premises to erect three blocks (18 tenements); to continue Britannia Place, hitherto a cul-se-sac, into Hope Street, and at the same time to widen Hope Street between Britannia Place and York Road. These additional proposals had not been completed by the end of the year. In consequence of these proposed alterations in the Scheme, the Council decided not to proceed with the eleventh block of dwellings. Overcrowding. During 1927, 125 cases were referred to the London County Council. 98 The following table shows the result of such action during the year. Referred in 1926 but not dealt with in that year. Referred in 1927. Total. Families accommodated 2 31 33 Offer declined by applicant or applicant otherwise suited 21 4 25 Recommendation not accepted by L.C.C. 9 39* 48 Still under consideration 6 51† 57 Total 38 125 163 *Includes 1 case twice submitted. †Includes 2 cases twice submitted. 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 Acts, either informally or by the service of notice under section 3 of the Housing Act, 1925, during 1927. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. No 1 District. Belfour Street 1 Savona Street 7 Woodgate Street 1 Corunna Road 1 Stewarts Road 1 Total:—5 streets, 11 houses. No. 2 District. Berkeley Street 10 Brougham Street 26 Longhedge Street 2 Blondel Street 8 Havelock Terrace 1 Sheepcote Lane 2 Total:—6 streets, 49 houses. No. 3 District. B'sea Park Road 1 Home Road 1 Octavia Street 2 Granfield Street 9 Inworth Street 2 Radstock Street 1 Total:—6 streets, 16 houses. 99 Street. Houses dealt with. Street. Houses dealt with. Street. House dealt with. No. 4 District Afghan Road 1 Latchmere Grove 65 Patience Road 1 Creek Street 1 Lavender Road 5 Rowena Crescent 1 Duffield Street 2 Lavender Terrace 1 Shillington Street 1 Este Road 1 Lithgow Street 3 Speke Road 1 Falcon Grove 3 Lubeck Street 1 Stainforth Road 1 Gwynne Road 4 Mantua Street 1 Verona Street 1 Heaver Road 2 Meyrick Road 3 Wayford Street 3 Ingrave Street 1 Musjid Road 4 Yelverton Road 1 Khyber Road 1 Newman Street 1 Total :—26 streets, 110 houses. No. 5 District. Acanthus Road 1 Gideon Road 2 Shirley Grove 21 Culvert Road 2 Hanbury Road 2 Tipthorpe Road 3 Dorothy Road 4 Knowsley Road 38 Wickersley Road 5 Elsley Road 1 Latchmere Road 3 Wycliffe Road 1 Eversleigh Road 1 Mossbury Road 3 Total:—14 streets, 87 houses. No. 6 District. Maysoule Road 17 Sewell Road 4 Wilson Street 1 Mendip Road 2 Tritton Street 12 York Road 1 Middleton Road 1 Usk Road 1 Total:—8 streets, 39 houses. No. 7 District. Nil. No. 8 District. Chatham Road 44 Northcote Road 1 Stonells Road 10 Total:—3 streets, 55 houses. Summary. No. 1 District 5 streets 11 houses. „ 2 „ 6 „ 49 „ „ 3 „ 6 „ 16 „ „ 4 „ 26 „ 110 „ „ 5 ,, 14 „ 87 „ „ 6 „ 8 „ 39 „ „ 7 - „ - „ „ 8 „ 3 „ 55 „ Totals 68 streets 367 houses The following is a list of streets in the Borough in which houses were the subject of action during the previous year, either informally or by the service of notice, under section 3 of the Housing Act, 1925, but to which the necessary works of repair had not been completed during 1926. 100 Street. Houses dealt witn. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Corunna Terrace 1 New Road 1 Stewarts Road 2 Total:—3 streets, 4 houses. No. 2 District. Arthur Street 6 Kilton Street 19 Warsill Street 1 Austin Road ... 1 Longhedge Street 1 Weybridge Street 1 B'sea Park Road 1 Park Grove 2 Total:—8 streets, 32 houses. No. 3 District. Banbury Street 2 Granfield Street 1 Home Road 1 Goulden Street 1 Total:—4 streets, 5 houses. No. 4 District. Afghan Road 2 Kerrison Road 1 Speke Road 2 Barmore Street 1 Knox Road 1 Stainforth Road 2 Benfield Street 2 Latchmere Grove 29 Urswicke Road 14 Duffield Street 1 Lavender Road 6 Verona Street 3 Este Road 1 Mantua Street 1 Wayford Street 1 Falcon Grove 1 Meyrick Road 3 Winstanley Road 2 Grant Road 1 Newman Street 1 Yelverton Road 1 Ingrave Street 2 Pearson Street 1 Total:—23 streets, 79 houses. No. 5 District. Basnett Road 12 Knowsley Road 2 Wickersley Road 1 Dorothy Road 1 Total:—4 streets, 16 houses. No. 6 District. Abyssinia Road 1 Sewell Road 1 Usk Road 1 Linda Street 1 Total:—4 streets, 4 houses. Eccles Road 1 No. 7 District. Sugden Road 1 Total:—2 streets, 2 houses. No. 8 District. Nil. Summary. No. 1 District 3 streets 4 houses. „ 2„ 8 „ 32 „ „ 3 „ 4 „ 5 „ „ 4 „ 23 „ 79 „ „5 „ 4 „ 16 „ „ 6 „ 4 „ 4 „ „ 7 „ 2 „ 2 „ „8„ - „ - „ Totals 48 streets 142 houses Statistics for the year ending 31st December, 1927. 1. General. (a) Estimated population 169,000 (b) General Death Rate 12.2 per 1,000 (c) Death rate from tuberculosis 1.04 per 1,000 (d) Infantile mortality rate 53.5 per 1,000 (e) Number of premises used as habitations by all classes 27,901 (f) Estimated number of working class dwellinghouses 25,010 (g) Number of new working class dwellings erected *90 2. Unfit Dwelling-Houses. (a) Inspection— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,384 (b) Number of dwelling-houses which were inspected and recorded under Part IV of the Housing Consolidated Regulations, 1925 3,909 (c) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for habitation ... Nil (d) Number of dwelling-houses (exclusive of those referred to under the previous heading) not found to be in all respects reasonably fit for habitation 3,582 (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 407 (c) Action under statutory powers— (I.) Proceedings under section 3 of the Housing Act, 1925 (a) Number of dwelling-houses in respect of which notices were served requiring repairs †24 (b) Number of dwelling-houses which were rendered fit:— (i.) By owners 35 (ii.) Work commenced by local authority but workmen subsequently withdrawn and work completed by owner Nil *Includes 18 tenements erected under Plough Road Improvement Scheme. † In addition 1 notice was re-served. 102 (iii.) Work commenced by owner but workmen subsequently withdrawn and work completed by local authority Nil (iv.) By local authority in default of owners Nil (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 3,229 (b) Number of houses in which defects were remedied. (i.) By owners 3,193 (ii.) By local authority in default of owners Nil (III.) Proceedings under sections 11, 14 & 18 of the Housing Act, 1925:— (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 Nil (d) Number of dwelling-houses in respect of which Demolition Orders were made Nil (e) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 3. Staff. Staff engaged on Housing work with briefly the duties of each officer:— 1. Medical Officer of Health. 2. Senior Sanitary Inspector. Housing Inspector. Seven District Inspectors. 3. Two Clerks (mainly engaged on matters relating to housing work). 103 APPENDIX. Diphtheria—The Schick Test. Report of the Medical Officer of Health. Diphtheria was known to the ancient Greek physicians Aretaeus and Galen. It was first accurately described by Home in 1765, but it was the French physician Brettoneau who showed in 1821 that Angina Suppurative "Cynanche Maligne" and other forms of malignant sore throat were one and the same disease, to which he gave the name " la diphtherite." It was not however, until 1884 that the specific organism was discovered by Klebs and Loeffler. Following on the discovery of the causative germ, diphtheria anti-toxin was in the year 1890 introduced by Behring and Kitisato, but it did not come into general use until 1895. Unfortunately its action is often materially affected by delay in its administration due to neglect either in calling in medical assistance in time, or to difficulties of diagnosis in doubtful cases. In this connection the " carrier " is a fertile source of danger and difficulty, particularly during epidemic prevalence, and much time and trouble is experienced in following up and tracing these cases and contacts. It is evident, therefore, that while the discovery of the diphtheria germ and the introduction of anti-toxin have greatly improved our knowledge and methods of treatment, and, to a certain extent of prevention in Diphtheria, there is still a high incidence and mortality from the disease in this country. It is fortunate, therefore, that recent scientific developments such, for example, as the Schick Test, have considerably advanced our knowledge in regard to preventive measures against diphtheria and other dangerous infectious diseases. Diphtheria is one of the most dangerous infectious diseases of child life, and its most deadly effect is on the age group under five years of age. It levies a heavy toll yearly amongst the child population, and apart from the danger to life during an attack, it further frequently leaves in the case of surviors serious damage to the constitution and more or less permanent physical disability. Although owing to the discovery of the specific organism or germ responsible for the disease and the consequential universal application of anti-toxin as a remedy, the death-rate from diphtheria has greatly decreased in recent years, there is still a heavy mortality, and, furthermore, the incidence of the disease relatively speaking shows little diminution. The causes mainly responsible for this unsatisfactory position are:— (1) The presence of "carriers," i.e., persons while not themselves suffering from clinical evidence of the disease, harbour the germs in the air passages or elsewhere in the system, but who are capable of transmitting to more susceptible individuals the disease. 104 (2) Conditions favouring spread of the disease either by lowering the natural resistance of the body, or by increasing the opportunity for transmission by direct personal infection. (3) Occasionally but rarely, outbreaks of the disease have been caused by infected food, principally by milk infected with the diphtheria germ. The Schick Test. This test is based on the fact that newly-born infants are immune to diphtheria for the first few months of life. This natural immunity is rapidly lost up to the fourth or fifth year, after which it again begins to be gradually recovered. The highest incidence of mortality occurs, therefore, in this period, and although older children and occasionally adults are liable to be attacked, and in some cases with fatal results, it is amongst the younger children that infection is most rapidly spread and with the greatest risk of a fatal termination. The Schick Test, discovered by Professor Bela Schick, of Vienna, in 1913, and called after the name of its discoverer, consists of the injection of a minute measured dose of diluted diphtheria toxin into not under the skin of the left fore-arm. If the person injected has no natural antitoxin in his blood or an inadequate amount for his protection, a positive reaction follows, which is indicated by a small area of redness at the site of inoculation in 24 to 48 hours. This is an indication of lack of immunity or of the presence of insufficient anti-toxin to neutralize the trace of toxin injected. The test is a simple and very sensitive one, and therefore extremely useful for application to a community to differentiate the immune from the non-immune. It is the usual routine to apply a control test by injecting a similar amount of sterilized toxin into the other fore-arm of the person tested. The technique is very simple and has been greatly improved in the light of earlier experience of its use. In the hands of skilled operators and observers, there is no danger and the results are invariably of a most satisfactory character. The Schick test, although comparatively new to this country, has been largely employed in America, and in 1922 Dr. Park, of New York, states that no ill-effects had followed its application and the subsequent immunisation by toxin-antitoxin of 100,000 school children. Since then it is stated on high authority that " almost a million inoculations in New York without the slightest distress, and hundreds of thousands elsewhere in the United States, should be sufficient evidence as to the safety of the method and as to its great desirability." Use in Great Britain. The Schick test as to diphtheria susceptibility was in the earlier days in this country restricted to its action as a test without attempting active immunisation. During the last four years, however, an 105 increasing amount of immunising work has been carried out in London and the provinces, and valuable results have been obtained wherever preventive inoculation has been performed. Within the past two years the children in a large private boarding school in this borough have been inoculated, and it is satisfactory to be able to record that although there have been in past years outbreaks of diphtheria in this school, not a single case has occurred since the test and subsequent immunisation was introduced. In Scotland, so far much greater use has been made of this preventive method against diphtheria than in this country. As a means of controlling diphtheria outbreaks in institutions, it has been employed in Birmingham, Bristol and other places with excellent results. I have pointed out in the beginning of this report that it is amongst the children of pre-school age that the danger of diphtheria is greatest. It is obvious, therefore, that it is amongst this agegroup of the community that active immunisation is most essential. Nor is it necessary, having regard to the fact that over 50 per cent, of the total mortality from diphtheria occurs amongst this age group to apply the test preparatory to inoculation with toxinantitoxin. In at least one London borough this prophylactic agent has been for the past two years successfully employed at one of the Maternity and Child Welfare Clinics, and I have had opportunities of personally seeing the work carried on with highly successful results at one of the Welfare Clinics. There is no compulsion, and the parents are invited to use this protective measure for their children and increasing numbers of them readily avail themselves of the opportunity. The same opportunities on even a larger scale exist in Battersea for introducing this powerful preventive method against Diphtheria, and I would most earnestly advise the Health Committee to secure for the children of the Borough the most potent instrument available for combatting this deadly menace to child life. Diphtheria, as in past years, has recently been extremely prevalent in Battersea and other metropolitan boroughs and with disastrous results as the mortality statistics amongst the younger children show. It seems surprising, therefore, that as experience of its use on a large scale in America and other countries has proved that there is at hand a simple, safe, and certain preventive method for the protection of the child population of this country, it should have been so slow in being adopted. That the Ministry of Health has recognised its value is evident from a perusal of the Report of the Chief Medical Officer for 1925, who states:— "For several years careful observation has been made of the use of the Schick Test and of immunisation against Diphtheria. As a result of improvement in material and technique (the substitution of toxoid-anti-toxin for toxin-anti-toxin) the 106 method of prevention has now passed beyond the experimental stage and is widely regarded as the best way of protecting against the disease. In my Annual Report (1924) its appropriate use was advocated and local education authorities and those in charge of maternity and child welfare centres were recommended to consider its adoption in suitable circumstances. The experience of the past year has justified this recommendation. The Schick Test and immunisation in the United States continue to give satisfactory results which are confirmed by our more limited experience in this country. It is of particular value to nurses and others brought into daily contact with cases of Diphtheria and otherwise. It is surprising that there are still many infectious disease hospitals where nurses are allowed to attend Diphtheria cases without having been offered the advantage of this method of treatment. As anti-toxin has proved itself the best method of treatment, so immunisation appears to be our best prophylactic." This strong confirmation of the value of this preventive measure from such an authority as Sir George Newman, is I think, significant. Should the Council decide as I hope they will to adopt it, as a preliminary step one of the maternity and child welfare centres in the Council's Scheme might be made use of for the establishment of the preventive method. A weekly session could be held in the selected centre and patients invited to avail themselves of this clinic to have their children immunised against Diphtheria. The cost, including the services of a skilled operator and observer, would not at first, I estimate, amount to more than £120 to £130 per annum for this service. The adoption of this prophylactic method would, apart from its other advantages, especially the saving of life, enormously reduce the expenditure now incurred in securing hospital isolation for this disease. It has been estimated that in 1921, Diphtheria alone, cost the ratepayers of London, about £500,000. I have appended to this report statistics relating to the incidence and mortality of Diphtheria in London. It will be noted that the death-rate from the disease in Battersea while not the highest, is among the highest in the metropolitan area. This is not surprising when the social conditions existing in many of the lower wards of the borough are borne in mind. Destitution, overcrowding, bad housing, are factors in determining the incidence and spread of this as other infectious diseases. In asking the Committee to recommend the Council to make use of this powerful preventive measure, I feel sure that they will give my request their careful and sympathetic consideration, and I look forward to seeing this fatal disease in the near future no longer in Battersea a menace to the children of the Borough. April, 1927. G. QUIN LENNANE, Medical Officer of Health. 107 APPENDIX. Diphtheria in Metropolitan Boroughs in the Years 1923, 1924 and 1925. Borough. 1923. 1924. 1925. Population. Rate per 10,000. Death • rate per 10.000. Population. Rate per 10,000. Death rate per 10,000. Population. Rate per 10,000. Death rate per 10,000. Paddington 146,200 15.2 1.0 146,400 18.9 1.0 147,100 23.0 0.7 Kensington 178,500 13.9 0.8 178,500 12.7 0.8 179,400 16.6 0.6 Hammersmith 133,600 17.4 1.5 133,600 19.8 1.2 134,500 15.5 0.9 Fulham 161,600 17.1 1.2 163,100 16.0 0.7 163,700 16.6 0.6 Chelsea 64,480 15.2 1.6 64,580 12.4 0.5 64,820 26.6 1.1 Westminster 140,430 6.9 0.4 139,900 16.9 1.8 139,600 20.7 1.2 St. Marylebone 105,400 12.4 0.2 105,300 11.8 0.3 106,100 12.5 0.7 Hampstead 87,410 12.2 0.9 87,600 11.7 0.3 88,040 18.0 0.2 St. Pancras 214,400 24.1 0.9 214,300 28.5 1.0 215,900 32.6 1.5 Islington 336,600 26.5 0.6 337,400 25.1 0.9 339,200 27.0 0.6 Stoke Newington 52,820 10.8 0.8 52,920 19.6 0.9 55,190 14.0 0.8 Hackney 226,400 23.3 1.5 226,900 24.2 1.4 228,300 29.0 1.3 Holborn 43,376 23.5 0.9 43,250 16.4 0.9 43,315 19.0 0.5 Finsbury 77,230 40.4 1.2 77,180 25.1 1.8 77,560 32.7 0.8 London, City of 13,772 13.1 0.7 13,621 7.2 — 13,629 14.0 0.7 Shoreditch 106,200 34.0 1.2 106,500 36.3 1.4 107,300 41.1 1.4 Bethnal Green 118,700 41.0 1.7 119,200 47.3 2.4 119,800 41.6 1.4 Stepney 253,850 24.1 1.2 253,740 22.0 0.9 255,370 25.4 0.9 Poplar 166,400 21.9 1.8 167,300 24.0 1.2 168,500 21.8 0.4 Southwark 187,464 41.1 2.7 187,714 41.8 2.7 189,000 48.0 1.6 Bermondsey 121,700 48.4 2.7 122,100 43.9 2.1 123,000 43.6 2.4 Lambeth 308,500 18.9 1.5 309,300 19.4 1.7 311,100 26.7 1.8 Battersea 170,600 25.2 2.0 171,000 25.3 1.5 172,100 26.6 0.6 Wandsworth 336,100 11.0 0.8 338,200 13.6 0.7 340,900 22.5 0.8 Camberwell 272,300 31.7 2.7 273,700 30.0 1.9 275,400 33.6 1.5 Deptford 114,900 35.3 2.9 115,200 30.4 1.3 115,900 50.3 2.0 Greenwich 102,777 21.2 1.l1 102,470 30.7 1.4 102,936 42.3 1.4 Lewisham 182,400 15.8 1.5 184,900 9.8 0.5 185,600 13.2 0.9 Woolwich 140,000 10.6 0.1 139,930 13.7 0.6 140,740 20.9 0.9 London 4,564,109 22.6 1.3 4,576,505 23.0 1.2 4,602,000 27.2 1.1 The above statistical figures are instructive and show that certain Boroughs, including Battersea, practically in each year show a case and mortality rate above the average rate for London. 108 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 1927 and Previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate.* of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate.* Number Rate per 1,000 Nett Births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1917 167,233 B.† 2,709 2,960 17.7 2,567 17.1 727 445 299 101 2,285 15.2 150,023 D.† 1918 168,014 B.† 2,407 2,700 16.1 3,195 21.3 857 471 267 99 2,809 18.7 149,951 D.† 1919 165,960 B.† 2,765 3,075 18.5 2,409 15.1 730 382 228 74 2,061 12.9 159,316 D.† 1920 166,093 B.† 4,218 4,669 28.1 2,393 14.4 700 386 386 83 2,079 12.5 165,664 D.† 1921 169,200 3,580 3,742 22.1 2,445 14.5 800 415 276 74 2,060 12.2 1922 169,200 3,577 3,665 21.1 2,679 15.8 864 412 254 69 2,227 13.2 1923 170,600 3,415 3,434 20.1 2,368 14.0 874 345 170 49 1,839 10.8 1924 171,000 3,180 3,139 18.4 2,506 14.7 858 370 196 62 2,018 11.8 1925 172,100 3,264 3,184 18.5 2,397 13.9 920 328 186 58 1,805 10.5 1926 171,900 3,198 2,969 17.3 2,547 14.8 948 361 183 62 1,960 11.4 1927 169,000 3,099 2,801 16 6 2,773 16.4 1,102 394 150 53 2,065 12.2 Area of District in acres (land and inland water), 2,163 acres, dwelling. 6.17 (Census Report 1921). Total population at all ages, 167,739; number of occupied separate dwellings, 27,191; average number of persons per occupied separate *Rates calculated per 1,000 of estimated population. † Registrar General's estimated population for purposes of calculating:—(B), birth-rate ; (D) death-rate. 109 TABLE II. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1927. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 680 5 188 412 52 23 ... 354 256 70 354 254 67 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 78 ... 3 9 7 48 1 37 27 14 11 5 4 Scarlet Fever 376 4 88 242 27 15 ... 151 140 85 150 140 81 Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 4 ... ... 2 ... 2 ... 2 2 ... 2 2 ... Puerperal Fever 9 ... ... ... 4 5 ... 5 2 2 4 2 1 Puerperal Pyrexia† 25 ... ... ... 16 9 ... 11 6 8 4 6 4 Meningococcal Meningitis 6 ... 4 1 1 ... ... 2 3 1 2 3 1 Ophthalmia Neonatorum 48 48 ... ... ... ... ... 22 20 6 5 3 1 Polio-myelitis, &c. 7 ... 5 2 ... ... ... 4 3 ... 3 3 ... Encephalitis Lethargica 4 ... ... 1 ... 3 ... 1 3 ... 1 ... ... Polio-encephalitis 1 ... 1 ... ... ... ... 1 ... ... 1 ... ... Malaria 2 ... ... ... ... 2 ... ... 2 ... ... ... ... Dysentery 1 1 ... ... ... ... ... ... 1 ... ... ... ... Acute Influenzal Pneu 164 4 21 10 28 82 19 65 62 37 15 14 13 Acute Primary Pneu 263 21 80 36 25 78 23 126 104 33 59 39 15 Totals 1,668 83 390 715 160 267 53 781 631 256 611 471 187 T uberculosis— Pulmonary 233 ... 1 12 72 142 6 104 57 72 ... ... ... Non-Pulmonary 75 6 10 25 18 15 1 37 21 17 ... ... ... Totals (Tuberculosis) 308 6 11 37 90 157 7 141 78 89 ... ... ... Totals 1,976 89 401 752 250 424 60 922 709 345 611 471 187 Whooping-cough* 507 67 293 143 4 ... ... 239 209 59 31 13 4 Measles* 265 20 83 148 8 6 ... 162 61 42 5 4 2 Grand Totals 2,748 176 777 1,043 262 430 60 1,323 979 446 647 488 193 * Notifiable in Batter sea from 24th April, 1922. †Notifiable from 1st October, 1926. 110 TABLE III Causes of, and Ages at, Death during the Year 1927. CAUSES OF DEATH. Nett Deaths at subjoined aces of "Residents" whether Occurring within or without the District. Total Deaths of "Residents" and "NonResidents" in Institutions in the District. Al! 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 ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 1 1 ... ... ... ... ... ... ... ... 4. Scarlet Fever 3 ... 1 ... ... ... ... 2 ... ... 5. Whooping-cough 15 4 5 5 1 ... ... ... ... 12 6. Diphtheria 25 ... 2 7 14 2 ... ... ... 4 7. Influenza 83 1 4 ... 1 5 10 21 41 36 8. Encephalitis ... ... ... ... ... ... ... ... ... ... Lethargica 2 l ... ... ... 1 ... ... ... 1 9. Meningococcal Meningitis 3 ... 2 1 ... ... ... ... ... 1 10. Tuberculosis of Respiratory System 151 ... ... ... 2 45 55 41 8 136 11. OtherTuberculous Disease 24 3 4 4 2 8 2 1 28 12. Cancer 252 1 ... ... ... 1 20 125 105 210 13. Rheumatic Fever 12 ... ... ... 4 2 2 1 3 5 14. Diabetes 17 ... ... ... ... ... 2 7 8 15 15. Cerebral Haemorrhage, etc. 83 ... ... ... 1 1 3 27 51 103 16. Heart Disease 404 ... ... ... 1 7 29 106 261 390 17. Arterio-Sclerosis 69 ... ... ... ... ... ... 19 50 8 18. Bronchitis 156 3 2 2 1 1 9 31 107 81 19. Pneumonia (all forms) 123 23 17 5 3 7 9 22 37 117 20. Other Respiratory Diseases 22 ... ... 1 1 2 2 12 4 24 21. Ulcer of Stomach or Duodenum 28 ... ... ... ... ... 6 17 5 36 22. Diarrhoea, &c. 13 7 ... 1 ... ... 3 ... 2 10 23. Appendicitis and Typhlitis 14 ... ... ... ... 3 6 4 1 16 24. Cirrhosis of Liver 13 ... ... ... ... ... 2 9 2 11 25. Acute and Chronic Nephritis 66 ... ... ... ... 1 6 31 28 54 26. Puerperal Sepsis 1 ... ... ... ... ... 1 ... ... 3 27. Other diseases of Pregnancy 5 ... ... ... ... ... 5 ... ... 12 28. Congenital Debility and Malformation, Premature Birth 74 74 ... ... ... ... ... ... ... 38 29. Suicide 25 ... ... ... ... 3 7 9 6 12 30. Other Deaths from Violence 67 3 1 4 7 2 10 14 26 81 31. Other Defined Diseases 314 29 6 7 12 14 35 80 131 300 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... All Causes M. 1012 88 22 19 24 52 110 318 379 916 F. 1053 62 22 18 26 53 114 261 497 828 Totals 2065 150 44 37 50 105 224 579 876 1744 111 East Battersea. TABLE IV. Infant Mortality, 1927. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2 3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F M. F. M. F. M. F. M. F M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis Other Tuberculous ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 ... 3 3 4 1 9 5 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Enteritis ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 1 ... ... 1 ... 3 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 5 5 2 3 3 ... 1 1 ... ... 11 9 3 ... ... ... ... ... ... ... 14 9 Congenital Malforma- tion ... ... ... ... ... ... ... ... ... 1 ... l 1 ... ... ... ... ... ... ... 1 l Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... 2 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... 4 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... I 1 Atelectasis & Asphyxia Neonatorum 2 1 ... ... ... ... ... ... ... ... 2 l ... ... ... ... ... ... ... ... 2 l Lack of Care 2 ... ... ... ... ... ... ... ... ... 2 ••• ... ... ... ... ... ... ... ... 2 ... Convulsions ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Homicide 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 2 1 10 7 3 4 3 1 1 2 ... 1 17 15 7 2 6 3 9 4 7 1 46 25 Totals 17 7 4 3 1 32 9 9 13 8 71 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1216 35 1251 66 5 71 112 North-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1927. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F M. F. M. F M. F. M. F M. F M. F. M. F. M. F. M. F M . F Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... Pneumonia, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 3 1 6 2 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 3 1 4 3 ... 2 3 1 ... ... 10 8 ... ... ... ... ... ... ... ... 10 8 Congenital Malformation ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... 1 2 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis and Asphyxia Neonatorum ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Lack of Care 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Convulsions ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... l ... 3 ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Causes ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 1 1 1 ... ... 2 3 4 3 5 5 1 3 1 ... ... 13 11 2 1 3 4 6 2 5 1 29 19 Totals 7 10 3 4 ... 24 3 7 8 6 48 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 883 32 915 45 3 48 113 South-West Battersea. TABLE IV.—[contd.) Infant Mortality, 1927. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M f M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pul monaryT uberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Otljer Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia, all forms Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 1 4 4 1 ... ... 1 ... ... 9 6 ... 1 ... ... ... ... ... ... 9 7 Congenital Malformation ... 1 ... 1 1 ... ... ... ... 1 1 3 ... ... ... ... ... ... ... ... 1 3 Congenital Debility ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis & Asphyxia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... 1 ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... 1 2 ... ... ... ... ... 3 ... ... ... ... ... 1 ... ... ... 4 4 2 4 7 2 2 1 1 ... 1 11 13 1 3 1 1 ... 1 ... 13 18 Totals 6 11 4 2 1 24 4 2 1 ... 31 Nett Births in the year. Nett Deaths in the year(Infants under 1 year Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 613 22 635 31 ... 31 114 Borough of Battersea. TABLE IV.—(contd.) Infant Mortality, 1927. Nett 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 1 year. Percentage of Total. 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.67 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.67 Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 2 2 ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.67 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 1... ... ... ... ... ... ... ... 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.67 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.67 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... 0.67 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 ... 1.33 Pneumonia (all forms) ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 2 1 5 3 7 2 15 8 2.00 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15.33 Diarrhœa & Enteritis ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 2 1 ... ... 1 ... 4 ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 4.67 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 0.67 Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.33 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 0.67 Premature Birth 11 8 11 1(J 4 2 4 3 ... ... 30 23 3 1... ... ... ... ... ... ... ... ... 0.67 Congenital Malformation ... 1 ... 2 1 ... ... ... ... ... 1 5 1 1 ... ... 1 ... ... ... 3 6 38.00 Congenital Debility ... ... ... ... ... ... 1 ... ... ... 1 ... 2 1... ... 1 ... ... ... 4 1 6.00 Icterus Neonatorum Injury at Birth ... ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 1 0.67 Atelectasis & Asphyxia Neonatorum 2 2 1 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 2 1.33 Lack of Care 3 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... 2.00 Convulsions ... 1 ... 1 1 ... ... ... ... ... 1 2 ... ... ... ... 1 1 ... ... ... 3.33 Homicide 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 0.66 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Other Causes ... ... ... ... ... ... ... ... ... ... ... 4 ... ... 1 1 3 3 ... ... 4 8 8.00 17 12 13 16 6 5 5 4 ... 2 41 39 10 6 10 8 U 7 12 2 88 62 100.00 Totals 29 29 11 9 2 80 16 18 22 14 150 — Percentage of Total ... 19.3 19.4 7.3 6.0 1.3 53.3 10.7 12.0 14.7 9.3 100.0 — M. 58.7% F. 41.3% Nett Births in the year. Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M. 1,338 44 1,382 81 7 88 F. 1,374 45 1,419 61 1 62 Totals 2,712 89 2,801 142 8 150 115 Form T53. TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary (or Dispensaries) during the year 1927. Diagnosis. Pulmonary. Non- Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during (a) Definitely tuberculous 85 59 3 3 11 7 7 9 96 66 10 12 (b) Doubtfully tuberculous — — — — — — 75 42 23 29 (c) Non-tuberculous — — — — — — — 80 93 64 51 B.—Contacts examined during the year :— (a) Definitely tuberculous 3 — — — — — — — 3 — — — (b) Doubtfully tuberculous 1 6 12 7 (b) Non-tuberculous — — — — — — — — 20 45 60 45 C.—Cases written off the Dispensary Register as (a) Cured — 7 — 1 1 — 5 4 1 7 5 5 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 166 243 176 142 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 324 219 72 87 25 22 92 «S6 349 241 164 143 (6) Diagnosis not completed — — — — — — — — 21 29 17 15 1. Number of persons on Dispensary Register on January 1st 1,119 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 57 2. Number of patients transferred from other areas and of "lost sight of " cases returned 20 10. Number of consultations with medical (a)At Homes of Applicants 19 3. Number of patients transferred to other areas and cases "lost sight of " 100 (b) Otherwise 700 11. Number of other visits by Tuberculosis Officers to Homes 167 4. Died during the year 111 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 5,434 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 35 13. Number of (a) Specimens of sputum, &c., 535 6. Number of attendances at the Dispensary (including Contacts) 4,180 (b) X-ray examinations made in connection with Dispensary work 115 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or supervision - 14. Number of Insured Persons on Dispensary Register on the 31st December 462 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 190 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for 16. Number of reports received during the year in respect of Insured (a) " Light " treatment 231 (b) Other special forms of treatment 122 (a) Form G.P. 17 5 lb) Form G.P. 36 219 116 TUBERCULOSIS SCHEME OF THE METROPOLITAN BOROUGH COUNCIL OF BATTERSEA. From T56 (a) Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1927, arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. 1921—25. 1 1926. 1927. 1928. 1929. Class T.B minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. J Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. 1 Total (Class T.B. plus.) alive. Discharged as cured. Adults m. 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Chil- dren m. 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease arrested. Adults m. 11 4 6 - 10 1 - - - - - - - - - - - - - - - - - - - - - - - - f. 11 - 1 - 1 - - - 1 1 - - - - - - - - - - - - - - - - - - - - Children m. 4 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. 4 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults m. 6 18 40 1 59 8 3 22 8 33 17 9 40 15 64 - - - - - - - - - - - - - - - f. 8 7 13 4 24 8 4 15 8 27 14 1 26 9 36 - - - - - - - - - - - - - - - Children M. 3 - 2 - 2 4 - - - - 2 - 1 - 1 - - - - - - - - - - - - - - - f. 8 - 2 - 2 2 - - 1 1 3 - - - - - - - - - - - - - - - - - - - Condition not ascertained during the Year. 14 8 9 7 24 3 4 3 3 10 - - - - - - - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register. 63 30 70 30 130 4 1 11 2 14 3 - - - - - - - - - - - - - - - - - - - dead. Adults M. 19 16 68 122 226 1 1 12 22 35 - - 3 11 14 - - - - - - - - - - - - - - - f. 6 12 47 89 148 3 - 4 11 15 1 - 1 11 12 - - - - - - - - - - - - - - - Children m. 3 - 1 3 4 - - - - - - - - - - - - - - - - - - - - - - - - - f. 5 1 2 1 4 - - - 1 1 - - - - - - - - - - - - - - - - - - - - totals 173 99 281 257 637 34 13 67 57 137 40 10 75 46 131 - - - - - - - - - - - - - - - 117 (6) Non-Pulmonary Tuberculosis. Form T56 Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1927, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the 1 ast record made during the year to which the Return relates. 1921—25. 1926. 1927. 1928. 1929. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. I Abdominal. Other Organs. Peripheral Glands. Total. ALIVE. Discharged as cured. Adults M. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children M. 2 1 — 4 7 — — — — — — — — — — — — — — — — — — — — — — — — — F. 2 1 — 8 11 — — — — — — — — — — — — — — — — — — — — — — — — — Disease arrested. Adults M. 1 3 2 2 8 2 — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — 2 3 — — — — — — — — — — — — — — — — — — — — — — — — — Children M. 6 4 1 25 36 1 — — 1 2 — — — — — — — — — — — — — — — — — — — — F. 5 2 — 17 24 1 — 1 2 4 — — — — — — — — — — — — — — — — — — — — Disease not arrested. Adults M. 1 — 2 — 3 1 1 1 — 3 6 — 1 4 11 — — — — — — — — — — — — — — — F. 3 1 4 1 9 1 1 — 4 6 2 — — — — — — — — — — — — — — — — — — — Children M. 2 2 1 21 26 3 2 2 10 17 2 3 3 — 8 — — — — — — — — — — — — — — F. 2 2 1 9 14 1 — — 6 7 1 2 2 8 13 — — — — — — — — — — — — — — — Transferred to Pulmonary — 1 — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — Condition not ascertained during the Year. 6 1 1 5 13 2 — — 2 4 — — — — — — — — — — — — — — — — — — — — Lost Sight of or otherwise removed from Dispensary Register. 14 — 6 32 52 1 2 1 3 7 — — — — — — — — — — — — — — — — — — — — DEAD. Adults M. 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — 1 3 1 5 — — — — — — — — — — — — — — — — — — — — — — — — — Children M. 1 — — 1 2 — — — — — — — — — — — — — — — — — — — — — — — — — F. — 1 — 2 3 — — — — — — — — — — — — — — — — — — — — — — — — — TOTALS 50 20 21 131 222 13 6 7 28 54 12 5 6 17 40 — — — — — — — — — — — — — — —