Battersea Borough Council. With the compliments of the Medical Officer of Health. ??? 2 MUNICIPAL BUILDINGS, LAVENDER HILL, S.W Metropolitan Borough of Bettersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, For the YEAR 1919. BY G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H MEDICAL OFFICER OF HEALTH. 3 Health Committee. As constituted 9th November, 1918. As constituted 9th November, 1919. Chairman: Alderman G. WEADRIFF. Chairman: Councillor Mrs. C. S. GANLEY, J.P. HIS WORSHIP THE MAYOR (Councillor W. J. Moore, J.P.) Councillor C. BARRINGTON. „ W. M. BRADFORD. „ J. COLTMAN. „ F. DUNMORE. „ C. E. MASON. „ R. W. MOFFREY, J.P, „ J. W. O'BRIEN. „ A. M. T. SIMMONDS. „ E. S. STRANGE. „ J. J. TAYLOR. „ J. W. TAYLOR. „ H. THOMAS. HIS WORSHIP THE MAYOR (Councillor A. Winfield, J.P.) Councillor W. R. CROUCHER. „ G. DAVIS. „ Mrs. E. H. D. DUVAL. „ P. P. HAYTHORNTHWAITE „ Mrs. J. HOCKLEY. „ T. JONES. „ R. MOORE. „ J. W. O'BRIEN. „ G. A. SAUNDERS. „ E. E. TOMALIN. „ A. WELSH. „ H. WHITE. 4 Staff of the Public Health Department. (at 31st December. 1919.) Chief Sanitary Inspector. I. Young. Woman Sanitary Inspector & Health Visitor. Miss A. E. Moss, San. Insp. Board's Cert., C.M.B. Health Visitors. Miss N. Bourdillon, San. Insp. Board's Cert., C.M.B. Miss B. L. Kaye, „ „ „ „ Miss N. Playne, „ „ „ „ Miss J. Round, „ „ „ Food Inspector. A. Chuter, Cert. San. Inst. & Meat Insp. Cert. Workshop Inspector. W. E. Benjamin, Cert. San. Inst. District Sanitary Inspectors. No. 1 District J. Herrin, Cert. San. Inst. „ 2 „ J. J. Burgess, San. Insp. Board's Cert. „ 3 „ J. Lawrence, Cert. San. Inst. & Meat Insp. Cert. „ 4 „ A. E. Purnell, Cert. San. Inst. „ 5 „ J. T. Baxter „ „ „ 6 „ H. Marrable „ „ „ 7 „ A. Odell, Cert. San. Inst. & Meat Insp. Cert. „ 8 „ H. H. May, Cert. San. Inst. Clerical Staff. Chief Clerk F. E. Ward. Second Class Clerk E. Cole. Third Class Clerks W. Halstead. H. C. Godfrey. Superintendent of Disinfecting Station. C. H. Woodhouse. Mortuary Keeper. G. Streat. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health and sanitary state of Battersea for the year 1919. I returned from Military service on the 24th March, 1919, but the Report deals with the whole of the year from January to December. During the war public health activities were necessarily restricted. Most of the clerical staff were absent on Military service, and this branch of the department suffered the loss of two of its members, who sacrificed their lives in the service of their country. The loss of the Chief Clerk of the Health Department was a most grievous one. This Officer was most accomplished, useful and painstaking in the performance of his duties, his experience and special qualifications fitting him in every way to perform with efficiency the responsible and onerous duties he was called upon to carry out. The year was chiefly memorable from the administrative standpoint in that it was mainly a period of re-construction after the war. Strenuous efforts were made to bring the department back to its pre-war activities. These efforts were, on the whole, very successful, and their success is reflected in the results of the year's work as outlined in this Report, notwithstanding the heavy volume of new work requiring attention following recent legislative activity, especially in the direction of Housing and the care and welfare of women and young children. I have to acknowledge the support given me by the Health, Housing, and Maternity and Child Welfare Committees of the Council. To my colleagues the Chief Officers of the Council, and to the staff of the Public Health Department, my thanks are also due for assistance always willingly rendered. G. Quin LENNANE. Town Hall, Lavender Hill, S.W.11. 6 CONTENTS. Births, Marriages and Deaths. page Vital Statistics 9 Births 10 Illegitimate Births 12 Marriages 12 Deaths 12 „ (Age Periods) 14 Deaths in Public Institutions 14 Senile Mortality 15 Comparative Table of Births, Mortality, etc. (1857-1919) 16 Infant Mortality 17 Notification of Births Act 19 Milk Orders 20 Maternity and Child Welfare Scheme 24 Maternity and Infant Clinics 25 Health Visitors 26 Ante-Natal Work 27 Puerperal Fever 28 Ophthalmia Neonatorum 28 Acute Polio-Myelitis 28 Diarrhœa 28 Measles and German Measles 29 Whooping Cough 30 Notifiable Infectious Diseases 31 Contacts 34 Small-pox 35 Scarlet Fever 36 Diphtheria 36 Enteric Fever 37 Erysipelas 37 Cerebro-Spinal Fever 37 Encephalitis Lethargica 37 Tuberculosis 38 Battersea Dispensary for Prevention of Consumption 39 Tuberculosis—After-care 40 „ —Contacts 40 Home Treatment of Tuberculosis 41 Institutional Treatment 41 Day Sanatorium or Open-air School 41 Incidence of Tuberculosis 41 Non-Notifiable Infectious Diseases. Chicken-pox 44 Influenza 44 Bacteriological Examinations 46 Rabies 47 Anthrax 47 7 page Sanitary Circumstances 49 Sanitary Inspection, of the Borough 49 Summary of Sanitary Operations 49 Legal Proceedings in connection with Nuisances 50 Drainage 51 Revenue Act (1903) Certificates 51 Smoke Nuisance 51 Effluvium Nuisance 52 Sanitary Staff 52 Rag Flock Act (1911) 52 Personal Cleansing Station 53 Disinfecting Department 54 Summary of Work in Disinfecting Department 54 Mortuary 55 Inquests 55 Protection of Food Supply. 56 Unsound Food 56 Butchers' Shops 57 Slaughter Houses 57 Ice Cream 57 Milk Shops 58 Restaurant Kitchens 58 Fish Shops 58 Sale of Food and Drugs Acts 58 Milk 59 Legal Proceedings under the Food and Drugs Acts 60 Warranty Defence 61 Milk and Cream Regulations (1912 and 1917) 61 Factories, Workshops, Workplaces, and Homework. 63 1.—Inspections of Factories, etc. 63 2.—Defects found in Factories, etc. 63 3.—Registered Workshops 64 4.—Other Matters 64 Factories on Register 64 Workshops 65 Bakehouses 66 Outworkers 66 Home-work 68 Housing 69 Statistics for 1919 72 Report to Borough Council 73 Unhealthy Areas 80 Appendices. Deaths from all Causes 82 Summary of Legal Proceedings 92 Table I.—Vital Statistics 93 „ II.—Cases of Infectious Disease 94 „ III.—Causes of and Ages at Death 95 „ IV.—Infant Mortality 96 8 Summary of Vital Statistics for 1919. Area of Borough, 2,139 9 acres (excluding water), divided into three registration sub-districts, tvo Parliamentary Divisions, and nine Wards. Population—estimated 1919:— For births 165,960 For deaths 159,316 Density 74.45 Inhabited houses 24,926 Marriages 1,677 Marriage-rate 20.2 Births 3,075 Birth-rate 18.5 Deaths 2,061 Death-rate 12.9 Infantile mortality 74.1 Death-rate from the principal infectious diseases 0.60 CENSUS 1911. Population 167,743 Number of inhabited houses 24,321 Average number of persons per house 6.9 9 Births, Marriages and Deaths. Vital Statistics. The population of the Borough of Battersea at the Census taken in April, 1911, was 167,743. The estimates of the population, according to the Registrar-General, of the Borough for the year 1919 are:— For the Birth-rate 165,960 For the Death-rate 159,316 The estimated population, based upon the RegistrarGeneral's figures for registration sub-districts and for the nine Wards, is set out in the following table:— Registration Sub-District. For the purpose of the birth-rate. For the purpose of the death-rate. East Battersea 69,018 66,256 North-West Battersea 48,599 46,653 South-West Battersea 48,343 46,407 The Borough 165,960 159,316 Ward No. Ward. For the purpose of the birth-rate. For the purpose of the death-rate. 1 Nine Elms 27,085 26,001 2 Park 17,405 16,708 3 Latchmere 19,880 19,084 4 Shaftesbury 15,861 15,226 5 Church 19,171 18,404 6 Winstanley 20,032 19,230 7 St. John 8,129 7,803 8 Bolingbroke 18,298 17,566 9 Broom wood 20,099 19,294 The "birth-rate and marriage-rate population" includes all the elements of the population contributing to the birth and marriage rates. The "death-rate population," on the other hand, excludes all non-civilian males, whether serving at home or abroad. 10 This, it is stated, is necessary for the purposes of the local death-rates because it has proved impossible to transfer the deaths of non-civilians to their areas of residence, or to deal in any other satisfactory manner with the local mortality of this element of the population. The natural increase of population by excess of births over deaths during 1919 amounted to 1,014. The estimates of the Registrar-General for the Borough are probably too low. Judging from the rationing returns* and by the existing conditions as to housing in Battersea, it is probable that the population is at least equal to, if not greater than, that enumerated at the Census of 1911. The conditions brought about by the war render it very difficult to estimate with accuracy the present population. The Census is now nearly due (1921), and it will then be possible to ascertain the true facts in regard to the recent estimates of the population. Battersea is, in the main, a working-class district, and the principal industries employ only a comparatively small proportion of the population. It is, therefore, to a great extent, a dormitory for the residents, and its proximity to the large business areas of Central London and the West End makes it a convenient residential quarter for workers whose employment is situate in these districts. The housing difficulty has tended to strain the existing housing accommodation in the Borough, and the increased cost of transport has probably been instrumental in still further promoting the tendency to serious overcrowding, which is unfortunately becoming evident through the recent activity in house-to-house inspection. In spite of these, it is to be hoped, temporary drawbacks, the health of the Borough, as will be noted from a perusal of this Report, continues to be well-maintained, and compares favourably in this respect with other Metropolitan Boroughs. Births. During the year 3,075 births were registered in Battersea. Of these births 1,596 were males, and 1,479 females, showing an excess of 117 males. The births were 375 in excess of the number registered in the Borough in 1918. The births in the three registration sub-districts of the Borough were as follows:— Males. Females. Total. East Battersea 696 638 1,334 North-West Battersea 532 479 1,011 South-West Battersea 368 362 730 Borough 1,596 1,479 3,075 * The estimated population according to the Rationing Returns is 167,685 11 The birth-rate was 18.5, and is probably the lowest rate recorded in the old Parish and Borough of Battersea, with the exception of the years 1917 and 1918, when the rates were 177 and 161 respectively. The decline in the birth-rate, which is such a marked feature during recent years of the vital statistics of all civilised communities is very disquieting. This important question has been referred to in previous annual reports. It is satisfactory, at least, to note that one of the main causes responsible—i.e., venereal disease—is now receiving practical attention, and that steps are being taken to educate the public to the danger to the health and well-being of the nation from the unchecked ravages of venereal disease. The decline in the birth-rate in Battersea, as compared with that in London and in England and Wales, is shown in the table below:— Birth-rate per 1,000 Population. Years. England & Wales. London. Battersea. 1877-81 34.9 35.3 40.5 1882-86 33.3 34.0 40.0 1887-91 33.2 33.9 36.1 1892-96 30.1 30.6 32.4 1897-1901 29.0 29.5 30.8 1902-06 27.8 27.7 27.5 1907-11 25.5 25.5 24.8 1912-16 22.9 23.5 24.4 1917 17.8 17.9 177 1918 17.7 16.0 16.1 1919 18.5 18.3 18.5 The following tables show the birth-rates per 1,000 of the population for each of the nine Wards of the Borough, and the registration sub-districts:— Ward. Population 1919. Number of Births. Birthrate. No. 1, Nine Elms 27,085 630 23.3 No. 2, Park 17,405 350 20.1 No. 3, Latchmere 19,880 341 17.2 No. 4, Shaftesbury 15,861 219 13.8 No. 5, Church 19,171 407 21.2 No. 6, Winstanley 20,032 436 21.8 No. 7, St. John 8,129 137 16.9 No. 8, Bolingbroke 18,298 283 15.5 No. 9, Broomwood 20,099 272 13.5 12 Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1909 23.9 26.5 31.9 13.9 1910 23.7 26.6 30.5 14.8 1911 26.1 27.5 32.3 17.8 1912 25.4 28.4 28.9 17.6 1913 25.3 27.0 29.6 18.5 1914 25.7 27.9 30.9 17.2 1915 23.6 26.2 26.8 16.7 1916 21.8 23.0 25.0 16.8 1917 17.7 19.0 19.8 13.8 1918 16.1 17.7 17.8 12.0 Average 1909.1918 22.9 25.0 27.4 15.9 1919 18.5 19.3 20.8 15.1 Illegitimate Births. Of the total births registered in the Borough as belonging to Battersea 159 were of illegitimate children (i.e., 5.17 per cent.). Marriages. The marriages registered in Battersea during 1919 number 1,677; the marriage.rate, i.e., the number of persons married per 1,000 of the population being 20.2. Deaths The total number of deaths registered in Battersea during the year 1919 was 2,409, as compared with 3,195 in 1918. Of the total deaths registered 1,182 were males and 1,227 females, showing an excess of 45 females. The crude registered death-rate for Battersea in 1919 is 151 per 1,000 population. This rate is, however, uncorrected, and, on analysing the 2,409 deaths registered, it is found that 730 represent deaths of non-residents. These 13 deaths are to be deducted; but, on the other hand, there are 382 deaths of Battersea residents registered outside the Borough. These must be added, giving a corrected number of deaths for Battersea during 1919 of 2,061, and a nett corrected death-rate of 129 per 1,000 population as compared with 13.6 for London. Subdividing the death-rate amongst the three registration sub-districts, it will be noted that the rates have been fairly uniform in each of the sub-districts. It is noteworthy, however, that South-West Battersea shows a higher deathrate than either of the other two sub-districts. This SouthWest sub-district, heretofore, was inhabited, in the main, by a more prosperous class of resident; but it is apparent that a change is taking place in the character of the sub-district, and to this cause, to some extent at least, the increased mortality rate recorded in South-West Battersea during the year 1919 may be attributable. The following table shows the death-rates per 1,000 of the population for the Borough and the sub-districts for the ten years, 1909-1918 and the year 1919, respectively:— Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1909 13.0 14.0 16.5 8.7 1910 11.3 11.9 13.9 8.3 1911 14.3 14.9 16.8 10.9 1912 12.2 12.8 13.5 10.1 1913 14.1 15.0 16.3 10.8 1914 13.2 14.0 14.4 10.9 1915 16.4 16.2 18.8 14.2 1916 13.9 14.5 14.7 12.4 1917 15.2 15.4 16.3 14.0 1918 18.7 19 2 20.2 16.6 Average 1909-1918 14.2 14.8 16.1 11.7 1919 12.9 12.4 12.7 13.7 14 The death-rates per 1,000 inhabitants for each of the nine Wards are shown in the following table:— Ward. Population 1919. Number of Deaths. Deathrates. No. 1. Nine Elms 26,001 316 12.2 No. 2. Park 16,708 234 14.0 No. 3. Latchmere 19,084 217 11.4 No. 4. Shaftesbury 15,226 193 12.7 No. 5. Church 18,404 229 12.4 No. 6. Winstanley 19,230 252 13.1 No. 7. St. John 7,803 89 11.4 No. 8. Bolingbroke 17,566 265 15.1 No. 9. Broomwood 19,294 266 13.8 The position which the Borough occupies during 1919 in the Registrar-General's corrected returns among the twentynine Metropolitan Cities and Boroughs is satisfactory. The lowest mortality rate (11.2) is recorded for Wandsworth and the highest (16.2) for Holborn. There are nineteen with a higher general death-rate than Battersea. Age Periods. The following table shows the age-distribution of the total deaths (corrected) in Battersea during 1919:— Under 1 year. 1-2 5-10 10-15 15-25 25-45 45-65 65- Total. 228 56 67 89 101 304 510 706 2,061 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 370 402 772 Second quarter 217 233 450 Third quarter 183 169 352 Fourth quarter 265 222 487 15 Deaths in Public Institutions During 1919 the deaths of Battersea residents occurring in Public Institutions numbered 830. Of this number 463 occurred within and 367 outside the Borough. Of the 830 deaths in Public Institutions 461 occurred in Poor Law Institutions. Senile Mortality. During 1919 the deaths of 706 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 aud upwards. Total over 65. East Battersea 152 94 22 268 North-West Battersea 84 63 18 165 South-West Battersea 121 108 44 273 Borough of Battersea 357 265 84 706 The deaths over 65 in each year during the ten years 19101919 were:— 1910 510 1911 591 1912 570 1913 631 1914 604 1915 784 1916 724 1917 730 1918 730 1919 706 Comparative Statistics of Births, Mortality, &c. Year Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.0 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 292 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 595 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.7 669 22.1 129 471 1865 33,688 1,357 40.2 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.8 1,121 23.4 247 975 1870 51,320 2,70 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,190 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 5,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 30.5 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 1,033 1910 188,222 4,489 23.7 2,124 11.3 242 1,365 1911 167,765 4,381 261 2,404 14.3 336 1,977 1912 167,589 4,255 25.4 2,052 12.2 138 2,203 1913 167,464 4,240 25.3 2,365 14.1 208 1,875 1914 167,338 4,303 25.7 2,217 13.2 142 2,086 1915 161,945 3,820 23.6 2,653 16.4 334 1,167 1916 B*173,432 3,774 21.8 — — - - D* 159,402 . . 2,221 13.9 160 1,553 1917 B* 167,233 2,960 17.7 — — - - D* 150,023 . — 2,285 15.2 185 675 1918 B* 168,014 2,700 161 — — - - D*149.951 — — 2,809 18.7 204 —109† 1919 B* 165,960 3,075 185 — — - - D* 159.316 . . 2,061 12.9 95 1,014 *B = Population as estimated for purpose of the Birth-rate. *D = Population as estimated for purpose of the Death-rate, † Decrease. The years marked were census years. 17 Infant Mortality. During 1919 the deaths of 228 infants were registered as belonging to Battersea. The total number of births registered during the year was 3,075, giving an infant mortality rate of 74T. This is the lowest rate ever recorded in Battersea. Since the formation of the Borough and for the previous decennium, the infant mortality in Battersea and in London is set out in the following table:— Year. London. Battersea. 1891-00 158 162 1901 148 163 1902 139 136 1908 130 135 1904 144 147 1905 129 131 1906 129 126 1907 116 115 1908 113 107 1909 108 107 1910 103 97 1911 129 124 1912 91 83 1913 105 111 1914 104 92 1915 112 112 1916 89 84 1917 104 101 1918 108 99 1919 85 74 It will be seen from the above table that the decline in infant mortality in Battersea has been remarkable in recent years. The infant mortality rate for the County of London was 85 per 1,000 births, and is a lower rate than has hitherto been recorded. The lowest rate previously recorded was 89 per 1,000 births in 1916. 18 The distribution of the 228 infant deaths and the infant mortality rates for the registration sub-districts and for the wards is shown in the following tables:— Registration Sub-Districts. Deaths of Infants under 1 year of age. Infantile Mortality per 1,000 births. East Baltersea 96 72 North-West Battersea 82 81 South-West Battersea 50 68 The Borough 228 74 Infant Death Rates in Wards. Ward. Births. Infant Deaths. Infant Death- rate (per 1000 births). 1. Nine Elms 630 53 84 2. Park 350 21 60 3. Latchmere 341 18 53 4. Shaftesbury 219 16 73 5. Church 407 39 96 6. Winstanley 436 34 78 7. St. John 137 8 58 8. Bolingbroke 283 23 82 9. Broomwood 272 16 59 The next table shows the incidence of mortality from the chief diseases of infancy in the first and second trimesters and the second six months of the first year of life:— 19 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—12. Total. Diarrhœa 1 4 - 5 Prematurity 56 — 1 57 Marasmus and Debility 23 6 1 30 Developmental Disease 16 — 1 17 Bronchitis 3 2 4 9 Pneumonia 9 10 14 33 Convulsions 1 1 — 2 Suffocation — — — — Measles — 2 — 2 Whooping Cough 1 — 1 2 Tubercular Meningitis — — 4 4 Meningitis — — 2 2 Miscellaneous 29 14 22 65 139 39 50 228 From the above table it will be seen that 139, or 61 per cent., of these infant deaths occurred in the first three months of life, a fact not without significance when the measures which are being taken to combat infant mortality come under annual revision. The death-rate amongst illegitimate children during 1919 was 151 per 1,000 births, and was double the mortality rate of legitimate infants. Notification of Births Act. The Notification of Births Act, 1907, was adopted in the Borough, and came into operation in March, 1908. This useful legislative measure was passed to provide for the early notification of births to the Medical Officer of Health, and so to avoid the delay which arose through the late registration of births. The Act, which has now been in force for 12 years, provides that the birth of every child shall be notified to the Medical Officer of Health within 36 hours. The notification is "in addition to and not in substitution for the requirements of any Act relating to the registration of births," and applies to any child born "after the twenty-eighth week of pregnancy, whether alive or dead." In case of default a penalty of twenty shillings is provided. 20 During 1919 the number of notifications of births received was 2,928. The (corrected) number of births registered in Battersea was 3,075. The proportion of notified to registered births was, therefore, 95.2 per cent., compared with 85.8 in 1918 and 78.1 in 1917. 318 or 10.8 per cent. of the notifications were made by medical practitioners, 1,601 or 54.7 per cent. by midwives, and 1,009 (34.5 per cent.) by other persons. Sixty-eight still-births were notified during the year. The notified cases are visited by the Council's official or by the voluntary Associations' trained health visitors. It is not possible, of course, with the staff at our disposal to visit more than a proportion of the cases, but as far as circumstances will permit efforts are made to visit in the less prosperous districts of the Borough the home of every newly-born child notified. This very important work has suffered from the increased duties thrown upon the health-visiting staff in connection with the milk orders. In all cases of notified births visited enquiries are made into the methods of feeding, and breast feeding is encouraged wherever possible. The care and management of infants is tactfully explained to the mothers, who are at the same time invited to bring their babies to the nearest Infant Welfare Centre, so that the subsequent history and progress of the infants and the mothers can be followed up and kept under continuous observation. Returns of all births (with home addresses) registered in Battersea are obtained from the district Registrars weekly. This practice is most useful in providing a check on the notified returns. Milk Orders. The Milk (Mothers and Children) Order, 1918, and the Local Authorities (Food Control) Order (No. 1), 1918, were in force in the Borough of Battersea during the year 1919. These orders were administered mainly from the Town Hall Centre, but, in part, locally through the Council's Maternity and Child Welfare Centres, and through the Voluntary Associations' Centres linked up with the Council's scheme. The orders remained in force until rescinded on 22nd December, 1919, and were succeeded by the Milk (Mothers and Children) Order, 1919, and the Local Authorities Milk (Mothers and Children) Order, 1919. These two latter orders re-enacted the two former orders, with the following modifications:— 21 1. The orders relate to milk only and not to food. 2. The power of the Local Government Board to require Local Authorities to make arrangements for the supply of milk is omitted. 3. Local Authorities are empowered to supply milk free, or at less than cost price, not merely in necessitious cases, but also where such supply is necessary because of the retail price of milk in any area. 4. The quantity of milk to be supplied is prescribed by the new orders as follows:— (a) For children under 18 months—pints daily. (b) For children between 18 months and 5 years— 1 pint daily. (c) For expectant and nursing mothers—the quantity prescribed by the person certifying. The effect of the orders, therefore, is to empower Local Authorities to supply milk to expectant and nursing mothers and to young children without previously receiving the consent of the Ministry of Health (as required by the Maternity and Child Welfare Act, 1918, in respect of distribution carried out under that Act), free or under cost price, where some person authorised by the Local Authority has certified this to be necessary by reason of the retail, price of milk in its district. The Maternity and Child Welfare grant distributed by the Ministry of Health is limited to the cost of any food, including milk distributed to necessitous cases occurring among expectant and nursing mothers and children under 5 years of age, who are certified by the Medical Officer of the Welfare Centre, or by the Medical Officer of Health, to be in need of the food or milk, and separate accounts must be kept of milk supplied to non-necessitous applicants, which do not rank for a grant in aid, as in the case of necessitous applicants. The new orders have caused much extra work to the Public Health Department. The Borough Council gave instructions for their terms to be made known by circular throughout the Borough. The Medical Officer of Health was authorised to make the necessary arrangements to put into operation the powers of the orders, and it was left to his discretion, subject to the terms of the orders, as to the extent to which the scheme should be administered in the Borough. In accordance with the directions of the Ministry of Health, a circular letter was sent to all medical practioners, nurses, midwives, and others drawing their attention to the powers of the orders and asking for their co-operation. 22 As was to be expected, owing to the scarcity and high price of milk, very considerable use was made of the powers conveyed in the new orders. A scale of charges, based on the family income and number in family, was drawn up by the Medical Officer of Health to serve as a rough guide, and was approved by the Health and Maternity and Child Welfare Committees. The scale is as follows:— Free milk— Income not exceeding 29s. per week for man and wife. 6s. for first child. 3s. for each succeeding child. Half-price— Incomes under 35s. for man and wife. 10s. for first child. 5s. for each succeeding child. Cost price— Incomes under £3 per week for man and wife and one child. Copies of the handbill and circular letter referred to and of the form of application in use for the supply of dried milk are as follows:— Battersea Borough Council. Milk for Expectant and Nursing Mothers. Owing to the increase in the price of milk, arrangements are now being made to provide facilities for the issue of a supply of milk to nursing and expectant mothers who are likely to be unable to obtain sufficient milk. Arrangements can also be made to ensure a supply of milk in the case of children under school age. Enquiries should be addressed to the Medical Officer of Health, Public Health Department, Town Hall, Lavender Hill. G. Quin Lennane, Medical Officer of Health. By Order, W. Marcus Wilkins, Town Clerk. October, 1919. 23 Public Health Department, Municipal Buildings, Battersea, S.W. 11. 21th October, 1919. Dear Sir (or Madam), Facilities are now being considered by the Council of the Health Committee in connection with the supply of milk to expectant and nursing mothers who are likely to be unable to provide sufficient for themselves and their children, in view of the present high cost and the anticipated scarcity. These facilities also apply to children under school age, and parents are advised to bring them to the Welfare Centres, so that recommendations may be made in all suitable cases. I shall be glad, therefore, if you would report to me cases of expectant and nursing mothers who, in your opinion, require an additional supply of milk. Yours faithfully, (Sgd.) G. Quin Lennane, Medical Officer of Health. Dried Milk—Application for Supply at Reduced Rates. Name of Applicant Address Number in Family Special Circumstances. Ages of Children (Boys) (Girls) Father's Occupation Number of Rooms Rent Income— £ s. d. Father Others Milk required for Investigator's Signature Date 19 24 It should be borne in mind that the scale is intended to serve only as a basis, and a good deal of elasticity has to be given in its application ; but, on the whole, it seems to have worked fairly well. The economic conditions at present prevailing render it difficult to fix an arbitrary standard. ( are is taken to see that no exploitation is made of these very admirable powers. It is essential, however, that nursing and expectant mothers and young children should have a reasonable supply of milk, and while this point of view is fully recognised, in cases of doubt as to the financial status of the family it is the practice to interpret the orders in the spirit rather than in the letter. The total number of necessitous mothers and children receiving milk under the provisions of the orders were 165, of whom 28 had discontinued during 1919. Maternity and Child Welfare Scheme. The passing into law of the Maternity and Child Welfare Act of 1918 gave an enormous impetus to the efforts of health authorities in connection with Maternity and Child Welfare work. The Act is compulsory, and requires every sanitary authority to take effective measures for the welfare of nursing and expectant mothers, and of children who are not attending public elementary schools, or who are under 5 years of age. Every sanitary authority was called upon to appoint a Maternity and Child Welfare Committee, and provision was made in the Act for the co-option of outside members, of whom at least two should be women. In 1919 an important and valuable memorandum was issued by the Local Government Board, which set out in detail the measures that could be included under the provisions of the Act for an effective scheme for co-ordinating and developing the existing methods being carried out by sanitary authorities and voluntary organisations in connection with Maternity and Child Welfare. The Act, moreover, provided that cost incurred by sanitary authorities in connection with such schemes would rank for contribution from the National Exchequer. A letter was received from the Local Government Board, dated the 21st March, 1919, stating that, from the report of one of their inspectors of a recent visit of enquiry into the Maternity and Child Welfare. Scheme of the Borough, it appears that the appointment of at least two additional health visitors is necessary if the work is to have its full value, and asking if the Statutory Maternity and Child Welfare Committee has now been appointed and asking, further, that on the return of (he Medical Officer of Health to duty the Council will consider the question of extending their scheme on the lines of the Board's circular letter of the 9th of August, 1918. 25 In November a special Maternity and Child Welfare Committee was appointed by the Council, consisting of the existing members of the Health Committee and of six co-opted women members from voluntary organisations, and from other associations interested in Child Welfare work, with a view to developing the existing Maternity and Child Welfare work of the Council in accordance with the Local Government Board's suggestions. At the end of 1919 the Council's comprehensive scheme comprised the following centres, maternity and infant clinics, day nurseries, etc:— 1. Municipal;— (a) West Battersea Centre (Latchmere Baths). (b) East Battersea Centre (Battersea Tabernacle). 2. Voluntary;— (c) Battersea School for Mothers (two Centres, Plough Road and Mundella Road). (d) Women's League of Service (111 Bridge Road West). (e) Chislehurst Mission Maternity and Child Welfare Centre (St. James's Hall, Ponton Road). (f) St. Mary's Hostel Rescue Home for unmarried mothers and their children (Vicarage Road). (g) St. Margaret's Day Nursery and Hostel (Cambridge Road). For administrative purposes the Borough was sub-divided into six areas, in each of which a Maternity and Child Welfare Centre is established, either municipal or voluntary. Each centre is supervised by a trained health visitor, and to each is attached a clinic attended by a qualified medical woman. At the end of the year proposals were under consideration for further development of the Council's Maternity and Child Welfare Scheme. These included the provision of a Maternity Home for the reception of maternity cases and for the training of midwives for district service. The necessity for this expansion of their scheme had become most urgent owing to the fact that the Institutions which had heretofore served, to a considerable extent, the needs of the Borough, were no longer available. Moreover, the medical practitioners in the district had practically eliminated midwifery practice from their routine work, and the number of certified midwives was inadequate to provide an efficient service, therefore, for the Borough. The Committee felt that provision of 26 a midwifery service was therefore imperative, and preliminary steps were being taken by the Committee, which it is expected will result in the establishment at an early date of a Maternity Home and Ante-Natal Clinic, as well as an adequate and efficient district midwifery service for the Borough. Proposals were also under consideration at the end of the year for dental treatment for expectant and nursing mothers. It is expected that this important and necessary addition to the Council's Maternity and Child Welfare Scheme will be provided in due course. The Council's scheme also includes provision for the hospital treatment of children attending the various centres comprised in the Council's Maternity and Child Welfare Scheme. The present arrangements are with the Victoria Children's Hospital, Chelsea, who admit children either as in or out-patients on the order of the Medical Officer of Health, or the Medical Officer in charge of the Clinic. There is no contract for this service with the hospital. The Council give a donation to the funds of the hospital, and, in return, the hospital places facilities at the disposal of the Council for the admission of children patients attending the Maternity Centres in the Borough. Much benefit has already resulted from the use made of this hospital, and having regard to the advantages to the Council's scheme of being able to utilise the services of an easily accessible and well-known children's hospital, it may be desirable to extend the sphere of its usefulness by a more defined relationship than at present exists between the hospital and the Council, in considering the fuller development in this direction of their Maternity and Child Welfare Scheme. Health Visitors. The work carried out during the year by the Council's Health Visiting Staff was, on the whole, satisfactory, and will be found summarised below. Many factors contributed to interfere with the fuller development and efficiency of the work. In the first place, it was not until after the return of the Medical Officer of Health from Military Service at the end of March that the Council's Maternity and Child Welfare Scheme, as outlined in the Local Government Board's memorandum, began to take shape. Accident and sickness amongst the Health Visiting Staff also interfered, to some extent, with the work, and we were, furthermore, unfortunate in losing the services of Miss Burnett and Miss Ware, who accepted more lucrative appointments in another Metropolitan Borough, and of Miss Ross Brown, who resigned her appointment for private reasons. The vacancies created were, of course, quickly filled up, but it cannot be expected that newly-appointed officers, until they have become acquainted with their districts, can be as efficient 27 as their predecessors. This drawback was counterbalanced to some extent by the appointment during the year of an additional Health Visitor. The following is a summary of the work carried out by the Council's and the Voluntary Associations' Health Visiting Staffs during 1919:— First Visits. Total Visits. Visits to expectant mothers 233 439 Visits to notified births 1,852 4,623 Visits to children, age 1 to 5 277 484 Visits to enqiure into infant deaths 8 8 Visits to cases of infectious diseases 834 1,869 Other visits 342 — Attendances at Maternity Centres 619 — By Voluntary Trained Health Visitors 960 3,428 Ante-Natal Work. Special efforts were made during the year to develop this aspect of the Maternity and Child Welfare Scheme. The midwives practising in the Borough were invited to send their patients to the Maternity Clinics, held at the various Maternity and Child Welfare Centres in the Borough, and the Health Visitors, in the course of their home visiting, sent into the clinics a considerable number of expectant mothers for consultation and record purposes. The number of mothers who attended the Maternity Clinics during the year is as follows:— Attendances. Municipal Clinic. Voluntary Clinic. Total. 123 9 132 The number of cases recorded during the year in the books of the Municipal Clinics was 70. Of these 70 cases 17 were sent in by local midwives, 37 by the Council's Health Visitors, and 16 attended of their own accord. Twelve cases were sent to hospital for more extended examination or for treatment. The Mother-Craft Classes at the Latchmere Centre, held on Wednesdays in each week, are largely attended. Here the mothers are taught how to cut out and make suitable garments for the lying-in period and for their newly-born infants. Flannel and other materials are sold to them at cost price—a matter of prime concern to working-class expectant and nursing mothers under existing economic conditions. 28 The question of the provision of Home Helps was also undergoing consideration at the end of 1919 in connection with the Council's Maternity and Child Welfare Scheme, and it is hoped that practical steps will be taken in the coming year, which will result in a much-needed service of efficient and experienced women being available for the needs of the Borough. In accordance with the instruction contained in the memorandum of the Ministry of Health as to contents and arrangement of annual reports of Medical Officers of Health, details of the incidence of puerperal fever, ophthalmia neonatorum, measles, whooping cough, epidemic diarrhoea, polio-myelitis, etc., are set out in this section of the report. Puerperal Fever. Eleven cases of puerperal fever were notified in Battersea during the year 1919, and four deaths were registered from the disease, giving a case-mortality of 37 per cent. The death-rate was 0.025 per 1,000 population. The four deaths from puerperal fever were distributed as follows: East Battersea, two; North-West Battersea, two; South-West Battersea, nil. Ophthalmia Neonatorum. During 1919 in the Borough of Battersea 78 cases of ophthalmia neonatorum were notified, as compared with 34 in 1918. Visits are at cnce made, on receipt of notification, to the homes of children suffering from this serious infectious disease of the eyes. Steps are taken to see that nursing attendance is provided by arrangement with the South London Nursing Association if the case is being treated at home. Eight cases were removed to the Metropolitan Asylums Board Hospitals, and the majority of the other cases were attending as out-patients at General Hospitals. Acute Polio-Myelitis. Six cases of acute polio-myelitis were notified in Battersea during 1919, as against two cases in 1918. Four cases were removed to hospital. No deaths were reported from this cause during the year. Diarrhœa. During 1919 the number of deaths from diarrhoea and enteritis registered as belonging to the Borough of Battersea was 45. The death-rate was '28 per 1,000. Of the 45 deaths 29 from diarrhoea and enteritis 33 were of children under 5 years of age, and 28 (i.e., 62 per cent.) of the deaths were of infants under one year of age. Special measures of precaution are taken by the Health Department to prevent epidemic diarrhœa, which is one of the chief causes of infant mortality. These measures are mainly set out in the work of the Health Visiting Staff, and include the following:— (1) Visiting of houses wherein births were notified under the Notification of Births Act, 1907, or wherein deaths have occurred from epidemic diarrhoea. (2) Distribution of leaflets setting out the danger to life from summer diarrhoea, and the precautions to be taken to prevent the contamination of food supplies (especially milk), the necessity for strict attention to domestic and personal cleanliness, the importance of ventilation, and the free admission of fresh air and sunlight to living rooms. (3) Teaching of proper feeding, especially breastfeeding, and the care and management of infants, which is carried on systematically at the Infant Welfare Centres throughout the Borough. (4) Supply of dried or fresh milk at cost price or at reduced rates or free in necessitous cases to children under 5 years and to nursing and expectant mothers. Measles and German Measles. During 1919, 699 cases of measles and 100 of German measles were notified, as compared with 1,724 and 87 respectively in the previous year. Eighteen deaths occurred from measles, as compared with 57 deaths in 1918. Measles and German measles were made compulsorily notifiable on January 1st, 1916, and remained so up to the end of 1919. Compulsory notification was rescinded as from the 1st January, 1920, by the Public Health (Measles and German Measles) Rescission Order, 1919. All cases of measles and German measles, when notified, are visited, and such measures of a precautionary character as are practicable are taken, especially in regard to the protection of the younger children. Nursing attendance is provided where required free of cost by the Borough Council. 30 Whooping Cough. During 1919, in the Borough of Battersea, six deaths wore registered from whooping-cough, as compared with 59 in 1918. As the disease is not compulsorily notifiable, our information as to its incidence is mainly derived from school-teachers. Precautionary measures so far as practicable are taken in connection with this dangerous disease of early childhood. Visits are paid to the homes of children who are reported to be suffering from whooping-cough, and advice is given by the Health Visitors to the mothers to seek timely medical assistance, especially in regard to the younger children. Arrangements are also made for the provision of nursing attendance where required. 31 Notifiable Infectious Diseases. During 1919, under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 2,077 cases of infectious diseases (excluding tuberculosis) were notified, including: Measles, 699; German measles, 100; cerebro-spinal fever, 9; acute polio-myelitis, 6. Cases of infectious diseases, notified during 1919, arranged in Wards, and the case-rate per 1,000 population are shown in the following tables:— ze Number of Cases of Infectious Disease Notified in Battersea. 1919. Wards. No. 1 Nine Elms. No. 2 Park. No. 3 Latchmere. No. 4 Shaftesbury. No. 5 Church. No. 6 Winstanley. No. 7 St. John. No. 8 Bolingbroke. No. 9 Broomwood. Totals. Small-pox ... ... ... ... ... ... 3 ... ... 3 Diphtheria and Membranous Croup 52 35 31 23 17 23 10 24 14 229 Erysipelas 21 6 9 7 23 13 3 9 1 92 Scarlet Fever 107 94 29 53 49 48 20 41 43 484 Typhoid or Enteric Fever 6 ... • • • ... ... 3 1 1 ... 11 Ophthalmia Neonatorum 33 9 9 5 7 14 ... 1 ... 78 Puerperal Fever 2 2 3 ... 2 ... 2 ... ... 11 Polio-myelitis 1 1 ... ... ... ... 4 ... ... 6 Potio-encephalitis ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... • • • ... ... ... 1 1 1 3 Cerebro-spinal Fever 1 1 1 3 2 ... ... 9 Malaria 7 11 6 15 10 18 4 15 9 95 Dysentery 2 ... ... 1 ... 1 ... ... ... 4 Trench Fever ... ... ... 2 ... ... 1 ... ... 3 Acute Primary Pneumonia 26 23 13 7 16 13 6 10 ... 119 Acute Influenzal Pneumonia 19 18 15 7 20 13 8 12 19 131 Measles 141 49 68 89 98 110 37 91 16 699 German Measles 14 7 16 20 12 2 3 22 4 100 432 256 200 229 257 258 105 227 113 2077 83 Comparison of Prevalence of Sickness and Death from Infectious Diseases (Rates calculated per 1,000 persons on the population estimated to the middle of each year). Years. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Enteric and Continued Fever. Puerperal Fever. Cerebro-spinal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. s 1909 0.00 0.00 0.83 0.02 1.42 0.12 3.77 0.04 0.25 0.03 0.07 0.03 0.02 0.01 1910 0.00 0.00 0.90 0.04 1.10 0.06 2.33 0.03 1.21 0.03 0.08 003 0.02 0.02 1911 0.00 0.00 0.96 0.02 1.23 0.12 1.93 0.02 0.12 0.02 0.05 0.01 0.04 0.04 1912 0.00 0.00 0.79 0.02 1.25 0.10 2.54 0.03 0.12 0.01 0.03 0.005 0.00 0.00 1913 0.00 0.00 0.73 0.02 1.49 0.11 5.35 0.05 0.08 0.03 0.05 0.03 0.01 0.01 1914 0.00 0.00 0.93 0.03 1.46 0.10 5.55 0.06 0.10 0.01 0.07 0.02 0.005 0.005 1915 0.00 0.00 0.85 0.03 2.24 0.18 3.82 0.05 0.12 0.03 0.02 0.01 0.12 0.04 1916 0.00 0.00 1.20 0.01 2.01 0.17 2.01 0.04 0.14 0.01 0.13 0.04 0.14 0.03 1917 0.00 0.00 0.47 0.01 1.18 0.09 1.53 0.03 0.09 0.05 0.03 0.03 0.08 0.07 1918 0.00 0.00 0.50 0.01 1.43 0.15 1.64 0.03 0.04 0.00 0.01 0.01 0.06 0.05 Average 1909-1918 0.00 0.00 0.82 0.02 1.48 0.12 3.05 0.04 0.23 0.02 0.05 0.02 0.05 0.03 1919 0.02 0.00 0.58 0.02 1.44 0.13 3.04 0.02 0.07 0.02 0.07 0.03 0.06 0.04 This table is recommended for use by the Society of Medical Officers of Health as a record of "the frequency and mortality of infectious diseases in the whole district for a series of years." 84 The 2,077 cases occurred in 1,708 infected houses. Of the 2,077 cases, 726 (i.e., 35 per cent.) were removed to hospital, and 1,351 (i.e., 65 per cent.) remained under treatment at home. The numerous recently-added notifiable diseases render a comparison impossible in regard to the percentage of cases removed to hospital to the total number of cases notified. If these, however, are excluded, so as to make the 1919 figures comparable with those for previous years, the percentage of cases removed to hospital during 1919 would be 78 per cent. Full particulars of all notifiable infectious diseases will be found in tabulated form on page 94. The following table gives the drainage defects, etc., in houses in which cases of infectious disease were notified during 1919, and where inspections were found necessary:— DISEASE. No. of Houses invaded. Number showing defects. as to— Percentage showing drainage defects. Percentage showing no drainage defects. Drains. Traps, fittings and appliances. Total. Diphtheria 203 5 4 9 4 96 Erysipelas 91 • • • • • • ... ... 100 Scarlet Fever 401 ... 2 2 0.5 99.5 Typhoid 11 2 1 8 27 73 Puerperal Fever 11 ... ... ... ... 100 Total 717 7 7 14 2 98 Infeotious Diseases "Contacts." Many cases of "contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases as follows:— 35 Smallpox, Plague, Dysentery, Malaria, Cerebrospinal fever, Enteric fever, Typhus, Other infectious diseases. The above include civil as well as military cases. Contacts were also kept under observation in connection with cases of diphtheria in a civilian institution, viz., the St. James' Infirmary. Small-pox. During 1919 three cases of small-pox were notified in Battersea, of which the first case was notified on the 31st December, 1918, in the person of a young woman, E. B., who resided at 40 Bourton Street, St. Pancras, and who came to spend the Christmas holidays with some friends at 9 Severus Road, arriving there on the 25th December. The case was removed to hospital the same day. Subsequently on the 16th January, A. H. and E. H., residing at 9 Severus Road, were notified to be suffering from the disease. There can be no doubt that the Battersea patients were infected by their visitor from St. Pancras, and were part of a group of 18 cases which occurred between 7th December, 1918, and 31st March, 1919, in the Boroughs of St. Pancras (12), Islington (2), Battersea (2), Holborn (1), and the City of Westminster (1). The first of this group was a man (G. N.), who resided at 59 Red Lion Square, Holborn. A few days later, on the 11th December, an Australian soldier was found to be suffering from, small-pox. From enquiries it was found that this man had stayed at 59 Red Lion Square, Holborn, and that this house was much frequented by Overseas soldiers, and that small-pox had occurred among a party of soldiers who had passed through London previously. The Australian stayed with other friends at 40 Bourton Street, St. Pancras, a night or two before reporting sick on the 11th December, with the result that three further cases occurred at this house between the 28th December, 1918, and 6th January, 1919. The first of the St. Pancras group of cases, that of the 28th December, was the case notified in Battersea from 9 Severus Road on the 31st December. (I am indebted to the Report of the Medical Officer of Health of the County of London for the above information.) All three cases notified in Battersea recovered. 36 Precautions were taken to prevent the spread of the disease, all the occupants of 9 Severus Road being quarantined in their home and kept under medical inspection. Vaccination of all contacts was carried out, as well as other routine precautionary measures, and no further case occurred amongst any of the three families living in the house. During the year 1919 several "suspect" cases were referred to me by medical practitioners for investigation, but no further cases of small-pox occurred in the Borough during the year. Scarlet Fever. 484 cases of scarlet fever were notified in Battersea during 1919, as compared with 246 in 1918. The case-rate per 1,000 of the population was 3'04, and three deaths were regis tered from the disease in the Borough, giving a death-rate per 1,000 population of 0.02. Of the 484 cases notified 454 (i.e., 94 were cent.) were removed to hospital. Diphtheria. The number of cases of diphtheria (including membranous croup) notified during 19.19 was 229, as compared with 215 in 1918. The number of cases notified per 1,000 of the population was 1.44, as compared with 1.43 in 1918. Twenty deaths were registered from the disease in the Borough, giving a fatality-rate of 013 per 1,000 of the population, as against 015 in 1918. Of the 229 cases notified in Battersea 217 (i.e., 95 per cent.) were removed to hospital. Some difficulty was experienced in the autumn of the year in securing the removal of cases of infectious diseases to the Metropolitan Asylums Board's Hospitals, owing to several of the Board's hospitals being still retained by the Military Authorities, and also to the difficulty experienced in obtaining additions to the nursing and domestic staff required through the introduction of the 48-hour week. Priority of admission was given to those cases most urgently needing hospital treatment.. In view of the difficulty created and the particular circumstances of a working-class district like Battersea, urgent representations were made to the managers by the Council In order to minimise the risk incidental to the delay in the removal of cases, the medical men practising in Battersea were advised that the most urgent cases would receive priority for admission to hospital, and, at the same time, informed that anti-toxin would be supplied to them free at any hour of the day or night on application. 37 The total number of houses invaded by diphtheria was 203. Drainage defects were found in 9 (i.e., 4*4 per cent.) of the houses. During the year 13 cases (i.e., 5.7 per cent.) notified as diphtheria and removed to hospital were found not to be suffering from the disease, and were discharged to their homes. Enteric Fever. During 1919 11 cases of enteric fever were notified in the Borough, as against 6 in 1918 and 13 in 1917. Three deaths were registered from the disease, giving a case mortality of 27 per cent. and a death-rate per 1,000 of the population of 0'02. Erysipelas. During 19.19 92 cases of erysipelas were notified, and three deaths were registered from the disease, as compared with 76 cases and one death in 1918. The case-mortality was 3'26 per cent., and the death-rate per 1,000 of the population was 0 02. Cerebro Spinal Fever. During 19.19 nine cases of cerebro-spinal fever (epidemic cerebro-spinal meningitis) were notified in Battersea, as compared with nine cases in 1918 and 12 in 1917. All cases were removed to hospital. Six of the nine cases ended fatally. Encephalitis Lethargica. This disease was made compulsorily notifiable on January 1st, 1919, by order of the Local Government Board. The order was designed to secure the notification of cases of an infectious disease which occurred in epidemic form in the early spring of 1918. The order of the Board making the disease notifiable as from the 1st January, .1919, and dated 23rd December, 1918, was at first only for a period of one year. This period has since been indefinitely extended. This disease is described as presenting "a group of unusual cerebral symptoms resembling those of a rare disease called botulism, which is associated with the consumption of infected food." The illness displayed the characters of an acute general disease associated frequently with progressive languor, apathy and drowsiness passing into lethargy, with muscular 38 weakness passing into more or less complete disablement, and with paralysis of various groups of muscles, especially of the ocular and facial muscles. Three cases of the disease were notified in Battersea during 1919, all of which were removed to hospital. There was one death registered from this cause. Ophthalmia Neonatorum—Polio-Myelitis—Puerperal Fever. Particulars relating to cases of these compulsorily notifiable diseases will be found in the section relating to Maternity and Child Welfare (page 28). Tuberculosis. During 1919 208 deaths from tuberculosis were registered as belonging to the Borough of Battersea. Of this number 171 (i.e., 82.2 per cent.) were due to phthisis (tuberculosis of the lungs), 24 to tubercular meningitis, and 13 to other forms of the disease. The following table shows the death-rate from phthisis and other tubercular diseases in each year since 1901:— Year. Deaths from Phthisis per 100,000 persons. Deaths from other Tubercular Diseases per 100,000 persons. 1901 146 60 1902 129 44 1903 128 51 1904 139 41 1905 132 50 1906 122 48 1907 120 46 1908 119 46 1909 116 38 ]910 103 30 1911 129 42 1912 113 25 1913 114 32 1914 122 37 1915 142 31 1916 144 36 1917 168 25 1918 152 41 1919 107 23 39 The number of deaths from phthisis and other tubercular diseases and the death-rate per 1,000 population in each of the sub-districts are set out in the following table:— District. Phthisis. Other Tubercular Diseases. Total. No. of Deaths. Rate. No. of Deaths. Rate. No. of Deaths. Rate. East Battersea 65 .98 21 0.32 86 1.80 Nth-West Battersea 55 1.18 11 0.24 66 1.41 Sth-West Battersea 51 1.10 5 0.11 56 1.21 The Borough 171 1.07 37 0.23 208 1.31 The deaths from tuberculosis were 10T per cent. of the total deaths. The death-rate from phthisis (the most common form of tubercular disease was 1.07 in 1919. During 1919 514 cases of tuberculosis were notified in Battersea. The number of notifications received and the death-rates from all forms of tuberculosis in each year since 1909 are shown in the following table:— Year 1909. 1910. 1911, 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. No. of Notifications 257 166 314 542 743 616 613 565 523 501 514 Death-rates per 100,000 Pop. 155.3 153.9 172.3 139.0 146.3 163.7 165.5 171.3 183.3 173.9 130.0 1,477 visits to homes where cases of tuberculosis had been notified were made during 1919 by the Council's Sanitary and Health Visiting Staff. Battersea Dispensary for the prevention of Consumption. The Battersea Dispensary for the Prevention of Consumption is controlled by a voluntary organisation, but is temporarily approved by the Ministry of Health as the Tuberculosis Dispensary for Battersea in the Council's Tuberculosis Scheme. The question of the control of the dispensary by the Council as the sanitary authority responsible for the 40 administration of the Tuberculosis scheme for the Borough was again under consideration at the end of the year in connection with the renewal of the annual contract with the Dispensary Committee. Tuberculosis After care. A letter was received from the London County Council referring to the arrangements made by them for the establishment of Interim Tuberculous Care Committees in London, and suggesting that as the difficulties experienced during the war had largely disappeared, Borough Councils should establish permanent Tuberculosis Care Committees on the lines indicated by the Local Government Board in April, 1915. The Health Committee decided to postpone consideration of the matter pending a decision as to the future of the Tuberculosis Dispensary in the Borough Council's Tuberculosis Scheme for Battersea. The annual report of the Battersea Dispensary for the Prevention of Consumption for the year 1919 states that during the year 692 cases were referred to the dispensary for diagnosis and treatment, showing an increase of 121 cases over 1918, the increase, it is pointed out, being due, in great part, to the large number of ex-service men sent by the Local War Pensions Committee. Of the 692 cases examined 199 (i.e., 28.7 per cent.) were diagnosed as definitely tuberculous, showing a marked increase over the figures for each year since 1912. Of the 199 definite cases 131 were adults and 68 children. Of the 131 adults 100 were insured and 31 non-insured persons. Of the 692 cases 164 were found not to be suffering from tuberculosis and were discharged. Contacts. The number of contacts examined at the Dispensary during the year was 317—(adults, 78; children, 239). The Medical Officer (Dr. Macdonald) states that this most important work suffers owing, under existing circumstances, to lack of time to devote adequate attention to it. 67 "suspects" were definitely diagnosed during the year as tuberculous, and these added to the 199 new definite cases make a total of 266 cases notified, as compared with a total of 143 during 1918. 41 Home Treatment. During 1919 155 patients received domiciliary treatment from the Dispensary Medical Officer. 320 visits were paid during the year. 2,136 visits were paid by the Dispensary nurses during the year. 202 houses were reported to the Medical Officer of Health for sanitary action. Institutional Treatment. During 1919 96 patients were sent to Sanatoria or other Institutions, 70 of whom were insured persons. Day Sanatorium or Open-air School. The London County Council, having acquired Springwell House, Clapham Common North Side, transferred the Openair School held in Battersea Park, which had been found to be inadequate and unsuitable, to the new premises. The Medical Officer of the Battersea Dispensary for Consumption and a nurse supervise the health of the children attending the school. Incidence of Tuberculosis. The following tables show the particulars as regards age distribution of pulmonary and non-pulmonary tuberculosis, and the number of cases notified in the various Wards and subdistricts respectively:— Classification Age Periods. Totals. 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. Pulmonary Males - 5 26 17 28 26 46 36 32 8 4 228 Females — 4 21 17 15 29 87 32 12 5 6 178 Non-Pulmonary Males 1 13 19 9 2 20 - 3 1 2 - 52 Females 2 6 15 11 6 2 6 3 5 — — 56 Totals 3 28 81 54 51 59 89 74 50 15 10 514 42  Wards. Totals 1 2 3 4 5 6 7 8 9 Pulmonary 72 49 45 29 85 56 21 63 36 406 Non-Pulmonary 24 19 6 15 13 17 4 5 5 108 Totals 96 68 51 44 48 73 25 68 41 514 East Battersea. N.-W. Battersea. S.-W. Battersea. Borough. Pulmonary 169 114 123 406 Non-Pulmonary 59 35 14 108 Totals 228 149 137 514 Particulars are given in the table below of the localization of disease in the 514 cases notified. Localization of Disease. Pulmonary (406)— Lungs 397 Lungs and Larynx 1 Lungs and Meningitis 1 Lungs and Abdominal Glands 2 Pleura 1 Lungs and Breast 1 Lungs and Throat 2 Lungs, Meningitis, and General 1 43 Glands (50)— Glands 9 Mediastinum 2 Abscess of Neck 4 Cervical Glands 28 Adenitis 3 Larynx 1 Bronchial 1 Mesenteric 2 Abdominal (8)— Intestines 2 Peritoneum 5 Abdomen 1 Urinary, etc. (2)— Fallopian Tube Cystitis and Pyonephrosis 1 Brain, etc. (14)— Meninges 14 Skin, etc. (7)— Skin 5 Lupus 1 Skin of Neck 1 General (2)— Miliary Tuberculosis 1 General Tuberculosis 1 Bones (25)— Mid-Dorsal Spine 1 Fifth Lumbar Spine 1 Spine 3 Hip 6 Abscess of Hip 1 Knee 4 Left Shoulder Joint 1 Elbow Joint 2 Dactylitis 2 Sixth Left Rib 1 Bone 1 Jaw and Cheek 1 Nose 1 Total 514 44 The number of notifications of tuberculosis received during the year, arranged according to source of origin, were as follows:— Classification. New Cases. Duplicates. Totals. A. 462 141 603 B. — — — C. Poor Law Institutions 21 46 67 Sanatoria 23 115 138 D. Poor Law Institutions — 32 32 Sanatoria 8 100 108 Totals 514 434 948 45 Non-Notifiable Infectious Diseases. Chicken pox. During 1919 271 cases of chicken-pox were notified voluntarily. Influenza. The epidemic of influenza, which began in the late summer of 1918 and reached its height during the fourth quarter of that year, continued the first quarter of 1919. During 1919 the number of deaths from the disease are shown in the following table arranged in Wards:— wards. Deaths from Influenza. Estimated Population. Death-rate per 1000 Population. No. 1 (Nine Elms) 25 26,001 .96 „ 2 (Park) 21 16,708 1.26 ,, 3 (Latchmere) 21 19,084 1.10 ,, 4 (Shaftesbury) 18 15,226 1.18 ,, 5 (Church) 24 18,404. 1.30 ,, 6 (Winstanley) 20 19,230 1.04 ,, 7 (St. John) 7 7,803 .90 ,, 8 (Bolingbroke) 15 17,566 .85 ,, 9 (Broomwood) 26 19,294 1.35 The Borough 177 159,316 1.11 Deaths from Influenza. Age and Sex Distribution. Period. 0— 1— yr- 2— yrs. 5— yrs. 10 - yrs. 15— yrs. 25— yrs. 35— yrs. 45yrs. 55— yrs. 65— yrs. 75— yrs. 85— yrs. M. F. Total 1st quarter M. 3 l 1 2 1 7 15 5 8 10 8 3 64 87 151 F. 2 2 2 2 1 12 17 13 9 12 7 6 2 2nd quarter M. - - - - 1 1 1 - 4 - - - - 7 9 16 F. — — — 1 1 1 3 — — 1 1 1 - 3rd quarter M. - - - - 1 - 1 - - - 1 - - 3 - 3 F. - - - - - - - - - - - - - 4th quarter M. - - - - 1 - - - 3 1 1 - - 6 1 7 F. - - - - - - - - - - - - - Totals M. 3 1 1 2 4 8 17 5 15 11 10 3 - 80 97 177 F. 2 2 2 3 2 13 20 13 9 14 8 7 2 46 I he next table gives the deaths from influenza, showing age and sex distribution :— 17 The Public Health (Influenza) Regulations, 1918, and the Public Health (Influenza) Regulations (No. 2), 1918, which came into force on November 25th, 1918, were rescinded by order of the Local Government Board on May 6th, 1919. Bacteriological Examinations. During the year 1919, 794 bacteriological examinations of specimens sent in by medical practitioners practising in the Borough of Battersea have been made at the Clinical Research Association Laboratories at a cost of £104 11s. 1d., particulars of which are set out in the following table:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 95 341 436 Enteric fever 2 9 11 Tuberculosis 74 271 845 Cerebro-spinal fever - 2 2 Total 171 623 794 Rabies. Information was received from the Ministry of Health, the London County Council and other sources, that four persons had been bitten by dogs. In all cases the houses of the persons bitten were visited for purposes of investigation and report. Information was received from the Ministry of Health that three persons, one of whom resided in the Borough of Battersea, had been bitten by a dog suspected to be suffering from rabies. Arrangements were made by the Medical Officer of Health with St. Thomas' Hospital, at the request of the Ministry, to have specific treatment carried out in this case. In no instance was definite evidence of rabies reported. Anthrax. During the year notice was received from the Ministry of Health, and from the Medical Officer of Health of the City of London, that imported shaving brushes, some of which had been found to be infected with Anthrax, were traced to retail and wholesale firms within the Borough. 48 Steps were taken to trace these brushes, and, in the case of two retail firms, the greater number of the brushes were found to be unsold, and were returned to the wholesalers. It was found impossible to trace the two brushes which had been sold. A large wholesale firm in the Borough had obtained a stock amounting to 10 gross brushes. The firm offered every assistance in tracing the distribution of the brushes, a large number of which had been sold to their customers in various parts of the Kingdom. Information was sent to the Medical Officers of Health of the districts concerned, and, in some cases, notification was received that steps were being taken to see that all brushes which could be found should be returned to the wholesale firm. With regard to the unsold brushes still in the possession of the wholesale firm, amounting to 63 dozen, it was arranged to return the remainder of the stock to the importers, a firm in the City of London, and the Medical Officer of Health of the City was duly advised. Every assistance was given to the Officers of the Council in carrying out this troublesome duty, and in view of the long period which had elapsed between the time of the arrival of the brushes in Battersea and the date the notification was received, much difficulty was experienced in tracing the distribution of the brushes. No case of Anthrax was notified in Battersea during the year. 49 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1919. Total Sanitary Operations 49,608 Number of house inspections 37,844 House to house inspections 1,292 Bakehouse inspections 227 Bakehouse nuisances abated 50 Urinals—inspections 173 Do. altered, repaired or water laid on 75 Intimations served under Sec. 3 3,553 Notices served under Sec. 4, &c. 1,065 Notices served under Secs. 62 & 65 852 Complaints received & attended to 3,526 Number of houses disinfected 2,382 Houses supplied with disinfectants 1,837 House drains flushed with disinfectants after infectious disease 1,180 Overcrowding abated 7 Premises improved, cleansed and repaired 2,294 Drains tested By smoke 372 Do. „ water 812 Drains cleansed and repaired 242 Drains relaid 31 Frontage drains constructed or re-constructed 5 Soil pipes and drains ventilated 48 Sink and rain-water pipes discon nected or repaired 158 Water Closets cleansed & repaired 509 Cesspools abolished — Mews & Stables drained & paved 14 Yards and forecourts paved and repaired 188 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 45 Dust receptacles provided 456 Leaky house - roofs and gutters repaired 359 Houses supplied with water and fittings repaired 165 Houses let in lodgings 89 No. of inspections 631 Water Closets provided, supplied with water or supply disconnected from drinking water cisterns 236 Cisterns covered, cleansed and repaired 128 Additional water supplies to upper floors 11 Keeping of animals in unfit state discontinued 32 Smoke observations 3 Certificates of disinfection granted 1,502 Houses inspected and certificates granted (Sec. 48) — Proceedings ordered by Council and Health Committee 3,284 Summonses issued 107 Magisterial Orders obtained and enforced 40 Factories, Workshops, &c., inspections 3,489 Sanitary conveniences provided or improvements effected in Factories & Workshops (Sec. 38) 81 Underground sleeping rooms : Disused 1 Defects remedied 25 Gipsy van inspections 46 Drains laid to new houses and tenements 11 Samples taken under the Sale of Food and Drugs Acts 1,000 Miscellaneous 2,965 50 Legal Proceedings in Connection with Nuisances. Legal proceedings in connection with nuisances were taken by the Council in 23 cases during 1919. Particulars with regard to each case are set out below. Legal Proceedings under the Public Health (London) Act, 1891. Nature of Offence. Result of Proceedings. Nuisance at 45 Henley Street, and failure tc comply with notice to abate Nuisance having been abated, fined 10/- and £4 4s. Od. costs. Nuisance at 135 Speke Road, and failure to comply with notice to abate Nuisance having been abated, fined 5/- and £2 2s. Od. costs. Nuisance at 65 Livingstone Road Abatement Order and 10/6 costs. Nuisance at 115 Winstanley Road Abatement Order and 10/6 costs. Nuisance at 25 Blondel Street, and failure to comply with notice to abate Nuisance having been abated, fined 5/- and £2 2s. Od. costs. Nuisance at 27 Blondel Street, and failure to comply with notice to abate Nuisance having been abated, fined 5/- and £2 2s. Od. costs. Nuisance at 97 Latchmere Grove Abatement Order and 10/6 costs. Nuisance at 98 Latchmere Grove Abatement Order and 10/6 costs. Nuisance at 91 Grant Road Abatement Order and 10/6 costs. Failure to comply with notices to abate nuisances at 97 and 98 Latchmere Grove Fined £2 and £2 2s. Od. costs. Failure to comply with notices to abate nuisance at 91 Grant Road £1 1s. 0d. costs. Failure to comply with notices to abate nuisances at 65 Livingstone Road and 115 Winstanley Road £2 12s. 6d. costs. Failure to comply with notices to abate nuisance at 63 Ingrave Street £1 1s. 0d. costs. Failure to comply with notices to abate nuisance at 10, 12, 14, 16, 22 and 24 Orville Road £7 7s. 0d. costs. Failure to comply with notices to abate nuisances at 25,27,29 and 31 Orville Road £4 4s. 0d. costs. Nuisances at 22 and 24 Orville Road (5 summonses) £3 3s. 0d. costs. Nuisances at 59 Maysoule Road (3 summonses) £3 3s. 0d. costs. 51 Nature of Offence. Result of Proceedings. Nuisances at 72 Longhedge Street, and failure to comply with notice to abate nuisance arising from w.c. door off its hinges. (5 summonses). Abatement Orders (4) with costs. Summons in respect of failure to comply with notice to abate dismissed. Nuisances at 52 and 69 Musjid Road Nuisances having been abated, summonses ordered to be withdrawn on payment of £3 3s. Od. costs. Nuisance at 52 Meyrick Road Nuisance having been abated, summons ordered to be withdrawn on payment of £1 5s. Od. costs. Nuisance at 162 New Road, house unfit for human habitation Closing Order unless nuisance abated within three weeks and 7/- costs. Nuisances at 2 and 4 Este Road £2 2s. Od. costs. Laying drains at 125 and 127 Queens Road contrary to directions of late Vestry Drains having been relaid in accordance wi th plans approved by Council, summons withdrawn. Drainage. During 1919, 18 plans for the drainage of new buildings, and 30 plans for the alteration and reconstruction of drains in existing buildings have been received and approved. Revenue Act, 1903. No certificate under the provisions of the above-mentioned Act was applied for during 1919. Smoke Nuisances. During the year observations were made in 3 instances, and it was found necessary to serve notices. Owing to the difficulties created by the war the routine inspection by the Sanitary Inspectors of factory chimneys was largely in abeyance, and, pending a return to more normal conditions, it was not considered practicable to carry out the strict procedure of pre-war activity in this direction. Very few complaints were received during the year. 52 Effluvium Nuisance. During 1919 a complaint was received with reference to an alleged effluvium nuisance from the works of the Morgan Crucible Company. The necessary steps were taken to investigate the complaint, but no nuisance of the nature complained of was established by the Council's officers. Sanitary Staff. The Sanitary Inspectorial Staff consists of 1 chief inspector, 8 district inspectors, 2 special male inspectors for Food and Drug and Factory and Workshop inspection, 2 female sanitary inspectors (who also act as part-time health visitors), and three health visitors. A list of the staff is set out on page 4. Rag Flock Act, 1911. This Act was passed to prevent the use of material known as rag flock, which does not comply with the standard of cleanliness laid down in the Act. Rag flock was largely made from rags of various descriptions—e.g., old discarded clothing, carpets, etc.—usually dirty and unwholesome and perhaps infected. Rag flock so made was largely used in the manufacture of the cheaper kinds of bedding and upholstery, and its use for this purpose constituted a distinct danger to health. Flock manufactured from rags must now conform to the requirements of the Act, in that a sample of such rag flock shall not, on analysis, be found to contain more than the maximum, permissible amount of chlorine, viz., 30 parts of chlorine to 100,000 parts of the flock. Difficulties of a legal and technical character have arisen in connection with the administration of the Act by Sanitary Authorities, and in view of these difficulties not much use has so far been made of the powers contained therein. During 1919 a circular letter (dated May 26th, 1919) was received from the Local Government Board, reminding Sanitary Authorities of their duties under the Rag Flock Act, 1911, and drawing attention to legal decisions given by the High Courts under the Acts in regard to the cases of (1) Cooper v. Swift (1914), 1 K.B. 253, dealing with the interpretation of the term "flock," and (2) Gamble v. Gordon. (1913), 3 K.B. 149, as to whether "remakes" come within the scope of the Act. It was held that (1) the word "rag" has a wide meaning, and includes rags others than those cut or torn from a piece of material which has been used on a garment, or has become foul from contact with the human body, and (2) the Act does not apply to genuine 53 "remakes," i.e., the process of taking flock out of the covering of a mattress and refilling the covering with the same and no other flock. During 1919 in Battersea there were 14 premises where, in connection with the stuffing of bedding and furniture, flock was being used. Six samples were taken for purpose of analysis, and the nature of the flock and the result of analysis were as follows :— Chlorine parts Natural. per 100,000. Cotton flock 100 Cotton flock 172 Cotton flock 128 Rag flock 14 Rag flock 13 Rag flock 30 The first 3 samples (cotton flock) were found to contain considerably more than the permissible amount of chlorine laid down in the Act. The question as to whether the material "cotton flock" came within the term "rag flock" was referred to the Ministry of Health. A reply was received, stating:— "The Ministry have no authority to determine the question raised, but if the material referred to in your letter as cotton flock is manufactured from raw cotton, they are advised that it is doubtful whether the term 'flock manufactured from rags' would be held to apply to such flock." In view of the opinion contained in the Ministry's letter, the Health Committee decided to take no further proceedings in respect of samples of cotton flock manufactured from raw cotton. It appears to be very desirable that some amendment of the Act should be made: (1) in regard to the interpretation of the term "rag flock," and (2) as to "remakes." With regard to the first-mentioned point, an extension of the scope of the Act to include "all textile materials used for stuffing bedding and furniture" would simplify administrative procedure. With reference to the question of "remakes" it is difficult, from the public health standpoint, to understand why these should be exempt under the Act. Personal Cleansing Station. During 1919 3,214 children and 366 adults were cleansed at the Council's Personal Cleansing Station, Sheepcote Lane. of the total children who attended 1,125 were suffering from 54 scabies, and the remainder (2,089) were verminous. These children attended from the Public Elementary Schools in Battersea by arrangement with the London County Council as the Education Authority, who have entered into a contract with the Borough Council for the use of the facilities provided at the Personal Cleansing Station. The work of cleansing and treatment is supervised by the County Council's officers. Steps are taken while the children are being cleansed and treated to sterilise their clothing at the Disinfecting Station adjoining. The homes of children cleansed are also visited by the Borough Council's Sanitary and Health Visiting Staff, and where the houses or the bedding, clothing, etc., are found verminous, measures are taken to cleanse the homes, and the infected articles of bedding and clothing are collected and removed to the Disinfection Station for stoving. In December the Council provisionally approved of a plan for a proposed new cleansing station on the Council's land in Sheepcote Lane at an approximate cost of £2,300. It is to be hoped this building will soon be erected, as the existing accommodation is found to be inadequate and otherwise unsuitable. Disinfecting Department. During 1919 1,466 premises were disinfected by the Council's Disinfecting Staff. A total of 2,077 cases of notifiable infectious diseases was reported and dealt with during the year. In addition to these, a large amount of disinfection was carried out in connection with non-notifiable infectious diseases reported by school-teachers and others. Verminous rooms, bedding and articles of clothing, as will be seen from the subjoined summary, were dealt with to a very considerable extent by the Disinfecting Staff. Summary of Work carried out at the Disinfecting Department during 1919. Premises 1,466 Rooms 2,390 House drains flushed 1,180 Schools disinfected (89 rooms) 35 Bedding lent 168 Mattresses and palliasses tabbed 1,617 Number of articles disinfected 40,566 Number of articles destroyed 809 Library books collected 111 Number of articles laundered 27,370 Verminous clothing 28,640 The laundry attached to the disinfecting station, which was added in 1907, continues to do most useful work. 55 Mortuary. During the year 1919 the bodies of 178 persons were received at the Mortuary in Sheepcote Lane. On 165 of these bodies inquests were held, and 13 bodies were received at the Mortuary for sanitary and other reasons. Of the 165 bodies upon which inquests were held, in 98 instances post-mortem examinations were made. The results of the inquests held during 1919 were as follows:— Cause of death or verdict. Natural causes 92 Accidental 44 Suicide 13 Homicide 2 Open verdict 14 56 Protection of the Food Supply. Unsound Food. The following is a tabulated return of unsound food seized or voluntarily surrendered during 1919:— Food. Quantity. Bacon 621½ lbs. Beef 99 „ ,, boneless 100 cases ,, corned 15 tins Bloaters 5 boxes Brussels Sprouts 252 lbs. Butter 318 „ Cherries 3 ½-sieves Cod 2 cases Cod's Roe 2 boxes Dates 48 „ (about 1½ tons) Eggs 1715 Figs 1 box Herrings 1 „ Jam 446½ lbs. Kippers 34 boxes Mackerel 9 „ Margarine 52 lbs. Mutton, &c. 3 lambs 2 fore quarters do. 52 lbs. lamb 28¾ lbs. mutton Oats 1 sack Oxtails 2 boxes Pig 1 Pig's Liver 89 lbs. Plums 3 tons 9 cwts. 3 qrs. Rabbits 362 276 lbs. Salmon 2 cwts. 3 qrs. 2 lbs. Sheeps' Hearts 1 bag Tangerines 74 cases Tomatoes 39 boxes 48 lbs. Whiting 1 case Winkles 1 bushel 2 bags 57 In addition to the above a large quantity of unsound fruit pulp was dealt with at Nine Elms Goods Station. In view of the difficulty of making a satisfactory examination of the pulp at the goods station, it was permitted to be removed to the consignees' premises on condition that the Medical Officers of Health of the disticts concerned were advised of its arrival. The Medical Officers of Health in question were duly notified. Butchers' Shops. The number of these premises in the Borough appreciably decreased during the war. There are now only 70, as compared with 91 in pre-war days. Most of the butchers carried on sausage-making as an adjunct to their business prior to the war, but owing to the scarcity and increased cost of meat supplies only a few of the principal butchers carried on this part of their business. During the rationing period most of the meat supplies came day by day from the Metropolitan Market. In most cases in which it was found necessary to condemn meat it was generally ascertained to be in an unsound state when it reached the butcher's premises. Systematic inspection of butcher's shops was carried out during the year, and 992 inspections of these premises were made by the Food Inspector. Slaughter houses. There are three licensed slaughter-houses in the Borough, situated at 345 Battersea Park Road, 205 St. John's Hill, and 351 York Road (small animals only). In only one of these is slaughtering carried on systematically. In this case a special permit was granted, presumably as a temporary measure, during the war, to slaughter for other butchers as well as for the owner's butcher's business attached to the slaughter-house. Owing to the very considerable business carried on at this slaughter-house during the year, a systematic inspection of the carcases (many of which were distributed to butchers outside Battersea) was carried out, involving much of the time of the Food Inspector. The special permit granted by the Licensing Authority to the owner of this slaughter-house was still in force at the end of 1919. Ice Cream. There are 86 premises in the Borough in which ice cream is sold. Nine of these ice cream premises were occupied by Italians, of whom eight carried on a trade from street barrows. All these premises were kept under systematic inspection. During the year 340 inspections were made, and ten notices were served to remedy insanitary conditions, all of which were complied with. 58 Milk Shops. The number of premises where milk is sold was 139 at the end of 1919. 387 inspections were made, and 15 notices were served to remedy insanitary conditions found on inspection, all of which were complied with. The character of the business carried on in premises in which milk is sold in Battersea during 1919 was as follows:— Dairy produce only 64 General shops 55 Confectioners 11 Dwelling-houses 7 Wholesale 2 Total 139 The number of general shops in which milk is sold has been greatly reduced in recent years. Registration is refused in all cases where the premises for any reason are unsuitable for the sale of milk, and efforts are made to confine the sale of this article as far as possible to premises for the sale of dairy produce only. Restaurant Kitchens. The total number of restaurants and eating-houses on the register at the end of 1919 was 94. They were kept under systematic inspection during the year. It was found necessary to serve notices to remedy 23 defects found on inspection. Fish Shops. There are G2 premises in the Borough in which fish is sold. In 41 of these premises fried fish is sold; in 3 others a fishcuring business is also carried on, and 8 are businesses where fish-curing for sale on the premises is carried on. These premises were systematically inspected during the year. 120 inspections were made, and notices were served to remedy 28 more or less serious insanitary conditions found on inspection. Sale of Food and Drugs Acts. During 1919 1,000 samples were taken for analysis within the Borough of Battersea. Of these 1,000 samples, 66 (i.e., 6.6 per cent.) were certified to be adulterated. Five samples were certified to be of inferior quality. The following table gives details of the articles of which samples were procured during the year 1919:— 59 Description of Article. Total No taken. Genuine. Adulterated. Inferior. Arrowroot 5 5 — — Butter 34 34 — — Cheese 42 40 — 2 Chicory 3 3 — — Cocoa 36 35 — 1 Coffee 39 37 — 2 Lard 54 54 — — Margarine 26 26 — — Milk 617 573 44 — Milk (Separated) 9 7 2 — Oatmeal 12 12 — — Olive Oil 6 6 — — Pepper 8 8 — — Preserved Meats, &c. 19 17 2 — Rice 61 49 12 — Sugar 6 5 1 — Vinegar 23 18 5 — Totals 1,000 929 66 5 Milk. Of the total number of samples taken under the provisions of the Acts during 1919, 626 were milk samples. Of this number 46 (7"35 per cent.) were found on analysis to be adulterated. Two of the adulterated samples were separated milk. The nature, of the adulteration in the adulterated samples of milk was as follows :— 1. Extraneous water varying from 4 to 28 per cent, in 28 of the samples. 2. Deficiency in milk fat varying from 3 to 19 per cent, in 12 of the samples. 3. Extraneous water and fat deficiency 4 to> 9 per cent; extraneous water and 45"45 per cent, fat deficiency in 1 sample. The two adulterated samples of separated milk showed extraneous water 4 6 and 13 33 per cent, respectively. Ninety-five of the samples taken during the year were taken in course of delivery to the retailer. The following table gives details of the articles adulterated and the results of proceedings taken:— 60 Legal Proceedings under the Sale of Food and Drugs and Margarine Acts. Number of Sample. Article. Nature of Offence or Adulteration, &c. Result of Proceedings. 775 Milk 7 3% extraneous water Fined £2 and £2 2s. costs, inclusive for the three cases. 776 „ 6 47% extraneous water 777 „ 213% extraneous water 819 „ 9% extraneous water No fine, 12s. 6d. costs. 822 „ 7.4% extraneous water No fine, 12s. fid. costs. 834 „ 7% extraneous water No fine, 12s. 6d. costs. 835 „ 12 94% extraneous water and 11 87% fat abstracted Fined £2 and £1 1s. costs. 837 „ 14 7% extraneous water Fined £2 and £2 2s. costs. 843 „ 9% fat abstracted Fined £1 and £1 costs. 860 „ 4% extraneous water Fined 10s. and £1 costs. 877 „ 917% extraneous water Vendor fined £1 and £1 costs. Seller, no fine, 2s. costs. 896 „ 23% extraneous water Fined £4 and £4 costs. 897 „ 28% extraneous water and „ 5% fat abstracted 924 „ 7 3% fat abstracted Dismissed (warranty). 34 „ 6 3% extraneous water Dismissed (warranty) 41 „ 7 5% extraneous water No fine, £5 5s. costs, inclusive for the three cases. 133 „ 4.1% extraneous water 136 „ 4.3% extraneous water 85 „ 7.5% extraneous water and 13.3% fat abstracted Fined £5 and £2 2s. costs. 213 „ 4% extraneous water Fined 2s. 6d. and 10s. fid. costs. 283 „ 7.5% extraneous water No fine, £2 2s. costs. 236 „ 7.3% fat abstracted No fine, £2 2s. costs. 242 „ 10% fat abstracted No fins, £2 2s. costs. 255 „ 9.3% fat abstracted No fine, Vendor to pay £1 costs 285 Vinegar 17.5% extraneous water Fined 8s. and 12s. costs. 313 Milk 5.65% extraneous water and 5.3% fat abstracted Fined £1 in each case and £3 3s. costs in all. 314 „ 4.59% extraneous water and 45.45% fat abstracted 315 „ 542% extraneous water and 16.6% fat abstracted 316 „ 3.65% extraneous water Fined £5 and £3 3s. costs. 340 „ 15% extraneous water Withdrawn. Cork of third portion of sample blew out. 360 „ 17% extraneous water Fined £1 10s. and £3 3s. costs. 372 „ 10% extraneous water Fined £2 and £1 1s. costs. 389 „ 10% fat abstracted Dismissed (warranty). 414 „ 7.6% extraneous water Fined £4 and £2 2s. costs. 499 „ 5% extraneous water Fined £3 and £1 1s. costs. 542 „ 19% fat abstracted Dismissed (warranty). 606 „ 12.2% extraneous water Dismissed (warranty). 607 Separated Milk 4.6% extraneous water Fined £1 and £1 1s costs. 659 Milk 5.177% extraneous water Dismissed (warranty). 703 Separated Milk 13.33% extraneous water Fined £1 and £1 1s. costs. 741 Milk 4.9% extraneous water Dismissed (warranty). Proceedings against Warrantor, fined £1 and /3 3s. costs. 746 „ 8% extraneous water Fined £1 and £1 1s. costs. 61 Warranty Defence. Warranty as a defence was pleaded in connection with proceedings under the Sale of Food and Drugs Acts, and was successful in each of the 7 cases. In regard to one of them, however, proceedings were subsequently taken against the wholesale firm for false warranty, and the firm was convicted and fined and costs imposed (vide Tabular Statement of legal proceedings). The iniquity of the "warranty" defence has been pressed upon the notice of the Central Authority for years past, but nothing has been done to amend the Food and Drugs Acts in the direction of repealing the "warranty'' clauses in regard to milk. It is interesting to note that the Magistrate at the Southwestern Police Court (Mr. R. Bankes, K.C.), in a letter to the "Times" newspaper, pointed out that the "warranty" defence militated seriously against the purity of the milk supply, and he strongly advocated its abolition as a defence. The letter was brought to the notice of the Council, who directed that the views of the learned Magistrate should be brought to the notice of the Members of Parliament for the Borough. It is surely time that the hands of Local Authorities were strengthened by an amendment of the law abolishing the use of the "warranty" defence, which adversely affects the administration of the Acts. Milk and Cream Regulations, 1912 and 1917. All samples of milk are examined by the Public Analyst for the presence of preservatives, but in no case were preservatives found in the 617 samples taken in Battersea during 1919. Owing to the Orders of the Food Controller prohibiting the sale of cream, samples of cream were not obtainable in Battersea in 1919, and no action was therefore taken to enforce this part of the Regulations during the year. 1. Milk and cream not sold as preserved cream:— (a) Number of Samples examined for the presence of a preservative. Number of Samples in which a preservative was reported to be present. Milk 617 — Cream — — 62 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 — 2. Statements incorrect — Total — (b) Determinations made of milk fat in cream sold as preserved cream:— 1. Above 35 per cent. — 2. Below 35 per cent — Total — (c) Instances where (apart from analysis) the requirements as to labelling or declarations of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed 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 served cream and action taken when found Nil 4. Other observations (if any) Nil 63 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) 782 78 Workshops (including Workshop Laundries) 1,306 102 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 1,449 76 — Total 3,537 256 — 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 A ct:— NIL. NIL. Want of Cleanliness 54 54 Want of Ventilation 1 1 Overcrowding 3 3 Want of drainage of floors — — Other nuisances 71 71 Sanitary accommodation Insufficient 10 10 Unsuitable or defective 69 69 Not separate for the sexes 2 2 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (Sec. 101) — — Lack of Special Sanitary Requirements to Bakehouses (Secs. 97 to 100) 46 46 Other Offences (excluding Offences relating to Outworkers which are included in Part 3 of this Report) — — Total 256 256 61 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1919:- Bakehouses 41 Bootmaker 44 Dressmaker 70 Laundries 14 Milliners 13 Tailors 42 Other Trades 226 Total number of Workshops 450 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 25 Notified by H.M. Inspector — Underground Bakehouses (Section 101), in use at end of the year 24 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1919 :— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons Barge Builder 1 15 3 — — Baker 36 177 30 18 39 Bootmaker 11 26 — — — Builder 4 93 6 — — Butter Blender 1 96 10 36 36 Carpenter 1 6 — 70 — Chemical Works 4 237 20 14 Chaff & Forage 5 27 — 8 — Cycle Maker 8 6 1 — — Dyer 1 18 2 13 1 Engineer 20 549 8 5 — Flour Mills 2 144 — 20 — Firewood Cutter 12 37 2 47 — Foundry 2 76 — — — Lift Maker 2 10 — — — Mason 3 79 1 — — Mineral Water 2 20 — 25 — Printer 17 72 10 7 1 Steam Laundry 19 80 18 565 29 Other Trades 98 4477 578 683 435 Total 239 6245 689 1497 555 65 The duties of sanitary authorities in relation to the sanitation of factories are few, and are limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. Eighteen new factory premises were added to the register during the year, dealing with : (a) engineering, 4; (b) firewood cutting, 3; (c) toys, 2; (d) printing, 2; (e) lenses, 1; (f) miscellaneous, 6. During the year 37 defects were found on factory premises, for the most part relating to defective or insufficient sanitary accommodation. In 23 cases it was found necessary to serve notices under the Public Health (London) Act, 1891, to remedy defects, all of which were complied with. Workshops. . The following is a list of the workshops on the register at the end of 1919:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults Young Persons. Adults. Young Pesons. Baker 41 55 60 4 — — Billiard Table maker 1 2 4 — — — Blind maker 3 3 5 — — — Bootmaker 44 45 83 5 — — Carpenter 6 6 8 — — — Coach builder 12 16 25 1 — — Cycle maker 7 11 9 4 — — Dressmaker 70 92 — — 139 8 Embroiderer 3 4 — — 13 1 Farrier & Smith 12 12 30 — — — Firewood cutter 22 22 32 1 26 1 Laundry 14 22 1 — 31 — Mason 1 1 4 — — — Millinery 13 14 — — 37 9 Musical instruments 3 4 22 3 — — Photographer 3 6 4 1 5 — Picture framer 1 1 2 — — Ragsorter 26 26 51 — 40 — Saddler 5 5 8 — — — Tailor 42 54 50 2 70 2 Upholsterer 12 14 20 1 7 2 Other Trades 109 119 317 35 155 32 Totals 450 534 735 57 523 55 00 Fifty seven new workshops were added to the register dealing with: (a) tailoring, 8; (b) upholstery, 5; (c) motors, 5; (d) confectioners, 3; (e) millinery, 3; (f) laundry, 3; (g) dressmaking, 1; (h) boot-repairing, 3; (i) rag-sorter, 4; (j) blousemaking, 2; (k) toys, 2; (l) metal-work, 2; (m) miscellaneous, 17. The following table gives particulars relating to new workshops in which "protected persons" were employed, notices of which were duly sent to H.M. Inspector during 1919:— Trade. No. of Workshops. Protected Persons employed. Women. Young Persons. Total. Bootmaker 1 1 1 Baker 4 — 4 4 Dressmaker 1 — 8 8 Firewood cutter 3 4 2 6 Tailor 2 4 — 4 Miscellaneous 14 22 18 40 Totals 25 80 28 58 Bakehouses. There were 77 bakehouses on the register at the end of 1919. Of these 36 use power and are therefore factories. Fifty-three of the bakehouses are situated above ground, and 24 are under ground. 227 inspections were made during the year, and notices were served to remedy various defects, mostly for failure to carry out the bi-yearly limewhiting of the bakehouses within the statutory period. Out Workers. During 1919 the names and addresses of 511 out-workers were received. 119 lists were sent in by employers and by the Medical Officers of Health of Metropolitan Borough and District Councils. 67 The names and addresses of 101 out-workers, which were sent in by employers, were found to refer to other districts, and were accordingly forwarded to the Medical Officer of Health of these districts. The following table shows the number of out-workers' premises registered in the Borough, together with the trades and the number of persons employed:— Trade. ✓ Number on Register. Persons Employed. Premises Workrooms. Males. Females. Blousemaking 76 76 — 76 Bootmaking 36 36 36 — Boxmaking 8 8 — 8 Dressmaking 8 8 — 8 Embroidery 42 42 — 42 Glovemaking 18 18 1 17 Tailoring 73 73 34 39 Underclothing 64 64 — 64 Other trades 7 7 — 7 Totals 332 832 71 261 Ninety-five new out-workers (out-workers not previously registered) were registered during the year. During 1919 250 out-workers' premises were inspected. It was found necessary to serve notices under the Public Health (London) Act, 1891, in four cases to remedy dirty condition of premises and defective sanitary accommodation. 68 Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served Prosecutions. Instances. Orders made (S. 110). Prosecutions (Secs. 109, 110.) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making 29 37 277 3 — 3 12 — — 4 4 — — — (2) Cleansing and Washing — — — — — — — — — — — — — — — Furniture and Upholstery 1 — 1 — — — 1 — — — — — — — — Other Trades 3 — 14 — — — 1 — — — — — — — — Total 33 37 292 3 — 3 14 — — 4 4 — 1 — — 69 Housing. The Housing problem became very acute during 1919, and, as a result, very considerable preliminary activity was shown by the Council in dealing with the situation. Many causes are responsible for the present shortage of houses, but the chief immediate cause is undoubtedly the almost complete cessation of building during the war. The return of large numbers of demobilised soldiers has accentuated the difficulty of the situation, and there is no doubt that we are, therefore, face to face with a most serious social and public health problem. The Council has been most active in endeavouring to meet the position in regard to housing in the Borough, and much preliminary investigation has been carried out, with a view to disclosing the position of the housing situation as it exists in Battersea to-day. House-to-house inspection during the war had been seriously interrupted, and for part of the time had practically ceased owing to the time of the Sanitary Inspectorial Staff being taken up with other duties. It was not an easy matter, therefore, to ascertain the actual situation in regard to the Housing question in the Borough. There was practically not a single empty house, and as house-tohouse inspection progressed, congestion amounting in some districts to overcrowding was apparent. (The extent to which overcrowding exists at the present time in Battersea is for various reasons difficult to estimate; house shortage, subletting, induced by the high rent obtainable, etc., have contributed to the evil.) Moreover, the sanitary condition of large areas of house property in the lower wards of the Borough was found to be seriously defective, owing to conditions occasioned by the war, e.g, shortage of labour, high cost, scarcity of building materials, etc. Active steps had, therefore, to be taken to deal with the Housing problem in its two-fold aspect of (a) insufficiency and (b) unsuitability. The powers of the Council for dealing with the Housing problem were much strengthened by the Housing, Town Planning, etc., Act, of 1919, which became law on the 31st of July. The Act was passed to enable Local Sanitary Authorities to deal with the housing question on broad and comprehensive lines, (a) by the provision, where required, of new houses suitable for the working classes, and (b) by a general raising 70 of the standard of fitness, of existing housing accommodation. The Act, moreover, was intended to simplify and amplify the powers under the previous Housing Acts, especially in regard to procedure under the principal Act, i.e., the Housing of the Working Classes Act, 1890. Special powers are contained in the Act for dealing with insanitary dwelling-houses and slum areas, and, not least important, the financial provisions were designed to relieve local authorities of much of the heavy cost involved in carrying out their housing schemes. In November, the Council, in accordance with the suggestion of the Ministry of Health, appointed a special Housing Committee, to which it delegated its powers (except in financial matters). In considering the provision of new houses in Battersea it was evident that, although the need for houses was acute, the land available for building was extremely limited. Not much, therefore, was to be hoped for immediately in regard to this aspect of the question, but, nevertheless, steps were taken to ascertain what building land was available in the Borough. The Health Committee, and subsequently the newly-formed Housing Committee, visited all possible sites. These were subsequently surveyed and submitted for consideration. For various reasons, however, mainly economic, only a few of these sites were considered practicable. It was felt, therefore, that the main activities of the Council in regard to housing in Battersea would have to be focussed on the question of dealing with insanitary houses and slum areas. It is, in my opinion, undesirable, except for emergency purposes, to build further new houses in Battersea. The Borough is already too densely populated as it is. What is badly needed is the demolition of the old, worn-out, badly planned, badly built, dirty, damp, and dilapidated houses or groups of houses, which are incapable of being made reasonably fit for habitation. There is, unfortunately, a considerable amount of this class of property in the Borough, especially in the lower wards; and its gradual elimination, followed by improvement or reconstruction schemes, is very desirable from the public health standpoint. Under existing conditions it is, of course, impossible to carry out such schemes immediately, owing to lack of accommodation for the dispossessed population. The acquisition of such insanitary areas, as a preliminary measure, by the Local Authority, and the temporary improvement of the defective houses, until the acuteness of the house shortage has subsided, would be the most useful procedure to adopt in the present emergency. 71 The Housing Question in London is a very complex one, and can only be solved by a consideration of the problem as it affects London as a whole. Migration of the surplus population and the removal of the industries involved to the outer zone round London, with an intervening belt of open country, has been advocated as the best method of dealing with the question, and, doubtless, the building of a ring of Garden Cities round London would be followed by a considerable easing of the situation. Any other method of solution will have to take into account the transport question. The housing survey, required by the Ministry of Health, was prepared by the Health Committee, and submitted on October 31st, 1919. A Special Report on the Housing Act, 1919, was submitted to the Council by the Medical Officer of Health, a copy of which will be found on page 73-80. Considerable progress was made by the Housing Committee by the end of 1919. Preliminary surveys were made of areas which might be considered, on the report of the Medical Officer of Health, suitable for official action by the Council in relation to improvement or reconstruction schemes for the clearance of insanitary areas under Part I. or Part II. of the Housing of the Working Classes Act, 1890, as amended by subsequent Acts. A preliminary list, containing nine of these areas, was submitted to the Ministry of Health with the Form of Survey. Steps had already been taken to ascertain the number of empty or derelict houses in the Borough which were suitable for conversion into working-class tenements. The Housing Board, in order to expedite matters, temporarily undertook this part of their scheme on behalf of the Council. With regard to the provision of new working-class dwellings, progress was being made with the preparation of preliminary plans and estimates in respect of part of the limited amount of building land available in the Borough. These plans contemplate the erection of 110 tenements (two storeys); 24 houses, containing two four-roomed tenements, on various sites, and 31, containing two three-roomed tenements, on the vacant site on the Latchmere Estate. Progress was being made by the Housing Committee in their efforts to secure that all premises in the Borough shall be in good sanitary condition, and by the end of 1919 a number of houses had been dealt with under the provisions of Section 28 of the Housing, Town Planning, etc., Act, 1919. (This does not, of course, take account of the considerable number of houses dealt with by the Health Committee under the provisions of the Public Health (London) Act, 1891, particulars of which will be found in the Summary on page 49). 72 With regard to action under Section 17 of the Housing Act, 1909, dealing with the making of Closing Orders, it was considered inadvisable, save in very exceptional circumstances, to close any insanitary dwelling-houses in the Borough owing to the difficulty of the situation through lack of housing accommodation. Statistics for the Twelve Months ended 31st December, 1919. 1. Number of dwelling-houses in respect of which complaints were made that they were unfit for habitation— (a) By householders Nil (b) In the case of Rural Parishes by Parish Council Nil 2. Action under Section IT of the Housing Act of 1909— (a) Number of houses inspected under and for the purpose of this section 259 (6) Number of dwelling-houses which were considered to be unfit for human habitation 4 (c) Number of dwelling-houses, the defects in which were remedied without the making of closing orders - 3. Action under Section 28 of the Housing Act of 1919— (a) Number of orders for repairs issued 31 (b) Number of cases in which repairs were carried out by the Local Authority Nil (c) Number of houses voluntarily closed on notice by owner that they could not be made fit without re-construction Nil 4. Closing Orders — (a) Number of Representations made Nil (b) Number of dwelling-houses in regard to which closing orders were determined on the houses being made fit for habitation Nil 5. Demolition Orders— (a) Number of demolition orders made Nil (b) Number of houses demolished in pursuance of demolition orders Nil 6. Number of dwelling-houses demolished voluntarily Nil 73 7. Obstructive Buildings— (a) Number of representations made (Section 38 of the Housing Act of 1890) Nil (b) Number of buildings demolished Nil (c) Number of representations still under consideration Nil 8. Staff engaged in Housing Work, with brief duties of each officer— Medical Officer of Health. Chief Sanitary Inspector. Eight District Sanitary Inspectors. Report of Medical Officer of Health on the Housing, Town Planning Act, 1919. To the Battersea Borough Council. The question of the provision of new houses for the working classes will have to be considered by the Council in connection with their proposals to be set out in an Outline Scheme in the manner prescribed by the Ministry of Health. As pointed out in my previous reports to the Health Committee, it is obligatory under the provisions of the New Housing Act: (1) To ascertain the needs of their district in regard to housing, and (2) to provide new houses where necessary. That there is at the present time in Battersea a demand for houses, does not, I think, admit of dispute. Building has been at a standstill in the Borough since 1914, and during the ten years, .1909-1919, only 326 (small) houses have been built, mainly on the Battersea Rise Estate. During the same period a considerable number of working-class houses have been demolished in the lower Wards. Small groups of houses, totalling in the aggregate to a considerable number, have been acquired and pulled down for the extension of existing railway and factory premises, or for the extension or provision of schools by the London County Council, Education Authority, without any special provision for rehousing the displaced inhabitants. The fact, moreover, that there is practically not a single empty working-class house in the Borough is further proof of the acuteness of the housing shortage. At the same time, it is clear, as pointed out in my previous reports to the Health Committee, that there is comparatively little ground available in the Borough for the erection of new houses, a matter of importance when the Council comes to 74 consider the question of dealing with insanitary areas, which it is equally their duty to do in connection with their proposed Outline Scheme. A list of the available sites tor building has been submitted with my previous report, together with a rough estimate of the approximate number of working-class dwellings which might be erected thereon. These sites have since been inspected by the Housing Sub-Committee, and the Borough Surveyor will be able to furnish the necessary details as to the extent, suitability, and building potentialities of these sites. It is probable that at least 200 working-class dwellings might be erected on land remaining in the Borough which may be available for building purposes. The provision of even this number of working-class dwellings would greatly assist and expedite the task of the Council in dealing with insanitary areas of the Borough, which, in my opinion, might with advantage be undertaken as an urgent and necessary part of this proposed Outline Scheme. In submitting the Outline Scheme in relation to the provision of new houses, it will be necessary to show the approximate number and nature of the houses to be erected and the locality of the land to be acquired, the average number of houses per acre, and the time in which the scheme or part of it is to be complete. INSANITARY AREAS. Under Parts I. and II. of the Housing Act, 1890, powers are given to the Council to deal with insanitary areas:— fa) By the clearance or reconstruction of large unhealthy areas (Part I.). (b) By the improvement or demolition of unfit houses, the demolition of obstructive buildings, and the clearance or reconstruction of small unhealthy areas (Part II.). (c) By the provision of new houses for the workingclasses (Part III.), now made obligatory, where necessary, under the new Housing Act. It is the duty of the Medical Officer of Health to draw the attention of the Council as Local Authority to unhealthy areas or to unfit dwelling-houses, and the Council, if satisfied that an area is unhealthy and if they possess sufficient resources, are required to carry out an improvement scheme and to provide for the rehousing of the dispossessed tenants, and, in the case of unfit dwellings, to make a closing order if satisfied that they are unfit for human habitation. 75 I have lately brought to the notice of the Health Committee the existence of certain areas in the lower Wards, which, in my opinion, are either unhealthy areas or are rapidly becoming so, and the Housing Sub-Committee have inspected some of these areas. Heretofore it has not been an easy matter for Local Authorities to deal with slum areas. The procedure was cumbersome, officially and legally dilatory, and the cost generally prohibitive. Action has had, therefore, to be confined to the closing and demolition of individual houses, and, prior to the war, a good deal of necessary action in this direction was carried out by the Council. The new Act has greatly simplified the procedure under Parts I. and II. of the principal Act, and, furthermore and not less important, the clearance of slum areas will rank for financial assistance from the Government. This fact provides, in my opinion, an unique opportunity to the Council for the gradual clearance of the slum areas of the Borough. There are scattered groups of houses in the lower Wards which are, owing to the bad arrangement, faulty construction, old, worn-out, dilapidated, verminous and generally unhealthy state of many or all of the houses, unfit for human habitation. These areas should be considered for inclusion in the Council's Outline Scheme, and appended is submitted for consideration a list of the areas which, in my opinion, may be found suitable for action under the Council's Housing Scheme, under Part II. If the number of houses to be dealt with in an unhealthy area exceeds ten houses, the Authority to deal with the unhealthy area is the (London) County Council. Smaller areas, containing ten houses or less, are dealt with by the Borough Council. Many, if not all of the insanitary areas in the Borough, can probably be dealt with by pulling down the worst houses and making the remainder fit for habitation. In view of the shortage of houses now prevailing, as pointed out in previous reports to the Health Committee, I recommend that the less drastic procedure be followed, i.e., action under Part II. of the Housing Act, 1890. In my opinion, so far as Battersea's housing needs are concerned under present conditions, a gradual process of elimination of the more unfit houses and the raising of the standard of habitable repair of the remaining houses to a reasonable level, will be found to be sufficient in most cases to deal with the existing housing situation. It should, however, be borne in mind that any steps by the Council to deal with insanitary areas will, having regard to the housing shortage, in my judgment, be contingent upon 76 the provision in advance of an equal amount of accommodation in the shape of new working-class dwelling-houses to house the displaced persons. The following points are quoted from the recentlypublished pamphlet on Housing and the powers of Local Authorities for the information of the Committee:— "One of the principal difficulties in the past has been the price which has had to be paid for land and buildings. This has deterred Local Authorities from taking action. A serious burden on the rates might be involved, and it was unfair to pay high prices for insanitary property, especially in cases where the owners had failed in their duty. "If a slum area is to be cleared, the price to be paid for it is the value of the land alone, without any payment for the buildings. If the whole of the land in an improvement scheme is a slum area and is required by the scheme to be used for rehousing (or, as may be desirable in some cases, partly for rehousing and partly as an open space), the price to be paid for the land will be its value to a person who proposes to develop it for working-class dwellings, subject to the restrictions imposed by the scheme. The land might fetch a big price for business premises or factories, and, in the past, the Local Authority would have had to pay this price for it, even though it was used for re-housing. In some cases the Local Authority will find it necessary to acquire buildings which do not form part of the unhealthy area, but are included for the purpose of making the scheme efficient. The compensation payable to the owners in these circumstances is not affected by the new Housing Act. "Perhaps the most important provision in the Act for helping to get improvements carried out is that under which financial assistance is to be given by the State to Local Authorities who clear away slums and re-house the persons displaced. Under the new Act, Local Authorities may receive the same kind of assistance in clearing any area, if re-housing is provided, whether the re-housing is on the cleared area or on another site, as for the provision of new houses, where the Ministry of Health are satisfied that the slum clearing and the re-housing are necessary. "It has to be borne in mind that often much the best plan will be to clear an area and then to use the land not for housing (for which it may be badly suited), but for 77 other purposes. Under the new conditions, therefore, a Local Authority can proceed with housing reform in a comprehensive manner. They can provide not only new houses to meet the shortage, but also, where necessary for proper housing accommodation, can clear away slums and re-house the people; and for the loss on the total schemes the local rates will not be burdened with more than a rate of one penny in the pound." The favourable terms, which are set out in the above quotation and upon which Local Authorities may now rely, should prove a powerful stimulus to any progressive Municipality desirous of dealing in a practical and comprehensive manner with the important and pressing matter of Housing Reform. There is no use toying with the question. Past experience shows clearly that only by a forward and systematic policy in regard to the housing needs of a district can the present unsatisfactory state of affairs be checked and gradually improved. The failure of the Public Health Act, upon which Sanitary Authorities have mainly relied in past years, is sufficiently evident from the fact that the legislature has been compelled to pass two or three drastic amending Housing Acts to strengthen the Principal Housing Act, and, my experience, as your Medical Officer of Health has convinced me, that as an instrument for improving, or even of maintaining, the standard of fitness for habitation of working-class houses, the Public Health Act has proved signally ineffective. Now that the State has come to their assistance by providing funds from the Exchequer to relieve the local rates of the heavy cost of Housing Schemes, the Council will, I have no doubt, give full consideration to the needs of their district. The proposals now submitted for their consideration are based upon a hurried and imperfect survey of the district, unavoidable owing to the form of survey requiring to be filled in (with particulars of the needs of the district and proposals as to the Council's Outline Scheme), and submitted to the Ministry by the 31st of October. This difficulty has, moreover, been enhanced owing to the absence of reliable data in regard to the present sanitary state of housing generally in the Borough. During the war the systematic inspection of houses had to be modified and, for part of the time, discontinued, and it has been impossible, in the circumstances, to obtain evidence of the actual extent of the conditions now prevailing. For the Form of Survey, reliance has had, therefore, to be placed upon previous knowledge, aided by inspections of typical streets and groups of houses. There is ample proof, however, that in most of the lower Wards of the Borough there is a pressing need for the improvement of the 78 housing conditions. The Sub-Committee has recently viewed houses reported to them by the Medical Officer of Health as being insanitary in various parts of the Borough, and will have noted for themselves the unsatisfactory conditions prevailing in many of the houses. It is unnecessary for me, therefore, to enter into details, but it is, nevertheless, incumbent on me as Medical Officer of Health, to bring to the urgent notice of the Committee and the Council the evil effect of such insanitary housing conditions upon the health and physical development of the people who have to live in them. The shortage of houses and the difficulty of re-housing the dispossessed tenants is the stumbling block to effective action for dealing immediately with insanitary areas and unhealthy dwelling-houses. The provision of 50 or 100 new working-class dwellings as a beginning is, therefore, in my opinion, a sine qua non, and it is to be hoped that from among the list of available building sites, sufficient suitable land will be acquired to provide this measure of new housing accommodation. In concluding this report, I beg to submit the following recommendations for consideration:— 1. That no action at present be taken in regard to schemes under Part I. of the Housing Act, 1890, dealing with large improvement schemes, the urgency of the need of such schemes not being, in my opinion, immediately indicated. Moreover, the difficulties at present being experienced, e.g., house shortage, lack of available building land in Battersea, etc., would appear to preclude any action being undertaken in this direction. 2. (a) The immediate provision of 100 to 200 working-class dwellings under Part III. of the Housing Act in connection with schemes under Part II., dealing with small insanitary areas or unhealthy dwelling- houses. (b) Empty or derelict houses in the Borough to be acquired and altered, repaired, or converted into tenements or flats suitable for occupation by the working-classes. (This has already been undertaken on behalf of the Council by the Ministry.) 3. Action under Part II. of the Housing Act, 1890, as amended by the Housing, Town Planning, etc., Act, 1909, dealing with the condemnation and demolition of houses individually and in small groups, that are unfit for habitation. 79 4. Active measures to be taken in regard to houses found, on inspection, to be seriously defective, but capable of being made reasonably fit for habitation. 5. Measures to secure the raising to a reasonable standard of fitness for habitation, houses at present in fair condition, but falling below the level at which such houses should be maintained. Appended will be found set out a list of the areas containing houses or groups of houses which appear to call for early attention in regard to action under Part II. to be considered in connection with the proposals under Part III. of the Housing Act. I have not yet officially represented any of these groups to the Council for reasons previously reported. G. Ouin Lennane, Medical Officer of Health. 31st October, 1919. BATTERSEA BOROUGH COUNCIL. HOUSING, TOWN PLANNING, ETC., ACT, 1919. Survey of housing needs and scheme under Section 1 of the Act, forwarded to the Ministry of Health, 31st October, 1919. SUMMARY AND PRECIS. Average number of working-class houses built annually before the war 65 Estimated number of empty buildings which might be made suitable, or converted into flats 24 Number of tenements with more than two occupants per room 3,275 Census, Total number of occupiers 21,814 1911. Number of houses intended for one family, but occupied by two or more families 10,313 Estimated number of working-class houses required during next three years— (a) To meet unsatisfied demand 500 (b) To re-house persons displaced by clearing insanitary areas 100-200 80 UNHEALTHY AREAS WHICH REQUIRED TO BE DEALT WITH. Acreage approximate. No. of Houses. Population approximate. Didcot Street .62 29 156 Britannia Place .74 33 225 Field Place .64 23 117 Lothair Street .27 8 52 Savona Street (West Side, Even Nos.) 1.00 26 192 Aegis Grove .93 33 197 Ponton Street .30 15 82 Goslings Yard .79 6 27 Orville Road... 1.30 35 497 6.59 208 1545 APPENDICES. 82 Deaths Registered from all Causes for the Year 1919. Cause of Death. AGES. Registration District. Sex. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. E. N.W. S.W. M. F. 1.—General Diseases. 1. Enteric Fever ... ... ... ... ... 1 ... ... 1 1 ... ... ... 3 ... 3 ... 1 2 2. Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Malaria ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 1 ... 5. Small Pox— (a) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Not Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Measles 2 6 7 2 ... 1 ... ... ... ... ... ... ... 18 5 10 3 12 6 7. Scarlet Fever ... 2 1 ... 3 2 1 1 2 8. Whooping Cough ... ... 1 ... 1 ... ... ... ... ... ... ... ... 6 1 3 2 3 3 9. (a) Diphtheria ... 4 8 ... 3 ... ... ... ... ... ... ... ... 20 9 7 4 11 9 (b) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Influenza ... 3 3 ... 6 ... 37 ... 24 ... 18 10 ... 177 72 53 52 80 97 11. Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14. Dysentery ... ... ... ... ... ... 1 ... 1 1 1 ... ... 4 1 2 1 2 2 15. Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16. Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17. Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18. Erysipelas 2 ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 ... 2 2 1 19. (a) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20. (a) Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Septicaemia 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 (c) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21. Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22. Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24. Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25. Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26. Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28. (a) Pulmonary Tuberculosis 1 ... 1 4 7 30 27 38 20 8 12 2 150 61 43 46 77 73 (b) Phthisis (not defined as Tuberculosis) ... ... 1 ... ... 2 5 5 3 1 ... ... ... 17 3 10 4 10 7 29. (a) Acute Phthisis ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... 1 ... (b) Acute Miliary Tuberculosis ... ... 1 1 ... ... ... ... 1 ... ... ... ... 3 1 2 ... 2 1 30. Tuberculous Meningitis ... ... 11 1 4 ... ... ... ... ... ... ... ... 24 12 8 4 16 8 31. (a) Tabes Mesenterica ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... (b) Other peritoneal and intestinal tubercle ... 1 ... 1 1 ... 2 ... ... ... ... ... ... 5 4 1 ... 4 1 32. Tuberculosis of Spinal Column ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 33. Tuberculosis of Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 34. (a) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Tuberculosis of other Organs ... ... ... ... 1 ... ... 1 ... 1 ... ... ... 3 2 1 ... 2 1 35. Disseminated Tuberculosis ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 3 2 1 ... 2 1 36. Rickets, Softening of Bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37. Syphilis 6 1 ... ... ... 2 1 ... 3 ... 1 ... ... 14 5 6 3 10 4 38 Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39. Cancer of the Buccal Cavity ... ... ... ... ... ... ... ... 2 4 4 1 11 5 4 2 9 2 40. „ Stomach, Liver, &c. ... ... ... ... ... ... ... 1 9 25 22 7 2 66 14 22 30 40 26 41. „ Peritoneum, Intestines, and rectum ... ... ... ... ... ... ... 1 7 9 11 3 1 32 7 4 21 14 18 42. Female Genital Organs ... ... ... ... ... ... ... 6 8 4 2 3 ... 25 4 8 13 ... 25 43. , Breast ... ... ... ... ... ... ... 7 11 1 5 2 ... 26 4 9 13 1 25 44. ,, Skin ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 1 1 1 1 45. Cancer of other or unspecified Organs ... ... ... 2 ... ... 2 5 7 8 7 4 2 37 16 9 12 21 16 83 Deaths Registered from all Causes for the Year 1919—continued. Causes of Death. AGES. Registration Districts. Sex. 0 to 1 l to 2 2 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. E. N.W. S.W. M F. 46. Other Tumours (situation undefined) ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 47. Rheumatic Fever ... ... ... ... 3 ... ... 1 2 1 ... ... ... 7 ... 2 5 3 4 48. (a) Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Osteo-ArthritiS ... ... ... ... ... 1 ... ... ... 2 ... ... ... 3 2 ... 1 1 2 (c) Gout ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 1 ... 49. Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50. Diabetes ... ... ... ... ... ... 1 ... 2 3 ... ... ... 8 2 3 3 3 5 51. Exophthalmic Goitre ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 2 ... ... ... 2 52. Addison's Disease ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 53. Leucocythæmia, Lymphadenoma ... ... ... ... 1 ... ... ... ... ... ... ... 1 2 1 1 ... 2 ... 54. Anaemia, Chlorosis ... ... ... ... ... 1 3 1 2 2 ... ... ... 11 5 1 5 4 7 55. (a) Diabetes Insipidus ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... 1 ... (b) Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... (c) Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other General Diseases ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 ... ... 2 ... 56. Alcoholism (acute or chronic) ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... 57. (a) Occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Non-occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58. Other Chronic Occupational Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59. Other Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diseases of the Nervous System and of the Organs of Special Sense. 60. Encephalitis ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 2 ... ... 1 1 61. (a) Cerebro-Spinal Fever ... ... ... 1 ... 2 1 ... ... ... ... ... ... 4 2 1 1 3 1 (b) Posterior Basal Meningitis 1 ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 1 1 1 1 (c) Meningitis, other forms 1 2 ... 1 ... ... 1 1 ... ... ... ... ... 6 3 2 1 2 4 62. Locomotor Ataxy ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 2 ... ... 1 1 84 63 (a) Other Diseases of the Spinal Cord ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 ... 1 2 ... (b) „ „ „ „ ... ... ... ... ... ... 1 2 1 3 2 ... ... 9 4 1 4 5 4 64. (a) Cerebral Haemorrhage; Apoplexy ... ... ... ... ... ... ... 1 2 4 2 2 1 12 5 1 6 7 5 (b) Serous Apoplexy&CEdema of Brain 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... 1 1 2 ... (c) Cerebral Congestion ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 1 (d) Cerebral Atheroma ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 1 ... 1 2 ... (e) Cerebral Haemorrhage 1 ... ... ... ... 1 1 1 9 12 19 10 2 56 20 16 20 26 30 65. Softening of Brain ... ... ... ... ... ... ... 1 ... ... 2 1 ... 4 ... 1 3 2 2 66. (a) Hemiplegia ... ... ... ... ... ... 1 ... ... 3 3 ... ... 7 4 ... 3 4 3 (b) Paraplegia ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... 67. General Paralysis of the Insane ... ... ... ... ... 1 ... ... 3 1 1 ... ... 10 7 1 2 9 1 68. Other forms of Mental Alienation ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... 1 1 ... 2 69. Epilepsy ... ... ... 1 ... ... 2 ... 1 1 3 1 ... 9 4 4 1 4 5 70. (b) Convulsions (Non-puerperal; 5 yrs. and over) ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 71. (a) Infantile Convulsions (with teething) 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... (b) Other Infantile Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 72. Chorea ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 2 ... ... ... 2 73. Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74. (c) Cerebral Tumour ... ... ... ... ... 1 1 2 1 ... ... ... ... 6 3 3 ... 4 2 (d) Other Diseases of the Nervous System ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 75. Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76. (a) Mastoid Disease ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... (b) Other Diseases of the Ears ... ... ... 2 1 2 ... 2 1 ... ... ... ... 8 4 3 1 ... 8 3.—Diseases of the Circulatory System. 77. Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78. (a) Acute Myocarditis ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 1 1 ... 2 ... (b) Infective Endocarditis ... ... ... ... ... 1 2 ... ... ... 1 ... ... 4 ... 2 2 2 2 (cj Other Endocarditis ... ... ... 1 ... ... 2 1 ... 1 ... ... ... 5 3 1 1 3 2 79. (a) Valvular Disease ... ... ... ... ... 5 10 11 15 22 26 18 2 109 39 28 42 53 56 (b) Fatty Degeneration of the Heart ... ... ... ... ... ... ... ... ... 2 2 ... 1 5 2 2 1 2 3 (c) Other Organic Disease of the Heart ... ... ... ... ... 1 ... 2 11 17 9 4 2 46 21 8 17 22 24 80. Angina Pectoris ... ... ... ... ... ... ... ... 1 1 2 ... ... 4 1 ... 3 3 1 85 Deaths Registered from all Causes for the Year 1919.—continued. Causes of Death. AGES. Registration Districts. Sex. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. E. N.W. S.W. m. f. 81. (a) Aneurism ... ... ... ... ... ... ... ... ... 1 2 ... ... 3 3 ... ... 3 ... (b) Arterial Sclerosis ... ... ... ... ... ... 1 ... 2 8 36 45 14 106 37 39 30 44 62 (c) Other Diseases of the Arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 82. (a) Cerebral Embolism and Thrombosis ... ... ... ... ... ... ... ... 2 3 4 4 ... 13 4 3 6 5 8 (b) Other Embolism and Thrombosis ... ... ... ... ... ... ... ... ... 2 1 ... ... 3 1 1 1 2 1 83. Diseases of the Veins, (Varices, Haemorrhoids, Phlebitis, &c.) ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... 1 ... 84. (a) Status Lymphaticus 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 (b) Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 1 ... 85. (a) Haemorrhage; other Diseases of the Circulatory System ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... (c) ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 1 ... 4—Diseases of the Respiratory System. 86. Diseases of the Nasal Fossæ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87. (a) Diseases of the Larynx ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 88. Diseases of the Thyroid Body ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 1 89. (a) Bronchial Catarrh, &c.(under 5yrs.) 8 6 6 ... ... ... ... ... ... ... ... ... ... 20 8 10 2 8 12 (b) „ „ (over 5 yrs.) 90. (a) Bronchitis (under 5 yrs.) 2 ... ... 2 ... ... 3 12 16 34 61 41 8 179 69 49 61 94 85 (b) „ (over 5 yrs.) 91. Broncho-Pneumonia 22 15 8 ... 1 ... 3 1 1 7 8 7 1 74 37 22 15 37 37 92. (a) Lobar Pneumonia 4 ... ... 1 1 1 3 3 3 3 1 1 ... 21 8 4 9 10 11 (b) Pneumonia (type not stated) 7 ... ... ... ... 4 1 5 6 6 5 4 ... 38 19 12 7 25 13 93. (a) Empyema 1 ... 1 ... ... ... ... ... ... ... ... ... ... 2 2 ... ... 1 1 (o) Other Pleurisy ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... 1 ... 94. (a) Pulmonary Apoplexy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Pulmonary Congestion 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 1 1 1 1 86 95. Gangrene of the Lung ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 96. Asthma ... ... ... ... ... ... ... 2 3 1 ... 1 ... 7 2 3 2 5 2 97. Pulmonary Emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 98. (a) Fibroid Disease of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Other Diseases of the Respiratory System ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 5.—Diseases of the Digestive System. 99. (a) Diseases of the Teeth and Gums 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... (b) Other Diseases of the Mouth and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100. (a) Tonsilitis ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 1 1 ... 1 1 (b) Other Diseases of Pharynx ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 101. Diseases of œsophagus ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 1 ... 102. Perforating Ulcer of Stomach ... ... ... ... ... 1 2 2 1 2 1 ... ... 9 7 1 1 4 5 103. (a) Inflammation of Stomach 4 ... ... 1 ... ... ... ... ... ... 2 ... ... 7 4 1 2 1 6 (b) Other Diseases of Stomach ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 1 ... 1 2 ... 104. (a) Infective Enteritis 9 ... ... ... ... ... ... ... ... ... ... ... ... 9 6 1 2 6 3 (b) Diarrhœa (not returned as infective) 2 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... 1 2 (c) Enteritis (not returned as infective) 8 1 ... ... ... ... ... ... ... ... ... ... ... 9 3 4 2 5 4 (d) Gastro-Enteritis (not returned as infective) 9 1 ... ... ... ... ... ... ... ... ... ... ... 10 5 3 2 6 4 (e) Dyspepsia (under 2 years of age) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (f) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (g) Ulceration of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (h) Duodenal Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105. (a) Infective Enteritis ... ... 1 1 ... 1 ... ... 1 ... ... ... ... 4 1 2 1 2 2 (b) Diarrhœa (not returned as infective) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Enteritis (not returned as infective) ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 2 ... ... ... 2 (d) Gastro-Enteritis (not returned as infective) ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 2 ... ... 2 ... (e) Dyspepsia (under 2 years of age) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (f) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (g) Ulceration of Intestines ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 ... 1 ... 2 (h) Duodenal Ulcer ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 2 ... ... 2 ... 106. Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 Deaths Registered from all Causes for the Year 1919—continued. Causes of Death. AGES. Registration Districts. Sex. 0 to 1 l to 2 2 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. E. N.W. S.W. M. F. 107. Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108. Appendicitis ... ... 1 1 2 1 ... 2 2 ... ... ... ... 9 5 ... 4 3 6 109. (a) Hernia 1 ... ... ... ... ... 1 ... ... 2 4 4 ... 12 9 2 1 7 5 (b) Intestinal Obstruction 2 ... ... ... ... 1 ... ... ... 2 4 ... ... 9 4 1 4 4 5 110. Other Diseases of the Intestines 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 111. Acute Yellow Atrophy of Liver ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 ... 1 1 1 1 112. Hydatid of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113. (a) Cirrhosis of the Liver (not returned as alcoholic) ... ... ... ... ... ... ... ... 3 6 1 1 ... 11 3 3 5 10 1 (b) Cirrhosis of the Liver (returned as alcoholic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Diseases formerly classed to "Other Diseases of the Liver and Gall Bladder " ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114. Biliary Calculi ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 1 115. Other Diseases of the Liver 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 3 1 ... 2 ... 3 116. Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117. Peritonitis (cause unstated) 1 ... ... ... ... ... 2 1 1 ... 2 ... ... 7 5 1 1 5 2 118. Other Diseases of the Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Non-Venereal Diseases of the Genito-Urinary System and Annexa. 119. Acute Nephritis ... ... ... ... 1 1 ... 1 2 ... 1 ... ... 6 4 1 1 6 ... 120. (a) Bright's Disease ... ... ... 1 ... 2 1 3 3 11 9 8 ... 38 23 7 8 23 15 (b) Nephritis and Uræmia ... ... ... 1 ... ... 4 2 3 2 3 ... 1 16 8 3 5 8 8 121. Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 122. (b) Cystic Disease ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 (d) Other Diseases of the Kidney and Annexa ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 123. Calculi of the Urinary Passages ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... 2 ... 2 124. Diseases of the Bladder ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... 1 1 2 ... 125. (b) Diseases of the Urethra, Urinary Abscess, &c. ... ... ... ... ... ... 1 ... 1 ... 1 1 ... 4 3 1 ... 4 ... 126. Diseases of the Prostate ... ... ... ... ... ... ... ... ... 1 2 9 ... 12 4 3 5 12 ... 127. Non-Venereal Diseases of Male Genital Organs 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... 128. Uterine Hæmorrhage (Non-puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129. Uterine Tumour (Non cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 130. (b) Other Diseases of the Uterus ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 1 131. Ovarian Cyst, Tumour (Non-cancerous) ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 1 132. (b) Other Diseases of the Female Genital Organs ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... 1 133. Non-Puerperal Diseases of the Breast (Non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—The Puerperal State. 134. (a) Accidents of Pregnancy ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 ... 2 ... ... 2 (d) „ „ ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 1 (e) „ „ ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... 1 135. Puerperal Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136. Other Accidents of Childbirth ... ... ... ... ... ... 1 3 ... ... ... ... ... 4 1 2 1 ... 4 137. Puerperal Fever ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 138. (b) „ Albuminuria ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 2 ... ... ... 2 (c) „ Convulsions ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... ... 2 ... 2 139. (a) „ Phlegmasia Alba Dolens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) „ Embolism and Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140. „ Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141. „ Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Deaths Registered from all Causes for the Year 1919—continued. Causes of Death. AGES. Registration Districts. Sex. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 86 and upwards Totals. E. N.W. S.W. M. F. 8.—Diseases of the Skin and of the Cellular Tissue. 1 142. (a) Senile Gangrene ... ... ... ... ... ... ... ... ... 2 ... 2 ... 4 2 1 1 2 2 (b) Gangrene (other types) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143. Carbuncle, Boil ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 144. Phlegmon, Acute Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145. Diseases of the Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bones ... 1 ... 1 1 1 1 ... ... ... ... ... ... 5 3 1 1 4 1 147. Diseases of the Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148. Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149. Other Diseases of Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10.—Malformations. 150. Congenital Malformations: (a) Congenital Hydrocephalus 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... 1 1 (c) Congenital Malformation of Heart 7 ... ... 1 ... ... ... ... ... ... ... ... ... 8 3 2 3 5 3 (d) Other Congenital Malformations 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 2 3 1 11.—Diseases of Early Infancy. 151. {a) Premature Birth 52 ... ... ... ... ... ... ... ... ... ... ... ... 52 17 24 11 28 24 (b) Infantile Debility, Icterus, ant Sclerema 37 ... ... ... ... ... ... ... ... ... ... ... ... 37 15 14 8 17 20 152. (a) Diseases of Umbilicus, &c. 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 (b) Other Diseases peculiar to ear Infancy 6 ... ... ... ... ... ... ... ... ... ... ... ... 6 5 ... 1 3 3 153. Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 12.— Old Age. 154. (a) Senile Dementia ... ... ... ... ... ... ... ... ... ... 1 1 ... 9 ... ... 2 1 1 (b) Senile Decay ... ... .. ... ... ... ... 1 ... 1 22 60 43 127 46 30 51 44 83 13.—Affections Produced by External Causes. 155. Suicide by Poison ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... 1 156. „ Asphyxia ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... 1 167. „ Hanging or Strangulation ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... ... 2 2 1 168. „ Drowning ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... 1 ... 159. „ Firearms ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 160. „ Cutting or Piercing Instruments ... ... ... ... ... ... 1 ... ... 1 1 1 ... 7 ... 4 3 5 2 161. „ Jumping from High Place ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 162. „ Crushing ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 1 ... 1 2 1 163, „ Other Means ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164. Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165. Other Acute Poisonings 1 ... ... 1 ... ... ... ... ... ... ... ... ... 2 2 ... ... 1 1 166. Conflagration ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 167. Burns (Conflagration excepted) ... 3 4 1 ... 1 ... ... 1 ... ... ... ... 10 7 2 1 3 7 168. Absorption of Deleterious Gases (Conflagration excepted) ... ... ... ... 1 1 ... ... ... ... ... ... ... 2 1 ... 1 1 1 169. Accidental Drowning ... ... ... 1 1 ... ... ... ... 1 1 ... ... 4 2 1 1 3 1 170. Injuries—Firearms ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 1 ... 171. „ Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 172. „ Fall ... ... 1 ... ... ... ... ... 2 4 5 2 1 17 4 5 8 12 5 173. „ Mines and Quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 174. „ Machines ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 175. „ Vehicles, Railways, &c. ... ... 2 4 1 1 3 2 6 3 1 ... ... 23 7 7 9 17 6 176. „ by Animals ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 9 17 6 177. Starvation ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... 1 ... 178. Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179. Effects of Heat ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 180. Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181. Electricity (Lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 184. Homicide 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 186. Other Violence 1 ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... 1 ... 1 189. Ill-defined causes ... 4 1 ... 1 ... ... ... ... ... ... ... ... 6 5 1 1 3 3 91 92 Summary of Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 107 cases during the year 1919:— Prosecutions. Convictions. Fines. Costs. Public Health (London) Act, 1891, and the bye-laws made thereunder 47 15 £ 3 s. 5 d. 0 £ 45 s. 8 d. 0 Under Metropolis Management Act 1 - - - - - - - Sale of Food and Drugs Acts 59 25 47 10 6 49 19 0 Total 107 40 £50 15 6 £95 7 0 TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole District during 1919 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 1914 167,338 4,080 4,303 25.7 2,470 14.4 685 432 397 92 2,217 13.2 1915 161,945 3,604 3,820 23.6 2,992 18.5 798 459 428 112 2,653 16.4 1916 173,432 B. † 3,523 3,774 21.8 2,502 15.7 705 424 318 84 2,221 13.9 159,402 D.† 1917 167,233 B.† 2,709 2,960 17.7 2,567 17.1 727 445 299 101 2,285 15.2 150,023 D.† 1918 168,014 B. † 2,407 2,700 16.1 3,195 21.3 857 471 267 99 2,809 18.7 149,951 D. † 1919 165,960 B.† 2,765 3,075 18.53 2,409 15.1 730 382 228 74 2,061 12.9 159,316 D. † * Rates calculated per 1,000 of estimated population. Area of District in acres (land and inland water), 2,307 acres. Total population at all ages, 167,743; number of inhabited houses, 24,321; average number of persons per house 6.9 at Census of 1911. † B =Registrar General's estimated population for purpose of calculating birth-rate. † D.= Do. do. death-rate. 93 TABLE II. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1919. Notifiable Disease. Casks Notified in Whole District. Total Cases Notified in each Locality. No. of Casks Removed to Hospital from each Locality. At all Ages. At Ages—Years. East Battersea. N.-West Battersea. S.-West Battersea. East Battersea. N.-West Battersea. S.-West Battersea. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 3 ... ... ... 2 1 ... ... ... 3 ... ... 3 Cholera ... ... ... ... ... ... ... ... ... ... ... ... 3 Diphtheria 229 2 53 139 25 10 ... 120 59 50 118 53 46 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 92 1 ... 14 5 61 11 37 40 15 2 4 1 Scarlet Fever 484 2 96 337 30 19 ... 272 108 109 252 100 102 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 11 ... 1 4 2 4 ... 6 3 2 6 2 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 11 ... ... ... 1 10 ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever 9 1 2 2 4 ... ... ... ... ... ... ... ... Glanders ... ...... ...... ... ... ... ... ... 3 3 3 3 3 3 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 78 78 ... ... ... ... ... 47 27 4 5 2 1 Polio-myelitis, &c. 6 1 1 4 ... ... ... 4 ... 2 2 ... 2 Encephalitis Lethargica 3 ... ... 2 1 ... ... 4 1 1 1 ... 2 Malaria 95 ... ... ... 18 77 ... 35 30 30 ... ... ... Dysentery 4 ... ... ... 1 3 ... 3 1 ... ... ... ... Trench Fever 3 ... ... ... 1 2 ... 2 ... 1 ... ... ... Acute Influenzal Pneu 131 1 7 13 15 77 18 52 44 35 ... ... ... Acute Primary Pneu 119 6 19 16 18 45 15 64 33 22 ... ... ... Measles 699 32 316 317 21 13 ... 316 239 144 2 1 ... German Measles 100 1 21 61 8 9 ... 50 18 32 ... ... ... Tuberculosis— o 9 ... 50 18 32 ... ... Pulmonary 406 ... 9 81 98 208 10 169 114 123 ... ... ... Non-pulmonary 108 3 19 54 12 20 / UJ 59 1 1 35 14 J 14 ... ... ... Totals 2,077 125 516 909 152 331 44 1,018 604 455 396 167 163 The Tuberculosis figures are not included in the total. 94 95 TABLE III. Causes of, and Ages at, Death during the Year 1919. CAUSES OF DEATH. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Enteric Fever 3 ... ... ... ... 1 ... 2 ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Measles 18 2 6 7 2 1 ... ... ... 12 Scarlet Fever 3 ... ... 2 1 ... ... ... ... ... Whooping-cough 6 2 2 1 1 ... ... ... ... 1 Diphtheria and Croup 20 ... 4 8 8 ... ... ... ... ... Influenza 177 5 3 3 11 21 55 49 30 107 Erysipelas 3 2 ... ... ... ... ... ... 1 1 Phthisis (Pulmonary Tuberculosis) 171 1 ... 3 13 32 76 32 14 87 Tuberculous Meningitis 24 4 4 11 5 ... ... ... ... 9 Other Tuberculous Diseases 13 ... 1 1 4 ... 4 3 ... 12 Cancer, malignant disease 203 ... ... ... 2 ... 24 97 80 123 Rheumatic Fever 7 ... ... ... 3 ... 1 3 ... 2 Meningitis 12 2 2 ... 2 3 3 ... ... 6 Organic Heart Disease 305 ... ... ... ... 8 26 92 179 29 Bronchitis 177 9 5 5 2 ... 10 40 106 65 Pneumonia (all forms) 128 33 17 6 3 3 15 24 27 30 Other diseases of respiratory organs 18 2 ... 3 ... ... 4 4 5 5 Diarrhoea and Enteritis 45 28 3 2 1 2 2 3 4 18 Appendicitis and Typhlitis 10 ... ... 1 4 1 2 2 ... 8 Cirrhosis of Liver 12 ... ... ... ... ... ... 10 2 5 Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 48 ... ... ... 3 3 10 17 15 51 Puerperal Fever 4 ... ... ... ... ... 4 ... ... 3 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... ... 3 5 ... ... 10 Congenital Debility and Malformation, including Premature Birth 96 95 ... ... 1 ... ... ... ... 22 Violent Deaths, excluding Suicide 65 3 3 7 10 3 8 21 10 52 Suicide 15 ... ... ... ... 1 5 5 4 4 Other Defined Diseases 469 40 5 7 13 19 50 106 229 500 Diseases ill-defined or unknown 1 ... 1 ... ... ... ... ... ... 2 Totals 2061 228 56 67 89 101 304 510 706 1164 96 TABLE IV. Battersea. Infant Mortality, 1919.—Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSES OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... 1 1 ... ... 1 ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... 1 ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... 2 2 4 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions 1 ... ... ... 1 ... 1 ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 3 2 2 2 10 Pneumonia (all forms) ... 1 ... ... 4 5 10 9 5 33 Diarrhœa ... ... ... ... ... 1 4 ... ... 5 Enteritis ... 1 1 ... 2 3 10 4 5 24 Gastritis ... ... 1 ... 1 1 ... 1 ... 3 Syphilis ... ... ... ... ... 4 ... 1 2 7 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 6 ... ... ... 6 ... ... ... ... 6 Congenital Malformations 7 ... 1 ... 8 2 ... 1 ... 11 Premature Birth 42 6 5 1 54 2 ... 1 ... 57 Atrophy, Debility and Marasmus 8 3 6 ... 17 6 6 1 ... 30 Other Causes 8 1 1 ... 10 5 4 3 6 28 Totals 74 13 17 2 106 33 39 28 22 228 Nett Births in the year—Legitimate, 2,916; Illegitimate, 159. Nett Deaths in the year of Legitimate Infants, 204; Illegitimate Infants, 24. 97 TABLE IV.—(continued). East Battersea. Infant Mortality, 1919.—Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSES OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks, 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths, under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... 1 ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... 1 ... 2 Pneumonia (all forms) ... 1 ... ... 1 3 8 6 3 21 Diarrhœa ... ... ... ... ... 1 2 ... ... 3 Enteritis ... 1 ... ... 1 2 4 1 ... 11 Gastritis ... ... ... ... ... ... ... 1 ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformations 2 ... 1 ... 3 1 ... ... ... 4 Premature Birth 14 ... 2 1 17 1 ... ... ... 18 Atrophy, Debility and Marasmus 1 1 3 ... 5 4 3 1 ... 13 Other Causes 3 ... ... ... 3 4 2 2 1 12 Totals 25 3 6 1 35 19 21 13 8 96 Nett Births in the year—Legitimate, 1,259; Illegitimate, 74. Nett Deaths in the year of Legitimate Infants, 88; Illegitimate Infants, 8. 9b TABLE IV.—(continued). North-West Battersea. Infant Mortality, 1919.—Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSES OF DEATH.; Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... 1 1 ... ... 1 ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... . . ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 2 1 2 7 Pneumonia (all forms) 1 ... 1 ... 2 1 1 3 1 8 Diarrhœa ... ... ... ... ... ... 2 ... ... 2 Enteritis ... ... 1 ... 1 1 4 2 ... 8 Gastritis ... ... 1 ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... 2 ... 1 ... 3 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 ... ... ... 1 1 ... ... ... 2 Premature Birth 16 4 2 ... 22 1 ... 1 ... 24 Atrophy, Debility and Marasmus 5 2 2 ... 9 2 2 ... ... 13 Other Causes 2 1 ... ... 3 ... ... 1 5 9 Totals 25 7 7 1 40 10 12 12 8 82 Nett Births in the year—Legitimate, 958; Illegitimate, 54. Nett Deaths in the year of Legitimate Infants, 69; Illegitimate Infants, 13. 99 TABLE IV.—(continued). South-West Battersea. Infant Mortality, 1919.—Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSES OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... 1 ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 ... ... ... ... 1 Pneumonia (all forms) ... ... ... ... 1 1 1 ... 1 4 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 2 1 2 5 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... 2 3 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 4 ... ... ... 4 ... ... 1 ... 5 Premature Birth 12 2 1 ... 15 ... ... ... ... 15 Atrophy, Debility and Marasmus 2 ... 1 ... 3 ... 1 ... ... 4 Other Causes 3 ... 1 ... 4 1 2 ... ... 7 Totals 24 3 4 ... 31 4 6 3 6 50 Nett Births in the year—Legitimate, 699; Illegitimate, 31. Nett Deaths in the year of Legitimate Infants, 47; Illegitimate Infants, 3.