AC4 386 BAT 27 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1928. by G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. WlGHTMAN & Co., LTD., Printers, Regency Street, S.W. 1, and Dugdale Street, S.E. 5. Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1928. by G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. 1 Health Committee. As constituted 9th November, 1927. As constituted 9th November, 1928. Chairman : Chairman : Councillor J. Hendrick. Councillor E. W. Coles. His Worship the Mayor. His Worship the Mayor. (Alderman J. F. Lane,J.P.) (Councillor J. Edwards,J.P.) Councillor Mrs. T. Amphlett. Alderman J. R. Archer Alderman J. R. Archer. Councillor Mrs. K. S. D. Baker. Councillor H. W. Carpenter. „ Rev. E. J. Daly. „ E. W. Coles. „ J. Hendrick. Alderman G. Fineran. „ Miss G. S. Jacob, R.R.C. Councillor G. H. Lawther. „ R. Moore. „ R. Moore. „ J. Morgan. „ J. Morgan. „ N. G. M. Prichard, b.sc. „ N. G. M. Prichard, b.sc. „ Mrs. E. R. Reed. Alderman Mrs. M. J. Robinson. ,, Mrs. M. J. Robinson. Councillor Mrs. M. H. Rose. „ Mrs. M. H. Rose. Maternity and Child Welface Committee. As constituted 9th November, 1927. As constituted 9th November, 1928. Chairman : Chairman : Councillor Mrs. M. H. Rose. Councillor Mrs. M. H. Rose. His Worship the Mayor. (Alderman J. F. Lane, J.P.) His Worship the Mayor. The Health Committee, as above, and (Councillor J. Edwards,J.P.) the following Co-opted Members : The Health Committee, as above. Mrs. K. S. D. Baker. Mrs. H. Bowler. Mrs. M. F. Douglas. Mr9. E. E. Kemp. Mrs. H. E. Mellor. Mrs. F. Young. Housing Committee. As constituted 9th November, 1927. As constituted 9th November, 1928. Chairman : Chairman : Councillor H. Harling. Councillor H. Harling. His Worship the Mayor. His Worship the Mayor. (Alderman J. F. Lane, j.p.) (Councillor J. Edwards, j.p.) Councillor Mrs. T. Amphlett. Councillor J. R. Blackburn. „ C. Barrington. „ W. Bridge-Collyns. „ J. Bruce. „ Rev. E. J. Daly. Councillor W. Geard. „ T. R. Jones. „ W. J. McIver. „ W. J. McIver. „ J. Morgan. „ P. E. Molloy. Alderman C. J. Powell. „ C. J. Powell. Councillor N. G. M. Prichard, b.sc. „ N. G. M. Prichard, b.sc. Alderman Mrs. M. J. Robinson. „ Mrs. M. J. Robinson. Councillor E. S. Strange, j.p. „ E. S. Strange, j.p. „ H. G White. Alderman I. O. Thomas. 2 Committee to issue certificates and reports under the Rent and Mortgage Interest Restrictions Acts,1920 and 1925, as to the condition of bwelling houses. As constituted 9th November, 1927. As constituted 9th November, 1928. Chairman : Chairman : Councillor H. Harling. Councillor H. Harling. His Worship the Mayor. His Worship the Mayor. (Alderman J. F. Lane, j.p.) (Councillor J. Edwards, j.p.) Alderman G. Fineran. Councillor W. Bridge-Collyns. Councillor W. Geard. Alderman G. Fineran. „ E. S. Strange, j.p. Councillor W. Geard. H. G. White. „ E. S. Strange, j.p. Tuberculosis Committee. As constituted 9th November, 1927. | As constituted 9th November, 1928. The Health Committee, as above. | The Health Committee, as above. Tuberculosis Care Committee. As constituted 9th November, 1927. As constituted 9th November, 1928. Chairman—Alderman J R. Archer. Chairman : Alderman G. Fineran. Alderman J. R. Archer. Councillor J. Hendrick. Councillor Mrs. K. S. D. Baker. „ R. Moore. Alderman G. Fineran. „ E. S. Strange, j.p. Councillor R. Moore. C. H. Young C. H. Young, j.p. Other Member : Other Members : Mrs. E. W. Coles. Mrs. E. W. Coles. Mrs. F. Young. Members of the late Dispensary Committee: Members of the late Dispensary Mrs. Dermott Mr. G. J. W. Gilder. Mr. B.R.Thorne. Committee: Mr. Dermott. Mr. G. J. W. Gilder. Members of the late Voluntary Care Mr. B. R. Thorne. Committee . Members of the late Voluntary Care Mrs. Causton. Committee : Miss B Home. Miss B. Home. Miss Morris. Miss Morris. Consultative Members : Consultative Members : L.C.C. District Organiser for Children's L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Care Committee Work (Miss Thomas) Representative of the War Pensions Representative of the Invalid Chil- Committee (Mr. F. H. Richardson). dren's Aid Association. Representative of the Invalid Child- Representative of the War Pensions ren's Aid Association. Committee. Lady Almoner, St. Thomas's Hospital Lady Almoner, Brompton Hospital (Miss Cummins). (Miss Marx). After-Care Sister, Victoria Hospital Lady Almoner, King's College Hospital (Miss Underwood). (Miss Edmonds). Tuberculosis Almoner, St. George's Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Hospital (Miss Hamilton). Lady Almoner, King's College Hospital Lady Almoner, St. Thomas's Hospital (Miss Edmonds). (Miss Cummins). Representative of the S.L. District After-Care Sister, Victoria Hospital Nursing Association (Miss A. M. (Miss Underwood). Stanford). Representative of the London Insur- Representative of the London Insur- anceCommittee (Mr. R. A. Hanson). ance Committee (Mr. R. A. Hanson). Representative of the S.L. District Lady Almoner, Brompton Hospital Nursing Association (Miss A. M. (Miss Marx). Stanford). Representative of the British Red Representative of the British Red Cross Society (Mrs. C. E. Peach). Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector Health Visitor and Sanitary Inspector (Miss J. Round). (Miss J. Round). 3 Staff of Public Health Department. (At 31st December, 1928). Tuberculosis Officer—G. MACDONALD. M.A., M.B., Ch.B., D.P.H. Assistant Medical Officer (Maternity and Child Welfare)— (Miss) M. L. HAMILTON. M.B., Ch.B., D.P.H. Do. (part-time)— (Miss) ALICE BLOOMFIELD, M.D., F.R.C.S. Resident Medical Officer, Borough Maternity Hospital— (Miss) HILDA McKERNAN, M.B., Ch.B., B.A. Medical Officer, Diphtheria Immunisation Clinic— (Mrs.) MABEL BRODIE, M.B., Ch.B., D.P.H. Public Analyst—C. HACKMAN, F.I.C. Women Sanitary Inspectors and Health Visitors— Miss A. E. Moss, San. Insp. Board's Cert., Cert. C.M.B. Miss J. Round, H.V. Diploma, San. Insp. Board's Cert. Health Visitors— Miss B. L. Kaye, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss N. Playne, San. Insp. Board's Cert., Cert. C.M.B. Miss M. Carr, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss D. Heap, H.V. Diploma, San. Insp. Board's Cert. Miss F. B. Goodall, H.V. Diploma, Cert. C.M.B., San. Insp. Board's Cert. Miss A. Bannerman, H.V. Cert., Cert. C.M.B. Miss E. M. Hoyles, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Sanitary Inspectors— Mr. J. Lawrence, Cert. San. Inst, and Meat Insp. Cert. (Senior Insp.) District Inspectors. 1. Mr. W. E. Selway, Cert. S.I.E.J.B., and Meat Insp. Cert. 2. Mr. J. J. Burgess, San. Insp. Board's Cert. 3. Mr. H. H. May, Cert. San. Inst. 4. Mr. F. H. Chuter, San. Insp. Board's Cert. & Meat Insp. Cert. 5. Mr. J. R. Holloway, San. Insp. Board's Cert. 6. Mr. C. Binding, San. Insp Board's Cert, and Meat Insp. Cert. 8. Mr. J. T. Baxter, Cert. San. Inst. Mr. H. E. Wheeler (Housing) San. Insp. Board's Cert., and Meat Insp. Cert. Food Inspector—(Appointment Vacant.) Workshops Inspector—Mr. A. Webb, Cert. S.I.E.J.B., Meat. Insp. Cert. Organising Rat Officer—Mr. H. Renham. Clerical Staff— Chief Clerk—Mr. F. E. Ward. Mr. J. W. Brown (Statistical). Miss G. E. Newton. Mr. E. Cole. Mr. W. C. Turner. Mr. W. Halstead. Miss R. Dove. Mr. H. C. Godfrey. Office youth. Mr. R. Graham. Miss M. A. Weller (M. & C.W. Records). Maternity Home— Matron—Miss J. Gibson, Cert. C.M.B. Tuberculosis Dispensary— Tuberculosis Nurses—Miss M. Schotburgh, Miss B. O'Connor, Miss C. Thompson. Secretary and Clerk—Miss L. Wadham. Dispenser—Miss E. F. Davies. Clerks—Miss C. Turner. Miss Brown. Disinfecting Station—Superintendent—C. Woodhouse. Mortuary—Keeper—W. Newman. 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit for your information my Annual Report on the Sanitary State of the Borough of Battersea for the Year 1928. The Vital and Morbid Statistics for the year are on the whole satisfactory, and the progressive improvement of recent years continues to be maintained. The birth-rate, however, the steady decline of which has been a disturbing feature of the vital statistics of the country generally during the past two decades, has now reached its lowest figure in Battersea and remains practically stationary, being 16.7 per 1,000 of the population as compared with 16.6 in the previous year. On the other hand it is satisfactory to note that the general death rate (11.9) is lower than that for the year 1927. The Infant death-rate is higher, 64.2 per 1,000 births as compared with 53.5 in 1927. The increase was mainly due to the prevalence of respiratory diseases, bronchitis and pneumonia, in the first quarter of the year, and for the remaining nine months of the year the infant mortality was almost equal to that for the previous year (53.5 per 1,000 births), which was, with the exception of 1923, the lowest recorded in the Borough. The increase of rate for 1929 may therefore be regarded as accidental, and there is no reason to fear that there is any permanent interruption in the normal progressive decline in the Battersea Infantile Mortality rate statistics. Certain of the common Infectious Diseases have been very prevalent in Battersea as well as in other Metropolitan Districts during the year, notably Measles, Whooping Cough and Diphtheria. Notwithstanding the high incidence of these diseases the mortality has been relatively low as compared with outbreaks in previous years. It is satisfactory to note also that although Smallpox was prevalent in many parts of London, including the Boroughs immediately adjoining, only one case occurred in Battersea during the year, and it is probable, though the evidence was inconclusive, that this patient was infected outside the Borough. A good deal of the time of the Departmental Staff, indoor and outdoor, was, however, taken up in following up and dealing with the large number of contacts referred from other Boroughs. Considerable activity has been displayed in the Maternity and Child Welfare work of the Council during the year. The acquisition by the Council of the commodious building known as Southlands College and its grounds, has enabled the largest Welfare Centre and Clinic to be transferred from the Latchmere Baths to the new environment. Portions of this large block of buildings have been adapted and equipped for various Health Services, including Maternity and Child Welfare, and the accommodation 5 available for this branch of preventive health work has been rendered suitable in every respect for the purpose, and will make for greater efficiency in this highly important work. The development of the Ante-Natal side of the work has been a highly satisfactory feature of this year's work in connection with the Maternity and Child Welfare Scheme. The accommodation provided for the chief ante-natal clinic at the Borough Maternity Hospital has been found inadequate, and in other respects unsuitable for the efficient carrying out of this important branch of maternity work. Accordingly it has been decided on the report of the Maternity and Child Welfare Committee to erect a new Out-Patient building adjoining the Maternity Hospital. Plans and specifications have been prepared and submitted to the Ministry of Health, and approved, and it is anticipated that this new Wing to the Hospital will be completed in the coming year. The importance of ante-natal work in its effect upon the reduction of Maternal Mortality will be appreciated by a perusal of the report of the year's work on pages 27 to 33 of this Report. The Borough Maternity Hospital and the District Midwifery Service continue to do useful work. The Hospital was occupied to its fullest capacity during the year, and notwithstanding the large number of difficult and dangerous cases admitted, it is worthy of note that only one maternal death has occurred during the past three years out of over 1,800 cases admitted. The Hospital for some time past has been run on the Team principle, providing complete co-ordination between the Consultant in charge of the Ante-Natal Clinics which every patient admitted is required to attend before her admission, the Resident Medical Officer and the Obstetric Consultant, who is available in cases of grave emergency. I regret to have again to allude to the serious over-crowding which exists in some of the lower Wards of the Borough, and for purposes of illustration I have prepared an analysis of the number of applications received during a period of ten weeks for housing accommodation from families residing, or rather existing, in Battersea under, in many cases, conditions of hardship and dangerous overcrowding. An examination of this Return will give some idea of the unhealthy environment and social degradation under which many of these unfortunate people are condemned to live. In conclusion, I have again to record my appreciation of the support and assistance extended to me by the Mayor, the Chairmen of the various Committees', and the Members of the Council. I have also to acknowledge the valuable help which I have received from my colleagues, the Chief Officers of the Council, and to the Staff of the Public Health Department my thanks are also due for services always willingly rendered. G. Quin Lennane, Medical Officer of Health. Town Hall, Lavender Hill, S.W. 11. 6 CONTENTS. General. Page Constitution of Committees 1-2 Staff of Public Health Department 3, 79 Introduction 4-5 Summary of Statistics 8 Births, Marriages and Deaths. Vital Statistics 9, 112 Population 9 Marriages 10 Births and Birth-rates 10 11, 17-18, 112 Illegitimate Births 11 Deaths in Borough 11-12, 17, 112, 114 Deaths in Public Institutions and Senile Mortality 13-14 Comparative Table of Births, Deaths, &c. (1858-1928) 18 Infant Mortality 14-17, 19, 115-118 Illegitimate Infant Deaths 17 Comparative Statistics, Metropolitan Boroughs 17 Notification of Births Act and Still-births Registration 20 Maternity and Child Welfare. Maternity and Child Welfare Scheme 20 Centres 21-22 Hospital Provision 23 Southwark Diocesan Homes 23 Milk and Dinners for necessitous persons 23 Convalescent Homes 24-25 Nursing Facilities 25 Health Visitors 25-26 Test-feeding (St. Thomas's Cornwall Babies' Hostel) 26 Ante-Natal Work 27-31 Visiting Work for Hospitals 31 V.D 31-33 Maternal Mortality 33 Maternity Hospital 34-37 District Midwifery Service 37-38 Dental Clinic 38-39 Nursing Homes—Solarium 39 Infectious Diseases—(i.) Notifiable 40 Summary of Notifications 41,113 Bacteriological Examinations 54,62 Contacts 40 Small-pox 42 Scarlet Fever 42 Diphtheria and Diphtheria Prophylaxis 43-45 Enteric Fever. Cerebro-Spinal Fever 46 Puerperal Fever and Puerperal Pyrexia 45 Encephalitis Lethargica 46 Polio-Myelitis and Polio-Encephalitis 45 Ophthalmia Neonatorum 46-47 Erysipelas 47 Measles and Whooping Cough 48 Tuberculosis 48—59, 119—127 Cases Notified 49 Localisation of Disease 50 Non-notification and notification after death 50, 52 Deaths from Tuberculosis 50-52 Public Health (Tuberculosis) Regs. 1925 57 Dispensary 52-55 (Report of) 122-127 Sputum Examination, X-Ray Examination 54-55 Institutional Treatment 54, 123 Open-Air School (Day Sanatorium) 53, 125 Tuberculosis Dental Clinic 55, 126 Care Committee 126 Training and Employment 123, 126-127 Non-Dispensary Patients 55-57 Summary Tables 58-59, 119 121 Zymotic Deaths 60 7 Infectious Diseases—continued. Page (ii.) Non-Notifiable Diseases 60 Chicken-pox: diarrhœa 60 Influenza: cancer : silicosis 61,131-133 Removal of the aged and infirm 62 Sanitary Circumstances. Summary Table 63 Legal Proceedings 64-68 Common Lodging Houses 68 Drainage Work 68-70 L.C.C. (General Powers) Act, 1928 62, 69, 70 Licensed Premises (Sanitary Conveniences) 70 Smoke and Effluvium Nuisances 70-71 Water Supply 71 Van Dwellings 71 Model dwellings, staircases 72 Rag Flock Act 73 Rats and Mice Destruction Act 73 Sanitary Conveniences 74 Rag and Bone Dealers 74 Fouling of Footways by Dogs 74 Personal Cleansing Station 78 Disinfecting and Disinfectants 75,79 Health Exhibition 75, 128 130 Coroner's Court and Mortuary 80 Staff 3,79 Thames Flooding 76-78 Protection of the Food Supply. Inspection and Supervision 81 Unsound Food 81 Cow-Houses and Slaughter-Houses 81 Butchers' Shops 82 Public Health (Meat) Regulations, 1924 82 Sale of Food and Drugs Acts 82 Results of Analysis 83-84 Ice-Cream Vendors 88 Milk and Dairies Order, 1926 89 Milk and Dairies (Consolidation) Act, 1915 88 Milk (Special Designations) Order, 1923 89 Milk Shops 89 Public Health (Preservatives, & c., in Food) Regulations, 1925 90 Agricultural Produce and Merchandise Marks Acts 91 Fish Shops, Restaurant Kitchens, Street Stalls 91 92 Factories, Workshops, &c.—General Tables 93 Factories 94 Workshops 95 Outworkers 96-97,99 Bakehouses, Warehouses and Wharves 98 Housing. General 100 New Houses 100 Overcrowding 100 Legal decision, Council v. Watts 102-104 Repair of Unfit Houses 102 Appeals 105 Closing Orders 105 Underground Rooms 105 Increase of Rent, &c.. Acts 106 Action under Section 5, Housing Act, 1925 106 Insanitary Areas 106 Houses let in Tenements 107 Insanitary Houses 107-109 Statistics and Summary of Housing Work 110-111 Appendices. Table I. Summary of Vital Statistics 112 „ II. Infectious Disease Notifications 113 „ III. Causes of, and Ages at, Death 114 „ IV. Infant Mortality 115 118 Tuberculosis Scheme of the Borough Council— Return of Work of the Dispensary 119 121 Report of Tuberculosis Medical Officer 122 127 Health Exhibition—Report of Medical Officer of Health 128-130 Silicosis—Report of Medical Officer of Health 131-133 8 Summary of Statistics, 1928. 1. General. Area of Borough— (Including land and inland water) acres 2,163 (Excluding water) acres 2,139.9 Population— (Census, 1921) 167,739 (Registrar-General's estimate, mid-year 1928) 164,100 Number of Private Families (Census 1921) 42,988 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value £1,144,028 Sum represented by a penny rate £4,709 2. Extracts from Vital Statistics of the Year. Births— (Males, 1,386 ; females, 1,357) 2,743 Legitimate births (1,321 males, 1,299 females) 2,620 Illegitimate „ (65 males, 58 females) 123 Birth-rate 16.7 Deaths— (Males, 980, females, 974) 1,954 Death-rate 11.9 Number of women dying in or in consequence of childbirth— From sepsis 3 Other causes 4 Death-rate of infants under 1 year per 1,000 live births. Legitimate 63.7 Illegitimate 73.2 64.2 Deaths from Measles (all ages) 36 „ Whooping-cough (all ages) 14 ,, Diarrhœa (under 2 years of age) 26 Census, 1911— Population 167,743 Number of inhabited houses 24,321 9 Births, Marriages and Deaths. VITAL STATISTICS. Population. The population of the Borough of Battersea estimated to the middle of 1928 is 164,100. This figure shows a decrease as compared with 1927 and is the result of a revision by the RegistrarGeneral based, it is understood, upon information as to migration. It is probable that the figures given by the Registrar-General will be found an under-estimate. Information obtained from local sources would appear to indicate that the population of the Borough is approximately 170,000, and that practically no change has taken place during the intercensal period. It is however the practice, for the sake of uniformity, to adopt the estimate of the Registrar General for the purpose of calculating mortality rates, &c., and the figures appearing in this report are based upon the Registrar General's estimate. The estimated population based upon the Registrar-General's figures, for the registration Sub-districts and for the nine Wards into which the Borough is divided, is set out in the following Table:— Registration Sub-Districts. Estimated Mid-Year Population, 1928. Males. Females. Total. East Battersea 32,646 35,354 68,000 North-West Battersea 22,708 24,222 46,930 South-West Battersea 21,598 27,572 49,170 Total 76,952 87,148 164,100 Wards. No. 1. Nine Elms 12,999 13,717 26,716 No. 2. Park 8,411 9,409 17,820 No. 3. Latchmere 8,856 9,869 18,725 No. 4. Shaftesbury 7,286 7,788 15,074 No. 5. Church 8,863 9,231 18,094 No. 6. Winstanley 9,747 10,423 20,170 No. 7. St. John 3,515 4,869 8,384 No. 8. Bolingbroke 8,302 10,263 18,565 No. 9. Broomwood 8,973 11,579 20,552 Total 76,952 87,148 164,100 10 MARRIAGES. The marriages registered in Battersea during 1928 numbered 1,354. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 16.5. Year. Marriages. Marriage-Rate. 1923 1,352 15.8 1924 1,367 16.0 1925 1,382 16.1 1926 1,304 15.2 1927 1,428 16.9 Mean, 1923-27 1366.6 16.0 1928 1,354 16.5 BIRTHS. The number of births registered in the Borough during 1928 was 3,054 (1,557 males, 1,497 females), an excess of 60 males. Of this number, 627 were transferred out, the permanent residence of the parents being outside the Borough, and 316 were transferred here, giving on balance a total of 2,743 births relating to Battersea residents, and a corrected birth-rate of 16.7 per 1,000 of the population. The following table gives the distribution of the births and the birth-rate per 1,000 of the population in the Sub-districts and in the Wards for the year 1928. Sub Districts. Estimated Population, 1928. Number of Births. Birthrate. East Battersea 68,000 1,220 17.9 North-West Battersea 46,930 893 19.0 South-West Battersea 49,170 630 12.8 Wards. No. 1, Nine Elms 26,716 504 18.9 No. 2, Park 17,820 356 20.0 No. 3, Latchmere 18,725 350 18.7 No. 4, Shaftesbury 15,074 211 14.0 No. 5, Church 18,094 336 18.6 No. 6, Winstanley 20,170 380 18.8 No. 7, St. John 8,384 120 14.3 No. 8, Bolingbroke 18,565 255 13.7 No. 9, Broom wood 20,552 231 11.2 11 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1928, and during the previous decennium 1918-1927 :— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1918 16.1 17.7 17.8 12.0 1919 18.5 19.3 20.8 15.1 1920 28.1 29.8 32.0 21.8 1921 22.1 23.8 26.6 15.5 1922 21.7 23.0 24.8 16.8 1923 20.1 23.0 22.0 14.4 1924 18.4 19.9 21.9 12.8 1925 18.5 20.6 20.6 13.6 1926 17.3 18.9 20.6 11.9 1927 16.6 17.9 18.9 12.5 Average 1918-1927 19.7 21.4 22.6 14.6 1928 16.7 17.9 19.0 12.8 This is the lowest birth-rate recorded in Battersea with the exception of the years 1918 and 1927. The birth-rate shows a decline in three of the Wards of the Borough—Winstanley, Park and Shaftesbury Wards. The birth-rate in Battersea is 3.0 per 1,000 lower than the average for the previous decennium 1918— 1927. The birth-rate for the County of London was 15.9 per 1,000 of the population, and for England and Wales the rate was 16.7. Illegitimate births numbered 123 or 4.48 per cent, of the total births. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of stillbirths was made compulsory. During 1928, 90 stillbirths were registered as belonging to Battersea. The total number of stillbirths notified during the year was 78. DEATHS. The number of deaths registered in the Borough during 1928 was 2,674. Of these 1,091 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 371 deaths of Battersea residents 12 registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,954 (males 980, females 974). This gives a recorded death-rate of 11.9 compared with 11.6 for London, and 11.7 for England and Wales. According to the factor supplied by the Registrar-General, for correction of death-rate in reference to age and sex distribution, the corrected death-rate for Battersea during 1928 was 11.5. The distribution of the deaths and the death-rate per 1,000 inhabitants for each of the nine Wards is shown in the following Table. Ward. Estimated Population 1928. N umber of Deaths. Deathrate. No. 1, Nine Elms 26,716 308 11.5 No. 2, Park 17,820 220 12.3 No. 3, Latchmere 18,725 228 12.2 No. 4, Shaftesbury 15,074 163 10.8 No. 5, Church 18,094 217 12.0 No. 6, Winstanley 20,170 275 13.6 No. 7, St. John 8,384 92 11.0 No. 8, Bolingbroke 18,565 217 11.7 No. 9, Broomwood 20,552 234 11.4 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1928 :— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 98 57 19 8 47 103 281 367 980 F 78 50 10 9 54 97 215 461 974 Ttls. 176 107 29 17 101 200 496 828 1,954 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 303 298 601 Second quarter 244 254 498 Third quarter 206 167 373 Fourth quarter 227 255 482 980 974 1,954 13 The decrease in the death-rate (12.2 to 11.9 as compared with 1927) is accounted for chiefly by the decreased death-rate in the first quarter of the year from respiratory diseases and influenza. The death-rate was lowest in the Shaftesbury Ward (10.8), and highest in Winstanley Ward (13.6). The deaths of persons over 65 years numbered 828 or 42.4 per cent, of the total deaths. The average age at death was 51.5 years, as compared with 53.4 in 1927. The greatest decrease was in the Shaftesbury Ward. Increased death-rates were recorded in Latchmere, Winstanley and St. John Wards. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1918 18.7 19.2 20.2 16.6 1919 12.9 12.4 12.7 13.7 1920 12.5 12.8 12.4 12.3 1921 12.2 12.3 12.7 11.5 1922 13.2 13.1 13.8 12.6 1923 10.8 11.2 10.4 10.6 1924 11.8 11.9 12.5 11.0 1925 10.5 10.5 11.0 10.0 1926 11.4 11.5 11.4 11.3 1927 12.2 12.0 12.6 12.1 Average 1918-27. 12.6 12.7 13.0 12.2 1928 11.9 11.8 12.7 11.3 The natural increase of population (that is the excess of births over deaths) was 789 in 1928. There was an adverse balance of 109 in 1918, and in 1917 the natural increase was only 675. Deaths in Public Institutions. During 1928 the deaths of Battersea residents occurring in Public Institutions numbered 1,011. Of this number 700 occurred within and 311 outside the Borough. Of the total Battersea deaths in Public Institutions 647 occurred in Poor Law Institutions. 14 Senile Mortality. During 1928 the deaths of 828 persons aged 65 years and upwards were registered in the Borough of Battersea. The distribution of these deaths is set out in the following table :— District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. Total. M. F. M. F. M. F. M. F. East Battersea 68 63 56 68 11 20 135 151 286 N.W. Battersea 66 51 41 51 12 13 119 115 234 S.W. Battersea 67 78 37 78 9 39 113 195 308 Borough of Battersea 201 192 134 197 32 72 367 461 828 Births and Deaths Registration Act, 1926. The Births and Deaths Registration Act, 1926, came into force on 1st July, 1927. The Act amends the law relating to certification of deaths and the disposal of the dead. A certificate of death can be given only by a registered Medical Practitioner and in the prescribed form and must be delivered by the practitioner himself to the Registrar. Other changes of importance relate to the particulars of the cause of death, a new form of certificate is provided for the use of Medical Practitioners, which was drawn up after consultation between the Registrar-General and representatives of the medical profession, in order to secure more accurate records of the causes of death. Infant Mortality. During 1928 the deaths of 176 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,743, giving an infant mortality rate of 64-2 per 1,000 births, as compared with 53-5 in 1927. It will be noted that the infant mortality-rate was higher during 1928 than in the previous year. The main cause of the increase was a higher mortality among infants in the first quarter of the year (vide tables on pp. 15-16) from respiratory and intestinal diseases. The distribution of the 176 infant deaths and the infant mortality-rates for the registration sub-districts and the Wards, are shown in the following table: — 15 Registration Sub-District. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. m. f. total. East Battersea 1,220 57 38 95 77.9 North-West Battersea 893 24 27 51 57.1 South-West Battersea 630 17 13 30 47.6 The Borough 2,743 98 78 176 64.2 Ward. 1. Nine Elms 504 27 17 44 87.3 2. Park 356 16 8 24 67.4 3. Latchmere 350 13 8 21 60.0 4. Shaftesbury 211 6 8 14 66.4 5. Church 336 8 7 15 44.6 6. Winstanley 380 11 17 28 73.7 7. St. John 120 4 5 9 75.0 8. Bolingbroke 255 4 4 8 31.4 9. Broom wood 231 9 4 13 56.3 It will be noted that in the sub-districts the rate was highest in East Battersea (77.9) and lowest in South-West Battersea (47.6). In the Wards, Nine Elms showed the highest rate (87.3) and Bolingbroke the lowest (31.4). The infant mortality rate in the County of London and in England and Wales during 1928 was 67 and 65 respectively. The number of infant deaths and the infant mortality in each quarter of the year was as follows : — Births registered. Infant deaths. Infant Mortality Rate. First quarter 709 61 860 Second quarter 702 33 47.0 Third quarter 685 38 55.5 Fourth quarter 647 44 68.0 During the last 9 months of the year the infant death-rate was 56.5. There were 71 deaths of infants during the first four weeks of life (or 40.3 per cent, of the total infant deaths) as compared with 80 deaths (or 53.3 per cent.) in 1927 and a percentage for the quinquennium (1923-1927) of 45.6. 16 Measles accounted for 8 infant deaths during the year. The deaths from developmental diseases were 63 as compared with 74 in 1927. The next tables show the incidence of mortality from the chief diseases of infancy in the first four weeks and during the four trimesters:— Table showing Deaths of Infants under 1 day, under 1 week and under 4 weeks from 1923 to 1928. Year. Under 24 hrs. 1 to 7 days. 1 to 4 weeks. Total under 4 weeks. Percentage deaths under 4 weeks of total infant deaths 1923 33 21 23 77 45.3 1924 21 29 27 77 39.3 1925 25 29 35 89 47.8 1926 20 38 23 81 44.3 1927 29 29 22 80 53.3 Total 1923-7 128 146 130 404 — Mean do 25.6 29.2 26.0 80.8 45.6 1928 23 27 21 71 40.3 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. %of Total. Measles — — 1 7 8 4.54 Influenza — — 1 — 1 0.57 Erysipelas — — 1 — 1 0.57 Whooping Cough 1 2 2 1 6 3.41 Meningococcal Meningitis — — 2 — 2 1.14 Diarrhoea and Enteritis 4 8 10 3 25 14.20 General Tuberculosis — — — — — — Tuberculous Meningitis 1 — — 1 2 1.14 Pulmonary Tuberculosis — - - - - - Pneumonia 7 14 7 10 38 21.59 Bronchitis 6 2 — — 8 4.54 Other Respiratory Diseases 1 — — — 1 0.57 Prematurity 37 — — — 37 21.02 Marasmus 5 5 — — 10 5.68 Icterus Neonatorum — — — — — — Congenital Malformations 12 1 — 1 14 7.95 Injury at Birth 2 — — — 2 1.14 Suffocation (overlying) 2 — — — 2 1.14 Convulsions 1 — 1 — 2 1.14 Atelectasis & Asphyxia N. 6 — — — 6 3.41 Lack of Care 2 — — — 2 1.14 Syphilis 1 — — — 1 0.57 Accident and Homicide 1 — — — 1 0.57 Miscellaneous 2 2 2 1 7 3.97 Total 91 34 27 24 176 100.0 Percentage of Total 51.7 19.3 15.4 13.6 — 100.0 17 Illegitimate Infant Deaths. The death-rate amongst illegitimate children during 1928 was 73.2 per 1,000 births, as compared with 89.9 per 1,000 births in 1927, 162.2 in 1926, 113.2 in 1925, 148-1 in 1924 and 130.4 in 1923. The corresponding death rate of legitimate children in 1928 was 63.7, the ratio of the mortality-rate of illegitimate infants to that of legitimate being 1.15 to 1. Comparative Statistics, Metropolitan Boroughs. Table showing the birth-rates, death-rates and infant mortalityrates in the 29 Metropolitan Cities and Boroughs for the year 1928:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 Births. 1. Finsbury 20.4 1. Lewisham 10.0 1. Chelsea 48 2. Shoreditch 20.1 2. Wandsworth 10.6 2. Wandsworth 49 3. Poplar 19.9 3. Woolwich 11.0 3. Woolwich 50 4. Southwark 19.2 4. St. Marylebone 11.1 4. Lewisham 52 5. Bethnal Green 19.0 5. Greenwich 11.1 5. Greenwich 53 6. Bermondsey 18.1 6. Hammersmith 11.4 6. Hampstead 54 7. Stepney 18.0 7. Stepney 11.4 7. Holborn 57 8. Islington 17.8 8. Fulham 11.5 8. City of minster 58 9. Lambeth 16.8 9. City of Westminster 11.5 9. City of London 61 10. Battersea 16.7 11. Hammersmith 16.6 10. Hampstead 11.6 10. Camberwell 61 12. Greenwich 16.4 11. Hackney 11.7 11. Stoke Newington 61 13. Deptford 16.3 12. Bethnal Green 11.7 12. Lambeth 61 14. Woolwich 16.1 13. Poplar 11.8 13. Islington 64 15. Hackney 16.0 14. Camberwell 11.9 14. Battersea 64 16. St. Pancras 15.9 15. Battersea 11.9 15. Hackney 67 17. Camberwell 15.8 16. Greenwich 12.0 16. Hammersmith 69 18. Fulham 15.4 17. City of London 12.2 17. Southwark 70 19. Stoke Newington 15.3 18. Lambeth 12.3 18. Poplar 71 20. Lewisham 15.2 19. StokeNewington 12.5 19. Stepney 72 21. Paddington 15.0 20. St. Pancras 12.7 20. Bethnal Green 73 22. Kensington 14.3 21. Southwark 12.7 21. Deptford 76 23. Wandsworth 13.0 22. Islington 12.8 22. Fulham 77 24. St. Marylebone 12.6 23. Kensington 13.0 23. St. Marylebone 79 25. Chelsea 12.6 24. Paddington 13.0 24. St. Pancras 80 26. Holborn 12.0 25. Bermondsey 13.2 25. Shoreditch 80 27. Hampstead 11.6 26. Holborn 13.5 26. Kensington 83 28. City of Westminster 10.3 27. Chelsea 13.5 27. Paddington 85 28. Shoreditch 13.8 28. Finsbury 85 29. City of London 7.2 29. Finsbury 15.1 29. Bermondsey 85 London County 15.9 London County 11.6 London County 67 England and Wales 16.7 England and Wales 11.7 England and Wales 65 18 COMPARATIVE STATISTICS OF BIRTHS, MORTALITY, &c. Year. Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.4 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 291 1860 18,676 680 36.4 399 21.3 62 281 1861 19,682 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.8 669 22.1 129 471 1865 33,688 1,357 40.3 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 211 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36 . 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 .9 898 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 14.4 342 2,282 1906 179,622 4,654 25.9 2,384 13.2 321 2,270 1907 181,736 4,574 25.1 2,406 13.2 243 2,168 1908 183,873 4,629 25 .1 2,272 12.3 228 2,357 1909 186,036 4,450 23.9 2,417 12.9 237 2,033 1910 188,222 4,489 23 .7 2,124 11.3 209 2,365 1911 167,765 4,381 26 .1 2,404- 14. 3 331 1,877 1912 167,589 4,255 25.4 2,052 12.2 133 2,203 1913 167,464 4,240 25.3 2,365 14.1 197 1,875 1914 167,338 4,303 25.7 2,217 13.2 142 2,086 1915 161,945 3,820 23.6 2,653 16.4 334 1,167 1916 B# 173,432 3,774 21.8 - - - D* 159,402 — 2,221 13.9 160 1,553 1917 B* 167,233 2,960 17.7 - - - D*150,023 — 2,285 15.2 185 675 1918 B* 168,014 2,700 16.1 - - - D* 149,951 — — 2,809 18.7 204 -109† 1919 B* 165,960 3,075 18.5 — - D* 159,316 — — 2,061 12.9 95 1,014 1920 B* 166,093 4,669 28.1 D* 165,664 — — 2,079 12 .5 188 2,590 1921 169,200 8,742 22 .1 2,06) 12 .2 173 1,682 1922 169,200 3,665 21 .7 2,227 13.2 192 1,438 1923 170,600 3,434 20.1 1,839 10 .8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,805 10.5 64 1,379 1926 171,900 2,969 17.3 1,960 11.4 119 1,009 1927 169,000 2,801 16.6 2,065 12.2 57 736 1928 164,100 2,743 16.7 1,954 11.9 111 789 • Population a9 estimated for purpose of (B) Birth-rate, (D) Death-rate. † Decrease. Census years in heavy type. 19 Chart Showing Birth, Death and Infant Mortality Rates in Battersea from 1858 to 1928. 20 Notification of Births Act. During 1928 the number of notifications of live births received was 2,601. The corrected number of births registered during the year in Battersea was 2,743. The proportion of notified to registered births was, therefore, 94.8 per cent. The number of still births notified during the year was 78 or 2.68 per cent, of the total births registered. 202 living and 14 still-births of Battersea children born in other districts were notified from the districts in which these births occurred. The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926, on 1st July, 1927. During 1928 there were 116 still births registered in Battersea, of which 44 were of non-resident, and 72 of Battersea parents. 18 still births occurring outside the Borough were registered as belonging to Battersea, making 90 in all, relating to Battersea. This total represents a still birth-rate of 31.8 per 1,000 births registered. Of the 90 still births 7 (7.8 per cent.) were registered as illegitimate. 78 still births were notified during the year as belonging to Battersea, 64 from within and 14 from without the Borough, the number notified being 86.7 per cent, of the total still births registered. Notified births are visited and revisited by the Council's official Health Visitors and the visitors of the Voluntary organisations included in the Council's Maternity and Child Welfare Scheme. A weekly return of all births notified is forwarded to the London County Council, in accordance with the requirements of Sec. 5, Sub-Sec. 2, of the Notification of Births Act, 1907. MATERNITY AND CHILD WELFARE SCHEME. The Maternity and Child Welfare Scheme of the Council includes Municipal and Voluntary effort and the activities of both are fully co-ordinated. In order to enable the Voluntary Associations to keep their work efficient and in uniformity with that of the Municipal Centres and Clinics they receive, in addition to the grants from the Ministry of Health, an annual contribution from the Council. 21 Maternity and Child Welfare Centres. The Borough is divided into nine Health Visitor's districts, in each of which a centre, either municipal or voluntary is situate. Each Health Visitor is assigned a district for the home visiting in which she is responsible. The average number of home visits paid by Health Visitors in 1928 was approximately 3,000. The Centres, Municipal and Voluntary, are situate as follows :— 1. Municipal. (a) Southlands, High Street (entrance in Castle Street). (b) All Saints Parish Hall (Prince of Wales Road). (c) Plough Road Baths. (d) Chatham Hall (Chatham Road). (e) Dental Centre and Clinic (Southlands). (/) Maternity Hospital, out-patients' department (anteand post-natal clinics). 2. Voluntary. (а) Battersea School for Mothers (55 Mundella Road). (b) Women's League of Service (Southlands, Castle Street). (c) Chislehurst Mission (St. James' Hall, Ponton Road, Nine Elms). Other ancillary services included in the Scheme are :— (1) St. Mary's Hostel, Macaulay Road, Clapham Common. (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road. At each of the Centres a clinic is held, a woman Medical Officer and a nurse being in attendance. Each centre is under the supervision of a trained Health Visitor and Voluntary Helpers assist in the work of these centres. The Voluntary Centres are conducted on similar lines to those of the Municipal Centres. Owing to the growth of the work in connection with the Council's various centres, and the distance of the Bolingbroke Ward and neighbourhood from the nearest Centre, the Maternity and Child Welfare Committee decided to recommend the Council to establish an additional centre in that Ward, and to appoint a Health Visitor to supervise the work in that district and centre. The sanction of the Ministry of Health has been obtained to the proposed extension and steps were being taken at the end of the year to obtain suitable accommodation. The transfer of the centre formerly held at Latchmere Baths to Southlands has considerably increased the distance to the nearest Centre for those mothers residing in the neighbourhood of South-east Battersea. The following table gives a summary of the work carried out at the Centres in 1928 :— 22 Summarised Statistics Relating to Infant Centres, 1928. Municipal. Voluntary. Grand Total. "Southlands" Centre. Plough Road Centre. East Battersea Centre. Chatham Road Centre. Total Battersea School for Mothers. Chislehurst (St James's) Mission. Women's League of Service. Total Municipal and Voluntary. Sessions held 146 99 100 149 494 95 50 70 215 709 Attendances 6,009 3,948 3,952 5,873 19,782 3,143 1,152 1,799 6,094 25,876 First attendances 403 325 297 320 1,345 235 53 96 384 1,729 Average attendances per session 41 40 40 39 40 33 23 26 28 36 Average ditto weekly 116 76 76 113 381 60 22 34 117 498 Doctor's attendances 98 47 48 51 244 95 27 69 191 435 Babies seen by Doctor 2,027 1,060 1,143 1,149 5,379 2,379 394 1,319 4,092 9,471 Average ditto per attendance 21 23 24 23 22 25 15 19 21 22 Weights recorded 5,116 3,416 3,511 5,279 17,322 3,127 1,026 1,682 5,835 23,157 Advice only 893 532 441 594 2,460 16 126 117 259 2,719 23 Hospital Provision. In addition to the provision of Midwifery Services, Hospital and District, the Council have provided facilities for the needs of children requiring special Hospital treatment by arrangement with the Victoria Children's Hospital, Chelsea, and the Fulham Babies' Hospital (chronic debility and wasting diseases). The Council contribute an annual sum in the case of the former, and a per capita payment to the latter Institution in respect of these facilities. Women and children where necessary are referred from the AnteNatal and Child Welfare Centres to other appropriate Institutions. Number of cases referred to Hospitals and Institutions from the Maternity and Child Welfare Clinics during 1928:— St. Thomas's Hospital 30 Victoria Hospital, Chelsea 225 St. James's Hospital 9 Bolingbroke Hospital 14 Borough Tuberculosis Dispensary 6 Fulham Babies' Hospital 6 St. Thomas's Cornwall Babies' Hostel 194 Chelsea Hospital for Women 2 Infants' Hospital, Vincent Square 3 Invalid Children's Aid Association 5 494 Southwark Diocesan Homes. For some years past the Council has contributed towards the cost of the maintenance during the period following confinement of unmarried mothers resident in their district and their children, by the Southwark Diocesan Association for Preventive and Rescue work, in St. Mary's House, Macaulay Road, Wandsworth, which is an Institution affiliated to the Council's Maternity and Child Welfare Scheme. They also contribute to the cost of Battersea unmarried mothers who are received into other homes maintained by the Association, with the sanction of the Ministry of Health, on a per capita basis a sum not exceeding £65 per annum. Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, milk is provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. The following table gives particulars relating to the number of persons 24 supplied, quantities distributed and cost after deducting payments made by those able in part to contribute:— Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons supplied. lbs. supplied. Persons supplied. Pints supplied. £ 1920 1,473 15,588 233 31,894 3,330 1921 2,391 49,020 301 27,254 5,011 1922 2,469 61,511 260 23,879 5,279 1923 2,231 50,110 219 25,633 3,288 1924 1,840 51,837 178 17,654 2,533 1925 1,620 44,805 222 26,079 2,631 1926 609 (469) 30,762 699 (469) 89,435 3,262 1927 111 (53) 2,912 1,381 (53) 206,717 3,438 1928 119 (65) 4,901 1,216 (65) 149,307 2,520 N.B.—The figures in brackets indicate the number of persons who received both dried and fresh milk, and are therefore included in the number of persons supplied in both columns. In addition to the above, dinners to the number of 672 were supplied during 1928 to necessitous expectant and nursing mothers and children at a cost of £18 15s. 6d. The Minister of Health in March addressed a letter to local authorities administering the Maternity and Child Welfare Act with regard to the need of economy in administering the distribution of milk at reduced rates or free of charge, and reducing the amount allowed in the annual estimates for this service by the sum of £1,241. The Shoreditch Borough Council, to whom a similar letter had been addressed, convened a Conference upon the subject, which was attended by representatives of the Council. The Conference passed resolutions requesting the Minister to re-consider his attitude in the matter, and requesting him to receive a deputation on the subject. Subsequently a deputation (upon which the Council were represented) waited upon the Minister, who, in his reply, stated that while Councils were perfectly free to accept the suggestions contained in his letter as to how economies might be effected, he could not withdraw his intimation as to the reduced grants which would be given in view of the economies which the Department, in common with other Government Departments, had been called on to make. Convalescent Homes. During 1928, accommodation was provided for 29 mothers and 29 children attending the various Maternity and Child Welfare Clinics. Of these, 24 mothers and children were sent to St. Mary's Convalescent Home, Birchington, and the remainder to the Burnett 25 Cottage Home, Herne Bay. The cost incurred by the Council amounted to £60 18s. 0d., the mothers and a voluntary association contributing the balance of approximately £46. Through other charitable organisations 15 mothers and 16 children from the Council's Centres were sent for country and seaside holidays for a period of one or two weeks, in each case. Nursing Facilities. During 1928 the total number of attendances made by the District Nursing Service in connection with the Council's Scheme was:— Nursing Service, 1928. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Affns. 110 2,576 - - 110 2,576 Measles 67 746 16 179 83 925 Whooping Cough 7 86 3 42 10 128 Diarrhœa & Vomiting 9 57 — — 9 57 Chicken Pox 1 6 1 18 2 24 Pemphigus Neonatorum 2 23 - - 2 23 Puerperal Pyrexia — - — — — — Pneumonia 42 724 53 792 95 1,516 Influenza 1 16 17 148 18 164 Erysipelas 1 15 3 45 4 60 Encephalitis Lethargica - - - - - - Paratyphoid Fever — — 1 4 1 4 Totals 240 4,249 94 1,228 334 5,477 The cost of the-Nursing Service in 1928 was £182 11s. 4d. as compared with £220 11s. 4d., in the previous year. Health Visitors. The Health Visiting Staff consists of 9 full time Health Visitors, two of whom are partly employed as Women Sanitary Inspectors. Facilities are granted by the Council to students of recognised Training Bodies for practical instruction and training as Health Visitors. During the year a number of students from the Hygiene Department, Battersea Polytechnic, Bedford College and the College of Nursing received a course of training under the Council's Maternity and Child Welfare Scheme. 26 The work carried out during 1928 by the Council's Health Visitors and those of the voluntary organisations included in the Borough Maternity and Child Welfare Scheme is summarised in the following table:— C'cl. Vol. Total. Visits to Expectant Mothers 2,129 411 2,540 Visits to Notified Births 6,738 1,675 8,413 Visits to Still Births 78 4 82 Visits to children aged 1-5 years 2,701 1,662 4,363 Visits to enquire into Infant Deaths 156 44 200 Visits to cases of Notifiable Infectious Disease 6,632 999 7,631 Visits to cases of Non-Notifiable Disease 366 202 568 Visits re prevention of Diphtheria 310 3 313 Visits re Summer Diarrhoea 405 211 616 Visits to Dental Cases 217 39 256 Visits to V.D. Cases 30 - 30 Other Visits *1,487 777 2,264 21,249 6,027 27,276 St. Thomas's Cornwall Babies' Hostel. The arrangements temporarily made in 1926 with St. Thomas's Cornwall Babies' Hostel, with the sanction of the Ministry of Health, for the provision of facilities for cases sent from the Borough Maternity and Child Welfare Clinics for test feeding and the encouragement of breast feeding amongst Battersea mothers, were continued during 1927 and 1928. The results of the year's work have been very promising and are summarised below A. Test Feeds. Number of cases, 123, comprising: Mothers, 123; babies, 126. Number of attendances, 295. (146 mothers and 149 babies). 16 of these cases received in-patient treatment. B. In-Patient Treatment. 40 Battersea cases received, made up of— 17 mothers and 21 babies sent by Council. 2 babies sent from other sources. Period of stay. 38 cases sent by Council— 17 mothers and 21 babies, 979 days {Average 25.8 days} 2 other cases— children, 26 days; Average 13 days. *Includes 320 visits in connection with the flood which occurred in January, 1928. 27 A contribution of £100 was made by the Council towards the cost of this work, which is included in the estimates of the Maternity and Child Welfare Scheme. Ante-Natal Work. The development of Ante-Natal work has been one of the features of the Maternity and Child Welfare Scheme of the Council in recent years. The establishment of the Borough Maternity Hospital has greatly facilitated the development of this side of the scheme. It is generally recognised now that unless antenatal work is carried on directly in connection with a Maternity Hospital, where beds are available for patients attending these Clinics, the results obtained are unsatisfactory. Furthermore, it is essential that the Medical Officer in charge should be a specialist in this branch of medicine. From the beginning, therefore, these factors have been kept in view, and the system in operation now in Battersea for the provision of an efficient Ante-Natal and Midwifery Service may be regarded justifiably as a fairly comprehensive one. Owing to the great extension of the Ante-Natal work and the unsuitability of the existing accommodation the Council decided to build an extension to the Borough Maternity Hospital to provide additional accommodation for an Outpatients' Department. Provisional plans were prepared and submitted to the Ministry of Health, and it is hoped that the new building will shortly be erected, as at present the accommodation is severely strained and otherwise unsuitable for the purpose.* The Ante-Natal Clinics are under the supervision and direction of Miss Alice Bloomfield, F.R.C.S., who attends the Clinics on four sessions weekly, three of these being at the Borough Maternity Hospital Out-Patients' Department, and one at the new Central Maternity and Child Welfare Centre at Southlands, and who reports as follows as to the work carried out during 1928:— Tuesday Afternoon, Special Clinic.—This has been well attended, the average number of patients at each session being about 16 as against 13 in 1927, 825 new and 110 old patients—935 in all—attended, whereas in 1927 712 new and 77 old—789—was the total. Blood tests were taken in 825 cases, of which 14 or 1.7 per cent. gave a positive result. A number of smears of cervical and urethral discharges were made and examined, and a large number of patients complaining of excessive or abnormal vaginal discharge were seen, and, if necessary, treatment carried out. With the institution of a post natal clinic under the charge of the R.M.O., the number of post natal cases seen at the special clinic has naturally diminished, only those cases attending which were referred as requiring a special opinion. *The Ministry in 1929 Sanctioned this extension 28 Ante-natal Clinics. Wednesday and Thursday Morning Clinics.—The attendance at these clinics speaks well for the popularity of the Borough Maternity Scheme—and Home—the average attendance per clinic being 25.1, with 490 new cases and a total of 2,585 attendances. A large proportion of the patients attending continue to be primiparæ and booking, as a rule, is carried out at a reasonably early date, i.e. before the 5th month in most cases. Friday Morning Latchmere (Southlands) Clinic.—This clinic shows a good attendance, many patients now being referred to it from the other non-central clinics, i.e., All Saints and Plough Road, which tends to centralise the cases and unify the Ante-natal work. The average attendance at this clinic is 13.5, a figure at first apparently rather low, when compared with the Maternity Home clinic figure of 25.1; 208 new cases have, however, been seen during the year, which compares very favourably with the 490 new cases seen by the Wednesday and Thursday Home Clinics, the rather low average being accounted for by the transference of cases from this clinic to the Home clinics during the last month of pregnancy. General Remarks.—The year 1928 has been, I hope, a proof of the necessity of a Resident Medical Officer at the Borough Maternity Home. Personally, I have found the R.M.O. of great assistance to me in carrying out treatment suggested by me, for ante-natal patients —e.g. albuminurias, antepartum haemorrhages—whose admission to the Home has been necessary, and also by her knowledge of the patients gained during her attendance with me, at the Ante-natal Clinics she assists in linking up the Ante-natal work with the consultant service when this is necessary. I should like to again emphasise the desirability of booking early in pregnancy, i.e. about the 3rd month. Patients during the past year have shown a greater tendency to do this, especially in cases where difficulty in a former pregnancy, or loss of a child at a former confinement has taken place. Among conditions requiring treatment, which have been diagnosed at a stage in pregnancy which allows this to be carried out with benefit, I may mention the following: cardiac disease, pulmonary T.B. and other chest conditions, nose and eye conditions, dental caries, haemorrhoids, anal fistula, uterine fibroids, &c. The booking of patients for admission to the Home, &c., during these last one or two months of pregnancy, which occasionally happens, is in my opinion to be definitely deprecated. I am adding below a short table of figures, which are of interest in connection with the ante-natal work. 29 The following deserve emphasis:— A fairly large number of cases of albuminuria have been treated with only two cases of eclampsia, one of whom showed no albuminuria. The number of forceps deliveries is low—only 31 in all—in cases attending the ante-natal clinics. The induction results have been satisfactory. Albuminurias. Cases occurring at A.N. Clinics 48 Cases recommended admission to B.M.H. 14 Cases of Eclampsia (one without previous albuminuria) 2 Cardiac Diseases. Many mild cases watched at clinics. Recommended admission to B.M.H. 2 Antepartum Hemorrhage. Number of cases for admission 9 Inductions.—Number of cases 23 Results—12 bougies. Mothers good—all. Child—1 still birth. 11 quinine, &c. Mothers good—all. Child good—all. Forceps Deliveries (2 private, not seen at A.N. Clinic) 33 Reasons for forceps delivery— Delayed 2nd stage, inertia and foetal distress 13 Maternal collapse 1 Cystocele and rectocele 1 Persistent occipito posterior 6 Slight degree pelvic contraction 7 Brow 1 Face 1 Threatening uterine rupture 1 Examinations under General Anesthetic in Ante-Natal Period. Number of cases 19 Ext. version for Breech presentation— Successful 6 Unsuccessful 11 For estimation of fit of foetal head into pelvis 8 30 Number of cases delivered as Breech presentations 17 Diagnosed, 11; undiagnosed, 5—at full term—of whom 1 was not examined at Ante-natal Clinic. Apart from those cases from the Borough attending the AnteNatal clinics held at Hospitals adjacent to the Borough, like St. Thomas' and York Road, an ante-natal clinic is held at the Battersea Centre of the Women's League of Service. This centre, which includes many other useful activities of a Maternity and Child Welfare Centre, e.g., provision of meals for necessitous, expectant and nursing mothers, is linked up with the Borough Council's Scheme, and receives a subsidy to enable the work to be brought up to the standard of efficiency of that of the Council's scheme. The general statistical results of the work carried out at this Centre which was transferred during the year to Southlands, is set out in those referring to the work of all Voluntary Agencies included in the Council's Scheme. Below will be found the report of Dr. A. Maud Swanson, medical officer in charge of the clinic attached to this Centre:— Ante-natal Work. The sessions are held fortnightly, and considering the small area they have been well attended. The average attendance at each session is about 8, and the total number of attendances 237. 9 mothers were confined at the Borough Maternity Home. 36 mothers were confined in their own homes. 5 mothers were confined at St. James' Hospital. 8 cases were referred to hospitals. 1 Caesarian Section at Queen Charlotte's Hospital. Result—good. 1 operation for Fibroids at Chelsea Hospital for Women. . Result—good. 5 minor complaints treated at Chelsea Hospital for Women. Results—satisfactory. Infant Welfare Work. 5 cases were referred to hospital. 1 congenital malformation—Great Ormond Street. 2 otorrhœa—Tite Street. 2 operations for tonsils and adenoids—Tite Street. For about nine months of the year we have been working at Southlands College. Our new premises have been most satisfactory. The rooms are larger, sunnier and altogether pleasanter to work in. The Borough Council kindly carried out any alterations we deemed necessary. 31 The change, at first, caused a slight decrease in numbers until the mothers became accustomed to the new address, but we have good promise for the coming year both in ante-natal and infant welfare work. The dinners for mothers continue to justify their existence, and very materially help the mothers to continue breast feeding. Dinners for toddlers—from 1 to 5 years—have been re-started, and have proved very beneficial. It is a part of our work which we hope to extend. The Samaritan Fund is helping to send mothers and children either to the country or seaside. This fund is entirely supported by voluntary contributions. In addition to the Ante-Natal work carried out under the Maternity and Child Welfare Scheme of the Council a considerable amount of visiting and reporting of cases is done by the Council's Health Visiting Staff for the Obstetric and Gynaecological Departments of the larger Hospitals in connection with Battersea patients attending these institutions. The following is a summarised statement showing the Hospitals and the visiting and reporting work carried out for them during 1928. Ante-natal and postnatal. Other. Total. St. Thomas' Hospital 164 198 362 Charing Cross Hospital 2 — 2 General Lying-in Hospital 186 — 186 King's College Hospital 3 — 3 Middlesex Hospital 1 — 1 St. George's Hospital 18 — 18 Westminster Hospital 6 — 6 Victoria Hospital, Chelsea - 68 68 380 266 646 Ante-Natal (V.D.) Clinic. This special treatment clinic was established in connection with the Ante-Natal Out Patient Department at the Borough Maternity Hospital late in 1921. The Clinic is fully equipped with the necessary requisites for diagnosis and treatment, and is under the direction and supervision of a Specialist Medical Officer. Unfortunately, Dr. A. C. Roxburgh, F.R.C.P., who has been in charge of the Clinic since its inception, was compelled by the pressure of his other work to relinquish his appointment and his place has been filled by Mr. Corsi, F.R.C.S. The work carried out during 1928 is summarised in the table on page 32. 32 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results. Year. Number of expectant mothers tested by w.r. Number giving positive w.r. Per cent. Number of expectant mothers with positive w.r. treated during pregnancy. Babies. Healthy Neg. w.r. Healthy looking. Not yet tested. Positive w.r. Still-born. 1922 - - - 1 1 0 0 0 1923 - - - 8 5 2 1 0 1924 517 18 3.5 15 11 3 0 1* 1925 653 14 2.1 8 7 1 0 0 1926 658 10 1.5 9 7 2 0 0 1927 674 12 1.7 12 6 4 2 0 1928 934 12 1.3 18 5 6 0 0 * Not syphilitic. 33 Dr. Corsi reports—"No infant was born syphilitic in the Home in 1928. All cases of syphilis were cases of latent syphilis except one, which was one of gummatous neuritis of the ocular nerve. Cases of latent syphilis can never be discharged as finally cured. Ultimately, therefore, nearly all patients weary of attending the Clinic and disappear or refuse to come. Most, however, have had sufficient treatment to render it improbable that they will have syphilitic offspring. Nor are they likely to be infective to others. But it is highly desirable that patients be followed up by the Health Visitor and advised to attend for treatment or advice as long as possible." Maternal Mortality. During 1928, there were 7 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 2.55 per 1,000 births. Four of these deaths occurred in St. James' Hospital, 2 in other hospitals, and 1 in a nursing institution outside London. The causes of death were certified as being:— Puerperal sepsis 3 Eclampsia 3 Spontaneous rupture of uterus 1 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1923. 1924. 1925. 1926. 1927. Mean 1923-7 1928. Deaths from Puerperal Sepsis - 4 3 3 1 2.2 3 Deaths from other causes connected with child-birth 10 5 3 7 5 6.0 4 Total Maternal Deaths connected with child-birth 10 9 6 10 6 8.2 7 Rate per 1,000 births— Puerperal Sepsis - 1.27 0.94 1.01 .36 0.72 1.09 Other Maternal deaths 2.91 1.59 0.94 2.36 1.78 1.92 1.46 Rate per 1,000 births all Maternal deaths in child-birth 2.91 2.86 1.88 3.37 2.14 2.63 2.55 Rate per 1,000 population— Puerperal Sepsis - .023 .017 .017 .006 .013 .018 Other Maternal deaths .059 .029 .017 .041 .030 .035 .024 Rate per 1,000 population all Maternal deaths in childbirth .059 .052 .034 .058 .036 .048 .042 There has to be recorded a very slight rise in Maternal Mortality during 1928, but an inspection of the above table shows that, notwithstanding, the improvement in recent years has been maintained. 34 Borough Maternity Hospital. The Borough Maternity Hospital is situate at 19 and 20 Bolingbroke Grove, overlooking Wandsworth Common. It was established soon after the war, and was opened for the reception of maternity cases in February, 1921. Accommodation is provided for 30 patients at one time. The Hospital is a recognised training institution for pupil-midwives, and a District Midwifery Service for the attendance of the District Midwife on patients in their own homes is directed from the Borough Maternity Hospital. The Central Ante-Natal Clinics and Special Treatment Clinics are held at the Out-Patient Department of the Hospital. The Nursing Staff of the Hospital consists of a Matron, Sister and 5 Staff Nurses. There is accommodation in the Hospital for 12 pupil midwives undergoing training at one time. Owing to the great increase—to the fullest capacity of the Hospital—in the number of patients admitted, many of them cases of extreme gravity or emergency, on the recommendation of the Medical Officer of Health a resident Medical Officer Was appointed by the Council in 1927. This Officer, in addition to conducting difficult cases of labour, acts as a liaison officer between the AnteNatal and Obstetric Consultants. This appointment has been fully justified by the results obtained, only one maternal death amongst 1,800 patients admitted having occurred during the past three years. The appointment of this Officer has also enabled a Post-Natal Clinic to be established at the Hospital where women who have been confined in the Hospital attend for examination by the Resident Medical Officer six weeks after confinement. The services of the Consultant Obstetrician to the Hospital, Dr. J. S. Fairbairn, M.D., F.R.C.S., F.R.C.P., Senior Obstetric Physician to St. Thomas' Hospital (or his deputy, Dr. A. H. Richardson, F.R.C.S.) are also available in cases of grave emergency. It was found necessary to call in the services of the Consultant Obstetrician in 32 cases during the year as compared with 12 cases in 1927. During 1928, 653 cases were admitted to the Hospital as compared with 634 cases in 1927, 625 in 1926, 560 in 1925 and 400 in 1924. 35 Particulars relating to the admissions during 1928 are set out as follows:— Total number of cases admitted 653 Average duration of stay 14 days Number of cases delivered by midwives 581 Number of cases delivered by doctors (including 5 delivered by own doctors) 53 Of the above cases, 19 patients were admitted for Ante-Natal treatment prior to re-admission at a later date for confinement. Number of cases in which medical aid was sought by the midwife with reasons for requiring assistance:— (a) Ante-Natal.—64 Accidental hæmorrhage 2 Pernicious vomiting 1 Albuminuria 14 Placenta prævia 7 Contracted pelvis 4 Uterine inertia 3 Cystocele and Rectocele 1 64 Heart cases 2 Induction 23 Malpresentation 7 (b) During Labour—191. Discharging rectal fistula 1 Retained membranes 4 Foetal distress 6 Ruptured perineum 131 Forceps deliveries 33 Rupture of sphincter muscle 1 Heart disease 4 191 Prolonged labour 3 P.P.H. and retained placenta 8 (c) After Labour—32. Influenza 4 Abdominal pain 3 Eclamptic fits 2 Varicose veins 6 Pain in coccyx 1 Tb. lung 2 Pain in groin, &c. 4 Old Tb. kidney 1 Pyelitis 1 32 Rupture of uterus 1 Rashes on face, &c. 4 Chest conditions 3 36 (d) For Infant—80. Drop wrists 2 Anaemia neonatorum 1 Discharging wounds from forceps 4 Imperforate urethra 1 Watery eyes 48 Hæmoptysis 2 Ophthalmia neonatorum 2 Cardiac and pneumonia 1 Hydrocephalic 2 Feebleness 6 Convulsions 4 Syphilis 3 80 Club feet 2 Lax ligaments 2 Number of maternal deaths (ruptured uterus) 1 Number of cases in which temperature rose above 100.4° F. for 24 hours with rise of pulse rate 36 Number of cases notified as Ophthalmia neonatorum with result of treatment (Both cured. No permanent damage to eyes.) 2 Number of cases with discharge from eyes however slight 48 Number of infants not entirely breast fed 9 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia (9 recovered, 1 result unknown) 10 Number of foetal deaths (15 still-born, 10 within 14 days of birth) and their causes 25 Still birth— Died within 14 days— Eclampsia 1 Hæmoptysis 2 Breech presentations 5 Heart and chest l Acute partum hæmorrhage 2 Premature 5 Rupture of uterus 1 Asphyxia 1 Prolonged 2nd stage 1 Pernicious anaemia 1 Induction for contracted pelvis 1 Hydrocephalus 1 Prematurity after A.P.H. 2 Cause unknown 1 The Consultant Obstetrician was called in in 32 cases of grave emergency, particulars of which are set out below:— Ante-partum haemorrhage 4 Malpresentat ions 2 Bougie induction 2 Pressure pain in coccyx 1 Caesarean section 5 Puerperal pyrexia 6 Caesarean section and sterility of uterus 1 Pyelitis 1 Severe œdematous condition of vulva and albuminuria 1 Complete tear of rectus muscle 1 Contracted pelvis 1 Tonic contraction and no dilatation of cervix 1 Forceps delivery 6 I am indebted to the courtesy of the Borough Treasurer for the following statement of the cost of the Home during the financial year ended 31st March, 1929:— 37 Maternity Hospital, 1928-1929. Total beds, 30; total cases, 626; percentage of beds occupied 80.26 per cent. Statement showing expenditure for the year ended 31st March, 1929, in respect of the Maternity Hospital. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 602 0 9 7 Nursing 602 0 9 7 Domestic and other 513 0 8 2 Provisions 1,279 1 0 5 Drugs and other Medical Requisites 330 0 5 3 Heating and Lighting 606 0 9 8 Laundry 457 0 7 4 Repairs and renewals Domestic 347 0 5 7 Structural 347 0 5 7 Taxes and Insurance 78 0 1 3 Loan Charges 1,288 1 0 7 Miscellaneous 298 0 4 9 Gross cost £6,747 £5 7 9 Income Pupil Midwives 249 0 4 0 Patients' Payments 3,001 2 7 11 Other 20 0 0 4 Net cost £3,477 £2 15 6 District Midwifery Service. During 1928 there were 137 cases attended in their own homes by the District Midwife as compared with 157 in the previous year, a decrease of 20 cases. Particulars relating to this Service during the year are set out below:— Total number of cases attended in the district 137 Average number of visits to each case 18 Number of cases delivered by:— (a) Midwife 132 (b) Doctors (including 2 privately engaged) 5 Number of cases where medical assistance was called for, with reasons for requiring assistance:— (a) Ante-Natal—Nil. 38 (b) During Labour—5. Adherent placenta 2 Prolonged labour—forceps delivery 2 Difficult breech—hydrocephalus 1 (c) After Labour—10. Ruptured perineum 2 Varicose veins 2 Tuberculosis 1 Asthma 1 Poor general condition 1 Pleurisy and bronchitis 1 Unsatisfactory sixth day 1 Ruptured uterus 1 (d) For Infant—4. Dangerous feebleness (prematurity) 1 Ophthalmia neonatorum 2 Slight inflammation of eyes 1 Number of cases of— Puerperal sepsis — Maternal deaths (ruptured uterus) 1 Still births 2 Death within 10 days (difficult breech delivery, spina bifida and hydrocephalus) 1 Infants not entirely breast-fed — Inflammation of eyes (slight) 1 Ophthalmia neonatorum (both cured) 2 Dental Clinic. During 1928 the work carried out at the Dental Clinic was satisfactory. The Clinic was established as an integral part of the Council's Scheme for Maternity and Child Welfare for providing facilities for the dental treatment of expectant and nursing mothers and children under 5 years of age. The Dental Clinics are also available for patients recommended by the Medical Officers of the Maternity and Child Welfare Clinics of the Voluntary Associations linked up with the Council's Scheme. The work of the Dental Clinic during 1928 is summarised as follows:— Women. Children. Sessions held 149 43 No. of patients treated 334 124 No. of new patients 176 92 No. of patients referred to hospital 6 16 Total attendances 1,924 452 39 Work carried out:— Women. Children. Extractions— Ordinary 3 3 With local anaesthetic 60 3 „ general anaesthetic 262 84 Total 325 90 No. of teeth extracted 1,044 222 Scaling and polishing 15 2 Fillings 47 23 Upper dentures 56 — Lower dentures 61 — Denture visits 502 — Dressings and treatment to gums 61 3 Repairs to dentures 45 — Advice 828 319 The estimated cost of dental treatment (Maternity and Child Welfare) in the financial year 1928-9 was £609 17s. 6d. This sum includes £182 3s. 6d. paid for dentures supplied, the cost of which is distributed as under:— £ s. d. Contributed by patients 109 2 3 Grants from British Dental Hospital 9 10 0 Grants from Saturday and Sunday Hospital Funds 33 8 0 Grants from other philanthropic agencies 21 8 3 Contribution by the Council 8 15 0 £182 3 6 The net cost of this service during 1928-9 was £436 9s. 0d. Solarium. During the year the Council on the recommendation of the Maternity and Child Welfare and Health Committees decided to establish a clinic for light treatment in connection with their Maternity and Child Welfare and Tuberculosis schemes. It is expected that this new Centre will be opened at Southlands during 1929. Nursing Homes. Representations were made by the Borough Council to the London County Council during the year as to the desirability of the delegation by the County Council of the powers conferred upon them by the Nursing Homes (Registration) Act, 1927, which came into force on the 1st July, 1928. The County Council, however, stated that they did not at present consider it advisable to delegate this portion of the Health Services administered by them pending consideration of the delegation of certain powers to the Borough Councils, which may arise in future. 40 Notifiable Infectious Diseases. During 1928 under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 5,873 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 4, acute poliomyelitis 1, enteric fever 8. The following is a list of the diseases compulsorily notifiable in Battersea:— Small-pox. Acute polio-myelitis. Cholera. Acute polio-encephalitis. Diphtheria. Glanders. Membranous croup. Anthrax. Erysipelas. Hydrophobia Scarlet fever. Acute influenzal pneumonia. Typhus fever Acute primary pneumonia. Typhoid or enteric fever. Malaria. Relapsing fever. Dysentery. Continued fever. Plague. Puerperal fever. Acute encephalitis lethargica. Puerperal pyrexia Measles. Ophthalmia neonatorum. Whooping cough. Cerebro-spinal fever. Tuberculosis. The distribution of the cases notified in the registration subdistricts and the wards is shown in the table on p. 41. Excluding measles and whooping cough, there were 1,682 cases which occurred in 1,427 houses. Of these cases 1,295, or 77 per cent., were removed to the Isolation Hospitals of the Metropolitan Asylums Board or to other Institutions and 387, or 23 per cent., remained under treatment at home. Full particulars of all notifiable infectious diseases will be found in the form required by the Ministry of Health (Table II.) in the Appendix. Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 41 Notifications of Infectious Diseases, 1928, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox - - - 1 - - - - - 1 - - 1 Diphtheria 112 133 99 48 73 93 24 28 42 321 231 100 652 Erysipelas 17 8 11 7 8 19 4 4 6 35 34 15 84 Scarlet Fever 76 62 64 46 74 61 17 50 30 196 181 103 480 Enteric (Typhoid) Fever — 2 — 1 — — 1 3 1 2 — 6 8 Ophthalmia Neonatorum 11 2 1 2 6 10 1 1 5 16 16 7 39 Puerperal Fever 1 1 2 — 1 — — 1 1 3 2 2 7 Puerperal Pyrexia 6 6 1 4 3 6 — 2 3 17 9 5 31 Polio-myelitis — — — — — 1 — — — — 1 — 1 Polio-encephalitis - — — — — — — — — — — — — Encephalitis Lethargica - - - - - - - - - - - - - Cerebro-Spinal Meningitis — — 1 1 —. 1 — — 1 1 2 1 4 Malaria — 1 2 — 2 2 1 1 - 2 5 2 9 Dysentery — 1 — — — — — — — 1 — — 1 Acute Primary Pneumonia 53 32 44 17 49 76 12 22 9 109 163 42 314 Acute Influenzal Pneumonia 2 5 8 7 6 13 2 4 4 18 23 10 51 *Whooping Cough 209 98 133 40 97 145 30 37 21 379 335 96 810 *Measles 651 422 434 304 409 576 108 272 205 1,510 1,254 617 3,381 Totals 1,138 773 800 478 728 1,003 200 425 328 2,611 2,256 1,006 5,873 * Notifiable in Battersea from 24th April 1922 42 Small-Pox. One case of small-pox occurred in Battersea during 1928. This is the first case notified in the Borough since September, 1923. The history as to the source of infection in this case was vague and inconclusive. It was stated, however, that the patient was employed at a warehouse in Southwark, and that he worked with another youth who resided in a house in Lambeth from which a case of Small-pox had been removed. This contact had been absent from work for three weeks. The patient lived with his parents and six other members of his family of adult age. The father and mother had been vaccinated in infancy and one brother during the War. The remaining members of the family had never been vaccinated. The patient was immediately removed to the isolation hospital and was discharged on the 4th February, 1929, after an absence of seven weeks. All members of the family and immediate contacts were vaccinated or revaccinated within a few hours of the removal of the case to Hospital. No further cases occurred in this family or amongst the contacts. During the year 303 cases of this disease were recorded in London, 88 of these cases occurring in the neighbouring borough of Wandsworth ; 46 in Lambeth and 64 in Poplar. The disease was also prevalent in Greater London, West Ham having a large number of cases. 296 "contacts" with cases of Small-pox occurring in other districts were reported to the Medical Officer of Health, and were visited daily during the incubation period, involving much extra work for the Inspectorial Staff. In England and Wales, 12,464 cases of small-pox were notified during 1928. Scarlet Fever. The incidence of Scarlet Fever was higher in 1928, 480 cases being notified as compared with 376 in the previous year. The case-rate per 1,000 of the population was 2.93 and 5 deaths were registered from the disease giving a death-rate of 0.03 per 1,000 as compared with 3 deaths and a death-rate of 0.02 in 1927. Of the cases notified 471 or 98.1 per cent. were removed to hospital. The infected houses numbered 425. In 63 of the notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at Hospital. 43 Diphtheria. The number of cases of Diphtheria notified in Battersea during 1928 was 652 as compared with 680 in 1927, 540 in 1926, and 396 in 1925. The number of deaths registered from the disease was 26, giving a death-rate of 0.158 as compared with 25 deaths and a death-rate of 0.148 in 1927. Of the 652 cases notified 649 or 99.5 per cent. were removed to hospital. The infected houses numbered 558. In 66 cases notified (not included in the above total) the diagnosis of Diphtheria was not confirmed at hospital. The case-rate per 1,000 population was 3.97 as compared with 4.02 in 1927, 3.14 in 1926, 2.30 in 1925, 2.18 in 1924, and 2.19 in 1923. The case-mortality was 3.99 per cent. as compared with 3.68 in 1927, 3.70 in 1926, 2.53 in 1925, and 6.72 in 1924. The incidence of the disease was highest in the Park, Latchmere and WinstanleyWards. The following table shows the incidence and mortality of diphtheria during 1928 in the Borough, the sub-districts and the wards:— Ward. Cases. Deaths. Cases per 1,000 Popltn. Deaths per 1,000 Popltn. Percentage Case Mortality. 1 112 5 4.19 .19 4.46 2 133 4 7.46 .22 3.01 3 99 4 5.29 .21 4.04 4 48 3 3.18 .20 6.25 5 73 2 4.03 .11 2.74 6 93 5 4.61 .25 5.38 7 24 — 2.86 — — 8 28 2 1.51 .11 7.14 9 42 1 2.04 .05 2.38 E. 321 13 4.72 .19 4.05 N.W. 231 10 4.92 .21 4.33 S.W. 100 3 2.03 .06 3.00 Boro' 652 26 3.97 .158 3.99 44 Incidence and Mortality, 1895-1928. Period. Mean Quinquennial Rates. Mean No. of cases per annum. Mean case rate. Mean No. of deaths per annum. Mean deathrate. Case mortality per cent. 1895-1899 569.6 3.43 93.4 .564 17.02 1900-1904 265.2 1.57 22.6 .134 8.34 1905-1909 267.4 1.58 22.2 .131 8.18 1910-1914 224.4 1.34 17.4 .104 7.74 1915-1919 261.0 1.66 22.4 .143 8.56 1920-1924 531.8 3.15 43.4 .257 8.06 Year 1925 396 2.30 10 .058 2.53 ,, 1926 540 3.14 20 .116 3.70 ,, 1927 680 4.02 25 .148 3.68 „ 1928 652 3.97 26 .158 3.99 During the year 36 phials (approximately 136,000 units) of diphtheria anti-toxin were supplied, on request, to medical practitioners practising in the Borough. Schick Test Clinic. Summary of Work Carried Out, 1928. As stated in my previous annual report a Schick test clinic was established at the close of 1927, and has since been held weekly at the Latchmere, and since November, at the Southlands Maternity and Child Welfare Centre. The work is carried on under the supervision of Dr. Mabel Brodie, m.b., Ch.b., "d.p.h. The result of the year's work is summarised as follows:— Sessions held 51 Patients attending in 1928 (new 178) 259 Attendances 825 ,, (average per session) 16.2 Patients tested 86 Readings of tests (including 16 1927 patients) (positive 61, negative 39, result unknown 2*) 102 Patients inoculated— Without test 92 After positive test 50 142 Inoculations 420 Total immunised (including 52 1927 patients) 96 Patients still under treatment at end of year 99 Discontinued treatment 39 * These patients attended once only. Reading of test not therefore taken. 45 The total number of patients immunised or found by test to be immune is 135, out of a total of 273 patients who have attended since the clinic was opened (49.5 per cent.). Acute Polio-Myelitis. There was only one case of Acute Polio-Myelitis notified in Battersea during 1928. No death was recorded from the disease. Particulars of Notified Case. Identification. Age & Sex. Date Notified. Result. P.J. 17/12 F. 22 Oct. Attending Hospital for massage. Reported cases (not in acute stage). A.R. 3 M. 24 Jan. In hospital at Carshalton. P.B. 16/12 M. 17 April Attending St. Thomas's Hospital. At the end of the year there were 29 cases under observation, 26 having been notified or reported prior to 1928. Of these 29 cases, 26 were under 5 years of age when first brought under observation. When last visited 5 were reported well, 6 were in hospital, 1 under convalescent treatment, and 14 were undergoing outpatient treatment. Of the remaining 3 cases, 1 was reported to be limping slightly and 2 were reported to be still wearing instruments. Acute Polio-Encephalitis. No case of this disease was notified during 1928. Puerperal Fever and Puerperal Pyrexia. There were 7 cases of Puerperal Fever notified in Battersea during 1928 as compared with 9 cases in 1927, 12 cases in 1926, and 6 cases in 1925. There were 3 deaths from the disease. The number of cases per 1,000 births was 2.55, as compared with 3.21 in 1927, 4.04 in 1926, and 1.88 in 1925. The notified cases were distributed as follows:—East Battersea, 3; North West Battersea, 2; South West Battersea, 2. The case mortality was 42.9 per cent., and the death-rate per 1,000 births was 1.09. There were 293 cases of Puerperal Fever notified in London and 2,376 in England and Wales during 1928. The number of cases of puerperal pyrexia notified during 1928 was 31, and the incidence per 1,000 births was 11.30. 46 The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Amendment Regulations, 1928, amended the main Regulations of 1926 by requiring the notification of a case of Puerperal Pyrexia to be sent to the Medical Officer of Health of the district within which the case occurs, instead of as before, to the place in which the residence of the woman was situate, but in the case of a patient in a Hospital the notification is to be sent to the Medical Officer of Health of the district from which the patient was brought to the Hospital. There were 767 cases of puerperal pyrexia notified in London and 5,450 in England and Wales during the year. Enteric Fever. During 1928 thirteen cases of enteric fever (including 8 of Paratyphoid Fever) were notified in Battersea. Of these 5 cases (one notified as paratyphoid) were cancelled, the diagnosis not being confirmed at hospital. There was one death from this disease during 1928, this being a case occurring in a mental hospital, and not notified in Battersea. Cerebro-Spinal Fever. During 1928 six cases of this disease were notified in Battersea, two of which were subsequently cancelled. Four deaths were recorded from this disease, one of these being notified as Encephalitis Lethargica, but the original diagnosis was not confirmed on removal to hospital. Encephalitis Lethargica. Two cases of Encephalitis Lethargica (sleepy sickness) were notified in Battersea during 1928. In neither of these cases was the diagnosis confirmed and the notifications were subsequently cancelled. One death was recorded from the disease (this being an un-notified case in a mental hospital)* giving a death-rate of 0.006 for the year. Four cases were notified in 1927 and four in 1926. In 1928 the number of notified cases of this disease in England and Wales was 1,318, and in London 108. Ophthalmia Neonatorum. There were 39 cases of Ophthalmia Neonatorum notified in Battersea during 1928 as compared with 48 in 1927, 35 cases in 1926, 32 cases in 1925, and 41 cases in 1924. The rate per 1,000 births was 14.2, as compared with 17.1 in 1927, 11.8 in 1926, 10.0 and 13.1 in 1925 and 1924 respectively. *This death was certified as being due to Encephalitis Lethargica following a post-mortem examination. 47 The disease was most prevalent in the less prosperous districts of the Borough, East Battersea and North West Battersea contributing 82.1 per cent, of the total cases notified. During 1928 the number of visits paid by nurses supplied by the Borough Council in cases of Ophthalmia Neonatorum or other inflammatory condition of the eyes of the newly-born was 2,576. In addition 192 visits of enquiry and supervision were made by Health Visitors. There were 10 severe cases amongst the 39 notified, all which were removed to St. Margaret's (M.A.B.) Hospital for treatment. No permanent damage to the eyes of infants suffering from Ophthalmia Neonatorum or other inflammatory condition of the eyes was recorded during the year. Two infants died whilst under treatment for this disease in hospital (St. Margaret's, M.A.B., and St. James's), the causes of death being atelectasis and atrophy respectively. The following table shews the distribution of the cases notified:- Sub-Districts. Ward. Cases. Births. Rate per 1,000 Births, Year. Cases. Births. Rate per 1,000 Births. E. Battersea 16 1,220 13.1 1923 42 3,434 12.2 N.W. Battersea 16 893 17.9 S.W. Battersea 7 630 11.1 1924 41 3,139 13.1 1. Nine Elms 11 504 21.8 1925 32 3,184 10.0 2. Park 2 356 5.6 3. Latchmere 1 350 2.9 1926 35 2,969 11.8 4. Shaftesbury 2 211 9.5 5. Church 6 336 17.9 1927 48 2,801 17.1 6. Winstanley 10 380 26.3 7. St. John 1 120 8.3 8. Bolingbroke 1 255 3.9 Mean 9. Broomwood 5 231 21.6 1923.7 39.6 3,105 12.8 Borough 39 2,743 14.2 1928 39 2,743 14.2 The Public Health (Ophthalmia Neonatorum) Amendment Regulation, 1928, which came into force on 1st July, 1928, provided that the notification of a case of Ophthalmia Neonatorum should be made to the Medical Officer of the district within which the medical practitioner was attending a child instead of, as before, to the Medical Officer of the district in which the residence of the parents was situated. Erysipelas. There were 84 cases of Erysipelas notified and 5 deaths were recorded from the disease during 1928 in Battersea. The casemortality was 5.95 per cent, and the death-rate per 1,000 population was 0.03. 48 Measles. The number of cases of Measles notified or otherwise reported in 1928 was 3,885 and there were 36 deaths recorded from the disease. Of the 3,885 cases 3,381 were notified under the Regulations—The Battersea (Measles and Whooping Cough) Regulations, 1922— and the remaining 504 cases were reported by the public elementary schools or from other sources. The case-mortality was 1.06 per cent. of the notified cases; in the previous epidemic year the case-mortality was 1.28 per cent. Special precautionary measures are taken to deal with outbreaks of Measles. These include the home visiting of patients and their removal to hospital where environmental conditions render this course advisable. Advice is also given as to the isolation of unprotected children. The home visiting is carried out by the Health Visitors in close co-operation with the School Nurses. The Metropolitan Asylums (Measles) Rescission Order, 1928, issued in August, provides that the Metropolitan Asylums (Measles) Order, 1911, which prescribed Regulations and restrictions subject to which patients suffering from measles might be admitted to their Hospital shall be rescinded. The effect of the new Order is to empower the Metropolitan Asylums Board to admit persons subject to such arrangements as they might themselves make. Whooping-Cough. During 1928 there were 810 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 418 additional cases were reported from the public elementary schools and other sources. There were 14 deaths registered from this disease, the deathrate being 0.085, as compared with 15 deaths and a death-rate of 0.09 in 1927, 13 deaths and a death-rate of 0.08 in 1926, 20 deaths and a death-rate of 0.12 in 1925, and 17 deaths and a death-rate of 0.10 in 1924. The total number of cases notified or otherwise reported during 1928 was 1,228 as compared with 749 in 1927, 1,210 in 1926, 1,320 in 1925, 816 in 1924 and 1,024 in 1923, the increase in 1928 compared with 1927 being 64-0 per cent. The disease, with measles, was made compulsorily notifiable in Battersea, in 1922, and the precautionary measures taken against the disease are similar to those in connection with the latter disease, in view of the danger to life in the younger children. TUBERCULOSIS. During 1928 there were 301 cases of Tuberculosis (all forms) notified in Battersea as compared with 308 in 1927, 344 in 1926 and 335 in 1925. 49 In the following table is shown the distribution of the notified cases in the Sub-Districts and Wards of the Borough:— Classification. Wards. Sub-districts. 1 2 3 4 5 6 7 8 9 E. N.W. S.W. Pulmonary Non- 47 27 35 21 28 28 10 33 22 1ll 71 69 Pulmonary 11 6 5 3 8 4 2 5 6 23 14 13 Totals 58 33 40 24 36 32 12 38 28 134 85 82 The Borough : Pulmonary 251 Non-Pulmonary 50 Total 301 The following table shows the age and sex distribution of the cases of Tuberculosis notified in each Ward and in the Registration Sub-Districts during 1928:— Ward. Ages : Total, all ages. Grand Total. Rate per 100,000 population. Under lyr. 1-5 5-15 15-25 25-45 45-65 65 up M. F. 1 - 2 6 19 23 7 1 35 23 58 217 2 - 1 2 10 12 7 — 14 18 32 180 3 - - 4 14 16 6 1 22 19 41 219 4 - - 3 10 6 5 — 13 11 24 159 5 - 3 3 11 9 10 — 21 15 36 199 6 - - 4 12 8 8 — 16 16 32 159 7 - - 1 3 4 4 — 6 6 12 143 8 - 3 2 14 15 4 — 20 18 38 205 9 2 1 1 9 10 5 — 19 9 28 137 Boro' 2 10 26 102 103 56 2 166 135 301 183 E. - 3 11 47 48 23 2 75 59 134 197 N.W. - 3 10 29 24 19 — 44 41 85 181 s.w. 2 4 5 26 31 14 — 47 35 82 167 Rate per 10 0,000 population in each age group Boro 56 94 82 359 212 178 21 216 155 183 — In the table on pp. 58-9 is shown the information required by the Ministry of Health in regard to notifications. 50 The localisation of the disease in the 301 cases notified in 1928 is summarised below:- Localisation of Disease. Pulmonary (251) Bones and Joints (12) Genito-urinary (3) Lungs 244 Ankle 2 Kidney 1 Lungs and Larynx 3 Elbow 1 Epididymus 1 Lungs and Bowel 1 Hip 2 Fallopian Tubes 1 Lungs and Testicle 2 Knee 4 Lungs, Throat and Bowel 1 Spine 2 Skin (1) Wrist 1 Brain (10) Cheek 1 Meninges 10 General (1) Miliary and Peritoneum 1 Glands (18) Abdominal (5) Cervical 8 Peritoneum 4 Abdominal 1 Unspecified i Unspecified and Various 9 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 7 years 1922-1928:— Year. Not notified (dead). Notified after Death. Primarily Notified on Form C or D. (Form a not received). Reported from Other Sources Total. 1922 7 41 35 3 86 1923 3 33 8 — 44 1924 6 30 3 7 46 1925 19 18 4 4 45 1926 13 10 4 7 34 1927 12 14 — — 26 1928 8 10 2 3 23 From an examination of the above table giving particulars of non-notification of the disease, it will be noted that there has been an improvement in 1928 as compared with previous years. In accordance with the suggestions contained in the Circular letter of the Ministry of Health, dated 22nd December, 1924, with reference to the requirements of notification, in all cases where the obligation of notification is not complied with the attention of the Medical Practitioner concerned is drawn to the omission, and an explanation requested. It was not found necessary to take any legal action during 1928. Deaths from Tuberculosis. The death-rate from Tuberculosis was markedly lower in 1928 than in the previous year, being 98.1 per 100,000 population, as compared with 103.6 in 1927. The lowest death-rate hitherto recorded was that of 1926, when it was 96.6 per 100,000 population. 51 In the subjoined table are given deaths from Tuberculosis at various ages in each Ward and in the registration sub-districts during 1928:- Wards. Rate per 100,000 population. 0-1 1-5 5-15 Ages 45-65 65- Total, All Ages. Totals. Grand Total. Pulmon ary. NonPul monary. 15-25 25-45 M. F. 1 109 - - 1 9 11 7 1 18 11 ?7 2 29 2 95 - 2 4 5 6 8 9 14 3 17 3 85 _ - 1 5 7 2 1 1 1 5 13 8 16 4 113 - - 1 6 6 3 1 9 8 16 1 17 6 111 — 1 2 7 5 4 1 10 10 16 4 20 6 124 _ 1 2 8 6 8 _ 12 13 23 2 25 7 72 — - 1 2 1 2 - 5 1 5 1 6 H 75 _ 2 2 8 2 _ 5 9 12 2 14 9 83 2 1 1 6 2 5 - 8 9 12 5 17 E. 101 - 2 3 20 25 17 3 40 30 6? 8 70 N. 115 - 2 4 19 15 13 1 28 26 47 7 54 S. 75 2 3 2 10 11 9 - 18 19 29 8 37 — 98 2 7 9 49 51 39 4 86 75 138 23 161 Rate per 100,000 popultn. 56 66 28 172 105 124 43 112 86 84.1 14.0 98.1 The death-rates per 100,000 of the population during the 25 years ended 1925 in quinquennial averages and in individual years from 1921 to 1928 are given in the following table:— Years. Pulmonary. NonPulmonary. Total. 1901-1905 134.8 49.2 184.0 1906-1910 116.4 41.8 158.2 1911-1915 124.2 33.8 158.0 1916-1920 134.8 30.0 164.8 1921-1925 92.6 23.0 115.6 Average (25 years) 120.5 35.6 156.1 1921 100.5 27.2 127.7 1922 101.0 20.1 121.1 1923 81.5 21.1 102.6 1924 89.5 21.6 111.1 1925 90.6 25.0 115.6 1926 82.0 14.6 96.6 1927 89.4 14.2 103.6 1928 84.1 14.0 98.1 52 During 1928 there were 161 deaths from Tuberculosis registered as belonging to the Borough of Battersea. Of this number 138 [i.e. 85.7 per cent.) were due to pulmonary tuberculosis, 15 (i.e. 9.3 per cent.) to tubercular meningitis and 8 (i.e. 5.0 per cent.) to other forms of the disease. In 1927 the number of deaths from tubercular diseases was 175. Of the 161 deaths registered from Tuberculosis during the year 25 cases were not notified until one month before death; in 10 cases the notifications were received after death, and in 8 cases no notification was received. Of the 8 cases in respect of which no primary notification was received 6 (3 pulmonary, 3 non-pulmonary) were patients who died in hospitals or infirmaries. Of the remaining cases 1 (pulmonary) was under treatment by a private medical practitioner, and the other (pulmonary) was certified by the Coroner after a postmortem examination. In one un-notified case the death, being due to cancer and miliary tuberculosis, was not ascribed to tuberculosis, and in a further case originally notified as encephalitis lethargica, the death, after a post-mortem examination, was ascribed to tuberculous meningitis. Of the 10 cases notified after death 2 (pulmonary) were notified by private medical practitioners, 6 (2 pulmonary, 4 non-pulmonary) from Poor Law Institutions and 2 (pulmonary) by hospitals. Tuberculosis Dispensary. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1928. The acquisition by the Borough Council of Southlands College has afforded—inter alia—an opportunity of the Council's providing more suitable accommodation for the Borough Tuberculosis Dispensary. Rooms on the first floor of that portion of the College buildings reserved for Health Services of the Council were fitted up and adapted for use as a Tuberculosis Dispensary, and include waiting-room for patients, and rooms for Doctor, nurses, clerical staff, laboratory, pharmacy, &c. The Dispensary is now housed in commodious premises in a more suitable environment, and free from the noise from the traffic, which was, among others, a disagreeable and disturbing feature of the old premises in Bridge Road. The rooms of the new premises are well lighted, airy, and commodious, and from every point of view are a distinct improvement. The only drawback is the absence of a lift, this provision in the planning of the adapted premises having been eliminated by the Ministry of Health. It is to be hoped that this omission will be 53 reconsidered as, in my opinion, it is a disadvantage, and may even be injurious to patients attending the Dispensary. The surrounding grounds add greatly to the amenities of the buildings, and it is hoped to utilise part of them for various contemplated health services, including the Tuberculosis Dispensary Service. The transfer of the Dispensary from 179 Bridge Road was effected in June, 1928. Staff Engaged on Tuberculosis Work. The staff engaged in Tuberculosis work and the Tuberculosis Dispensary is as follows:— 1. Chief Administrative Tuberculosis Officer—The Medical Officer of Health. 2. The Tuberculosis Medical Officer—Dr. George Macdonald. 3. Tuberculosis Nurses—Three in number, who attend at the Dispensary daily, and visit the homes of the patients attending the Dispensary under the supervision of the Tuberculosis Medical Officer. Health Visitor (1), District Sanitary Inspectors in cases not in attendance at the Dispensary. 4. Clerical Staff—At Dispensary: Secretary, two clerks. At Town Hall: one clerk (part time). 5. Laboratory Assistant (dispenser). 6. Caretakers. Specimens of sputum are examined at the Dispensary for Medical Practitioners and reports submitted to them. The Dispensary is affiliated to St. Thomas's and Brompton Hospitals, and cases presenting special difficulties in diagnosis are referred to these Institutions for X-ray examination and for artificial pneumo-thorax refills, &c. The Dispensary treatment of school children is carried on in close co-operation with the School Medical Service, and the Springwell House Open Air School on Clapham Common North Side, has, in this connection, carried on useful work during the year, particulars of which will be found in the report of the Tuberculosis Medical Officer on p. 125. The Tuberculosis Care Committee, the constitution of which will be found on p. 2, met weekly at the Tuberculosis Dispensary during the year, and details of the work of the Committee will be found set out on pp. 126-7. Dental facilities for tuberculosis patients were first provided by the Council in 1922. A weekly session is held at the Dental Centre, Plough Road, and patients requiring treatment or the provision of dentures are referred to the Clinic by the Tuberculosis Medical Officer. 54 Institutional treatment is provided by the London County Council for Battersea patients, this form of treatment being arranged for in the majority of cases through the Tuberculosis Dispensary. The report of the Tuberculosis Medical Officer is set out in the Appendix (pp. 122-7). The principal work carried out at the Dispensary during 1928 is summarised as follows:— Patients and Attendances. The number of new patients was 629 (462 adults, 167 children), and the number of contacts examined 170 (89 adults, 81 children). There were 18 patients transferred from other areas during the year who subsequently attended the Dispensary, making a total of 817 new patients or contacts. Of these 817 new patients and contacts 227 were found tuberculous, and these with 2 previously "doubtful" cases made 229 new cases notified. This number included 109 cases also notified by medical practitioners. The total number of attendances at the Dispensary during the year was 3,912. Visits to the homes of dispensary patients were made by the Tuberculous Officer in 181 instances, and 4,865 visits were made by the Dispensary Nursing Staff. The number of deaths of dispensary patients was 103. Thirteen of the patients were discharged as "cured" or "disease arrested" during the year, and 34 others ceased to attend, in addition to 53 patients who removed to other districts. Institutional Treatment. The number of patients who received Institutional treatment under the L.C.C. Tuberculosis Scheme was 137, and the average length of stay was 112 days. The average period of waiting before admission was 15 days. Material improvement as a result of institutional treatment was shown in 59 cases. Thirty-two patients discharged themselves while undergoing institutional treatment. The number of dispensary patients admitted to St. James's Hospital during the year was 28. Contributions of patients undergoing institutional treatment were collected by the Dispensary and remitted to the L.C.C. to the amount of £684 6s. Od. Examinations and Reports. Sputum examinations made during the year numbered 1,398, of which 517 were received from Medical practitioners, and 383 from St. James's Hospital. The number of positive examinations was 282 or. 20.2 per cent. 55 Reports to public bodies were made to the number of 1,004. Consultations with medical practitioners at the houses of patients and reports made on patients sent to the Dispensary totalled 956, while reports received in respect of insured persons numbered 158 (Form G.P. 36, 157, form G.P. 17, 1). 175 patients were referred to hospitals, including 142 sent to St. Thomas's for X-ray examination. Tuberculosis Dental Treatment. Sessions held ... 49 Total attendances ... 243 Average attendance ... 4.96 Extractions ... 48 Scalings 3 Fillings 26 Dressings 22 Dentures supplied— Whole sets 5 Partial sets 2 Repairs to dentures 1 Advice 88 Total — 195 Average per session ... 3.98 In the Appendix (pages 119 to 121) will be found Form T. 53, which contains the returns required by the Ministry of Health of the work of the Dispensary during the year 1928, and Form T. 56, which shows in a summarised form the condition of all patients whose case records were in possession of the Dispensary at the end of 1928, arranged according to the years (from 1921 to 1928) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. NON-DISPENSARY CASES. The following particulars relate to notified cases of Tuberculosis not on the roll of patients attending the Tuberculosis Dispensary, some of whom were subsequently transferred to the Dispensary. These cases are systematically visited by the male and female Sanitary Inspectors. Women and Children. During 1928 the number of new cases notified (including 8 notified after death) and not attending the Tuberculosis Dispensary was 90 (women 60, children 30). There were in addition 9 cases among women and children which came to the knowledge of the Council either upon registration of the deaths or by information as to the removal of the patients into the Borough. Of the notified 56 cases, after correction and adjustment of the figures as to cases not traced, transferred to the Dispensary and to other districts, and cases in regard to which no information could be obtained, the following particulars are given:— There were 29 deaths (including 12 of tubercular meningitis) recorded amongst these 90 notified cases. In 16 cases death had occurred prior to the first visit and 13 deaths were subsequently recorded during the year. In addition there were 6 deaths of unnotified cases, not included in the above 90 cases. The following table gives the age and sex distribution of the 90 women and children (non-dispensary cases) notified to be suffering from Tuberculosis (all forms) during 1928:— Age and Sex Distribution. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 upwards All ages Pulmnnarr M. - 2 - - - - - - - - - 2 F. — — 1 2 12 11 11 7 9 1 — 54 Tubercular M. i 2 - - - - - - - - 3 Meningitis f. 1 4 1 — 1 - - - - - - 7 Other M. 4 5 1 - - - - - - - 10 Forms f. — — 3 3 2 4 1 — — 1 - 14 Total M. 1 6 7 1 — — — — — — - 15 F. 1 4 5 5 15 15 12 7 9 2 - - 75 Grand Total 2 10 12 6 15 15 12 7 9 2 90 The home conditions of 86 of these cases were investigated. In the majority of cases the sanitary state of the home was found to be satisfactory, the average number of persons per room being 1.3. In 5 cases, however, the conditions were found to be unsatisfactory, the patient's family occupying only a single room. As compared with the years 1927 and 1926, however, there is a distinct improvement—when 9 and 18 families respectively were found to be occupying a single room. During the year 51 of these cases received hospital, sanatorium or other form of institutional treatment. At the end of 1928 there were 424 women and children nondispensary patients (a decrease of 1 as compared with 1927), including new cases notified during the year, on the register, and 1,008 visits were paid by the female Sanitary Inspector (Miss J. Round) to the homes of these patients. Efforts are made, in as many cases as possible, to induce nondispensary patients to attend the Tuberculosis Dispensary, and during 1928,39 cases were transferred, 23 of these being new cases. 57 It is satisfactory to record that the efforts to secure protection against infection of other members of the family have met with considerable success, e.g., separate room or bed was found to be in use in 45.3 per cent, of the cases; and 50 new patients consented during the year to avail themselves of institutional treatment. Adult Male Patients. There were 281 adult male patients not on the Dispensary roll on the register at the end of 1928. There were 73 new cases notified during 1928, and of these 15 died during the year. The following table gives particulars of the non-dispensary new cases notified in 1928:— 16-20 20-25 Age Distribution. 65 up All ages. 25-35 35-45 45-55 55-65 Pulmonary 1 10 15 10 23 6 1 66 Tubercular Meningitis — — — 1 — — - 1 Other tubercular Diseases 3 1 — — 2 — — 6 Total 4 11 15 11 25 6 1 73 The homes of all these patients were systematically visited during the year by the District Sanitary Inspectors, and 429 visits, including 73 first visits to new cases were paid. Six of the new cases notified were found to have died on the first visit. Of the new cases 34 received institutional treatment and 30 were transferred to the Dispensary. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action during the year under report in regard to the provisions of these Regulations. 58 Public Health (Tuberculosis) Regulations 1912. Summary of Notifications during the period from the 1st January, 1928, to the 29th December, 1928, in the area of the Metropolitan Borough of Battersea (to which this return relates). Age Periods. Notifications on Form A. Notifications on Form B. No. of Notifications on Form C. Number of Primary Notifications* of New cases of Tuberculosis.† Total Notifications on Form A. No. of Primary Notifications* of New cases of Tuberculosis.† Total Notifications on Form B. Poor Law Institutions Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total all ages. Under 5 5 to 10 10 to 15 Total (0 to 15) Pulmonary— Males 1 2 8 25 35 26 32 10 2 141 204 - - - - - 40 102 Females — — 2 3 24 30 25 14 8 2 — 108 152 - - - - - 31 78 Non-Pulmonary— Males 1 3 11 — 3 2 1 1 1 — — 23 29 — 1 — 1 1 2 11 Females 1 6 4 3 5 4 1 - 1 1 - 26 30 - - - - - 1 11 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) In filling up the form the following notes should be carefully observed— Patients notified as suffering from both pulmonary and non-pulmonary disease should be included in " pulmonary" returns only. All notifications on Form D should be disregarded in preparing this return. •Primary notifications relate to patients who have never previously been notified, either on Form A or on Form B in the sanitary district in which the case was notified in 1928. Any additional notification of a case which has been previously notified in the same sanitary district is to be regarded as duplicate. †Cols. (2.13) and (15.18) Only those cases which have been notified for the first time during the year on Form A or on Form B in the area to which the return relates, and which have not been brought to the notice of the M.O.H., in a previous year otherwise than through formal notification, should be included in Cols. (2-13) or (15-18), respectively. [In completing the form in respect of a County area, it is to be noted that under the 1912 Regulations, a person who changes his residence from one sanitary district to another in the same County may properly be the subject of Primary notification in each such district during the period of his residence therein. Only the first of such notifications, however, should be recorded in Cols. (2.13) if on Form A, or in Cols. (15.18), if on Form B. Subsequent notifications should be included in Col. (14) if on Form A, or in Col. (19), if on Form B.] Col. (14). All notifications on Form A whether duplicate or not should be included in this column. Col. (19). All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B should be included in this column. Col. (21). In the case of an institution belonging to the Council of a County Borough, formal notifications on Form C may not be made to the Medical Officer of Health in respect of patients from the County Borough. If such is the case, the totals of the weekly admissions of such patients during the year should be shown in brackets in Col. (21) (according to the classification in Col. (1)), and these figures should be regarded as additional to the figures showing the number of formal notifications on Form C in this column. 59 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 1st January, 1928, to the 29th December, 1928, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912 * Age Periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases. Pulmonary Males — 1 — — — — — — - 3 — 4 „ Females — - 1 — 1 1 — 1 4 1 — 9 Non-pulmonary Males - - - 1 — — — 1 1 — — 3 „ Females - 1 2 | 1 1 1 1 - - - 7 The source or sources from which information as to the above-mentioned cases was obtained should be stated below :— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death Returns {i.e., from Local Registrars, or transferable deaths from Registrar General) 4 4 "Transfers" from other areas (other than transferable deaths) 1 2 Forms C and D (in respect of cases not previously known to the M.O.H.) 2 — Other sources, e.g., posthumous notifications 6 4 Note.—New cases of tuberculosis first coming to knowledge otherwise than by formal notification may in some instances afterwards be formally notified on Form A or Form B. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the M.O.H., it should be recorded in Cols. (2.13) or (15.18) of the Summary of Notifications overleaf, and NOT in the supplemental return UNLESS such formal notification was improperly made, e.g., after death of the person. In the event of a formal notification being received in respect of a person recorded in the supplemental returns for a previous year, such notification should NOT be recorded in Cols. (2.13) or (15.18), of the Summary overleaf, but ONLY in Col. (14) or Col. (19), whichever is appropriate. No case should be included both in the Summary of Notifications and in the Supplementary return for the same year. 60 Deaths from Zymotic Diseases. The principal zymotic diseases are small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping-cough, enteric fever and diarrhoea. The deaths from these causes in 1928 numbered 111, as compared with 57 in 1927, an increase of 94.7 per cent., mainly due to the outbreak of measles. There was a corresponding increase in the zymotic death-rate from 0.338 in 1927 to 0.676 in 1928. The mean death-rate from each of the principal zymotic diseases for the ten years 1908-1917, and for the ten years 19181927, are compared with the corresponding rates for 1927 and 1928 in the following table :— Zymotic Diseases. Number of Deaths from each of the principal Zymotic Diseases in 1927 and 1928, with corresponding Death Rates for those years and for the 10 years 1908-17 and 1918-1927. Small Pox No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase (+) or Decrease ( - ), 1928 over 1927. 1928. 1927. 1928. 19081917. 19181927. Previous year. 19181927. - - - - .001 - -.001 Measles 1 36 .006 .219 .468 .189 + .213 +.030 Scarlet Fever 3 5 .018 .030 .053 .033 + .012 -.003 Diphtheria 25 26 .148 .158 .123 .188 + .010 -.030 Whooping-cough 15 14 .089 .085 .248 .141 - .004 -.056 Enteric fever — 1 — .006 .030 .007 + .006 - .001 Diarrhoea and enteritis 13 29 .077 .177 .675 .245 + .100 - .068 Total 57 111 .338 .676 1.597 .804 + .338 - .128 NON-NOTIFIABLE INFECTIOUS DISEASES. Chicken-Pox. During 1928 there were 632 cases of chicken-pox reported, as compared with 671 in 1927, 375 in 1926, 853 in 1925, and 541 in 1924. Diarrhœa. During 1928 the total number of deaths from diarrhoea of children under 2 years of age was 26, and was equivalent to a fatality-rate of .16. In 1927 there were 7 deaths and a fatalityrate of 0.04. The rate per 1,000 registered births in 1928 was 9.48. 61 Influenza. There were 14 deaths due to Influenza during 1928 as against 83 in 1927, 25 in 1926, 36 in 1925, and 84 in 1924. The mortalityrate was .085, as compared with .49 in 1927, .15 in 1926, .21 in 1925, and .49 in 1924. Influenzal Pneumonia was much less prevalent in 1928 than in the previous year, 51 cases being notified as against 164 in 1927. The death-rate was 0.02 per 1,000 of the population, as compared with 0.24 in 1927, 0.07 in 1926, and 0.09 in 1925. Cancer. During 1928 the number of deaths of Battersea residents from Cancer was 247 (males 112, females 135) as compared with 252 in 1927, 263 in 1926, 236 in 1925, and 231 in 1924. The death rate from the disease per 1,000 of the population was 1.51, as compared with 1.49 in 1927, 1.53 in 1926, 1.37 in 1925, and 1.35 in 1924. The following gives the comparative average death-rates from Cancer in Battersea for quinquennial periods since 1896:— 1896-1900 0.52 1921-25 1.33 1901-5 0.88 1926 1.53 1906-10 0.95 1927 1.49 1911-15 1.11 1928 1.51 1916-20 1.28 The following table shews the localisation of the disease in the case of the 247 deaths recorded in 1928. Localisation. No. of deaths. Total. % of Total. Male Female Buccal cavity 6 3 9 3.64 Stomach, liver, etc. 36 34 70 28.34 Peritoneum, intestines and rectum 29 28 57 23.08 Female genital organs — 23 23 9.31 Breast — 29 29 11.74 Skin — -— — — Other and unspecified organs 41 18 59 23.89 Total 112 135 247 100.00 Silicosis. During the year investigations were made by the Coroner into the deaths of two young female workers, age 17 and 19 years respectively, employed at a factory in the Borough in which the manufacture of a "scouring powder" was carried on. This article contained powdered quartz mixed with some alkaline material and in the process of filling the receptacles, considerable quantities of dust were given off. 62 The medical evidence showed that the cause of death was Silicosis in these two cases, and a third death, that of a young female worker aged 24 years, which was investigated by the Coroner in January, 1929, was also due to Silicosis. In the latter case there was evidence in addition of early tuberculosis. These cases are of special interest owing to the fact that the victims were of adolescent age, and in only one of the three cases was there post-mortem evidence, and that to a slight degree, of concurrent tuberculosis. It was also shown that within the preceding three years the deaths had occurred of four other persons working in this factory, one male, aged 44, and three females, aged .16, 17 and 19 years respectively, death in each case having been certified as being due to Tuberculosis. A report on this subject will be found in the Appendix, vide pages 131-3. Removal of the Aged and Infirm. Power is given by the London County Council (General Powers) Act, 1928, for the removal to a suitable Institution of aged, infirm or physically incapacitated persons or those suffering from any grave, chronic disease and unable to devote to themselves or to receive from persons with whom they reside, proper care and attention. These powers, although useful, will probably be found administratively difficult to enforce, because of the restrictions imposed giving rise to risk of delay in the removal to Hospital or other suitable environment. Bacteriological Examinations. During 1928 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 3,140. This number is exclusive of the Tuberculosis specimens, the examination of which was carried out at the Tuberculosis Dispensary. The following table gives particulars of the bacteriological examinations carried out during the year:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 416 2,689 3,105 Enteric fever 2 31 33 Puerperal Pyrexia. - 2 2 Total 418 2,722 3,140 The cost of these examinations amounted to £408 16s. 8d., and is borne by the Council. 63 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1928. Total Sanitary Operations 70,279 Dust receptacles provided 564 Number of house inspections 38,269 Leaky house-roofs and gutters repaired 925 House to house inspections 1,032 Bakehouse inspections 191 Houses supplied with water and fittings repaired 126 Bakehouse nuisances abated 51 Urinals—inspections 297 Houses let in lodgings registered 60 Do. altered, repaired or water laid on 27 No. of inspections of do. 1,035 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 118 Intimations served under Sec.3 3,712 Notices served under Sec.4,&c. 1,369 Notices served under Sees. 62 & 65 6,323 Cisterns covered, cleansed and repaired 90 Complaints received and attended to 3,649 Additional water supplies to upper floors 14 Number of premises disinfected 2,628 Houses supplied with disinfectants 1,375 Keeping of animals in unfit state discontinued 11 Overcrowding abated 14 Smoke observations 15 Premises improved, cleansed and repaired 2,813 Certificates of disinfection granted 4,215 Drains tested By smoke 703 Houses inspected and certificates granted (Sec. 48) 31 Do water 1,393 Drains cleansed and repaired 316 Proceedings ordered by Council and Health Committee 3,721 Drains relaid 103 Frontage drains constructed or re-constructed 30 Summonses issued 47 Magisterial Orders obtained and enforced 33 Soil pipes and drains ventilated 110 Sink and rain-water pipes disconnected or repaired 356 Factories, Workshops, &c., inspections 2,944 Water closets cleansed and repaired 562 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 42 Cesspools abolished — Mews and stables drained and paved Underground sleeping rooms: Yards and forecourts paved and repaired 297 Use discontinued — Defects remedied — Accumulations of manure and other obnoxious matter removed or proper receptacles provided 3 Gipsy van inspections 81 Drains laid to new houses and tenements 31 Samples taken under the Sale of Food and Drugs Acts 1,200 Miscellaneous 1,406 64 Legal Proceedings. Legal proceedings in connection with nuisances were taken by the Council in 38 cases during 1928. Particulars with regard to each case are set out below. Legal Proceedings under the Public Health (London) Act, 1891. Nature of Offence or Claim. Nuisance at 2, Spencer Street. (Two summonses) Nuisance at 47, Speke Road (1) Nuisance at 114 High Street (2) Failure to maintain in proper condition of repair the W.C. on ground floor of same premises Defective W.C. at 69 Cambridge Mansions Nuisance at 2 Patmore Street Failure to give notice before executing works to W.C. at 167 St. John's Hill Failure to comply with an Order of the Court to abate a nuisance at 167 St. John's Hill Nuisance at 39 Havelock Terrace Application ex parte for warrant authorising the Council to enter the premises 53 Eccles Road, for the purpose of examining as to the existence of a nuisance Nuisance at 1 Park Road, St. John's Hill Nuisance at 3 Park Road Nuisance at 6 Belleville Road Nuisance at 3 Woodgate Street Nuisance at 18 Woodgate Street Nuisance at 19 Woodgate Street Result of Proceedings. Order made in each case for nuisances to be abated within one month Nuisance having been abated and £1 1s. Od. costs having been paid, summons withdrawn. Nuisance having been abated and W.C. put in proper repair summonses dismissed on payment of 10s. 6d. costs in each case. Fined 20s. and £1 1s. Od. costs. Order made for nuisance to be abated wthin seven days, and for payment of £2 2s. Od. costs. Fined 2s. 6d. Fined 5s. Order made for nuisance to be abated within fourteen days. Warrant granted. Works required to abate the nuisance having been completed, summons withdrawn. The like. Order made for nuisance to be abated within seven days. Order made for nuisance to be abated within twenty-one days, and for payment of £1 1s. Od. costs. The like. The like. 65 Legal Proceedings under the Public Health (London) Act, 1891- continued. Nature of Offence or Claim. Nuisance at 12 Orville Road The like at 14 Orville Road The like at 16 Orville Road Nuisance at 13 Orville Road Nuisances at 5, 6, 7, 11, 13 and 15 Orville Road. (Eight summonses) Nuisance at 13 Ponton Street Nuisance at 52 Cabul Road Nuisances at 112 and 112a Wycliffe Road. (Two summonses) Nuisance at 122 Meyrick Road Nuisance at 3 Hillier Road Result of Proceedings. Works required to abate the nuisance having been commenced, summons adjourned for seven days. At adjourned hearing, work required to abate outstanding nuisance being practically finished and defendant undertaking to complete them immediately, summons dismissed on payment of £1 1s. Od. costs. Nuisance having been abated, summons dismissed on payment of £1 1s. Od. costs. The like. Order made for nuisance to be abated within 48 hours and for payment of £2 2s. Od. costs. In each case Order made for nuisance to be abated within fourteen days and for payment of £1 1s. Od. costs (£8 8s. Od. in all). Order made for nuisance to be abated within fourteen days and for payment of £1 1s. 0d. costs. This was a "combined drainage" case, and the defendant disputed that he was liable, but after hearing detailed evidence and legal argument, the Magistrate made an Order for the nuisancfe to be abated within fourteen days, and for payment of £1 1s. 0d. costs. Nuisances having been abated, summonses dismissed on payment of £1 1s. 0d. costs in each case (£2 2s. Od. in all) Nuisance having been abated summons withdrawn on payment of £2 2s. Od. costs. The "nuisance" complained of was a broken lavatory basin. Since the summons was issued the defendant had provided a new basin in place of the broken one. The summons was dismissed. 66 Legal Proceedings under the Public Health (London) Act, 1891— continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at 1 Meyrick Road Executing work to sanitary fittings at No. 78 St. Johns Road, in contravention of bye-laws made by the London County Council Proceedings not completed. Do. Nuisance at 91 Stewarts Road Do. Sale of Food and Drugs Acts. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 778 Milk 13% added water Defendant (employer) fined 2s. 6d. and £3 3s. costs; employee fined 20s. or 7 days. 856 Milk 13% deficient in milk fat Each defendant fined 20s. and £1 Is. costs, or in default 14 days imprisonment. 865 Milk 14% deficient in milk fat Dismissed under Probation of Offenders Act, 1907, on payment of £1 Is. costs. 105 Milk 12% deficient in milk fat (Sample taken at place of delivery) Dismissed under Probation of Offenders Act, 1907, on payment of £1 1s. costs. 150 152 153 154 156 Milk Milk Milk Milk Milk 3% deficient in milk fat} 18% deficient in milk fat} 8% deficient in milk fat} 12% deficient in milk fat} 1 % deficient in milk fat} (Samples taken at place of delivery) (5 summonses.) Dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. costs in each case (£10 10s. in all). 67 Milk and Dairies (Consolidation) Act, 1915. Nature of Offence or Claim. Result of Proceedings. Name and address not conspicuously inscribed on milk van With the permission of the Court, summons withdrawn. Milk and Dairies Order, 1926. Nature of Offence or Claim. Result of Proceedings. Selling milk in Battersea without being registered there Dismissed under Probation of Offenders Act, 1907, on payment of 15s. costs. Delivering milk in bottle which had not been filled and closed on registered premises Employer and Employee fined 10s. and 5s. respectively. The like. The like. The like. The like. The like. The like. The like. The like. The like. The like. Housing Act, 1925. Nature of Offence or Claim. Result of Proceedings. Claim by Council for £195 12s. cost of repairing the premises No. 18 Belfour Street (of which the defendant is "owner"), and interest at 5 per cent, from 30th December, 1925. Both the Council and the defendant were represented by Counsel. Order made in terms of claim. Case to be stated for opinion of Divisional Court if desired by defendant. The like for £268 15s. 6d. at No. 19 Belfour Street The like. The like for £247 16s. 7d. at No. 20 Belfour Street The like. 68 Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 58 cases during 1927. Acts and Regulations under which Proceedings taken. Persons Prosecuted including employees. Convictions Fines. Costs. Public Health (London) Act, 1891, and the bylaws made thereunder 25 16 £ s. d. £ s. d. 1 7 6 28 7 0 Sale of Food and Drugs Acts 7 4 3 2 6 17 17 0 Milk and Dairies(Consolidation) Act, 1915 1 - - - Milk and Dairies Order, 1926 13 12 4 10 0 0 15 0 Housing Acts 1 3 — — Total 47 35 9 0 0* 46 19 0* * The disproportion between the fines and costs imposed is accounted for by the fact that the Court in some instances dealt with defendants under the Probation of Offenders Act, discharging them on payment of costs. Common Lodging Houses. The following table gives a list of the common lodging houses in the Borough:— Premises. Authorised No. of Lodgers. Whether Males or Females. 75 Falcon Road 81 Males 134 High Street 54 Males 67 Winstanley Road 66 Females These are frequently inspected and any defects noted are referred to the London County Council, which is the authority responsible. Drainage Work. During the year new drains were constructed to 111 new buildings, or additions to existing buildings, and the drains of 103 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. 69 The drains of the following premises, being combined drains for the maintenance of any part of which liability was recognised by the Council, were repaired or reconstructed during 1928 at the cost of the Council:— Nos. 1 & 3 Park Road, St. Johns Hill; No. 35 Plough Road; Nos. 14 & 15 Parkham Street; Nos. 46 & 48 Gwynne Road; Nos. 2, 4 & 6 Stockdale Road; Nos. 47, 48 & 49 Havelock Terrace; Nos. 2 & 4 Basnett Road. The expenditure incurred by the Council under this head amounted to £236 0s. 6d., towards which a contribution of £20 was made by the owner of Nos. 2 & 4 Basnett Road. During the year the law relating to combined drains was amended by the passing of the London County Council (General Powers) Act, 1928, Sec. 32 of which provides that a drain for draining any group of houses by a combined operation shall not become a sewer within the meaning of the definition contained in the Metropolis Management Act, 1855, by reason only of the fact that the drainage of premises not included in the Order relating to such combined operation are connected with such drain, and any such additional drainage shall be deemed to have been included in such Order. Unfortunately this amendment of the law does not materially affect the issue in the majority of cases as the powers conferred fall short of those contained in the private Acts which have been obtained by two Metropolitan Borough Councils, notably Woolwich. The total number of plans of proposed drainage work deposited during 1928, as compared with 1927, was as under:— 1928 1927 Re-construction or repair of existing drains 74 85 New buildings or additions to existing buildings 72 72 146 157 In eleven cases work to drains and sanitary fittings was found to have been carried out without notice having first been given or plans submitted to the Council in accordance with the requirements of the drainage bye-laws. These cases were reported to the Health Committee, and in the majority of instances explanations having been tendered by the builder responsible the Committee ordered the offender to be cautioned. 70 During the year 1928, 703 drains were tested by smoke of which 101 were found defective. The water test was applied on 1,393 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 110 instances. Water closets were provided in 118 cases and existing closets repaired in 562 cases. The total number of drains relaid during the year was 103. Those cleansed and repaired numbered 316. A useful provision is that contained in Section 20 of the London County Council (General Powers) Act, 1928, which came into force on 1st January, 1929, by which the owner of premises in, under or attached to which there is a disused drain, is required under penalty to give notice of the existence of such drain to the Borough Council. Sanitary Conveniences attached to Licensed Premises. During 1928 the number of public-house urinals under inspection was 118. In 80 instances the accommodation is accessible to the general public as well as the users of the houses, and in 38 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 28 notices were served to remedy defects discovered. Smoke Nuisances. During the year 15 observations were made and 21 complaints received. Seven preliminary notices were served by the Council under the provisions of the Public Health (Smoke Abatement) Act, 1926, to abate smoke nuisances, and no recurrence of the nuisances having been reported no further action was necessary. Effluvium, &c., Nuisances. Complaint was received of effluvium nuisance from a large factory premises in Church Road, and on investigation it was found that the firm were engaged in experiments with a view to finding the most suitable means of preventing effluvium nuisance from their works, and that the complaint in question arose out of the accidental breakdown of the experimental plant. It was anticipated by the firm in question that when the new plant was installed the recurrence of the nuisance would be avoided. No further complaints with regard to these premises had been received at the close of the year. 71 During the year under review, as a result of representations made by the Council, considerable alterations were made by the Gas Light & Coke Co. to minimise the risk of nuisance from dust grit, &c., from their works at Nine Elms, and these appear to have given satisfactory results in mitigating the nuisance from these works. In June a complaint was received, signed by a number of residents in the vicinity of a factory in St. John Ward, complaining of nuisance from dust from such factory. The complaint appears to have been to some extent influenced by the publicity given to the enquiry of the Coroner into the deaths of two of the women workers of the factory shewn from medical evidence to have been due to Silicosis (vide pages 61, 131-3). Upon inspection of the houses in the neighbourhood, little or no evidence of the deposit of dust was found. The processes carried on at the factory included the making of a scourer, this product being made from powdered quartz (mainly silica) mixed with a dry soap powder and sold as a proprietary article. The process of manufacture is essentially a dusty one, and having regard to the risk to the actual workers (mostly girls) must be considered as a dangerous industry. Precautions had been taken by the employers to minimise the risk to the workers by the provision of dust collecting devices, including measures to prevent the escape of dust from the works. Suggestions for the further improvement of the plant were made to the proprietors, and these were carried out. Subsequently however, the manufacture of this article at these premises was discontinued and no further steps were necessary. Water Supply. During 1928 applications were received for certificates of water supply in respect of 31 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 14 cases additional water supply was provided to the upper floors of tenement houses, as required by the Borough Council under the provisions of Section 78 of the London County Council (General Powers) Act, 1907, and Section 48 of the Public Health (London) Act, 1891. Van Dwellings. The number of van dwellings in the Borough in 1928 was 64. In the following table are set out the situations of the dwellings and number of occupants:— 72 Situation of Vans. No. of Vans. No. Occupants. m. f. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 5 Mills' Yard, adjoining 80 Sheepcote Lane 5 7 7 1a Weybridge Street (rear of 91 Culvert Road) 1 1 1 Haines' Yard, Falcon Road 8 9 8 Manley's Yard, Cabul Road 29 † 21 27 Mills' Yard, Culvert Road 17* 15 23 Van dwellings are frequently inspected, and during the year none of the vans were found to be overcrowded. Ten vans were unoccupied. Model Dwellings—Lighting of Staircases. Under the provisions of Section 61 of the London County Council (General Powers) Act, 1927, the owner of every tenement building intended or used for occupation by the working classes is required (a) wherever practicable to provide every common staircase with adequate means of lighting by natural light, including (in the case of a building constructed or reconstructed after the commencement of the Act) a window or windows or opening or openings on the staircase of each storey opening directly into the external air; and (b) to provide adequate means for the artificial lighting of every common staircase, and to keep such means efficient and lighted daily from one hour after sunset until 11 o'clock in the afternoon. In the case of a common staircase leading to not more than two separate or self-contained flats or tenements in a two-storey tenement building the owner is not required to make provision for artificial lighting. There are in the Borough some 170 dwellings which appear to come within the purview of the Section, and in all but 61 cases these provisions were already being complied with. Of these 61 cases 49 are provided with artificial lighting, but owing to the structural difficulties it was found impracticable to provide natural lighting. Of the remaining 12 cases natural light was provided, but not artificial. As a result of negotiation with the owners concerned, artificial lighting has now been installed except in the case of two blocks of dwellings, which were still the subject of action at the end of the year. * Including one shed. † Including one cottage. 73 Rag Flock Act, 1911. This Act was passed to prevent the use of material known as rag flock, unless such material complies with the standard of cleanliness laid down in the Act. No proceedings were taken under the Act in Battersea during 1928. The Rag Flock Act (1911) Amendment Act, 1928, was passed into law during the year. Its purpose was to remove doubts as to the meaning of the phrase " flock manufactured from rags" used in the earlier Act, and it provides that this expression means "flock which has been produced wholly or partly by tearing up woven or knitted or felted materials, whether old or new, but does not mean flock obtained wholly in the processes of the scouring and finishing of newly woven or newly knitted or newly felted fabrics." Rats and Mice (Destruction) Act, 1919. This Act, which became operative on the 1st January, 1920, imposes on local authorities and occupiers of premises additional responsibilities in connection with rat repression. During 1928 the work carried out under the Council's Rat Repression Scheme is summarised as follows :— Premises visited 1,717 Contracts made or renewed 10 Poison baits used 24,000 Dead rats found 2,900 Value of contracts £165 0 0 Cash for poison bait £12 12 0 Total expenditure (financial year 1928-9) £529 10 3 Income (financial year 1928-9) £176 12 0 Drains were tested at 68 premises in connection with this work, and in 35 cases were found to be defective. Most of these defective drains were in private houses. The presence of rats in houses is usually regarded as prima facie evidence of drain defects. The work of the Rat Officer therefore is carried on in close co-operation with that of the district Sanitary Inspectors. The methods employed under the Rat Repression Scheme have been described in previous Annual Reports. It is only necessary, therefore, to state that as an inspection of the summarised figures shows, the work done during the year under this head has been as satisfactory as in previous years. 74 Sanitary Conveniences. During the year, plans and estimates were approved for the erection of a new Public Convenience for men and women in Town Hall Road, in substitution for the existing urinal there, and also at the corner of Cringle Street and Battersea Park Road. These conveniences were under construction at the end of the year. Rag and Bone Dealers. The bye-laws relating to the business of a rag and bone dealer were strengthened during the year by the making of additional by-laws by the London County Council as follows:— (1) A person carrying on the business of a rag and bone dealer shall not sell or distribute or cause or permit to be sold or distributed any article of food or any balloon or toy (a) in or from any part of the premises used for or in connection with his business, or (b) in the course of his business while carried on from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags, bones, fat, rabbit skins, or other like articles or (c) in any other way connected with his business. (2) A person carrying on the business of a rag and bone dealer who shall offend against the foregoing by-law shall be liable for every such offence to a penalty of Five Pounds. Provided nevertheless that the Court before whom any information may be laid or any proceedings may be taken in respect of any such offence may if the Court think fit adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by-law. The new by-laws came into force on the 20th June, 1928. During the year, an offence against the by-law was reported to the Committee, the offender being cautioned. Fouling of Footways by Dogs. The Council, in 1927, on the recommendation of the Health Committee, decided to make the following By-law with regard to the fouling of public footways by dogs :— "No person being in charge of a dog in any street or public place ahd having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this By-law shall be liable to a penalty not exceeding 40s. This By-law shall cease to be in force after the 30th June, 1929, unless a By-law confirming and continuing its provisions has been duly made and come into force before that date." 75 The By-law came into force in June, 1927. No proceedings were taken under this By-law during the year, but there is evidence that the existence of the by-law has had a deterrent effect with regard to this objectionable form of nuisance. Disinfectants. The Ministry of Health, by circular letter, drew attention to the danger of the distribution by Local Authorities of disinfectants in ordinary bottles and urged that such disinfectants should only be supplied in containers distinguishable by touch. No action on the circular was necessary as the Council's practice was in accordance with the suggestion of the Ministry. HEALTH PROPAGANDA. Health Exhibition, 1928. A Health Exhibition was held from the 5th to the 8th June, 1928, in the Grand Hall and annexes by courtesy of the Finance Committee. The opening ceremony was performed on the first day by the Mayor (Alderman J. F. Lane, j.p.), who was supported by many of his Metropolitan colleagues and other distinguished visitors. On succeeding days the opening ceremony was performed by Dr. John Fairbairn, Professor Louise Mcllroy and Lady Islington. The exhibits included models of the various phases of the Maternity and Child Welfare Work of the Council and the voluntary organisations carrying on ancillary work, and stalls shewing the public health work of the Council. Interesting exhibits were also kindly provided by the Victoria Hospital for Children, Chelsea (complete model of a sunlight treatment centre), the National Association for the Prevention of Tuberculosis, the Dental Board of the United Kingdom, the British Dental Hospital, the Clinical Research Association, the Metropolitan Water Board, and the Metropolitan Asylums Board. Special features, which were much appreciated, were the displays of physical exercises, Morris dancing and the singing of pupils from the elementary schools in the Borough. Lectures on various health subjects by distinguished specialists were given in the lower hall and attracted good audiences. Displays of films illustrating health topics were also given in the lower hall and were well attended. The Exhibition, as a whole, was highly successful, a conservative estimate of the number of visitors during the week being 30,000. The report of the Medical Officer of Health upon this Exhibition will be found set out in the Appendix. Of the total cost incurred (approximately £165) the sum of £70 was allowed by the Ministry of Health to rank for grant as expenditure incurred under the Council's Maternity and Child Welfare Scheme. 76 THAMES FLOODING. As briefly reported in the Annual Report for 1927, serious flooding occurred on the night of the 6th/7th January, 1928, owing to the overflowing of an abnormally high tide which affected all the riparian Metropolitan Boroughs, and occasioned serious loss of life in some places. The Mayor, accompanied by the Medical Officer of Health, immediately visited the area and instructions were given for every possible step to be taken to relieve the immediate needs of the victims. These consisted of efforts by the Sanitary Staff to secure the pumping out, cleansing and drying of the basements and ground floors of the premises flooded. A systematic inspection shewed that the following streets (mainly in Nine Elms and Church Wards) were more or less seriously affected. Nine Elms Ward. Street No. of houses affected Street No. of houses affected Arden Street 16 Nine Elms Lane 12 Belfour Street 35 Ponton Road 9 Currie Street 25 Ponton Street 13 Everett Street 38 Tweed Street 4 Haines Street 7 Woodgate Street 29 Total 188. Park Ward. Queens Road 1 Total:—1. Church Ward. Battersea Bridge Road 1 High Street 26 Bridge Road West 37 Hyde Lane 5 Church Road 12 Lombard Road 8 Goslings Yard 4 Orville Road 29 Granfield Street 14 Simpson Street 5 Gwynne Road 17 Surrey Lane 2 Henry Street 47 Vicarage Road 1 Winders Road 11 Total 219 Winstanley ward. Mendip Road i2 Total:—2. Grand Total:—410. On the instruction of the Mayor (Mr. Alderman J. F. Lane), immediate relief was given in the most urgent cases and a fund was inaugurated which was supplemented by a grant from the Lord Mayor's Fund. Ward Committees were formed consisting of 77 members of the Council and co-opted members of religious and social bodies interested in the welfare of the inhabitants. Each case was investigated on its merits and material assistance provided in the form of grants of coal, new furniture and monetary assistance where serious loss was sustained. It is satisfactory to note that the total amount subscribed, together with the grant from the Lord Mayor's Fund, was sufficient to meet all claims, and the balance of the fund was used for the purpose of providing country holidays for the children of the sufferers. The number of cases assisted amounted to 390 and over 94 tons of coal, to assist in the drying, etc., of the affected houses, were distributed. It is fortunate that in Battersea, although there were some narrow escapes, there was no loss of life as occurred in one or two riparian Boroughs, and it is satisfactory to be able to report that the prompt action taken by the Council was successful in mitigating the alarm, suffering and hardship of so many of the inhabitants of the low lying Wards. There was general appreciation of the efforts which were made to render temporary assistance in what was, so far as this Borough is concerned, an unprecedented experience. Following this catastrophe, the London County Council, in April, invited the views of the Council with regard to an opinion expressed by their Committee that the duty of supervising and inspection of the flood defence works within the County of London should be definitely placed upon the County Council. Their letter also pointed out that whatever the nature of the legislation to be promoted to give effect to this expression of opinion, it was essential that clear and definite provisions should be made as to the scope and character of the responsibility for the efficient upkeep of the works as well as for their initiation, and that this object could be obtained either (1) by placing upon the County Council the duty of continuous inspection throughout the whole length of the Thames within the county, in addition to the duty of prescribing any works necessary from time to time, or (2) by placing upon the Borough Councils the duty of inspection within their areas, and upon the County Council the duty of prescribing such works upon receipt of reports made as the result of inspection. The Borough Council expressed the opinion that the duty of continuous inspection of the banks of the river should be placed upon the County Council. The Council also considered a letter from the Metropolitan Boroughs Standing Joint Committee upon the subject of the use of underground rooms as dwellings, pointing out that where basement rooms in low lying areas liable to flooding do not comply with Statutory requirements, steps should be taken at the earliest practicable time to secure that they are no longer used as dwellings. The Health Committee, while in sympathy with the proposal to close such rooms, were of [opinion that this could not be done at 78 present in view of the existing housing shortage, but, however, gave instructions for a survey to be made of all such rooms. This survey was in progress at the end of the year. Personal Cleansing Station. During the year 1928, there were 3,769 children and 221 adults cleansed and treated at the station. Of the 3,769 children attending, 252 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,709 attended from the Public Elementary Schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of Officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's Sanitary staff. There was a considerable decrease in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. Number of Baths, &c. Year. Adults. Children. Expenditure. Amount Contributed.* Verminous and Scabies. Verminous and Scabies. £ £ 1906 141 2 29 — 1907 504 113 42 1908 1,011 656 82 1909 1,373 321 91 1910 1,583 341 88 1911 1,459 191 93 13 1912 1,351 841 237 65 1913 1,323 1,090 118 69 1914 1,050 1,602 132 78 1915 648 1,273 125 78 1916 475 1,773 143 94 1917 320 2,620 169 140 1918 291 3,179 237 187 1919 366 3,214 287 169 1920 419 4,213 456 331 1921 340 4,607 561 400 1922 274 4,444 584 400 1923 212 4,949 779 487 1924 311 5,394 912 488 1925 261 4,724 879 459 1926 229 4,371 916 425 1927 256 4,360 960 418 1928 221 3,769 863 400 14,418 58,047 £8,783 £4,701 * Financial year ending 31st March. 79 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1928. Total premises disinfected 2,628 Rooms disinfected 3,735 Staircases disinfected 186 Schools disinfected 37 Number of articles laundered 27,537 ,, ,, destroyed 1,246 „ verminous, etc., persons (including 3,709 school children) 3,990 „ infectious disease contacts 1,160 ,, Library books collected 418 Total Articles. No. Weight. Tons . cwts. qrs. lbs. Bedding, &c., disinfected 66,232 134 19 0 15 „ lent 1,535 4 14 1 22 Verminous clothing, &c. 4,052 1 10 1 2 Articles from Welfare Centres 2,997 (not weighed) Total 74,816 141 3 3 11 Staff of the Public Health Department. The personnel of the Staff of the Health Department will be found fully set out on page 3. The changes which occurred during 1928 are as under :— Dr. Hilda McKernan, M B., Ch.B., B.A., was appointed Resident Medical Officer of the Borough Maternity Hospital in the place of Dr. Joyce Peake, who resigned her appointment in February. Miss O. Baggallay, Health Visitor, resigned her appointment in January, 1928, and Miss D. Hopson was appointed to fill the vacancy. This lady, however, resigned in June, and Miss E. M. Hoyles was appointed. Mr. J. Herrin, Sanitary Inspector for No. 1 District, was superannuated, after 34 years service with the Council, in April. Mr. A. Chuter, Food and Drugs Inspector, who had been in the Council's service for 30 years, was superannuated in July. Mr. W. E. Benjamin, Workshops Inspector, retired on superannuation after 25 years service in April. The vacancies caused by the retirement of Messrs. Herrin and Benjamin were filled by the appointment of Mr. W. E. Selway (No. 1 District) and Mr. A. Webb (Workshops Inspector). The vacant appointment of a Food Inspector in place of Mr. Chuter had not been filled at the end of the year. 80 Coroner s Court ana Mortuary. Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1928 are set out in the following table:— Usual Place of Residence. Total Batter- sea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court ; postmortem at Mortuary 35 24 9 4 72 Inquest at Coroner's Court; postmortem elsewhere 44 78 32 1 155 Inquest at Coroner's Court; no postmortem 10 1 2 1 14 Total inquests at Coroner's Court 89 103 43 6 241 Post-mortem at Mortuary, inquest elsewhere 2 1 3 Post-mortem at Mortuary; no inquest (Coroner's Certificate) 76 17 2 95 Bodies received for sanitary reasons 4 — — 4 Other bodies received on which no inquest held at Mortuary 2 4 — — 6 Total bodies received 173 125 45 6 349 2nd post mortem : 1st held elsewhere — 3 3- Total post-mortems at Mortuary 113 45 11 4 173 VERDICTS AT INQUESTS HELD— Natural causes 12 23 3 — 38 Accidental Death— Anaesthesia 2 3 — — 5 Asphyxia (Food) 2 1 — — 3 Burns and scalds 10 4 — — 14 Coal Gas poisoning 2 1 — — 3 Diving — 1 — — 1 Fall 18 19 17 — 54 Overlying 2 — — — 2 Railway and street accidents 15 21 13 1 50 Septicaemia following injury 1 — — — 1 Cellulitis following injury 1 3 — — 4 Other accidents 7 5 1 — 13 0pen Verdict— Fall 1 — — — 1 Found drowned — — 2 2 Septicaemia (unknown origin) — 1 — — 1 Stillborn 1 2 1 4 Want of attention at birth 1 2 3 Cause unknown — — 1 1 Suicide— Cut throat 4 4 1 9 Drowning — 1 1 — 2 Jump under moving train 1 — 2 — 3 Hanging 1 1 — — 2 Poisoning—Coal gas 6 4 — — 10 „ Drugs, etc. 2 8 1 — 11 Homicide. Abortion — 1 1 2 Infanticide — — 1 1 Negligent Driving — — 1 — 1 Grand Total 89 103 43 6 241 81 Protection of the Food Supply. INSPECTION AND SUPERVISION OF FOOD. Unsound Food. The following is a tabulated return of unsound foods which, under the provisions of Section 47(8) of the Public Health (London) Act, 1891, were brought to the notice of the Sanitary Inspectors and voluntarily surrendered during 1928:— Food. Quantity. Food. Quantity. Fish. Fruit & Vegetables (fresh). Cod 3 boxes. Abacates 25 boxes. Crabs 3 barrels. Gherkins 12 casks. Dog Fish 1 box. Onions . ... 1 bag. Haddock 5 boxes. Tomatoes 14 bundles. Do. Roes 1 box. • Herrings 2 boxes. Meat & Poultry. Melts 1 box. Bacon 273 lbs. Mussels 2 crates. Ham 14½ lbs. Skate wings 3 boxes. Meat 200 lbs. Pig's head 1. Miscellaneous. Milk 6 gallons. Cow-houses. There is now no licensed cow-house remaining in the Borough, the use of that situate at 17 Wiseton Road having been discontinued during 1927. Slaughter-houses. There are only two slaughterhouses remaining in the Borough. These premises are kept under systematic inspection, and during the year 1928, 139 inspections were made by the Council's inspector. The carcases of 44 animals (calves 1, sheep 3, and pigs 40) were examined after slaughter. 82 The provisions of the Public Health (Meat) Regulations, 1924, have been brought to the notice of the occupiers of these slaughterhouses, and no contravention of the Regulations in regard to slaughterhouses were reported during the year. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1928 was 98. Three new shops were opened during the year and five closed, making a total of 96 butchers' premises carrying on business at the end of the year. All butchers' shops in the Borough are systematically inspected, and for the most part they are well kept and provided with cold storage facilities. During the year 1,203 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. During the year a contravention of the provisions of the above named Regulations was reported in regard to the storage of meat in unsuitable premises. The vendor having immediately discontinued the storage of foodstuffs in the premises in question, the Health Committee directed that he should be cautioned. Sale of Food and Drugs Acts. The total number of samples taken under the Acts during 1928 was 836, of which 22 or 2.6 per cent, were certified by the Public Analyst to be adulterated. In addition to the foregoing, 364 informal samples were procured, of which 5 (or 1.4 per cent.) were reported by the Public Analyst as being adulterated or containing preservative. The percentage of samples reported by the Public Analyst to be adulterated during the 5 years 1923-27, and in 1928, was as follows :— cYear. Formal Samples. Informal Samples. 1923 7.2% 7.4% 1924 3.9% 11.5% 1925 4.4% 2.8% 1926 4. 3% 3.7% 1927 4. 5% 0.8% Mean 4.9% 5.2% 1928 2.6% 1.4% 83 The following tables give details of the articles of which samples were obtained for the purpose of analysis:— Main Statement. TABLE I. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread - 6 6 - 0 0 Butter 20 66 86 0 2 2 Cheese 10 10 0 0 ,, Cream 3 3 1 1 Cocoa 10 8 18 0 0 Coffee 15 1 16 0 0 Confectionery (Sweets) — 1 1 — 0 0 Cream 5 15 20 0 0 0 Flour 5 5 0 0 „ Self-raising — 7 7 — 0 0 Jam — 10 10 — 0 0 Margarine — 30 30 — 1 1 Milk 665 3 668 21 0 21 ,, Machine Skimmed 1 1 0 - 0 ,, ,, Separated 2 — 2 0 — 0 ,, Condensed (Full Cream) 4 9 13 0 1 1 „ „ (Machine Skimmed) — 13 13 — 0 0 ,, Dried 2 2 — 0 0 Mustard 9 9 0 0 Sugar 4 4 — 0 0 Tea 3 3 — 0 0 Vinegar 31 — 31 1 — 1 Drugs — 29 29 — 0 0 Other Articles 73 140 213 0 0 0 Total 836 364 1200 22 5 27 TABLE II. Drugs. Examined. Adultered. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bicarbonate of Soda - 2 2 - 0 0 Boric Ointment 3 3 — 0 0 Camphorated Oil — 13 13 — 0 0 Cream of Tartar — 2 2 — 0 0 Milk of Sulphur — 3 3 — 0 0 lartaric Acid 3 3 — 0 0 Zinc Ointment — 3 3 — 0 0 Total — 29 29 — 0 0 84 TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot - 13 13 - 0 0 Baking Powder — 1 1 11 — 0 0 Barley, pearl — 11 11 — 0 0 Brawn 1 — 1 0 — 0 Cake — 3 3 — 0 0 ,, sponge — 13 13 — 0 0 Coffee & Chicory — 2 2 — 0 0 Custard Powder — 12 12 — 0 0 Dripping — 12 12 — 0 0 Fish Paste 1 6 7 0 0 0 Fruits (dried) — 14 14 — 0 0 Honey 9 — 9 0 — 0 Lard 11 4 15 0 0 0 Lemon Curd — 1 1 — 0 0 Meat (Sheep's Liver) — 1 1 0 0 0 Meat Paste — 1 1 — 0 0 Mince Meat (fruit) — 8 8 — 0 0 Olive Oil 10 4 14 0 0 0 Pepper — 9 9 — 0 0 Pickles — 2 2 — 0 0 Rice 17 5 22 0 0 0 Sago — 6 6 — 0 0 Sauces — o 2 — 0 0 Sausages 10 — 10 0 — 0 ,, preserved 7 — 7 0 — 0 „ liver 1 — 1 0 — 0 ,, luncheon 2 — 2 0 — 0 Wines (non-alcoholic) 4 - 4 0 - 0 Total 73 140 213 0 0 0 Milk. Of the 671 samples of milk (including 3 informal samples and 3 of separated milk) 21 or 3.1 per cent, were reported as adulterated, 9 of these samples being deficient in milk fat and 12 containing extraneous water. The greatest deficiency in milk fat amounted to 18 per cent, and the highest proportion of extraneous water was 13 per cent. 85 In the 5 years 1923-27, and in 1928 the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1923 702 43 6.1 1924 721 25 3.4 1925 808 40 4.9 1926 738 32 4.3 1927 696 37 5.3 Mean 733 35 4.8 1928 668 21 3.2 The present year shews a marked decrease over the average of the preceding five years in the number of adulterated samples, and having regard to the importance of milk as an article of diet, especially for infants and invalids, this must be regarded as highly satisfartnrv The average composition of the 647 samples reported as genuine proved to be as under:— Total milk solids 12.28% Milk fat 3.55% Non-fatty solids 8.78% The content of fat in these 647 samples ranged as follows:— 4-0% and over 39 samples or 6.0% Between 3.9 and 4 0% 17 ,, ,,, 2.6% ,, 3.8 „ 3.9% 56 ,, ,, 8.7% ,, 3.7 „ 3.8% 58 ,, ,, 9.0% ,, 3.6 „ 3.7% 80 ,, ,, 12.4% ,, 3.5 „ 3.6% 98 ,, ,, 15.1% ,, 3.4 „ 3.5% ... 122 ,, ,, 18.9% „ 3.3 „ 3.4% 88 ,, ,, 13.6% ,, 3.2 „ 3.3% 41 ,, ,, 6.3% „ 31 „ 3.2% 28 ,, ,, 4.3% ,, 3.0 „ 3.1% 20 „ ,, 3.1% Under 3.0% — ,, ,, — 647 100.0% 86 All samples were systematically tested for the presence of preservatives. In no case, however, was a positive result obtained. Milk sampling was carried out on 8 Sundays during the year, and 32 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 47 were taken during the year. The bulk of these samples was taken at Clapham Junction or South Lambeth Railway Stations. Samples of milk to the number of 56 were taken in course of delivery to elementary schools in the borough. No samples were taken in course of delivery during the year at the request of the Medical Officers of Health of neighbouring boroughs under the provisions of the Milk and Dairies (Consolidation) Act, 1915, which permits the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. Proceedings with regard to adulteration were taken in 9 instances—fat abstraction, 8; extraneous water, 1, particulars relating to which will be found set out in the tables on page 66. In no case was warranty pleaded. Cheese. Thirteen samples of cheese were submitted for analysis during the year, 10 of which were procured formally and 3 informally. One of the informal samples, described as " cream cheese," was found to contain only 6.4 per cent, of milk fat, and to have been prepared from skimmed milk. It was reported against by the Analyst as not up to standard. The remaining samples proved genuine. Sponge Cakes, Fairy Cakes, &c. During the year 13 samples of sponge cakes were submitted to the Public Analyst. All these samples were procured informally, and were found to be genuine. Three other samples of cake procured informally were reported by the Public Analyst to be genuine. Butter. The total number of samples of butter taken during the year was 86. Of these 20 were submitted formally. One of the informal samples was found to contain a slight excess of water over the permissible quantity of 16 per cent., namely 16.2 per cent., and one taken at the beginning of the year contained a trace of boric acid (0.07 per cent.). The whole of the remaining samples were reported as genuine. It is satisfactory to be able to report that all the samples with the exception of the informal one referred to above complied with 87 the requirements of the Public Health (Preservatives in Food) Regulations which came into force in regard to this article on the first of January, 1928. The average moisture content of the 84 samples reported as genuine amounted to 14.4 per cent. Margarine. Thirty samples of margarine were purchased and submitted to the Public Analyst for examination, all of which were procured informally. The provisions of the Public Health (Preservatives, etc., in Food) Regulations, came into force at the beginning of the year 1927 in regard to this article, and it is satisfactory to record that all these 30 samples were reported as being free from preservative. Reference to former annual reports indicates that previously it was exceptional to find a sample of margarine which did not contain a boron preservative. The average moisture content of the 29 genuine samples was 13.9 per cent. One sample was reported to contain an excess of moisture to the extent of 0.5 per cent, beyond the permitted maximum of 16 per cent. Sausages, Preserved Meats, &c. One informal sample of meat paste; 20 formal samples of sausages (including 2 of luncheon sausage, 1 of liver sausage and 7 formal samples labelled "Preserved Sausage") were submitted to the Public Analyst during the year. These were all reported to be genuine. The Public Health (Preservatives, etc., in Food) Regulations, permit the presence of Sulphur Dioxide in sausages to an amount not exceeding 450 parts per million, but the presence of preservative must be indicated on the label. Flour. Five samples of flour and seven samples of Self-raising flour submitted for analysis were all reported as genuine. These samples were all taken informally. Rice. Twenty-two samples of rice (17 formal and 5 informal) were procured and submitted to the Public Analyst and all were reported as genuine. Of these samples 6 were polished by the aid of talc, the average quantity amounting to 0.22 per cent. 88 Vinegar. Thirty-one samples of vinegar were procured formally and submitted to the Public Analyst. One of these was reported to be deficient in acetic acid to the extent of 5 per cent. A cautionary letter was, by order of the Health Committee addressed to the vendor of this sample. Ice Cream Vendors. There are 151 premises in the borough from which ice cream is sold, 18 of these being occupied by Italian vendors by whom this article of food is sold. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under daily inspection during the season. During 1928, 13 of the ice cream premises were removed from the register and 15 were added. There was, therefore, an increase of 2 in the number of premises compared with 1927. During the year 159 inspections were made and 4 notices were served to remedy defects found on inspection. In addition, during the summer season a daily inspection of street barrows and the utensils, glasses, towels, &c., used thereon was carried out. In two cases cautionary letters were addressed to itinerant vendors who were carrying on the sale of ice cream from barrows not bearing the name and address of the manufacturer. The improvement in the manner in which this commodity is now prepared and sold, referred to in previous annual reports, is being maintained. Milk and Dairies (Consolidation) Act, 1915. Under the Milk and Dairies (Consolidation) Act, 1915, proceedings were taken against a milk vendor for selling milk without having his name and address conspicuously inscribed-on the vehicle, (vide p. 67). During the year advantage was taken of Section 9 and the Third Schedule of this Act by 11 milk purveyors in regard to 34 samples of milk. Of these, 32 were reported by the Public Analyst to be genuine. In the case of the remaining 2 samples which were certified to be adulterated, both samples subsequently taken in course of delivery at the request of the vendors were certified to be genuine. In the first case (14 per cent, fat deficiency) the summons was dismissed on payment of one guinea costs. In the second case (4 per cent, extraneous water) no proceedings were instituted, the vendor being cautioned. 89 Milk and Dairies Order, 1926. The provisions of the above-named Order, which had already been brought to the notice of milk purveyors in the Borough and which are referred to in detail in the Annual Report for 1926 of the Medical Officer of Health, were enforced by the Council's Officers during the year under report. Proceedings were taken against a vendor of milk for selling milk in Battersea without having been registered by the Council. The summons was dismissed on payment of 15s. costs. Proceedings were also taken in 6 cases where a milk roundsman was observed to fill a milk bottle in the street, contrary to the provisions of the Order. In each case the employer was fined 10s. and the employee 5s. Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to issue licences to others than producers (i.e., persons producing milk for sale from herds over which they have control). The licences so granted are available for a period up to the end of the year in which they were issued. There is a scale of fees payable to the Licensing Authority by applicants for licences. During 1928 licences were issued as follows :— Certified milk (including 1 supplemental licence) 19 Grade A (Tuberculin tested) milk (2 supplemental) 58 Grade A milk (1 supplemental) 9 Pasteurised milk (1 supplemental) 13 Two licences to bottle Grade A (T.T.) milk and two licences to pasteurise milk were granted and are included in the above figures. During the year nine samples of Certified and Grade A (Tuberculin tested) milk were taken for bacteriological examination. The result of the examination shewed in each case that the sample conformed to the standards laid down by the Order. Bacillus coli was not found in any of the nine samples. The bacterial content per 1 c.c. ranged from 803 to 1,800 in the case of the three samples of certified milk and from 983 to 9,666 in the 6 samples Grade A (T.T.) milk, the average number being: Certified 1,159, Grade A (T.T.) 4,969. Milk Shops. The number of premises registered in Battersea for the sale of milk is 130 (including 5 wholesalers' premises). Two new premises was registered during the year for the sale of milk, and in three cases the sale of milk from registered premises was discontinued. In 9 cases registration was transferred on account of change of proprietorship. All milk shops are kept under inspection and during 90 the year 417 inspections were carried out and 19 notices were served to remedy defects found on inspection. These mainly referred to dirty and unsuitable premises and other minor defects. In addition to the above there are 74 persons registered in respect of premises in which sterilised milk in sealed bottles only is sold. 17 vendors whose licensed premised are without the borough are registered as purveyors within Battersea, and 5 premises used for the wholesale distribution of milk are registered by the Council. Preservatives in Food. During the year an event of importance to those responsible for the administration of the Food and Drugs Acts was the coming into full operation of the Public Health (Preservatives, &c. in Food) Regulations. It is now clearly defined which articles of food may contain certain specified preservatives and in addition the colouring matters, which may not be added to articles of food are set out. The first Schedule of the Regulations reads as follows :— Part I.—Articles of Food which may contain Preservative and Nature and Proportion of Preservative in each case :— The articles of food specified in the first column of the following table may contain the preservative specified in the second column in proportions not exceeding the number of parts (estimated by weight) per million specified in the third column:— Food. Preservative. Parts per Million. 1. Sausages and sausage meat containing raw meat, cereals and condiments. Sulphur dioxide 450 *2. Fruit and fruit pulp (not dried) for conversion into j am or crystallised glace or cured fruit as defined in items 6 and 7 : (a) Cherries Do. 3,000 (6) Strawberries and raspberries Do. 2,000 (c) Other fruit Do. 1,500 3. Dried fruit : (a) Apricots, peaches, nectarines, apples and pears. Do. 2,000 (b) Raisins and sultanas Do. 750 4. Unfermented grape juice and nonalcoholic wine made from such grape juice if labelled in accordance with the rules contained in the Second Schedule to these Regulations. Benzoic acid 2,000 5. Other non-alcoholic wines, cordials and fruit juices, sweetened or unsweetened . Either Sulphur dioxide or Benzoic acid 350 600 *6. Jam (including marmalade and fruit jelly prepared in the way in which jam is prepared) Sulphur dioxide 40 *7. Crystallised glace or cured fruit (including candied peel) Do. 100 91 Food. Preservative. Parts per Million. *7a. Fruit and fruit pulp not otherwise specified in this Schedule Do. 350 †8. Sugar (including solid glucose) and cane syrups. Do. 70 †8a . Cornflour (maize starch) and other prepared starches. Do. 100 9. Corn syrup (liquid glucose) Do. 450 10. Gelatine Do. 1,000 11. Beer Do. 70 12. Cider Do. 200 13. Alcoholic wines Do. 450 14. Sweetened mineral waters Either Sulphur dioxide 70 or Benzoic acid 120 15. Brewed ginger beer Benzoic acid 120 16. Coffee extract Do 450 17. Pickles and sauces made from fruit or vegetables. Do 250 * Amended forms of items 2, 6 and 7 substituted, and new item 7a added, by Regulations of 1926. † Amended form of item 8 substituted, and new item 8a added, byRegulations of 1927. It is satisfactory to record that with the exception of the informal sample of butter previously referred to, no contravention of these Regulations has been met with in the food supply of the Borough during the year. Agricultural Produce (Grading and Marking) Act, 1928. This Act came into force in August, 1928, empowering the Minister of Agriculture and Fisheries to make regulations prescribing "grading designations" for agricultural produce. The Act also contains provisions dealing with the registration of premises for the cold or chemical storage of eggs. Regulations under this Act dealing with the grading and marking of eggs produced in England and Wales were issued in December, 1928, and came into force in February, 1929. Merchandise Marks Act, 1926. Under this Act Orders in Council were issued in July and December requiring an indication of origin in a prescribed manner to be placed on imported honey, fresh apples, currants, sultanas, raisins, eggs in shell and dried eggs, and oat products. The Council are authorised to enforce the provisions of the Orders. Fish Shops. Fish shops in which fish either cooked or uncooked is sold, or in which the curing of fish intended for sale is carried on number 67. All these premises are kept under systematic inspection. 156 inspections were made during 1928 and 24 notices were served for various defects found on inspection. 92 Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1928 was 103, 12 having been added and 8 closed. During the year 166 inspections were carried out, and in 18 cases it was found necessary to serve notices to remedy defects, mainly for lack of cleanliness. Street Stalls for Sale of Food. There are 229 street stalls in the borough for the sale of foodstuffs of varied character, namely : Coffee 11, vegetables and fruit 159, fish and poultry 23, meats and rabbits 3, sweets 10, and other foods 23. Three notices were served for defective and insanitary conditions of premises used by street vendors for the storage of their stocks. 93 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) 590 67 - Workshops (including Workshop Laundries) 592 58 - Workplaces (other than Outworkers' premises included in the Table on page 99) 1,238 78 _ Total 2,420 203 - 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Found on Inspection. Remedied. Referred to H.M. Inspector. Number of Prosecutions. 1 2 3 4 5 Nuisances under Public Health Act — Want of Cleanliness 84 84 _ Want of Ventilation 2 2 - Overcrowding — _ Want of drainage of floors _ _ Other nuisances 67 67 - Sanitary accommodation Insufficient 2 2 - Unsuitable or defective 38 38 - Not separate for the sexes 2 2 Nil. - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (Sec. 101) - - - Other Offences (excluding Offences relating to Outworkers which are included in the Table on page 99) — _ - Total 195 195 - - 94 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1928:— Bakehouses 22 Bootmakers 30 Dressmakers 21 Laundries 5 Milliners 7 Tailors 40 Other Trades 190 Total number of workshops 315 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 1 Notified by H.M. Inspector 2 Underground Bakehouses (Section 101), in use at end of the year 26 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1928 :— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults Young Persons. Barge builder 2 35 1 - - Baker 50 189 37 41 18 Bootmaker 21 49 7 — Builder 4 111 9 — Butter blender 1 150 70 65 20 Chemical works 4 231 6 67 26 Chaff & forage 4 12 — 7 — Coach 2 18 1 1 Cycle maker 2 5 3 — — Dyer 3 54 1 67 — Engineer 26 1,186 82 — — Flour mills 2 127 5 15 — Firewood cutter 10 28 8 21 2 Foundry 1 35 — — — Lift maker 2 27 — — Mason 6 443 — — Mineral water 2 28 — 13 Motor repairs 19 186 21 9 — Printer 18 90 16 22 3 Steam laundry 16 96 8 476 170 Other trades 79 3,659 483 990 560 Total 274 6,759 758 1,794 799 95 The duties of sanitary authorities in relation to the sanitation of factories are few, and are limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. Twenty-three new factory premises were added to the register during the year, dealing with various trades, and 21 were removed. During the year 56 preliminary and 11 Statutory notices were served under the Public Health (London) Act, 1891, for defects found on factory premises, for the most part relating to defective or insufficient sanitary accommodation, all of which were duly remedied. Workshops. The following is a list of the workshops on the register at the end of 1928 :— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 22 31 35 2 - - Blind maker 2 3 8 — — Bootmaker 30 30 47 — — — Carpenter 7 8 14 — — — Coach builder 7 6 24 2 — — Cycle maker 7 11 11 5 4 — Dressmaker 21 23 — — 58 7 Embroiderer 1 2 — — 11 — Farrier & smith 12 12 23 2 — — Firewood cutter 4 4 5 1 — — Laundry 5 9 4 — 17 — Mason 3 3 7 1 -— — Milliner 7 7 — — 17 9 Motor repairs 15 16 40 3 — — Musical instrument 4 7 25 5 2 - Photographer 1 1 2 — 1 — Picture framer 4 4 8 — — — Rag sorter 20 21 41 — 12 — Saddler 1 1 1 — — — Tailor 40 51 58 11 50 5 Upholsterer 15 23 43 5 9 3 Other trades 87 98 245 33 56 46 Totals 315 371 641 70 237 70 96 In certain of these trades in which female labour is mainly used, the inspection of the workshops is carried out by a female sanitary inspector, and during 1928 the number of inspections amounted to 83. Forty-six intimation and 12 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 2 intimation notices were served by the female inspector. Forty-four new workshops were added to the register, dealing with the following trades:— Bootmaker 4 Rag sorter 5 Carpenter 3 Tailor 5 Firewood cutter 1 Upholsterer 2 Motor repairer 4 Other trades 19 Musical instrument 1 The following are the particulars relating to a workshop in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector during 1928:— Trade. No. of Workshops. Protected Persons employed. Women. Young Persons. Total. Dressmaker 1 2 1 3 Outworkers. During 1928, 347 names and addresses of outworkers were received in 106 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 173 names and addresses relating to 112 outworkers, sent in by employers, were found to refer to other districts, and were accordingly forwarded to the Medical Officers of Health of those districts. Male. The following table shows the number of male out-workers' premises registered in the Borough, together with the trades and the number of persons employed :— Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaking 38 38 48 Glovemaking 1 1 1 Tailoring 48 51 105 Other Trades 5 5 6 Totals 92 95 160 97 Fourteen new male outworkers' premises (not previously registered) were registered during the year, and 17 were removed from the register. I There were 106 inspections made of male outworkers' premises during 1928, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 2 cases to remedy sanitary defects found on inspection, viz. :—Defective w.c. ; defective roof. No case of infectious disease was notified during 1928 from premises occupied by male outworkers. Female. The following is a list of the female outworkers registered in the Borough, together with the trades and the number of persons employed:— Trade. Number on Register. Persons Employed. Premises. Workrooms Blousemaking 3 4 7 Dressmaking 36 40 60 Millinery 3 3 3 Embroidery 35 35 39 Fancy goods 4 4 4 Fancy boxes 4 4 4 Fine needlework 4 4 5 Glovemaking 2 2 2 Knitting and crochet 5 5 5 Tailoring 30 32 56 Underclothing 7 7 11 Other trades 29 29 29 Total 162 169 225 The number of new female outworkers' premises (not previously registered) registered during the year was 83, and there were 72 removed from the register. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 418. It was found necessary in 4 cases to serve notices under the Public Health (London) Act, 1891, to remedy defects. Four cases of infectious disease, viz.: diphtheria 1, erysipelas 1, scarlet fever 2, were notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in these cases. 98 Bakehouses. There were 72 bakehouses on the register at the end of 1928. Of these 50 use power, and are therefore factories. Forty-six of the bakehouses are above ground, and 26 are under ground. Two bakehouses were removed from the register, the premises being in one case disused and in the second case used for other purposes. Inspections made during the year were 191, and 31 intimation and 5 statutory notices were served, mainly for failure to carry out the half-yearly lime-whiting of the bakehouses within the statutory period. In the early part of 1928, as a result of complaint received, inspection was made of certain bakehouse premises, which were found to be in seriously insanitary condition. The Health Committee directed that legal proceedings should be taken in regard to the matter, but the requirements of the Act of Parliament having been complied with and the premises rendered in all respects fit for the purpose, the summons, by the order of the Committee, was not proceeded with. Warehouses and Wharves. At the end of 1928, there were 40 premises on the register, including railway yards. These premises were systematically inspected during the year, and 38 inspections were made. Six intimation notices were served to remedy nuisances found on inspection. 99 Home Work, 1928. 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, no; Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workers. Contractors. Workers. Wearing Apparel- (1) Making 39 22 164 4 — 25 49 - - 6 6 - 4 - — (2) Cleansing & Washing 2 — 2 - - - 2 - - - - - - - - Furniture and Upholstery 4 — 9 - - - 4 - - - - - - - - Other Trades 5 1 12 2 l 10 8 - - - - - - - - Total 50 23 187 6 1 35 63 - - 6 6 - 4 - - Note.—Of the 246 names included in this table, only 55 were of work people residing in Battersea, the remaining names being those of workers residing outside the Borough. The names of 170 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were therefore 225 Battersea home-workers named in the lists. 100 Housing. The housing conditions in Battersea, so far as adequate housing accommodation is concerned, are still very unsatisfactory, and during the year 1928 hundreds of cases of congestion and overcrowding have been brought to the notice of the Housing Committee. For reasons which have been fully referred to in previous Annual Reports it has been impossible, except to a very limited extent, to remedy these insanitary and otherwise undesirable conditions. Some slight alleviation of this distressing situation has been effected through the additional dwellings provided by the Borough Council, and by the quota allocated to Battersea by the London County Council on their various Housing Estates in cases of special hardship, &c. Unfortunately, however, there is still a large number of families in Battersea living under conditions which are, on sanitary and social grounds deplorable. New Houses. It has been pointed out in previous Reports that the Borough Council have had very limited opportunities of relieving the congestion and overcrowding resulting from the housing inadequacy in Battersea, practically the whole of the available area of the Borough being built upon. Such few opportunities as have arisen have been seized by them to erect working class dwellings. Apart from the Plough Road Improvement Scheme and the Plough Road Scheme Extension (vide pp. 106-7) no new workmen's dwellings were erected by the Council during 1928. During 1928 under private enterprise one house was erected in Blenkarne Road and one large house in Queens Square was converted so as to provide accommodation for seven families. Overcrowding. It is to be regretted that a considerable amount of overcrowding still exists notwithstanding the large number of houses which have been built by the London County Council and by private enterprise in London and its environs. Unfortunately these have had little effect on the housing question in Battersea. As pointed out in previous Annual Reports owing to the remoteness of the newlybuilt. houses from their work there is a reluctance on the part of the inhabitants of the Borough to accept accommodation on these estates. A more specific difficulty which has also been referred to is that in many cases it is quite impossible for the workers to pay the rents demanded for such houses. It is, therefore, essential that some steps should be taken to enable families, especially the large poor families of limited means to be provided with accommodation at rents which they are able to pay. Several suggestions have been put forward to meet this difficulty, the most practical of 101 which is probably that of Mr. E. D. Simon, M.P., Ex-Lord Mayor of Manchester, viz., that a children's allowance of 1/- (one shilling) per week per child should be given as a rebate in the rent. It is evident that something will have to be done as it is amongst this class of the population that the most severe overcrowding prevails. As shewing the need for accommodation for this, figures are shewn in the following table of the applications for housing accommodation received by the Medical Officer of Health during the 10 weeks ended 8th September, 1928. Summary of Applications for Housing Accommodation received by the medical officer of health during the 10 Weeks ending 8th September, 1928. Number of rooms occupied. Number in family. 2 3 4 5 6 7 8 9 10 11 12 13 Total 1 Room - 10 17 16 4 4 1 2 54 2 Rooms 1 2 10 19 5 8 8 — 1 — - — 54 3 Rooms — 2 5 4 4 2 1 2 — 1 1 — 22 4 Rooms 2 1 1 3 2 - - - - - 9 5 Rooms — — — — 2 — — — — 1 — — 3 Unclassified 1 — 3 - - - - - - - - 1 5 Total 2 16 36 40 18 14 12 4 1 2 1 1 147 Note.—Of this number 21 had made previous application. It will be noted from an examination of these figures that the conditions as to overcrowding among a certain element of the population constitute, from the health and social standpoints, a serious evil. During 1928, 189 applications for housing accommodation were referred to the London County Council with a view to special consideration being given thereto on the grounds of overcrowding or hardship. The following table shows the result of such action during the year. Referred in 1927 but not dealt with in that year. Referred in 1928. Total. Families accommodated 33 71 104 Offer declined by applicant or applicant otherwise suited 5 23 28 Recommendation not accepted by L,C.C. 4 33 37 Still under consideration 15 62 77 Total 57 189 246 102 Repair of Unfit Houses. A good deal of useful work in the repair and re-conditioning of unfit houses was carried out during the year under the provisions of the Housing and Public Health Acts, details of which will be found summarised on pp. 110-11. The work of the Council in this direction has been fully described in previous Annual Reports, so that it is unnecessary to say more than that the policy of the Council in using the powers of Housing Act, 1925, in securing the re-conditioning of seriously defective house property continues to be fully justified. It was not found necessary during the year for the Council to enter and carry out works of repair in default of compliance by the owner with notice served under section 3 of the Housing Act, 1925. Re 18, 19 and 20 Belfour Street. Battersea Borough Council v. Watts. Legal proceedings of considerable interest, however, were undertaken by the Council for the recovery of expenses incurred in the repair of certain houses in North Battersea amounting to £712 4s. 1d., together with interest at five per cent. from 30th December, 1925. The main point taken by the defendant was that he was not the "Owner" within the meaning of the Act. He contended that he merely acted as Solicitor for his Client in the administration of the estate of her late husband and whilst acting in this capacity he instructed a builder to collect the rents and pay them only to him. He maintained that he only received the balance of the rents as costs owing to him as such solicitor. This case was first heard on 30th March, 1928, before Mr. J. B. Sandbach, K.C., a Metropolitan Police Magistrate, sitting at the South Western Police Court, who gave a decision in favour of the Council. It next came before Mr. Justice Swift and Mr. Justice Acton on 8th November, 1928, sitting as a Divisional Court of the King's Bench Division of the High Court on appeal by way of case stated, and the appeal was dismissed with costs, but leave was given to appeal to the Court of Appeal. It was heard in that Court on 31st January and 1st February, 1929, by Lords Justices Scrutton, Greer and Sankey, and by a majority judgment a decision was again given in favour of the Council, with costs. Lord Justice Scrutton's judgment was as follows:— This is a case of some difficulty and of considerable importance and I am sorry to say there is a difference of opinion in the Court. The question arises under the Acts which were passed for, among other purposes, improving the condition and repair of houses suitable for occupation by people of the working classes, and in the Act of 1919, which is the beginning of the series (I do not think the subsequent Acts matter very much) Parliament provided by section 28 that if a house, otherwise suitable for occupation by persons of the working classes, was not kept in condition reasonably fit for human habitation the local authority might serve a notice on the owner of the house requiring him within not less than 21 days to execute *■ 103 such works as may be necessary to make the house in all respects reasonably fit for human habitation. There was a provision that if the house was in such a condition that it could not, without reconstruction, be made fit for human habitation the owner might say, " I will close it," and then there would be no obligation on him to execute repairs or reconstruction. But supposing the owner did not do that, and it was not a question of reconstruction, if the owner did not comply with the requisition of the local authority the local authority might do it themselves, and any expenses incurred by the local authority under this section could be recovered in a Court of Summary Jurisdiction, from the owner and those expenses were, if not paid, a charge on the premises. Then came the question, who is the owner ? and Parliament seemed to have contemplated that it might be difficult for the local authority to find the owner. He may not be in the United Kingdom at all; he may be of such kind of owner that it is difficult to get at and so the statute defined "owner" (under the earlier Act it is the Public Health Act, 1875, and under the later Act it is the London Act of 1891 in this case, but as the two provisions are exactly the same it does not matter which it is under)as meaning "the person for the time being receiving the rackrent of the lands or premises in connexion with which the word is used, whether on his own account or as agent or trustee for any other person." Parliament might have done several things. It might have said the agent is to be liable only to the extent of the rent he receives, but they have not said so. They have apparently assumed that the agent paying the money that was claimed from him under this definition would have a legal right of indemnity against the owner and they do not seem to have troubled their heads as to what would happen if the owner had no money to pay the agent, and consequently no doubt this definition may lead to hard cases. It may lead to a case where the agent is made liable for a very considerable sum, much more than the rent he receives and he cannot recover it from the owner because the owner has not got it. That was no doubt a matter that Parliament ought to have considered, that it may lead to hard cases. There is a well-known maxim (I do not know whether it has got into Broome's Legal Maxims) to the effect that hard cases make bad law. It is not for us to legislate because we think that Parliament has used words which plainly create a hardship. We endeavour to avoid hardship if we can, but our business is to interpret the words that Parliament has used and not, under the guise of construing those words, legislate in a manner in which Parliament does not legislate. The question therefore arises in this case, as it will in every similar case, was Mr. Watts, who has been hit for these expenses, receiving the rackrent of the lands as agent for any other person ? The facts are these and they are stated very carefully in the Special Case of the Police Magistrate. The three houses in this case, which were obviously small houses in a working class locality, belonged originally to a Mr. Edward James Henry Wallis, and while he was alive he employed a Mr. Spicer, a builder, to collect the rents of the houses. Mr. Wallis died in February, 1922, and apparently in the month before his death he made two contradictory wills; one left two of the houses to his widow and one to his son, the other disposed of the houses in another way which is not stated, but proceedings in Probate at once took place. The appellant, Mr. Watts, in those Probate proceedings acted as solicitor for the widow. It is not stated whether anybody acted as solicitor for the son, but apparently the widow's and the son's interests were the same. The son-in-law was propounding the other will. Ultimately those Probate actions were settled ; they were settled on the terms that the three houses should be sold and out of the proceeds the Plaintiff's costs of action were to be paid, the balance of the proceeds were to be divided and paid as to one-third to the son and as to two-thirds to the widow. The son-in-law apparently got his costs out of the estate or his legal advisers did. The date of that is not given in the exhibit. On the death of Mr. Wallis the son-in-law had directed Mr. Spicer to go on collecting the rents. On the 23rd February, 1922, the appellant, who was solicitor V 104 for the widow, gave the very proper instruction to Mr. Spicer not to part with any of the rents but to hold them as they would have to be accounted for to the person in title when the Probate dispute was settled. The Probate dispute was settled and Mr. Spicer, apparently hearing who were the people who by the settlement were entitled to the rents, proceeded to communicate with the widow who referred him to the solicitor, and after that, when any sums were to be paid out of the rents, Mr. Spicer applied to and obtained instructions from the Plaintiff, Mr. Watts, the Solicitor, as to whether or not he was to pay, and having got instructions from Mr. Watts he paid or did not pay according to the instructions he received. Further, on Mr. Watts' instructions, Mr. Spicer paid to Mr. Watts the net balance of the rents and rendered him an account of the rents collected. That went on for two or three years. The question on those facts is : Is Mr. Watts receiving the rackrent of the lands as agent for any other person ? Different minds take different views and, therefore, I ought not to say that the thing is clear; I only say that it is clear to me, but possibly what is clear to me is wrong. It seems clear to me that Mr. Watts, giving instructions as to what was to be done with the rents which were obeyed by Mr. Spicer, giving instructions to Mr. Spicer to pay and giving instructions to Mr. Spicer to pay to him the balance after making the authorised payments, is receiving the rackrents. It is perfectly true he is receiving them on behalf of the widow and her son, but that is receiving them as agent and he seems to me to be clearly receiving them as agent for another person. The Police Magistrate has taken that view and the Divisional Court has affirmed it. I am not at all sure that it is not a question of fact and if it is a question of fact the Police Magistrate has found that Mr. Watts received the rents. The reason why I doubt it is that there have been in the House of Lords a series of contradictory utterances as to what is a question of fact and what is a question of law. Some of the noble Lords, particularly Lord Wrenbury, have taken the view that when there is a statute it is always a question of law what the statute means ; when you have found out what the statute means it is a question of fact as to whether the particular instance comes within the meaning you get from the statute. But however simple the words of the statute it is always a question of law as to what they mean. For instance, if a statute says "pig" it is a question of law what "pig" means and having found out what "pig" means it is a question of fact whether a particular animal was a pig. On the other hand, there are noble Lords who take quite a different view of the matter and say when plain words are used in the statutes it is a question of fact whether the particular instance they are considering comes within the plain words and, but for Lord Wrenbury's views, I should have been disposed to think it was a question of fact and the fact to be ascertained being whether Mr. Watts was receiving the rackrents as agent for another person I should have thought he was clearly receiving the rackrents collected by Mr. Spicer who pays to Mr. Watts such sums as he is instructed to pay. They are clearly received by Mr. Watts for another person, namely, the widow and son who were employing him, and it would seem to be fairly clear that Mr. Watts therefore is a person receiving the rackrents of land as agent for another person. That is the view taken by the Police Magistrate. So far as it is fact its conclusion is not appealable. It is the view taken by the Divisional Court, and it is the view which I take. Consequently so far as it depends on me I dismiss the appeal with costs. Lord Justice Greer dissented, mainly on the grounds (1) that "the person receiving the rent" meant "the person receiving the rent from the tenant" and (2) that Mr. Spicer was not the agent of Mr. Watts. Lord Justice Sankey delivered a judgment to the same effect as that of Lord Justice Scrutton. 105. Appeals. During 1928 the right of appeal to the Minister of Health against notices under section 3 of the Housing Act, 1925, was exercised in only one case. This appeal, which was in respect of No. 37 Belfour Street, was the subject of a Local Inquiry. In this case the owner in order to provide light and ventilation to the staircase had inserted an air grating in the wall. This provision was considered to be unsuitable and inadequate to meet the requirements of the Council, and notice under section 3 of the Housing Act, 1925, was served, requiring, inter alia, the provision of a window of reasonable size made to open or other approved means of lighting and ventilation of the staircase. Against this the owner appealed. After a Local Inquiry held by the Ministry of Health the appeal was dismissed and the notice was subsequently complied with. In view of the fact that it has been the policy of the Council to require, where necessary, the provision of adequate light and ventilation to the staircases of houses, it is satisfactory to record that in past years several appeals against this requirement have been heard and in all cases the decision has been given in favour of the Council. There can be no doubt that this policy has resulted, from the health standpoint, in greatly improved conditions in many thousands of the older houses in the Borough, and it has in this respect brought these premises into line with those built in recent years where this provision is obligatory under the provisions of the London Building Act 1894. Closing Orders. No Closing Orders under Section 11 (1) of the Housing Act, 1925, were made by the Council during 1928. Underground Rooms. No Closing Orders in respect of Underground Rooms were made by the Council during 1928. On the instructions of the Health Committee an inspection of all underground rooms in the Borough is being carried out in order that steps may be taken to prevent a recurrence of the danger to life and damage and hardship which arose during the serious inundation of the River Thames which occurred early in the year (vide p. 77). In view of the housing shortage it is extremely difficult to enforce the provisions of the Housing and Public Health Acts in regard to such underground rooms used for sleeping purposes and the provisions of this Act can only be effectively applied when the shortage has been overcome. 106 Increase of Rent, etc., Acts. During 1928, ten applications were received from tenants for the certificate, and four* from owners for the report of the Sanitary Authority under the above-mentioned Acts. The application for the certificate was granted in eight cases and refused in the remaining two ; applications for reports were granted in each of the four cases. Action under Section 5 of the Housing Act, 1925. During 1928, 42 cases relating to 56 houses were reported to the Housing Committee for contraventions of Section 5 of the Housing Act, 1925, which requires the rent book (if such is provided) to be kept in the prescribed form. The attention of the owners was drawn to the omission and in 38 cases a satisfactory explanation was received and the requirements of the section were subsequently complied with. The Committee directed that cautionary letters be sent to the offenders concerned. In the remaining four cases the Committee authorised proceedings to be taken to enforce the requirements of the Section. Insanitary Areas. No additional insanitary areas were represented to the Council during 1928. During the year further progress was made with the Plough Road Improvement Scheme, the eighth, ninth and tenth blocks being completed, and the eleventh and final block nearly completed. As described in the Annual Report for 1927, the Council, in order to render the Plough Road Improvement Scheme more efficient decided to acquire by purchase cottages in Holtby Place and factory premises in Britannia Place adjoining, as the acquisition of these properties would enable the Council to improve their scheme very considerably by (1) continuing Britannia Place, hitherto a cul-de-sac, into Hope Street, and (2) rendering it possible to provide additional accommodation by the erection of three additional blocks (18 tenements). Some other improvements were also made possible in the planning of the Estate. The eleventh block in the Plough Road Improvement Scheme was erected on the South side of Britannia Place (partly on the site of the factory premises), and the vacant land at the rear of the blocks already built was converted into an open space. The site of the small cottages in Holtby Place was utilised for the erection of three blocks (18 tenements) and application was successfully made for the subsidy to be granted in respect thereof. * Includes 1 case under consideration at the end of 1927. 107 The action of the Council in acquiring these additional properties has to some considerable extent restored the efficiency of the scheme originally proposed by them, but which had to be curtailed and otherwise seriously impaired, the Ministry of Health being only prepared to agree to an amended scheme. It is to be hoped that when the Plough Road Scheme is completed steps will be taken by the Council to proceed with other similar improvement or reconstruction schemes which were prepared and submitted to the Ministry of Health in 1920. The transformation which has been effected in this area from the health and social standpoints by the demolition of these dirty, dilapidated, old, worn out and insanitary houses, and the erection of new, well built, adequately lighted and ventilated houses equipped with electric light, hot water supply and other necessary and hygienic amenities, should prove the value of such action and should be a stimulus in proceeding to deal quickly and systematically with other black spots in the Borough. Houses Let in Separate Tenements. During the year 60 houses were registered under the Bye-laws made by the London County Council under the provisions of the Public Health (London) Act, 1891, and the Housing Act 1925, with respect to houses intended or used for occupation by the working classes and let in lodgings, or occupied by members of more than one family. Pending the repeal of the Rent and Mortgage Interest (Restrictions) Acts 1920 and 1923, these bye-laws cannot be completely enforced. Insanitary Houses. The following is a list of streets in the Borough in which houses were found, on inspection, to be insanitary, and were dealt with by the Council under the provisions of the Housing Acts, either informally or by the service of notice under section 3 of the Housing Act, 1925, during 1928. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Acre Street 26 Gonsalva Road 1 Ponton Street 9 Belfour Street 7 Linford Street 30 Stanley Street 1 Currie Street 16 New Road 73 William Street 29 Etruria Street 36 Nine Elms Lane 7 Woodgate Street 10 Everett Street 37 Ponton Road 15 Total:—14 streets, 297 houses. No. 2 District. Blondel Street 71 Havelock Terrace 1 Oulton Street 1 Total:—3 Streets, 73 houses. 108 Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 3 District. Granfield Street 1 Parkham Street 12 Total :—2 streets, 13 houses. No, 4 District. Afghan Road 1 Ingrave Street 2 Pearson Street 2 Creek Street 20 Kerrison Road 1 Shillington Street 6 Currie Road 1 Knox Road 1 Simpson Street 1 Duffield Street 3 Lavender Road 6 Speke Road 1 Este Road 3 Lithgow Street 12 Stainforth Road 6 Falcon Road 1 Mantua Street 1 Thibet Street 10 Falcon Terrace 1 Meyrick Road 8 Totteridge Road 2 Gwynne Road 3 Musjid Road 2 Verona Street 2 Heaver Road 2 Patience Road 1 Wye Street 2 Total :—27 Streets, 101 houses. No. 5 District. Acanthus Road 2 Eland Road 1 Tipthorpe Road 3 Brassey Square 2 Eversleigh Road 1 Tyneham Road 1 Culvert Road 1 Latchmere Road 3 Wickersley Road 1 Dorothy Road 2 Mossbury Road 2 Total:—11 streets, 19 houses. No. 6 District. Maysoule Road 133 Winstanley Road 1 Total :—2 streets, 134 houses. No. 7 District. Craven Mews 1 Freke Road 1 Total:—2 streets, 2 houses. No. 8 District. Nil. Summary. No. 1 District 14 streets 297 houses. „ 2 „ 3 „ 73 „ „ 3 ,, 2 „ 13 „ „ 4 ,, 27 „ 101 „ „ 5 „ 11 „ 19 „ „ 6 ,, 2 „ 134 „ „ 7 ,, 2 „ 2 „ „ 8 „ - - Totals 61 streets 639 houses The following is a list of streets in the Borough in which houses were the subject of action during the previous year, either informally or by the service of notice, under section 3 of the Housing Act, 1925, but to which the necessary works of repair had not been completed during 1927. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Belfour Street 1 Total:—1 street, 1 house. No. 2 District. Berkeley Street 7 Brougham Street 9 Sheepcote Lane 2 Blondel Street 8 Havelock Terrace 1 Total :—5 streets, 27 houses. No. 3 District. B'sea Park Road 1 Granfield Street 4 Octavia Street 2 Total:- 3 streets, 7 houses. No. 4 District. Creek Street 1 Heaver Road 1 Musjid Road 2 Duflield Street 1 Ingrave Street 1 Rowena Crescent 1 Falcon Grove 1 Lithgow Street 3 Wayford Street 1 Gwynne Road 2 Meyrick Road 2 Total :—11 streets, 16 houses. No. 5 District. Acanthus Road 1 Dorothy Road 1 Tipthorpe Road 1 Culvert Road 1 Knowsley Road 6 Total :—5 streets, 10 houses. No. 6 District. Maysoule Road 4 Mendip Road 2 Total :—2 streets, 6 houses. No. 7 & 8 Districts. Nil. Summary. No. 1 District 1 street 1 house. „ 2 „ 5 streets 27 houses. „ 3 ,, 3 „ 7 „ „ 4 „ 11 „ 16 „ „ 5 ,, 5 „ 10 „ ,, 6 „ 2 „ 6 „ „ 7 „ - „ - „ „ 8 „ - „ - „ Totals 27 streets 67 houses. 109 110 Statistics for the year ending 31st December, 1928. 1. General. (a) Estimated population 164,100 (b) General Death Rate 11.9 per 1,000 popln. (c) Death rate from tuberculosis .98 per 1,000 „ (d) Infantile mortality rate 64.2 per 1,000 births (e) Number of premises used as habitations by all classes 27,908 (f) Estimated number of working class dwelling- houses 25,017 (g) Number of new working class dwellings erected *31 2. Unfit Dwelling-Houses. (a) Inspection— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,397 (b) Number of dwelling-houses which were inspected and recorded under Part IV of the Housing Consolidated Regulations, 1925 3,560 (c) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for habitation Nil (d) Number of dwelling-houses (exclusive of those referred to under the previous heading) not found to be in all respects reasonably fit for habitation 4,002 (b) Remedy of defects without service of formal notice— Number of dwelling-houses rendered fit in consequence of informal action by the local authority or their officers 417 (c) Action under statutory powers— (I.) Proceedings under section 3 of the Housing Act, 1925:— (a) Number of dwelling-houses in respect of 27 which notices were served requiring repairs (b) Number of dwelling-houses which were rendered fit:— (i.) By owners 30 (ii.) Work commenced by local authority but workmen subsequently withdrawn and work completed by owner Nil * Includes 18 tenements erected under Plough Road Improvement Scheme. 111 (iii.) Work commenced by owner but workmen subsequently withdrawn and work completed by local authority Nil (iv.) By local authority in default of owners Nil (c) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (II.) Proceedings under Public Health Acts:— (a) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,363 (b) Number of houses in which defects were remedied. (i.) By owners 3,606 (ii.) By local authority in default of owners 1 (III.) Proceedings under sections 11, 14 & 18 of the Housing Act, 1925:— (a) Number of representations made with a view to the making of Closing Orders Nil (b) Number of dwelling-houses in respect of which Closing Orders were made Nil (c) Number of dwelling-houses in respect of which Closing Orders were determined the dwelling-houses having been rendered fit Nil (d) Number of dwelling-houses in respect of which Demolition Orders were made Nil (e) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 3. Staff. Staff engaged on Housing work with briefly the duties of each officer:- 1. Medical Officer of Health. 2. Senior Sanitary Inspector. Housing Inspector. Seven District Inspectors. 3. Two Clerks (mainly engaged on matters relating to housing work). 112 TABLE I. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole District during 1928 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 19181 168,014 B. † 2,407 2,700 16.1 3,195 21.3 857 471 267 99 2,809 18.7 149.951 D. † 1919 165,960 B. † 2,765 3,075 . 18.5 2,409 15.1 730 382 228 74 2,061 12.9 159,316 D. † 19201 166,093 B. † 4,218 4,669 28.1 2,393 14.4 700 386 386 83 2,079 12.5 165,664 D. † 1921 169,200 3,580 3,742 22.1 2,445 14.5 800 415 276 74 2,060 12.2 1922 169,200 3,577 3,665 21.7 2,679 15.8 864 412 254 69 2,227 13.2 1923 170,600 3,415 3,434 20.1 2,368 14.0 874 345 170 49 1,839 10.8 1924 171,000 3,180 3,139 18.4 2,506 14.7 858 370 196 62 2,018 11.8 1925 172,100 3,264 3,184 18.5 2,397 13.9 920 328 186 58 1,805 10.5 1926 171,900 3,198 2,969 17.3 2,547 14.8 948 361 183 62 1,960 11.4 1927 169,000 3,099 2,801 16.6 2,773 16.4 1,102 394 150 53 2,065 12.2 1928 164,100 3,054 2,743 16.7 2,674 16.3 1,091 371 176 64 1,954 11.9 Area of District in acres (land and inland water), 2,163 acres. Total population at all ages, 167,739; number of occupied separate dwellings, 27,191; average number of persons per occupied separate dwelling, 6.17 (Census Report 1921). * Rates calculated per 1,000 of estimated population. t Registrar General's estimated population for purposes of calculating:- (B), birth-rate ; (D) death-rate. 113 (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1928. Notifiable Disease. Cases Notified in the Borough of Battersea. Total Cases Notified in each Sub-District No. of Cases Removed to Hospital from each Sub-District. At all Ages. Under 1 year. 1 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 65 years. 65 years and upwards. E. N.W. S.W. E. N.W. S.W. Small-pox 1 ... ... ... 1 ... ... 1 ... ... 1 ... ... Diphtheria 652 8 175 394 54 21 ... 321 231 100 321 231 97 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 84 2 6 7 11 48 10 35 34 15 6 11 4 Scarlet Fever 480 2 128 292 45 13 ... 196 181 103 193 180 98 Enteric Fever 8 ... 1 1 2 4 ... 2 ... 6 2 ... 6 Puerperal Fever 7 ... ... ... 1 6 ... 3 2 2 3 2 2 Puerperal Pyrexia 31 ... ... ... 11 26 ... 17 9 5 9 4 4 Meningococcal Meningitis 4 2 ... ... 1 ... 1 1 2 1 1 2 ... Ophthalmia Neonatorum 39 39 ... ... ... ... ... 16 16 7 4 2 4 Polio-myelitis, &c. 1 ... 1 ... ... ... ... ... 1 ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 9 ... ... ... ... 9 ... 2 5 2 ... ... ... Dysentery 1 ... ... 1 ... ... ... 1 ... ... ... ... ... Acute Influenzal Pneu 51 1 5 1 6 34 4 18 23 10 5 8 3 Acute Primary Pneu. 314 33 89 44 26 106 16 109 163 42 40 40 12 Totals 1,682 87 405 740 158 261 31 722 667 293 585 480 230 Tuberculosis— Pulmonary 251 ... 1 7 88 153 2 111 71 69 ... ... ... Non-Pulmonary 50 2 9 19 14 6 ... 23 14 13 ... ... ... Totals (Tuberculosis) 301 2 10 26 102 159 2 134 85 82 ... ... ... Totals 1,983 89 415 766 260 420 33 856 752 375 585 480 230 Whooping-cough* 810 101 446 258 2 3 ... 379 335 96 27 35 1 Measles* 3,381 154 1,689 1,507 18 13 ... 1,510 1,254 617 179 174 34 Grand Totals 6,174 344 2,550 2,531 280 436 33 2,745 2,341 1,088 791 689 265 * Notifiable in Battersea from 24th April, 1922. 114 TABLE III. Causes of, and Ages at, Death during the Year 1928. Causes of Death Nett Deaths at subjoined ages of " Residents" whether Occurring within or without the District. Total Deaths of "Residents" and" NonResidents" in Institutions in the District. All Ages. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years upward. 1. Enteric Fever 1 ... ... ... ... ... ... 1 ... ... 2. Small-pox ... • •• ... ... ... ... ... • •• ... ... 3. Measles 36 8 14 12 2 ... ... ... ... 35 4. Scarlet Fever 5 ... ... 2 1 2 ... ... • •• ... 5. Whooping-cough 14 6 5 2 1 ... ... ... ... 5 6. Diphtheria 26 ... 6 11 7 1 1 ... ... 1 7. Influenza 14 1 ... ... ... ... 3 1 9 7 8. Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... ... 9. Meningococcal Meningitis 4 2 ... 1 ... ... ... ... 1 ... 10. Tuberculosis of Respiratory System 138 ... 1 ... 2 47 47 37 4 110 11. OtherTuberculous Disease 23 2 2 4 7 2 4 2 ... 35 12. Cancer 247 ... ... ... 1 2 9 114 121 214 13. Rheumatic Fever 3 ... ... ... ... 1 2 ... ... 5 14. Diabetes 18 ... ... ... ... ... 3 5 10 20 15. Cerebral Haemorrhage, etc. 58 ... ... ... ... 1 2 18 37 76 16. Heart Disease 420 ... ... ... 1 9 27 103 280 437 17. Arterio-Sclerosis 79 ... ... ... ... ... 1 17 61 11 18. Bronchitis 102 8 1 1 1 ... 3 18 70 38 19. Pneumonia (all forms) 146 38 22 8 2 6 17 30 23 124 20. Other Respiratory Diseases 31 1 ... ... ... 4 5 5 16 18 21. Ulcer of Stomach or Duodenum 19 ... ... ... ... ... 3 12 4 32 22. Diarrhoea, &c. 29 25 1 ... 1 ... 1 ... 1 22 23. Appendicitis and Typhlitis 16 ... ... 1 3 3 2 6 1 21 24. Cirrhosis of Liver 11 ... ... ... ... ... 1 6 4 13 25. Acute and Chronic Nephritis 47 ... ... ... ... 1 8 12 26 60 26. Puerperal Sepsis 3 ... ... ... ... ... 3 ... ... 6 27. Other diseases of Pregnancy 4 ... ... ... ... ... 4 ... ... 11 28. Congenital Debility and Malformation, Premature Birth 65 63 ... ... 2 ... ... ... ... 37 29. Suicide 14 ... ... ... ... 2 3 6 3 10 30. Other Deaths from Violence 79 3 1 5 4 9 9 20 28 100 31. Other Defined Diseases 300 19 4 3 10 11 41 83 129 299 32. Causes ill-defined or unknown 1 ... ... ... 1 ... ... ... ... ... All Causes M. 980 98 33 24 27 47 103 281 367 904 F. 974 78 24 26 19 54 97 215 461 843 Totals 1954 176 57 50 46 101 200 496 828 1747 115 East Battersea. TABLE IV. Infant Mortality, 1928. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 ... 2 2 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 1 ... ... ... ... 4 3 Pneumonia (all forms) ... ... ... ... ... ... 2 ... ... ... 2 ... 1 ... 4 6 2 2 3 3 12 11 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 1 6 1 1 1 10 5 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 6 1 5 ... 1 1 2 1 ... ... 14 3 ... 1 ... ... ... ... ... ... 14 4 Congenital Malformation 1 2 1 ... ... ... 1 ... ... ... 3 2 1 ... 1 ... ... ... ... 1 5 3 Congenital Debility ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 ... ... ... ... 2 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Atelectasis & Asphyxia Neonatorum 1 ... 1 ... 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... Lack of Care ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 Convulsions ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... 1 ... ... 1 ... 2 2 Totals 9 6 7 1 2 2 5 1 2 ... 25 10 6 5 9 12 10 4 7 7 57 38 15 8 4 6 2 35 11 21 14 14 95 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1166 54 1220 90 5 95 North-West Battersea. 116 TABLE IV.—(contd.) Infant Mortality, 1928. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Pneumonia, all forms ... ... ... ... ... ... 2 ... ... 1 2 1 ... ... 2 2 2 ... 1 2 7 5 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 ... ... 1 5 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 2 2 1 2 ... 1 ... ... ... ... 3 5 ... 3 ... ... ... ... ... ... 3 8 Congenital Malformation ... ... ... 2 ... ... ... 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 Congenital Debility ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 1 ... ... ... ... 2 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Atelectasis and Asphyxia Neonatorum ... ... 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2 2 3 6 ... 1 3 1 ... 1 8 11 ... 5 6 4 8 1 2 6 24 27 4 9 1 4 1 19 5 10 9 8 51 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 853 40 893 48 3 51 117 South-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1928. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Menin gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... PulmonaryTuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia, all forms ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 3 Infarct Lung ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 2 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 1 3 2 ... ... ... 1 ... ... 4 4 ... ... ... ... ... ... ... ... 4 4 Congenital Malformation 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 1 Congenital Debility ... ... 2 ... ... ... 1 ... ... ... 3 ... ... ... 1 ... ... ... ... ... 4 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis & Asphyxia Neonatorum ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Accident ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 2 1 3 1 6 4... ... ... 1 2 ... ... 10 7 2 2 2 1 2 2 1 1 17 13 Totals 4 10 ... 3 ... 17 4 3 4 2 30 Nett Births in the year. Nett Deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total 601 29 630 29 1 30 118 Borough of Battersea. TABLE IV.—(contd.) Infant Mortality, 1928. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year. Percentage of Total. 1-2 2-3 3-4 1-3 3-8 6-9 9-12 M. F M F M F M F M F M F M F M F M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0•57 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 5 3 5 4•54 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 ... 1 ... 3 3 3•41 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0•57 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 1•14 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 1 1•14 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 3 3 1 1 ... ... ... ... 4 4 4•54 Pneumonia (all forms) ... ... ... ... ... ... 4 1 ... 1 4 2 1 ... 6 8 4 3 4 6 19 19 21•59 Infarct Lung ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0•57 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 2 6 2 8 2 1 2 17 8 14•20 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0•57 Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 9 4 9 4 1 2 2 2 ... ... 21 12 .... 4 ... ... ... ... ... ... 21 16 21•02 Congenital Malforma- 3 2 1 ? ... ... 1 1 ... ... ... 5 1 1 1 ... ... ... ... 1 7 7 7•95 Congenital Debility ... ... 2 ... ... ... 2 1 .... 5 ... ... ... 3 2 ... ... ... ... 8 2 5•68 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... 1 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 1•14 Atelectasis & Asphyxia Neonatorum 1 ... 2 2 1 ... ... ... ... ... 4 2 ... ... ... ... ... ... ... ... 4 2 3•41 Lack of Care ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 1•14 Convulsions ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 1•14 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... 1•14 Accident ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0•57 Other Causes ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 2 2 ... 1 4 3 3•97 14 9 16 11 2 3 9 4 2 1 43 28 8 12 17 17 20 7 10 14 98 78 100•00 Totals 23 27 5 13 3 71 20 34 27 24 176 — Percentage of Total 13 •1 15•3 2•8 7•4 1•7 40•3 11•4 19•3 15•4 13•6 ... ... M. 55•7% f. 44•3%_ Nett Births in the year. Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate Total. M. 1,321 65 1,386 94 4 98 f. 1,299 58 1,357 73 5 78 Totals 2,620 123 2,743 167 9 176 119 Form T53. TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary (or Dispensaries) during the year 1928. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during (a) Definitely tuberculous 98 76 — — 8 8 8 2 106 84 8 2 (b) Doubtfully tuberculous — — — — — — — — 27 34 17 13 (c) Non-tuberculous 83 106 69 43 B.—Contacts examined during the (a) Definitely tuberculous 2 2 - — — — - — 2 2 — — (b) Doubtfully tuberculous 4 b 3 2 (c) Non-tuberculouS 23 53 35 41 C.—Cases written off the Dispensary (a) Cured 2 4 - 1 — - 3 3 2 4 3 4 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) 127 188 120 100 D.—Number of Persons on Dispensary Register on December 31st (a) Diagnosis completed 338 241 73 84 29 28 91 SO 367 269 164 134 (b) Diagnosis not completed. — — — — — — — 19 21 14 11 Two cases written off as "cured" have since been restored to register. 1. Number of persons on Dispensary Register on January 1st 979 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 37 2. Number of patients transferred from other areas and of "lost sight of " cases returned 31 10. Number of consultations with medical practitioners:— 40 3. Number of patients transferred to other areas and cases "lost sight of " 118 (6) Otherwise 385 11. Number of other visits by Tuberculosis Officers to Homes 141 4. Died during the year 107 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,865 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 28 13. Number of (a) Specimens of sputum, &c., 556 (& 842 outside) 6. Number of attendances at the Dispensary (including Contacts) 3,912 (b) X-ray examinations made in connection with Dispensary work 142 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or supervision 14. Number of Insured Persons on Dispensary Register on the 31st December 467 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 77 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of 16. Number of reports received during the year in respect of Insured Persons:- (a) "Light" treatment 266 (b) Other special forms of treatment 179 (a) Form G.P. 17 1 (b) Form G.P. 36 157 120 . TUBERCULOSIS SCHEME OF THE METROPOLITAN BOROUGH COUNCIL OF BATTERSEA. F°»» T56- (a) Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1928, arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1921. 1921—5. 1926. 1927. 1928. Class T.B minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. | Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. 1 Total (Class T.B. plus & T.B. minus) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. 1 Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus.) ALIVE. Discharged as cured. Adults M. — - - - 48 3 1 - - 1 - - - - - - - - - - - - - - - - - - - - F. - - - - 54 4 - - - - - - - - - - - - - - - - - - - - - - - - Children M. - - - - 104 1 - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - 106 2 - - - - - - - - - - - - - - - - - - - - - - - - Disease arrested. Adults M. 15 7 3 - 25 5 3 4 - 7 3 - - - - - - - - - - - - - - - - - - - F. 9 2 2 - 13 10 - 3 - - - - - - - - - - - - - - - - - - - - - - Children M. 17 - - - 17 6 - - - - - - - - - - - - - - - - - - - - - - - - F. 16 1 - - 17 3 1 - - - - - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults M. 10 13 6 2 31 9 17 30 - 47 4 3 16 5 24 13 8 22 5 35 15 11 43 13 67 - - - - - F. 7 4 5 2 18 11 10 11 5 26 5 3 8 5 16 7 1 17 6 24 19 3 26 21 50 - - - - - Children M. 5 - — - 5 2 - 1 - 1 3 - - - - 1 - 1 - 1 2 - - - — - - - - - F. 8 2 1 1 12 9 - 1 - 1 3 - - - - 2 - 2 - 2 1 - - - - - - - — - Condition not ascertained during the Year. 30 5 5 — 40 14 8 14 3 25 2 — 2 2 4 5 1 3 1 5 - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register. — — — — 540 67 33 73 33 139 6 5 15 4 24 8 — 17 — 17 4 2 2 2 6 - - - - - DEAD. Adults M. - - - - 234 19 16 99 124 239 2 2 17 24 43 - - 7 20 27 2 - - 9 9 - - - - - F. - — - - 178 6 12 50 88 150 4 - 9 15 24 5 - 9 14 23 2 - - 7 7 - - — - - Children M. - - - - 11 3 - 2 3 5 - - - - - 1 - - - - - - - - - - - - - - F. - - - - 27 5 1 2 1 4 - - — 2 2 - - - - - - - - - - - - - - - TOTALS — — — — 1,480 179 102 290 257 649 34 13 67 57 137 42 10 78 46 134 45 16 71 52 139 - - - - - 121 (b) Non-Pulmonary Tuberculosis. form tm Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the 1 ast record made during the year to which the Return relates. Previous to 1921. 1921—5. 1926. 1927. 1928. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. ALIVE. Discharged as cured. Adults M. — — 1 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children M. — - - 9 9 2 1 - 6 9 - - - - - - - - - - - - - - - - - - - - F. 3 1 2 8 14 2 2 - 10 14 - - - - - - - - - - - - - - - - - - - - Disease arrested. Adults M. 3 - - - 3 - 1 3 - 4 1 - - - 1 - - - — - - — — - - - - — — — F. - - - - - 2 1 - 2 5 - - - 1 1 1 - - - - - - - - - - - - - - Children M. 3 - - 5 8 6 4 2 19 31 1 - - 3 4 1 - 1 - 2 - - - - - - - - - — F. - 1 — 8 9 3 2 - 10 15 1 - - 3 4 — - - 1 1 - — - - — - - - - — Disease not arrested. Adults M. - - 1 - 1 - - 3 - 3 2 1 1 - 4 5 - - 3 8 4 1 1 1 7 - - - - - F. - - 1 1 2 3 - 2 - 5 1 1 - 2 4 1 - - 1 2 1 2 3 2 8 - - - - - Children M. — — - - - 3 2 - 16 21 2 1 2 8 13 1 - 2 - 3 3 — — 3 6 — — - — — F. - - - 4 4 1 1 - 8 10 1 — - 4 5 1 1 1 6 - — 1 1 2 4 - - - - - Transferred to Pulmonary - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - Condition not ascertained during the Year. 2 — 2 2 6 8 3 3 19 33 2 1 — 3 6 — 3 1 4 8 - - - - - - - - - - Lost Sight of or otherwise removed from Dispensary Register. 19 8 12 44 83 15 1 5 35 56 2 2 2 4 10 1 1 1 2 5 — — — 1 1 — — — — _ DEAD. Adults M. 1 - - - 1 4 - - - 4 - - - - - 1 - - - 1 - - - - - - - - - - F. 1 1 — 3 5 - 1 3 2 6 - - - - - - - - - - - - - - - - - - - - Children M. - - - - - 2 - - - 3 - - - - 1 - - - - - - - - - - - - - - - F. 1 - - 8 9 - 1 - 2 3 - - - - - - — - - - — - 1 - 1 - - — — - TOTALS 33 11 19 93 156 51 21 21 131 224 13 6 7 28 54 12 5 6 17 40 8 4 6 9 27 - - - - - 122 APPENDIX. BATTERSEA TUBERCULOSIS DISPENSARY. Annual Report, 1928. To the Medical Officer of Health. I herewith submit a report on the work of the Borough Tuberculosis Dispensary for the year 1928. In June, 1928, the premises acquired by the Council at "Southlands," High Street, part of which was adapted as a new Tuberculosis Dispensary, were occupied. The removal from the old Dispensary premises at 179 Battersea Bridge Road, where the Dispensary had been since its inception in 1911, was carried out with expedition and with very little dislocation of the ordinary Dispensary work. For many years the work has been carried on with difficulty owing to the limited accommodation and the unsuitability for the purpose of the old building, and the new premises have proved to be very satisfactory and have been much appreciated both by the staff and by the patients. During the year under review the staff of the Dispensary has remained unchanged. The ordinary routine work of the Dispensary has been continued in the usual way. The closest co-operation is maintained with the General Practitioners in the area and such assistance as the Dispensary is able to provide is at their disposal. Each year the number of sputum examinations made on behalf of General Practitioners increases, and reports are sent to them on their patients who are discharged after a period of Institutional treatment under the London County Council's Tuberculosis Scheme. The value of the early diagnosis of Tuberculosis cannot be over-estimated, both from the point of view of treatment and prevention of infection, and one of the main duties of the Tuberculosis Dispensary is to find the disease at as early a stage as possible. The co-operation of the General Practitioner in this direction is all-important, as it is mainly through him that patients attend the Dispensary. No effort is spared to arrive at a definite diagnosis in each patient as soon as possible after a period of intensive observation. There is no doubt that as the co-operation between the General Practitioners and the Dispensary has become closer, so cases of Pulmonary Tuberculosis have been found at an earlier stage of the disease than was the case several years ago. Fewer patients attend the Tuberculosis Dispensary now for the first time with signs of advanced Tuberculosis. At the same time it must be admitted that the majority of the patients who attend the Dispensary for the first time are not really suffering from Tuberculosis in an early stage. They are intermediate cases and have had symptoms of chest trouble for many months before their first attendance. I am of the opinion that the insidious nature 123 of the disease and the comparative freedom from troublesome symptoms are responsible in many cases for the failure of patients to seek medical advice when the disease is still in an early stage. The true significance, however, of even a small hæmoptysis or of pleurisy with effusion as probable evidence of Tuberculosis is not yet sufficiently appreciated by some of the medical profession. With regard to the early diagnosis of Tuberculosis much assistance in the way of X-ray examinations, &c., has, as in past years, been received from St. Thomas's Hospital, with which the Tuberculosis Dispensary is closely linked as part of the Tuberculosis scheme of the Borough. Institutional treatment is provided by the London County Council and the majority of patients who have been recommended for such treatment have been accepted. In some advanced cases, however, the Council has reported its inability or unwillingness to provide residential treatment and when the patient is unwilling to go to the Poor Law Hospital he must needs remain at home— a source of infection often to the other inmates. During 1928, 137 patients were sent away for institutional treatment by the London County Council. Of this number 32 or approximately 23 per cent. took their own discharge. It is a well known fact that many Tuberculous patients are quite unsuitable temperamentally for residential treatment,and this applies more particularly to the more advanced cases. The majority of patients who take their own discharge come from the type of institution which admits the advanced case. From King George V. Sanatorium, Godalming, and from Pinewood Sanatorium comparatively few patients take their own discharge. The problem of finding employment for the ex-sanatorium patient who as a result of his Sanatorium treatment or otherwise has lost his occupation remains as difficult as ever. In the present state of the labour market it is almost an impossibility to find such patients suitable work. The consequences of this, both from a mental and from a physical point of view, are definitely harmful. It is gratifying, however, to be able to report that many employers readily assist patients to recovery by assuring them that their posts shall be kept open for them pending their return from Sanatorium. Artificial pneumo-thorax treatment is of great value in the treatment of certain types of Pulmonary Tuberculosis. An increasing number of Dispensary patients now receive this form of treatment. Treatment is commenced in Sanatorium and continued at Brompton Hospital or St. Thomas's Hospital on the patient's return, or the whole course is carried out at one or other of those hospitals without sending the patients to a residential institution. In one Dispensary patient the operation of thoracoplasty was carried out at Brompton Hospital during 1928. Many school children who are "Contacts" of a Tuberculous patient are referred to the School Medical Officer for observation and "delicate" children who attend the Dispensary for examination are similarly 124 referred. The majority of the children who attend Springwell House Open Air School on Clapham Common reside in the borough and derive much benefit from the day sanatorium regime at this School. The number of new patients attending the Dispensary during the year was 15 less than in the previous year and the number of "Contacts" examined 29 less than in 1927. 14 more adult "Contacts" were examined and 43 less children. Fewer attendances were made at the Dispensary by patients. The main function of the Dispensary is to serve as a centre for diagnosis and supervision, and treatment, apart from any specialised form, is not undertaken unless special circumstances make this necessary. It is desirable that as far as possible the patient should receive treatment from his own doctor in consultation with the Tuberculosis Officer. During 1928, 137 patients received institutional treatment under the London County Council's Tuberculosis Scheme. The average length of stay was 112 days, and the average period of waiting between recommendation and admission to an institution was 15 days. Material improvement, as a result of institutional treatment, was shown by 59 patients. 32 patients took their own discharge from institutions. During 1928, 629 new patients attended the Dispensary for examination. In addition 18 patients were transferred from other areas and attended the Dispensary for the first time during the year. Of the 629 new patients 462 were adults and 167 children. The "Contacts" examined at the Dispensary numbered 170— 89 adults and 81 children. Of the new patients and "Contacts" 227 were found to be suffering from Tuberculosis—213 adults and 14 children. During the year 2 patients in whom the diagnosis was at first doubtful were found to be suffering from Tuberculosis, and these added to the 227 new cases made a total of 229 notified cases. Of this number 109 had already been notified to the Medical Officer of Health, so that 120 were primary notifications from the Dispensary. The total number of attendances at the Dispensary during 1928 was 3,912. During the year 181 visits were paid by the Tuberculosis Officer to the homes of patients and 4,865 by the Dispensary Nursing Staff. In addition to admissions to institutions provided by the London County Council 28 patients were admitted to St. James's Hospital during the year. The majority of those patients were suffering from Tuberculosis in an advanced stage and were 125 suitable for Sanatorium treatment proper. In other cases, where this course appeared desirable, patients were advised to enter St. James's Hospital pending a vacancy in one of the London County Council's Institutions. Number of Dispensary patients who died during 1928 103 Number of Dispensary patients discharged as "cured" or disease arrested 13 Number of Dispensary patients who ceased to attend 34 Number of Dispensary patients who removed to other districts (and transferred to the Medical Officer of Health of the districts concerned) 53 The number of sputum examinations carried out at the Tuberculosis Dispensary during 1928 was 1,398—282 (20-2 per cent.) of which were positive. Of the total number of specimens examined 517 were sent by medical practitioners and 383 specimens were examined for St. James's Hospital. The number of reports sent to public bodies during 1928 was 1,004. Consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 956. The number of reports received during the year in respect of insured persons was :— (a) Form G. P. 17 1 (b) Form G. P. 36 157 175 patients were referred to hospitals, 142 of which were sent to St. Thomas's Hospital for X-ray examinations. Open Air School. Accommodation 125 Number on roll, 31st December, 1928 146 Average attendance during 1928 123-7 Number admitted during 1928 53 Number discharged during 1928 48 Reasons for discharge— (a) Fit for Elementary School 4 (b) Fit for work 29 (c) Transferred to Hospital or Sanatorium 9 [d) Removed from district 5 (e) Transferred to special school 1 Gain or loss in weight of children who have been in the school for more than 12 months— Children who have gained weight 105 Average gain in kilos. 3.83 Children who lost weight or whose weight was stationary Nil 126 Tuberculosis Dental Treatment. Total attendances 243 Sessions held 49 Average attendance per session 4.95 Extractions, 48; scalings, 3; fillings, 26; dentures supplied—whole sets 5, partial sets 2; repairs to dentures, 1; dressings, 22; advice, 88 (average per session 3.98) 195 The Tuberculosis Care Committee. The Care Committee met weekly during 1928, and the following is a summary of the work carried out by the Committee :— Battersea Borough Council—extra nourishment 90 Wandsworth Board of Guardians—financial assistance, 6; dentures, 2; clothing, 7; extra nourishment, 16; other assistance, 1 32 United Services Fund—financial assistance, 10; clothing, 15; other assistance, 1 26 Charity Organisation Society—financial assistance, 3; dentures, 3; clothing, 6; other assistance,1 13 London County Council—housing 5 Other Agencies—clothing, 4; financial assistance, 1 5 Training and Employment— Former employers 1 Battersea Borough Council 1 After Care Association 2 Labour Exchange 1 Dr. Jane Walker 2 Charity Organisation Society 1 Groom's Crippleage 1 The contributions of patients who were sent away for appropriate institutional treatment, collected by the Dispensary and remitted to the London County Council, amounted to £684 6s. 0d. The following are some illustrations of the work done by the Care Committee throughout the year:— C.E., aged 16.—Boy was doing well at elementary school, contracted enteric—in hospital for nine months. Tubercular trouble developed in hip—transferred to hospital for surgical tuberculosis. Away from home for three years. Could not get employment as he had had no training and left school before he had finished his education. Care Committee referred case to After Care Association for Crippled Children and in a very short time he had started commercial training and was doing well. F. G., aged 64.—Patient's father. Had been a butcher for many years but was unable to get further work as he was nearly blind. The family were in poor circumstances, and the 127 mittee took up the matter with the London Meat Trades' and Drovers' Benevolent Association, and obtained a grant of 30s. per month for a year. J. N.,aged 47.—Ex-service man suffering from tuberculosis. Institutional treatment recommended—man sent away for three months. Committee wrote to the Guardians, and on their recommendation clothing and dentures were granted to the man, and financial assistance. Later on the case ceased to be eligible for financial assistance from the Guardians, and the Committee then sent on the case to the United Services Fund, who granted financial assistance until the patient's return. As the man was still unfit for work the Committee arranged with the London County Council for five of his children to be boarded out under the Council's Contact Scheme. L. P., aged 25.—Approved Society suspended him from all future benefit as he had undergone a term of imprisonment. The Committee took up the matter with the Approved Society who reconsidered the matter and re-instated the patient and paid to him arrears of benefit that had accrued. A. H., aged 66.—Widow, tuberculous. Only income old age pension of 10s. per week. Lived with daughter who was really only earning enough to keep herself. Had worked at a large stores at Westminster for 43 years. The Care Committee wrote to these stores, and as a result a grant of 5s. per week was made to the patient. 128 APPENDIX. Report of the Medical Officer of Health as to the Health Exhibition, held in the Battersea Town Hall, from the 5th to the 8th JUNE, 1928. The Health Exhibition held by the Council from the 5th to the 8th June was, judging by the large attendances of the public on the four days it remained open, very successful. The object of the Exhibition was to interest the inhabitants of the Borough in the work which the Council have been carrying on in securing a high standard of Health and Sanitation in Battersea, for the past quarter of a century, in accordance with their duty and responsibility as the local Sanitary Authority. The Exhibition embraced all the main activities of the Health Department, and was held in the Grand Hall, kindly lent for the week by the Finance Committee. The Exhibits were set out in 26 stalls, of which 24 were in the Grand Hall and 2 in the Gentlemen's Cloakroom. The Lower Hall was used for lectures and cinema displays, and the kitchen adjoining for Cooking Demonstrations. Valuable assistance was given by Public Authorities, Voluntary Health Organisations, Hospitals, &c., many of them providing interesting health exhibits of an instructive character, and in many cases free of charge, or on merely nominal charges to cover expenses incurred by them. The arrangements as to safety from fire, &c., were approved by the County Council whose Officers concerned expressed themselves as fully satisfied. Great credit is due to the ladies who voluntarily gave up their valuable time to help in the decoration of the various stalls and in arranging many of the Exhibits. The opening ceremonies were carried out in accordance with the programme. On the first day, the Exhibition was opened by His Worship the Mayor of Battersea, who was supported by about fourteen of his Metropolitan colleagues, and other distinguished visitors. On Wednesday the opening ceremony was performed by Dr. John Fairbairn, by Professor Louise Mcllroy on Thursday, and by Lady Islington on Friday. There were approximately 450 invitations issued for the first day's opening ceremony, which was very numerously attended, and about 700 general invitations were issued. The exhibits included models of the various phases of Maternity and Child Welfare Work, e.g., Maternity Hospital, Bolingbroke Grove, showing models of Ward, Labour room, Ante-Natal and Post-Natal Clinics, Dental Clinic, &c. These interesting exhibits were supplemented by those of the Voluntary Organisations carrying on ancillary work and linked up in the Council's scheme of Maternity and Child Welfare, including the Battersea School for Mothers, 129 Women's League of Service, St. Thomas's Cornwall Babies Hostel, St. Margaret's Hostel and Day Nursery, &c. The Exhibit of the Victoria Hospital for Children, Tite Street, Chelsea, of a complete installation of the equipment for Artificial Sunlight Treatment was a great attraction to visitors, who were afforded an opportunity of seeing this treatment demonstrated practically on children. Other exhibits in this Section of the Exhibition were the Travelling Caravan Exhibit from Carnegie House and the British Social Hygiene Council (V.D.). The Tuberculosis Caravan Exhibit of the National Association for the Prevention of Tuberculosis was very well mounted, and was largely attended by visitors. This Exhibit provided a highly educational demonstration of the modern preventive measures being taken throughout the country against the White Scourge, and the presence of Dr. Brand, the Director, and his Assistant, Dr. Peill, contributed greatly to its educational value. The Dental Board of the United Kingdom provided an excellent exhibit of dental educational work, showing the need for the care of the teeth and how this may be secured. In the public Health Section, several stalls were devoted to the preventive work of the Health Department of the Council in respect of infectious and other diseases, protection of the food and water supplies, general sanitation, rat repression, drainage, &c. Specially fine and instructive exhibits were those provided by the Clinical Research Association, the Council's bacteriologists, showing laboratory work in the diagnosis and prevention of disease; and by the Metropolitan Water Board, showing how the water supply of London is maintained and protected against contamination. The model of the Borough Tuberculosis Dispensary and the exhibit of Springwell House Open-Air School for Tuberculous children were also interesting features of this Section of the Exhibition. In the Housing Section, inter alia, the model of one of the tenements built by the Council in the Plough Road Slum Clearance and Improvement Scheme was much admired. The Metropolitan Asylums Board kindly lent a model showing the methods carried out for the treatment of Surgical Tuberculosis, Rickets and other crippling diseases of children at Queen Mary's Hospital for Children, Carshalton. The programme included lectures on various health subjects by distinguished specialists. Those given by Professor Louise Mcllroy, Dr. Murray Levick, Mr. Geo. Thomson, Dr. Charles Porter, Dr. Mabel Brodie, Mr. R. Heeguard Warner, and others, were well attended, and contributed greatly to the educational value of the Exhibition. A series of talks illustrated by cinema demonstrations given by Dr. Sydney Peill, of the National Society for the Prevention of Tuberculosis, to selected parties of the senior scholars from the public elementary schools in the Borough was very popular. The 130 number of children who attended was over a thousand. Each party was in charge of a teacher and was well conducted and attentive. Valuable results may reasonably be expected to follow instructional talks on health subjects to young and impressionable audiences such as these. Cookery demonstrations in the kitchen adjoining the Lower Hall were given daily by experienced teachers in Cookery and Domestic Science, some of which were provided by the Borough Electricity Department. The articles cooked were sold to the public and the sale practically covered the entire cost of their demonstrations. Films on Health subjects were shown daily and were invariably attended by large audiences. Entertainments.—During the period the Exhibition remained open entertainments and displays of singing and dancing were given by pupils from the London County Council public elementary schools—Ethelburga Street School on Wednesday, Bolingbroke Road School on Friday, and Shillington Street School on Tuesday and Thursday—which were greatly appreciated by the visitors to the Exhibition. Two interesting displays of Physical Exercises were given by children from Springwell House (L.C.C.) Open-Air School. The Gymnastic class of the Battersea Men's Institute also gave two excellent displays of Physical Exercises, and the Institute provided in addition an orchestra which gave a fine selection of popular music. The Organ Recitals given at the opening ceremony on the first day and daily each evening by Mr. John Sellwood added greatly to the enjoyment of visitors. The Committee and the Council will no doubt feel greatly indebted to those responsible for providing these excellent musical and other entertainments free of charge, which greatly contributed to the success of the Exhibition. Competitions in baby craft, knitting and cooking, &c., were provided and prizes and certificates were given to the successful candidates. There was a parade of mothers and children, who took part in this Competition before the Mayor and Mayoress and Lady Islington. The Mayor distributed the prizes and certificates. Subsequently some time after this interesting ceremony had finished, some dissatisfaction was expressed by disappointed persons, probably owing to a misunderstanding that it was a baby show, and that these prizes were given to selected babies. An explanation was given to those aggrieved, and subsequently steps were taken at the Welfare Centres to make it clear that there was no baby show. A statement showing the expenditure upon the Exhibition will be found on p. 75. G. QUIN LENNANE, Town Hall, Battersea, S.W. 11. Medical Officer of Health. June, 1928. 131 APPENDIX. REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE HEALTH COMMITTEE. 3rd July, 1928. A complaint has been received signed by a number of residents in the vicinity of the Poli Varn Factory, Harbut Road, dated the 16th June, 1928, of the deposit of dust from this factory which affects their houses, and I have personally investigated the matter. The complaint appears to have been influenced to some extent by the enquiry which has just been concluded by the Coroner in which the deaths of two of the women workers employed in this factory are shewn from medical evidence to have been due to silicosis, from the inhalation of dust containing silica used in the manufacture or preparation of some of the firm's products. The exhibition on the part of the residents in the neighbourhood of this factory of a certain amount of alarm and anxiety as to risk to health is not, in the circumstances, surprising, but even if evidence was available that there was any serious discharge of dust from these works, the risk to health of persons living outside the premises would, in my opinion, be relatively slight. The factory has been under observation since the complaint was received by the Senior and District Sanitary Inspectors and myself; and many houses, occupied by persons who signed the complaint have been inspected, and little or no evidence of the deposit of dust from the factory has been observed. The factory is situate in Harbut Road, in the midst of a fairly populous residential area, and the yards and gardens of several of the houses abut on the factory premises. The processes carried on at these works consist of the making of metal polish, boot polish, and furniture polish, etc. The first mentioned is made from powdered quartz (mainly silica), which is mixed with dry soap powder, the resultant product being sold as a proprietary article called "Scourine." The raw material used in the preparation of the metal polish is purchased and consists of quartz in a fine amorphous and powdered state. The process of preparation is briefly as follows:— The powdered quartz is dumped from a sack into a hopper and passes into a "churn," a closed metal bin or trough, and is there mixed with a saponaceous powder, thence it passes through a conveyor to an elevator on the first floor, to a filler provided with six funnels. These discharge into containers, which are 1 lb. paper cartons. These containers or cartons are filled by girl operatives, and are passed on to a sealing machine, after which they are labelled and ready for sale. 132 The process is essentially a dusty one, and, having regard to the risk to the actual workers, must be considered a dangerous industry. Precautions have been taken to minimise the risk to the workers by the provision of dust collecting devices, and these precautions include measures to prevent the dust from the works escaping to the outside so as to give rise to nuisance. So far, therefore, on the results of my observation and inspection into the complaint of the escape of dust from these works to the premises of the adjoining residents, I am unable up to the present to establish the existence of a nuisance. The apparatus used to prevent the escape of dust consists of a cone-shaped metal container outside the factory building, into which opens an extraction shaft. The dust is drawn from the factory through this-shaft into the container, when it is collected. The container itself is covered, but provision has to be made for ventilation, and at times, especially in windy weather, some fine dust intermittently escapes. Suggestions towards further improving this plant were made, and are now being carried out, with a view to securing a more complete protection against the escape of dust. Most of the residents who signed the complaint of nuisance from these works admitted that the nuisance has been much less during the past three months, which period coincides with the installation of this plant. So far as this complaint of the residents adjacent to these works is concerned as to nuisance from the escape of dust from the factory premises, there is not sufficient evidence at present to justify action by the Council. Systematic observation will, however, be kept, and, in the event of its being necessary, a further report will be submitted to the Committee. It will be of interest to refer in this connection to the result of the recent enquiry into the deaths of two young women employed in these works from silicosis. It is clear, from the medical evidence given by Sir Bernard Spilsbury and other medical witnesses, that the disease from which these girls died was contracted from the inhalation of dust containing silica. It is further of interest that four other deaths occurred amongst the employees in this factory which were registered as being due to Tuberculosis. All these deaths occurred within the past two and a half years, and, as pointed out by the Coroner in his summing-up, "we have dropped almost by accident upon a very frightful state of affairs, and thanks to the acuteness of Dr. Maccormac," who carried out the post-mortem examination on the first of the two cases in which inquests were held, the second victim who died later in Brompton Hospital was ascertained to have suffered from the same disease, and, by implication, probably in at least three of the four previous deaths. The Poli Varn premises are a factory and, as such, come under the supervision of the Home Office Inspector, and the Officers of 133 the Council are only responsible in the case of factories for the supervision of sanitary accommodation. From the records in the Health Department, these premises were a workshop up to 1924, when, on the introduction of mechanical power, they automatically passed to the supervision of the Home Office Inspector as a factory. It will be noted that it was in 1926 that the first of the series of deaths amongst the workers occurred, and it was only gradually, as stated at the inquest, that the precautionary measures, which are not even yet complete, were carried out. I note in the evidence given by the Home Office Inspector that he is stated to have said: "I visited the place in 1926 before it became a factory." As already mentioned, the record in this Department shows that it became a factory on the 1st August, 1924. (Signed) G. QUIN LENNANE, Medical Officer of Health.