AC 4386 BAT 28 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1929. by G. QUIN LENNANE, F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. Wightman & Co., Ltd., Printers, Dugdale Street, S.E. 5, and Regency Street, S.W. l. Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea FOR THE YEAR 1929. 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, 1928. Chairman : Councillor E. W. Coles. His Worship the Mayor. (Councillor J. Edwards, j.p.) Alderman J. R. Archer Councillor Mrs. K. S. D. Baker. „ Rev. E. J. Daly. „ J. Hendrick. „ Miss G. S. Jacob, r.r.c. „ R. Moore. „ J. Morgan. „ N. G. M. Prichard, b.sc. „ Mrs. E. R. Reed. „ Mrs. M. J. Robinson. „ Mrs. M. H. Rose. As constituted 9th November, 1929. Chairman : Councillor E. W. Coles. His Worship the Mayor. (Councillor Rev. A. G. Prichard, j.p., l.c.c.) Alderman J. R. Archer. Councillor A. Bailey. „ Mrs. K. S. D. Baker. „ Rev. E. J. Daly. „ J. Hendrick. „ Miss G. S. Jacob, r.r.c. „ P. E. Molloy. ,, R. Moore. „ J. Morgan. „ Mrs. M. J. Robinson. „ Mrs. M. H. Rose, Maternity and Child Welfare Committee. As constituted 9th November, 1928. Chairman : Councillor Mrs. M. H. Rose. His Worship the Mayor. (Councillor J. Edwards, j.p.) The Health Committee, as above. As constituted 9th November, 1929. Chairman : Councillor Mrs. M. H. Rose. His Worship the Mayor. (Councillor Rev. A. G. Prichard, j.p., l.c.c.) The Health Committee, as above. Housing Committee. As constituted 9th November, 1928. Chairman : Councillor H. Harling. His Worship the Mayor. (Councillor J. Edwards, j.p.) Councillor J. R. Blackburn. „ W. Bridge-Collyns. „ Rev. E. J. Daly. „ T. R. Jones. „ W. J. Mciver. „ P. E. Molloy. C. J. Powell. N. G. M. Prichard, b.sc. „ Mrs. M. J. Robinson. ,, E. S. Strange, j.p. Alderman I. O. Thomas. As constituted 9th November, 1929. Chairman : Councillor H. Harling. His Worship the Mayor. (Councillor Rev. A. G. Prichard, j.p., l.c.c.) Councillor C. Barrington. ,, W. Bridge-Collyns. „ Rev. E. J. Daly. „ W. E. Heath. W. J. McIver. „ P. E. Molloy. „ C. J. Powell. „ E. S. Strange, j.p. Alderman I. O. Thomas. Councillor G. Weadriff. „ H. G. White. (Committee to issue certificates and reports under the Kent and Mortgage Interest Restrictions Acts, 1920 and 1923, as to the condition of dwelling houses. As constituted 9th November, 1928. Chairman : Councillor H. Harling. His Worship the Mayor. (Councillor J. Edwards, j.p.) Councillor W. Bridge-Collyns. Alderman G. Fineran. Councillor W. Geard. „ E. S. Strange, j.p. As constituted 9th November, I9J9. Chairman : Councillor H. Harling. His Worship the Mayor. (Councillor Rev. A. G. Prichard, j.p., l.c.c.) Councillor C. Barrington. Alderman G. Fineran. Councillor E. S. Strange, j.p. H. G. White. 2 Tuberculosis Committee. As constituted 9th November, 1928. The Health Committee, as above. As constituted 9th November, 1929. The Health Committee, as above. Tuberculosis Care Committee. As constituted 9th November, 1928. Chairman—Alderman J. R. Archer. Councillor Mrs. K. S. D. Baker. Alderman G. Fineran. Councillor R. Moore. „ C. H. Young, j.p. Other Members : Mrs. E. W Coles. Mrs. F. Young. Members of the late Dispensary Committee : Mrs. Dermott. Mr. G. J. W. Gilder. Mr. B. R. Thorne. Members of the late Voluntary Care Committee : Miss B. Home. Miss E. Morris. Consultative Members : L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Representative of the Invalid Children's Aid Association. Representative of the War Pensions Committee. Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, St. Thomas's Hospital (Miss Cummins). After-Care Sister, Victoria Hospital (Miss Underwood). Representative of the London Insurance Committee (Mr. R. A. Hanson). Representative of the S.L. District Nursing Association (Miss A. M. Stanford). Representative of the British Red Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector (Miss J. Round). As constituted 9th November, 1929. Chairman—Alderman J R. Archer. Councillor Mrs. K. S. D. Baker. Alderman G. Fineran. Councillor R. Moore. „ C. H. Young, j.p. Other Member : Mrs. E. W. Coles. Representative of the London Insurance Committee : Mr. G. W. Tatler. Representatives of the Wandsworth Guardians : *Mrs. F. E. Mills. *Mrs. F. Young. Members of the late Dispensary Committee : Mrs. Dermott. Mr. G. J. W. Gilder. Members of the late Voluntary Care Committee : Miss B. Home. Miss F.. Morris. Consultative Members : L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Representative of the War Pensions Committee (Mr. T. Jones). Representative of the Invalid Child ren's Aid Association. Lady Almoner, St. Thomas's Hospital (Miss C. Morris). After-Care Sister, Victoria Hospital (Miss Underwood). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, King's College Hospital (Miss Edmonds). Representative of the S.L. District Nursing Association (Miss A. M. Stanford). Lady Almoner, Brompton Hospital (Miss Marx). Representative of the British Red Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector (Miss J. Round). * Until 1st April, 1930. 3 Staff of public Health Department. (At 31st December, 1929). 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— F. PORTER SMITH, M.R.C.S., L.R.C.P. 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. Miss V. Ventris, H.V. 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. Appointment vacant. Mr. H. E. Wheeler (Housing) San. Insp. Board's Cert., and Meat Insp. Cert. Food Inspector—Mr. J. A. H. Brownlow, Cert. S.I.E.J.B., Meat Insp. Cert. 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). Mr. E. Cole. Mr. W. Halstead. Mr. H. C. Godfrey. Mr. R. Graham. Miss G. E. Newton. Mr. W. C. Turner. Miss R. Dove. Mr. F. Pedrick. Office youth. Miss M. A. Weller (M. & C.W. Records). Maternity Home— Matron—Miss M. Fevyer, 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 M. E. 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 1929. I regret that, owing to my long absence through illness, the Report is much later than usual. The record of the year's work is on the whole satisfactory. The decline in the birth-rate, which is a notable feature of the vital statistics of the Borough and of the country generally, was maintained in 1929, and, with the exception of the year 1918, has reached the lowest figure ever recorded in Battersea. The birthrate is 3.6 per 1,000 of the population lower than in the past 10 years, and the excess of births over deaths, i.e. the natural increase of population, was only 325. The general death-rate is markedly higher in 1929 than in the previous year. This is a general feature of the vital statistics of London and of the country generally, and is accounted for by the high death-rate from Influenza and respiratory diseases in the first quarter of the year. The infant death-rate is slightly lower than in 1928, notwithstanding that infant mortality, in common with the general death rate, was exceedingly heavy in the first quarter of the year, and that a severe outbreak of whooping-cough occurred, which was responsible for many deaths of infants under one year of age. The Maternity and Child Welfare work of the Council was carried on with unabated activity during the year. A new Centre and Clinic has been provided to serve the needs of the south-east area of the Borough, and was opened early in the new year at the disused Gideon Road School, leased for the purpose from the London County Council. The Health Visiting Staff has been increased by an additional officer to meet the extension of the Council's Scheme. The development of the ante-natal side of the work has been a satisfactory feature of the Maternity and Child Welfare Scheme, and the new building erected as an out-patient annexe to the Borough Maternity Hospital, by the increased facilities provided for the attendance and examination of patients, will very greatly improve the value and efficiency of this important work. The 5 new building provides excellent accommodation, waiting-rooms, clinics and, on the upper floor, additional wards and a nursery for infants. The rooms are well-lighted and ventilated and provided with central heating and fully equipped for the special purposes for which they are intended. The Borough Maternity Hospital was fully occupied during the year, and the District Midwifery Service directed from the Hospital continued its useful function with satisfactory results. Housing activities were mainly confined to the repair of unfit and seriously defective houses, and to the abatement of nuisances under the Housing and Public Health Acts. Unfortunately, I have again to refer to the serious and, in many cases, dangerous overcrowding, owing to the shortage of housing accommodation in certain of the lower wards of the Borough. It is to be hoped that the new Housing Bill, which is expected to become law some time in 1930, will provide for relief in the direction of adequate and suitable housing accommodation for the poorer element of our population at rents which they are capable of paying. I have again gratefully to acknowledge the continued support and assistance extended to me by the Mayor, the Chairmen of the various Committees and Members of the Council. I have also to express my thanks for the kind assistance of my Colleagues, the Chief Officers of the Council; and to the Staff of the Public Health Department my thanks are also due for their loyal and devoted services. G. Quin Lennane, Medical Officer of Health. Electric House, 204, Lavender Hill, S.W. 11. 6 CONTENTS. General. • Page. Constitution of Committees 1-2 Staff of Public Health Department 3, 74, 105 Staff of Tuberculosis Department 3,53 Introduction 4-5 Summary of Statistics 8 Births, Marriages and Deaths. Vital Statistics 8,9, 106 Population 9 Marriages 10 Births and Birth-rates 10-11, 17-19,106 Illegitimate Births 11 Deaths in Borough 11-14,17,106,108 Deaths in Public Insitutions and Senile Mortality 14 Comparative Table of Births, Deaths, &c. (1857-1929) 18 Infant Mortality 14-17, 19, 109-112 Illegitimate Infant Deaths .17 Comparative Statistics, Metropolitan Boroughs 17 Notification of Births Act and Still-Births Registration 20 Maternity and Child Welfare. Maternity and Child Welfare Scheme 21 Centres and work done thereat 21-23 Hospital Provision 24 Southwark Diocesan Homes 24 Home Helps 25 Milk and Dinners for necessitous persons 25 Convalescent Homes 26 Nursing Facilities 26 Health Visiting Staff and Statistics of Visits 26-27 Test-feeding (St. Thomas's Cornwall Babies' Hostel) 27—28 Ante-Natal Work, Municipal and Voluntary 28-31 Visiting Work for Hospitals 30-31 V.D 31-32 Maternal Mortality 33 Maternity Hospital 34-37 District Midwifery Service 37-38 Dental Clinic 38-39 Solarium 39 Infectious Diseases—(i.) Notifiable 40 Summary of Notifications 41,107 Bacteriological Examinations 55,61-62 Contacts 40, 42 Small-pox 42 Scarlet Fever 42 Diphtheria and Diptheria Prophylaxis 43-45 Polio-Myelitis and Polio-Encephalitis 45 Enteric Fever, Cerebro-Spinal Fever 45, 46 Puerperal Fever and Puerperal Pyrexia 45 Encephalitis Lethargica 46 Ophthalmia Neonatorum 46-47 Erysipelas 47 Measles and Whooping Cough 47, 48 Tuberculosis 48—59, 113—124 Cases Notified 48-49 Localisation of Disease 50 Non-notification and notification after death 50,52 Deaths from Tuberculosis 50-52 Shelters 52 Dispensary 53-55 „ (Report of) 113—124 Sputum Examination, X-ray Examination 55 Institutional Treatment 55,117 Open-Air School (Day Sanatorium) 53,121 Tuberculosis Dental Clinic 53,121 Care Committee 2, 121 Training and Employment 123, 126-127 Non-Dispensary Patients 55-57 Public Health (Tuberculosis) Regs. 1925 57 Revision of Register 57 Summary Tables 58-59, 113-115 Zymotic Deaths 60 7 Infectious Diseases—continued. Page (ii.) Non-Notifiable Diseases 60-61 Chicken-pox : diarrhoea 60 Influenza : cancer 61 Sanitary Circumstances. Summary Table 63 Legal Proceedings 64-68 Common Lodging Houses 69 Drainage Work 69-70 L.C.C. (General Powers) Act, 1907 and 1927 71 Licensed Premises (Sanitary Conveniences) 70 Smoke and Effluvium Nuisances 70 Water Supply 70 Van Dwellings 71 Model dwellings, staircases 71 Rag Flock Acts, 1911 and 1928 71 Rats and Mice Destruction Act 72 Fouling of Footways by Dogs 72 Personal Cleansing Station 73 Disinfecting Department 74 Health Propaganda 74 Staff, Changes in 74-75 Coroner's Court and Mortuary 76 Protection of the Food Supply. Inspection and Supervision 77 Unsound Food 77 Cow-Houses and Slaughter-Houses 77 Butchers' Shops 78 Public Health (Meat) Regulations, 1924 78 Food and Drugs Adulteration Act, 1928 78 Results of Analysis 79-85 Ice-Cream 85 Milk and Dairies Order, 1926 86 Milk (Special Designations) Order, 1923 87 Milk Shops 87 Public Health (Preservatives, &c., in Food) Regulations 88 Agricultural Produce and Merchandise Marks Acts 88 Artificial Cream Act, 1929 88 Fish Shops, Restaurant Kitchens, Street Stalls 89 Factories, Workshops, &c.—General Tables 90 Factories 90-92 Workshops 90-93 Outworkers and Home Work 93-96 Bakehouses, Warehouses and Wharves 95 Housing. General 97 New Houses 97 Overcrowding 98-99 Repair of Unfit Houses 99-100 Appeals 100 Closing and Demolition Orders 100 Underground Rooms 100 Increase of Rent, &c., Acts 100 Action under Section 5, Housing Act, 1925 101 Insanitary Areas 101 Insanitary Houses 101-103 Statistics and Summary of Housing Work 104-105 Appendices. Table I. Summary of Vital Statistics 106 „ II. Infectious Disease Notifications 107 „ III. Causes of, and Ages at. Death 108 „ IV. Infant Mortality 109-112 Tuberculosis Scheme of the Borough Council— Return of Work of the Dispensary 113-115 Report of Tuberculosis Medical Officer 116-124 8 Summary of Statistics 1929. 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 1929) 161,800 Number of Private Families (Census 1921) 42,988 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value (average 1929) £1,129,703 Sum represented by a penny rate £4,646 2. Extracts from Vital Statistics of the Year. Births— (Males, 1,316 ; females, 1,303) 2,619 Legitimate births (1,271 males, 1,257 females) 2,528 Illegitimate „ (45 males, 46 females) 91 Birth-rate 16.2 Deaths— (Males, 1,154, females, 1,140) 2,294 Death-rate 14.2 Number of women dying in or in consequence of childbirth— From sepsis 2 Other causes 3 Death-rate of infants under 1 year per 1,000 live births. Legitimate 61.3 Illegitimate 98.9 62.6 Deaths from Measles (all ages) 5 „ Whooping-cough (all ages) 43 „ Diarrhoea (under 2 years of age) 22 3. 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 1929 is 161,800. This figure shows a decrease as compared with 1928 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 166,000, and that little 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, 1929. Males. Females. Total. East Battersea 32,188 34,859 67,047 North-West Battersea 22,390 23,882 46,272 South-West Battersea 21,295 27,186 48,481 Total 75,873 85,927 161,800 Wards. No. 1. Nine Elms 12,817 13,525 26,342 No. 2. Park 8,293 9,277 17,570 No. 3. Latchmere 8,732 9,731 18,463 No. 4. Shaftesbury 7,184 7,679 14,863 No. 5. Church 8,739 9,101 17,840 No. 6. Winstanley 9,610 10,277 19,887 No. 7. St. John 3,466 4,800 8,266 No. 8. Bolingbroke 8,185 10,120 18,305 No. 9. Broomwood 8,847 11,417 20,264 Total 75,873 85,927 161,800 10 MARRIAGES. The marriages registered in Battersea during 1929 numbered 1,376. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 17.0. Year. Marriages. Marriage-Rate. 1924 1,367 16.0 1925 1,382 16.1 1926 1,304 15.2 1927 1,428 16.9 1928 1,354 16.5 Mean, 1924-28 1,367 16.1 1929 1,376 17.0 BIRTHS. The number of births registered in the Borough during 1929 was 2,877 (1,458 males, 1,419 females), an excess of 39 males. Of this number, 602 were transferred out, the permanent residence of the parents being outside the Borough, and.344, registered outside the Borough, were transferred here, giving on balance a total of 2,619 births relating to Battersea residents, and a corrected birth-rate of 16.2 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 1929. Sub-Districts. Estimated Population, 1929. Number of Births. Birthrate. East Battersea 67,047 1,170 17.5 North-West Battersea 46,272 831 18.0 South-West Battersea 48,481 618 12.7 Wards. No. 1, Nine Elms 26,342 486 18.4 No. 2, Park 17,570 349 19.9 No. 3, Latchmere 18,463 341 18.5 No. 4, Shaftesbury 14,863 184 12.4 No. 5, Church 17,840 308 17.3 No. 6, Winstanley 19,887 358 18.0 No. 7, St. John 8,266 106 12.8 No. 8, Bolingbroke 18,305 277 15.1 No. 9, Broomwood 20,264 210 10.4 11 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1929, and during the previous decennium 1919-1928:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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 1928 16.7 17.9 19.0 12.8 Average 1919-1928 19.8 21.4 22.7 14.7 1929 16.2 17.5 18.0 12.7 This is the lowest birth-rate recorded in Battersea with the exception of the year 1918. The birth-rate shows a decline in all Wards of the Borough with the exception of Bolingbroke Ward where there is an increase from 13.7 to 15.1. The birth rate in Battersea is 3.6 per 1,000 lower than the average for the previous decennium 1919-1928. The birth-rate for the County of London was 15.8 per 1,000 of the population, and for England and Wales the rate was 16.3. Illegitimate births numbered 91 or 3.47 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 1929, 71 stillbirths were registered as belonging to Battersea. The total number of stillbirths notified during the year was 57. DEATHS. The number of deaths registered in the Borough during 1929 was 3,314. Of these 1,400 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 380 deaths of Battersea residents 12 registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 2,294 (males 1,154, females 1,140). This gives a recorded death-rate of 14.2 compared with 14.1 for London, and 13.4 for England and Wales. According to the factor supplied by the Registrar-General, ror correction of death-rate in reference to age and sex distribution, the corrected death-rate for Battersea during 1929 was 13.7. The distribution of the deaths and the death-rate per 1,000 inhabitants for each of the Sub-Districts and the nine Wards is shown in the following Table. Sub-Districts. Estimated Population 1929. Number of Deaths. Deathrate. East Battersea 67,047 927 13.8 North-West Battersea 46,272 657 14.2 South-West Battersea 48,481 710 14.6 Wards. No. 1, Nine Elms 26,342 363 13.8 No. 2, Park 17,570 274 15.6 No. 3, Latchmere 18,463 272 14.7 No. 4, Shaftesbury 14,863 191 12.9 No. 5, Church 17,840 245 13.7 No. 6, Winstanley 19,887 263 13.2 No. 7, St. John 8,266 102 12.3 No. 8, Bolingbroke 18,305 284 15.5 No. 9, Broomwood 20,264 300 14.8 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1929 :— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 97 64 13 15 48 133 359 425 1,154 F 67 57 17 10 68 98 254 569 1,140 Ttls. 164 121 30 25 116 231 613 994 2,294 13 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 485 515 1,000 Second quarter 234 229 463 Third quarter 201 196 397 Fourth quarter 234 200 434 1,154 1,140 2,294 The increase in the death-rate from 11.9 in 1928 to 14.2 in 1929 is accounted for chiefly by the high mortality in the first quarter of the year from respiratory diseases and influenza. The death-rate was lowest in the St. John Ward (12.3), and highest in Park Ward (15.6). The deaths of persons over 65 years numbered 994 or 43.3 per cent, of the total deaths. The average age at death was 53.0 years, as compared with 51.5 in 1928. Increased death-rates were recorded in all Wards except Winstanley, which declined from 13.6 in 1928 to 13.2 in 1929. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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 1928 11.9 11.8 12.7 11.3 Average 1919-28 11.9 12.0 12.2 11.6 1929 14.2 13.8 14.2 14.6 The natural increase of population (that is the excess of births over deaths) was 325 in 1929. There was an adverse balance of 109 in 1918, and in 1917 the natural increase was 675. 14 Deaths in Public Institutions. During 1929 the deaths of Battersea residents occurring in Public Institutions numbered 1,178. Of this number 864 occurred within and 314 outside the Borough. Of the total Battersea deaths in Public Institutions 794 occurred in Poor Law Institutions. Senile Mortality. During 1929 the deaths of 994 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 77 72 70 94 10 33 157 199 356 N.W. Battersea 83 65 35 45 6 13 124 123 247 S.W. Battersea 75 93 58 114 11 40 144 247 391 Borough of Battersea 235 230 163 253 27 86 425 569 994 Infant Mortality. During 1929 the deaths of 164 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,619, giving an infant mortality rate of 62.6 per 1,000 births, as compared with 64.2 in 1928, and 53.5 in 1927. It will be noted that the Infant Mortality rate was slightly lower during 1929 than in the previous year, notwithstanding an abnormally high mortality in the first quarter, which was actually double that of the third quarter. The high death-rate amongst infants in the first 3 months of the year, in common with the general death-rate, was a consequence of the severe spell of cold weather during which there was a considerable increase in the number of deaths of infants from pneumonia and whooping-cough. The distribution of the 164 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 1,170 44 38 82 70.1 North-West Battersea 831 33 18 51 61.4 South-West Battersea 618 20 11 31 50.2 The Borough 2,619 97 67 164 62.6 Ward. 1. Nine Elms 486 18 23 41 84.4 2. Park 349 13 9 22 63.0 3. Latchmere 341 16 11 27 79.2 4. Shaftesbury 184 5 4 9 48.9 5. Church 308 10 9 19 61 .7 6. Winstanley 358 15 1 16 44.7 7. St. John 106 2 3 5 47.2 8. Bolingbroke 277 8 2 10 36.1 9. Broomwood 210 10 5 15 71.4 It will be noted that in the sub-districts the rate was highest in East Battersea (70.1) and lowest in South-West Battersea (50.2). In the Wards, Nine Elms showed the highest rate (84.4) and Bolingbroke the lowest (36.1). The infant mortality rate in the County of London and in England and Wales during 1929 was 69 and 74 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 657 62 94.4 Second quarter 677 33 53.2 Third quarter 657 31 47.2 Fourth quarter 628 35 55.7 During the last 9 months of the year the infant death-rate was 52.0. There were 65 deaths of infants during the first four weeks of life (or 39.6 per cent. of the total infant deaths) as compared with 71 deaths (or 40.3 per cent.) in 1928 and a percentage for the quinquennium (1924-1928) of 45.0. 16 Measles accounted for only 1 infant death during the year. The deaths from developmental diseases were 57 as compared with 63 in 1928. 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 1924 to 1929. 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 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 1928 23 27 21 71 40.3 Total 1924-8 118 152 128 398 - Mean do 23.6 30.4 25.6 79.6 45.0 1929 21 23 21 65 39.6 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Diphtheria — 1 — 1 2 1.22 Measles — — — 1 1 0.61 Influenza — 1 — — 1 0.61 Erysipelas 1 — — — 1 0.61 Whooping Cough — 1 8 6 15 9.15 Meningococcal Meningitis — 1 — — 1 0.61 Diarrhœa and Enteritis 2 8 5 5 20 12.19 General Tuberculosis — — 1 1 2 1.22 Tuberculous Meningitis — — — 1 1 0.61 Pulmonary Tuberculosis — 1 — — 1 0.61 Pneumonia 8 4 11 10 33 20.12 Bronchitis 3 2 — — 5 3.05 Other Respiratory Diseases — — 1 — 1 0.61 Prematurity 25 — — — 25 15.24 Marasmus 6 2 — — 8 4.88 Icterus Neonatorum 1 — — — 1 0.61 Congenital Malformations 17 — — — 17 10.36 Injury at Birth 6 — — — 6 3.66 Suffocation (overlying) — — — — — — Convulsions 1 — — — 1 0.61 Atelectasis & AsphyxiaN. 4 — — — 4 2.44 Lack of Care 3 — — — 3 1.83 Rickets 1 — — — 1 0.61 Accident and Homicide 2 — — — 2 1.22 Miscellaneous 5 2 4 1 12 7.32 Total 85 23 30 26 164 100.0 Percentage of Total 51.8 14.0 18.3 15.9 — 100.0 17 Illegitimate Infant Deaths. The death-rate amongst illegitimate children during 1929 was 98.9 per 1,000 births, as compared with 73.2 per 1,000 births in 1928, 89.9 in 1927, 162.2 in 1926, and 113.2 in 1925. The corresponding death-rate of legitimate children in 1929 was 61.3, the ratio of the mortality-rate of illegitimate infants to that of legitimate being 1.61 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 1929:- Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 Births. 1. Shoreditch 20.1 1. Hammersmith 11.5 1. Southwark 25.0 2. Bermondsey 19.8 2. Lewisham 11.6 2. Lewisham 44.2 3. Finsbury 19.3 3. Woolwich 12.6 3. StokeNewington 47.1 4. Poplar 19.1 4. Wandsworth 12.9 4. Hampstead 53.7 5. BethnalGreen 18.7 5. Greenwich 13.3 5. Hackney 56-7 6. Southwark 18.1 6. Deptford 13.3 6. Wandsworth 61.3 7. Stepney 17.4 7. StokeNewington 13.4 7. Hammersmith 61.5 8. Islington 17.2 8. Hampstead 13.5 8. Woolwich 62.3 9. Deptford 16.8 9. Camberwell 13.6 9. City of London 62.5 10. Woolwich 16.3 10. Bethnal Green 13.7 10. Battersea 62.6 11. Battersea 16.2 11. Fulham 13.8 11. Bethnal Green 64.4 12. Stoke Newington 16.1 12. Stepney 13.9 12. Lambeth 67.7 13. Hackney 16.0 13. Hackney 13.9 13. Camberwell 68.1 14. Hammersmith 15.8 14. City of London 14.0 14. Greenwich 70.5 15. Greenwich 15.8 15. Poplar 14.2 15. Chelsea 70.7 16. Lambeth 15.7 16. Battersea 14.2 16. Bermondsey 71.0 17. Lewisham 15.7 17. St. Marylebone 14.2 17. Fulham 72.7 18. St. Pancras 15.5 18. Bermondsey 14.5 18. Islington 73.1 19. Fulham 15.4 19. Islington 14.8 19. Holborn 74.0 20. Camberwell 15.3 20. Lambeth 14.9 20. Finsbury 75.0 21. Paddington 14.9 21. Westminster 14.9 21. Poplar 75.1 22. Kensington 14.5 22. St. Pancras 15.3 22. Deptford 75.8 23. Wandsworth 13.0 23. Kensington 15.4 23. St. Marylebone 77.0 24. St. Marylebone 12.0 24. Paddington 15.5 24. Westminster 77.4 25. Chelsea 11.7 25. Holborn 15.6 25. St. Pancras 82.6 26. Hampstead 11.4 26. Southwark 15.6 26. Kensington 83.7 27. Westminster 10.8 27. Chelsea 15.7 27. Shoreditch 83.8 28. Holborn 10.2 28. Shoreditch 16.0 28. Stepney 90.4 29. City of London 7.5 29. Finsbury 16.0 29. Paddington 101.0 County of London 15.8 County of London 14.1 County of London 68.6 England and Wales 16.3 England and Wales 13.4 England and Wales 73.9 18 COMPARATIVE STATISTICS OF BIRTHS, MORTALITY, &c. Year. Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.4 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 291 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.8 669 22.1 129 471 1865 33,688 1,357 40.3 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26.8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1.352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18. 7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 6,237 34.7 2,697 17.9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16.1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2,303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31.7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168.339 5,161 30.6 2.978 17.6 435 2,183 1901 169,100 5,025 29.7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 342 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 1,977 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*166,098 4,669 28.1 — — — D* 165,664 — — 2,079 12.5 188 2.590 1921 169,200 8,742 22.1 2,060 12.2 173 1,682 1922 169,200 3,665 21.7 2,227 13.2 192 1,438 1923 170,600 3,434 20.1 1,839 10.8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,801 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 1929 161,800 2,619 16.2 2.294 14.2 95 325 • Population as estimated for purpose of (B) Birth-rate, (D) Death-rate, † Decrease. Census years in heavy type. 19 20 Notification of Births Act. During 1929 the number of notifications of live births received was 2,461. The corrected number of births registered during the year in Battersea was 2,619. The proportion of notified to registered births was, therefore, 94.0 per cent. 210 living and 5 still-births of Battersea children born in other districts were notified from the districts in which these births occurred. The number of still births notified during the year was 57 or 2.13 per cent, of the total births registered. The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926, on 1st July, 1927. During 1929 there were 118 still births registered in Battersea, of which 56 were of non-resident, and 62 of Battersea parents. Nine still births occurring outside the Borough were registered as belonging to Battersea, making 71 in all, relating to Battersea. This total represents a still birth-rate of 26.4 per 1,000 births (live and still) registered. Of the 71 still births 8 (9.9 per cent.) were registered as illegitimate. 57 still births were notified under the Notification of Births Acts during the year as belonging to Battersea, 52 from within and 5 from without the Borough, the number notified being 80.3 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. 21 Maternity and Child Welfare Scheme. The Maternity and Child Welfare Scheme of the Council includes Municipal and Voluntary effort and the activities of both are fully co-ordinated. In order to enable the Voluntary Associations to keep their work efficient and in uniformity with that of the Municipal Centres and Clinics they received during the year, in addition to the grants from the Ministry of Health, an annual contribution from the Council. Maternity and Child Welfare Centres. The Borough is divided into ten Health Visitor's districts, and there are eight maternity and child welfare centres (5 municipal and 3 voluntary). 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 1929 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. (a) 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. 22 At each of the Centres a clinic is held, a woman Medical Officer and a nurse being in attendance. The question of the establishment of an additional Maternity and Child Welfare Centre to serve the South-East area of the Borough, was further considered and agreed to by the Council during the year and approved by the Minister of Health. Suitable premises were found in the disused London County Council School at Gideon Road, and an agreement was entered into with the London County Council for the rent of a portion of those premises for the purpose. This is a useful addition to the scheme and avoids the necessity and hardship on the part of mothers and children living in this area of having to travel long distances, the nearest centres being formerly a considerable distance away. The Centre was opened on 9th April, 1930. During the year, No. 2 Currie Street, the property of the Council, which has not been considered suitable for use under their Maternity and Child Welfare Scheme, was rented to the Salvation Army for the purpose of a Social Centre and Soup Kitchen. 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. The following table gives a summary of the work carried out at the Centres in 1929 :— Summarised Statistics Relating to Ini-ant Centres, 1929 Municipal. Voluntary. Grand Total. "Southlands " Centre. Plough Road Centre. Hast 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 149 101 101 138 489 95 50 70 215 704 Attendances 5,770 4,652 3,967 5,511 19,900 2,911 1,107 1,454 5,472 25,372 First attendances 374 353 310 283 1,320 206 40 94 340 1,660 Average attendances per 39 46 39 40 41 31 22 21 25 36 session Average ditto weekly 111 89 76 106 382 56 21 28 105 488 Doctor's attendances 98 49 49 51 247 95 26 70 191 438 Babies seen by Doctor 1,777 1,151 1,026 1,134 5,088 2,313 251 1,095 3,659 8,747 Average ditto per atten dance 18 23 21 22 21 24 10 16 19 20 Weights recorded 4,971 4,039 3,379 4.812 17,201 2,858 947 1,387 5,192 22,393 Advice only 799 613 588 699 2,699 53 160 67 280 2,979 23 24 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, the St. Thomas's Cornwall Babies' Hospital (vide page 27), and the Fulham Babies' Hospital (chronic debility and wasting diseases). The Council contribute an annual sum in the case of the two first named, and a per capita payment to the last mentioned of these Institutions in respect of these facilities. Women and children where necessary are referred from the Ante-Natal and Child Welfare Centres to other appropriate institutions. The following is a list of Hospitals and Institutions, including those to which grant is paid by the Council to which cases were referred from the Maternity and Child Welfare Clinics during 1929:— St. Thomas s Hospital 28 Victoria Hospital, Chelsea 125 St. James's Hospital 7 Bolingbroke Hospital 6 Borough Tuberculosis Dispensary 5 Fulham Babies' Hospital 5 St. Thomas's Cornwall Babies' Hostel 277† Invalid Children's Aid Association 2 Moorfield's Eye Hospital 1 Invalid Kitchens 5 461 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.* The number of cases in St. Mary's House, during the financial year 1929-30, to the maintenance of which the Council contributed, was 10, the cost to the Council being £200 15s. 9d. * This amount was increased in January, 1930, to £100 per annum, maximum. t Of this number 173 actually attended. 25 In the case of other homes, the number of cases during the financial year was 8, and the Council's contribution amounted to £92 Os. 2d. Home Helps. During the year arrangements were made by the Council, with the approval of the Ministry of Health, for the provision in suitable cases of assistance in the home during the mother's lying-in period. The names of suitable women are kept on a rota list, and they are paid an approved fee when sent out to cases on the instructions of the Medical Officer of Health. The scheme appears to be working satisfactorily, but has not been sufficiently long in operation to enable its effect to be judged. When its advantages are more generally known it is hoped that this scheme will prove to be a useful addition to the Maternity Scheme. Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, milk is provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. The following table gives particulars relating to the number of persons supplied, quantities distributed and cost after deducting payments made by those able in part to contribute :— Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons supplied. lbs. supplied. Persons supplied. Pints supplied. 1920 1,473 15,588 233 31,894 £ 3,330 1921 2,391 49,020 301 27,254 5,011 1922 2,469 61,511 260 23,879 5,279 1923 2,231 50,110 219 25,633 3,288 1924 1,840 51,837 178 17,654 2,533 1925 1,620 44,805 222 26,079 2,631 1926 609 (469) 26,924 699 (469) 89,435 3,262 1927 111 (53) 2,519 1,381 (53) 206,717 3,438 1928 119 (65) 3,286 1,216 (65) 149,307 2,667 1929 187 (60) 3,127 1,101 (60) 141,767 2,532 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 216 were supplied during 1929 to necessitous expectant and nursing mothers and children at a cost of £5 16s. 2d. 26 Convalescent Homes. During 1929, accommodation was provided for 33 mothers and 37 children attending the various Maternity and Child Welfare Clinics. Of these, 25 mothers and children were sent to St. Mary's Convalescent Home, Birchington, and the remainder to the Burnett Cottage Home, Heme Bay. The cost incurred by the Council amounted to £73 18s. Od., the mothers and a voluntary association contributing the balance of £27 16s. 3d. In addition through other charitable organisations 8 mothers and 4 children taken 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 1929 the total number of attendances made by the District Nursing Service in connection with the Council's Scheme was:— Nursing Service, 1929 Name of Disease. Age Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 90 2,052 — — 90 2,052 Measles 10 103 2 25 12 128 Whooping Cough 15 284 3 50 18 334 Diarrhoea & Vomiting 4 21 — — 4 21 Chicken Pox Pemphigus — — —— — — — Neonatorum — — — — — — Puerperal Pyrexia — — 5 84 5 84 Pneumonia 44 718 88 1,512 132 2,230 Influenza 7 100 52 656 59 756 Erysipelas — — 6 74 6 74 Encephalitis — — — — — — Lethargica — — — — — — Paratyphoid Fever — — 2 6 2 6 Totals 170 3,278 158 2,407 328 5,685 The cost of the nursing service in 1929 was £189 10s. Od. as compared with £182 lis. 4d., in the previous year. Health Visitors. The Health Visiting Staff consists of 10 full time Health Visitors, including an additional Health Visitor appointed in December, 1929, to deal with the area served by the new Centre at Gideon Road (vide page 22). Two of these are partly employed as Women Sanitary Inspectors. 27 Facilities arc granted by the Council to students of recognised Training Bodies for practical instruction and training as Health Visitors and Women Sanitary Inspectors. During the year a number of students from the Hygiene Department, Battersea Polytechnic, received a course of training under the Council's Maternity and Child Welfare Scheme. The work carried out during 1929 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 2,228 372 2,600 Visits to Notified Births 8,287 1,455 9,742 Visits to Still Births 60 11 71 Visits to children aged 1-5 years 3,640 2,049 5,689 Visits to enquire into Infant Deaths 159 40 199 Visits to cases of Notifiable Infectious Disease 4,076 488 4,564 Visits to cases of Non-Notifiable Disease 358 148 506 Visits re prevention of Diphtheria 444 13 457 Visits re Summer Diarrhoea 909* 299 299 Visits to Dental Cases 129 15 144 Visits to V.D. Cases 22 — 22 Other Visits 1,178 657 1,835 20,581 5,547 26,128 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 1929. The results of the year's work have been satisfactory and are summarised below:— A. Test Feeds. Number of cases, 173, comprising : Mothers, 173; babies, 176. Number of attendances, 406. (199 mothers and 207 babies). 8 of these cases received in-patient treatment. * These visits, having been made in conjunction with visits on other matters already enumerated, are not included in the total. 28 B. In-Patient Treatment. 23 Battersea cases received, made up of— 8 mothers and 11 babies sent by Council. 2 mothers and 2 babies sent from other sources. Period of stay. 19 cases sent by Council— 8 mothers and 11 babies, 458 days; Average 24.1 days 4 other cases— 2 mothers and 2 children, 141 days; Average 13 days Ante-Natal Work. Miss Alice Bloomfield, M.D., F.R.C.S., Consultant-in-charge of the Ante-Natal Clinics, reports :— Tuesday Afternoon Special Clinic.—During the year 1929, 878 cases attended this Clinic, of which 814 were new and 64 old cases. The majority of these patients —810—were referred to have blood tests taken for the routine Wassermann test, and of these 11 only gave a positive reaction. In addition 69 patients attended for other examinations, mostly on account of vaginal discharges or some other symptom of gynaecological disease. Nine cervical swabs were taken and 55 patients were retained for local gynaecological treatment. This clinic, apart from its routine work, occupies a very useful place in the ante-natal scheme ; at it pregnant and post-natal patients (i.e. patients attending post-natal clinics) suffering from gynaecological disease can be kept under observation and receive treatment. I consider, however, that as a treatment centre it should be reserved for these, and if other cases are admitted, e.g. mothers attending Welfare Centres, it should only be for diagnosis, and referring to a private doctor or hospital as necessary. Wednesday and Thursday Ante-Natal Clinics.—102 Clinics have been held, with an average attendance of 23-8 ; 462 new cases have been seen, of which more than one-half—244—were primiparous patients. Every encouragement is given to patients to book early; and of this advantage has been taken, 362 patients booking before the sixth month. The practice of booking late, and especially as in 8 cases, after the eighth month, is to be definitely deprecated. 29 Forty-nine cases of albuminuria were seen and treated, and 36 cases of cardiac disease, often of a very mild nature, were noted. " Other cases" numbered 49, and consisted of abnormalities, deformities, &c., e.g. enlarged thyroid, Rachitic chests, scoliosis. Other Clinics. New patients numbered as follows:— Southlands 254 All Saints 70 Plough Road 93 Although of these Southlands Clinic alone is under my care, all new cases are examined by me at the time of first attendance. At these Clinics the number of multiparas (230) greatly exceeds the number of primiparae (187), but 310 patients, or 74 per cent, (approximately) booked before the sixth month, showing how the mothers are becoming educated to realise the value and necessity of ante-natal care. 33 cases of albuminuria were seen and treated. 24 cases of cardiac disease were noted, while "other cases" numbered 49. In all 66 cases were referred for dental treatment and 4 cases to the Tuberculosis Dispensary. In conjunction with this report the following figures are of interest:— Albuminurias. Of the 82 cases attending the Clinics 14 only were considered to require admission to the Borough Maternity Hospital. Nine were delivered normally and five left the hospital relieved after treatment. No case of Eclampsia occurred. Antepartum. Hemorrhage. 4 Inductions— Bougie 16 Mothers—satisfactory (N.B.—One mother died in Metropolitan Asylum's Board Hospital six weeks after difficult forceps delivery). Babies—-1 still birth. Quinine, others, &c. 20 Mothers all well. Babies all well. Breech Deliveries. Undiagnosed at full term 2 30 Examinations under Anceslhetic. In Ante-natal period 20 For external version, 9 (successful, 5 ; unsuccessful, 4) ; for diagnosis of presentation, 7 ; for estimation of fit of foetal head to pelvis, 4. Forceps deliveries 32 (Persistent occipito posterior, uterine inertia, foetal distress) Ccesarian Sections 4 In addition to the Ante-Natal Clinics held at the Municipal Centres, there is also a Clinic for expectant mothers held fortnightly at the Southlands premises of the Women's League of Service. This Centre, which includes many other useful activities of a Maternity and Child Welfare Centre,* is linked up with the Borough Council's Scheme and receives a subsidy to enable the work to be carried out to the standard of efficiency of the Council's Scheme. During the year 24 Ante-Natal Clinics were held at this Centre, the attendances being 184, an average of 7.7. Of the mothers attending, 4 were referred for Hospital treatment. Nineteen mothers were confined at the Borough Maternity Hospital, 4 in St. James's Hospital and 13 in their own homes, including 3 who were attended by the Borough midwife. There were also 36 attendances of mothers for examination after confinement. Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports : " We have now been two and a half years in Southlands, and our work among the infants and mothers has increased. Our children are deriving considerable benefit from the Sunlight treatment provided by the Borough. We would like to shew our appreciation by having more of our children under treatment. Dinners for toddlers from 1 to 5 years are now fully established and working very satisfactorily. The Ante-Natal work is proving of greater interest each year. Many of our mothers have been able to be sent away to the country or seaside." 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 general work of this Centre is shewn in the table on page 23. 31 The following is a summarised statement showing the Hospitals and the visiting and reporting work carried out for them during 1929. Ante-natal and postnatal. Other. T otal. St. Thomas' Hospital 249 121 370 Charing Cross Hospital 2 — 2 General Lying-in Hospital 209 — 209 King's College Hospital 9 — 9 Middlesex Hospital 2 — 2 St. George's Hospital 39 — 39 Westminster Hospital 10 — 10 Victoria Hospital, Chelsea — 131 131 St. James's Hospital — 32 32 Bolingbroke Hospital — 1 1 City of London Hospital 1 — 1 South London Hospital for Women 2 — 2 523 285 808 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 Consultant, Mr. Corsi, F.R.C.S. The work carried out during 1929 is summarised in the table on page 32. Mr. Corsi reports :— In 1929, 804 Wassermann Tests for Syphilis were carried out on pregnant women attending the Clinics. This is a decrease of 130 on the previous year. Of these 13, i.e. 1.6 per cent, were found positive. Compared with figures of this kind published for various parts of England and other countries, this is a very low percentage, and therefore not likely to diminish much further. These 13 were cases of latent syphilis. All had ante-natal treatment with excellent results. This year it was possible to test the infant's blood in no less than ten cases, a remarkable improvement on the previous two years. In all ten cases the Wasserman Test proved negative. The remaining three had no clinical evidence of syphilis, so that it would appear that in 1929 as in 1928, so far as one can tell, no child was born syphilitic. 32 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1929. Year. Number of expectant mothers tested by W.R. Number giving positive W.R. Percent. 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 21 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 12 5 6 0 0 1929 804 13 1.6 13 10 3 0 0 * Not syphilitic. 33 Maternal Mortality. During 1929, there were 5 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 1-91 per 1,000 births. Four of these deaths occurred in St. James's Hospital and 1 in Clapham Maternity Hospital, Jeffreys Road. The causes of death were certified as being :— Puerperal sepsis 2 Placenta Prsevia 1 Ruptured ectopic gestation 2 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1924. 1925. 1926. 1927. 1928. Mean 1924 8 1929. Deaths from Puerperal Sepsis Deaths from other causes 4 3 3 1 3 2-8 2 connected with child-birth 5 3 7 5 4 4-8 3 Total Maternal Deaths connected with child-birth 9 6 10 6 7 7-6 5 Rate per 1,000 births— Puerperal Sepsis 1.27 0.94 1.01 .36 1.09 0.93 0.76 Other Maternal deaths 1.59 0.94 2.36 1.78 1.46 1.63 1.15 Rate per 1,000 births all Maternal deaths in child-birth 2.86 1.88 3.37 2.14 2.55 2.56 1.91 Rate per 1,000 population— Puerperal Sepsis .023 .017 .017 .006 .018 .016 0.012 Other Maternal deaths .029 .017 .041 .030 .024 .028 0.019 Rate per 1,000 population all Maternal deaths in childbirth .052 .034 .058 .036 .042 .044 0.031 It is satisfactory to note that the decline in Maternal Mortality which is in evidence during recent years in Battersea was maintained during the year under report. The Ministry of Health, in their circular letters Nos. 517 and 888, drew the attention of the Sanitary Authorities to the unsatisfactory condition with regard to Maternal Mortality in contrast with the great decline which has taken place in Infantile Mortality. The Maternity and Child Welfare Committee have taken steps to see that the views expressed by the Ministry of Health so far as Battersea is concerned, are being complied with. In addition to the measures already in force to deal with the question of Maternal Mortality, the Maternity Hospital has been recently extended so as to provide a modern, fully equipped outpatients' department with extended accommodation. The extension of the hospital was in progress at the end of 1929. 34 In this connection also, arrangements were made on the lines suggested by the Ministry to place at the disposal of medical practitioners specialist advice in difficult maternity cases. 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 also a recognised training institution for pupil-midwives, and, in addition, a District Midwifery Service for the attendance of the District Midwife on patients in their own homes is directed from the 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 4 Staff Nurses. There is accommodation in the Hospital for 12 pupil midwives undergoing training at one time. Many of the patients were cases of extreme gravity or emergency, requiring the calling in of the services of the Consultant Obstetrician. A resident Medical Officer appointed by the Council in 1927 acts as a liaison officer between the Ante-Natal and Obstetric Consultants. This appointment has been fully justified by the results obtained. The appointment of a Resident Medical Officer has also enabled a Post-Natal Clinic to be established at the Hospital where women who have been confined in the Hospital may attend for examination six weeks after confinement. During 1929 there were 49 sessions held and 483 attendances were made, 440 being new cases. The average attendance per session was 9-9. Of the patients treated at the Hospital during the year 131 failed to attend the Post Natal Clinic, 30 of these being non-Borough cases. There was a mild outbreak of infection in the Hospital towards the end of the year which affected a number of the patients. The cases were mainly characterised by a slight rise of temperature associated with an herpetic eruption around the mouth. Isolation was carried out as far as practicable, and before the end of the year the outbreak had apparently subsided. 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 20 cases during the year as compared with 32 cases in 1928. 35 During 1929, 605 cases were admitted to the Hospital as compared with 653 in 1928, 634 cases in 1927, 625 in 1926, 560 in 1925 and 400 in 1924. Particulars relating to the admissions during 1929 are set out as follows:— Total number of cases admitted 605 Average duration of stay 14 days Number of cases delivered by midwives 545 Number of cases delivered by doctors (including 8 delivered by own doctors) 50 Of the above cases, 10 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.—74 Accidental haemorrhage 1 Placenta praevia 3 Albuminuria 14 — Contracted pelvis 10 74 Induction 36 Malpresentation 10 (b) During Labour—175. Adherent placenta 7 Ruptured perineum (sutured) 89 Foetal distress 15 Ruptured perineum Forceps deliveries 33 tured) 10 Heart disease 2 Prolonged labour 10 175 Retained membranes 9 (c) After Labour—20. Influenza 8 Varicose veins 2 Pain in groin, &c. 1 Tb. lung 1 Rashes on face and body 3 — Chest condition 1 20 Abdominal pain 4 (d) For Infant—62. Blisters and septic fingers 6 Ophthalmia neonatorum 1 Eruptions on face and body 2 Hydrocephalic 1 Cyanosis 3 Convulsions 2 Feebleness 8 — Club foot and spina bifida 1 62 Sticky eyes 10 — Watery eyes 28 36 Number of maternal deaths 1* Number of cases in which temperature rose above 100.4° F. for 24 hours with rise of pulse rate 31 Number of cases notified as Ophthalmia Neonatorum with result of treatment 1 (Cured. No permanent damage to eyes.) Number of cases with discharge from eyes however slight 10 Number of infants not entirely breast fed 6 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia (13 recovered, 2 died in Hospital from sepsis) 15* Number of foetal deaths (22 still-born, 17 within 10 days of birth) and their causes 39 Still birth— Died within JO days— Face presentation 2 Congenital heart disease 6 Breech presentation 2 Premature 6 Prolonged 2nd stage 2 Asphyxia pallida 3 Macerated—albuminuria in mother 7 Cerebral haemorrhage and heart failure 1 Hydrocephalus 2 Anencephalus: cardiac failure 1 Prematurity 3 Anencephalus 2 Prolapse of cord 2 22 17 The Consultant Obstetrician was called in in 20 cases of grave emergency, particulars of which are set out below:— Forceps delivery 2 Malpresentations 2 Ante-partum haemorrhage 1 Puerperal pyrexia 7 Caesarean section 4 Puerperal mania 1 Extensive tear of walls 1 Post-partum haemorrhage 2 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, 1930:— Maternity Hospital, 1929-1930. Total beds (excluding isolation beds), 30; total cases, 566. number of weeks spent in Institution by such patients, 1,132. * Vide page 29. 37 Statement showing expenditure for the year ended 31st March, 1930, in respect of the Maternity Hospital. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 428 0 7 7 Cursing 638 0 11 3 Domestic and other 522 0 9 3 Provisions 883 0 15 7 Drugs and other Medical Requisites 219 0 3 10 Heating and Lighting 521 0 9 2 Laundry 410 0 7 3 Repairs and Domestic 275 0 4 10 renewals Structural 1,154 1 0 5 Miscellaneous items— Telephones, Water, Stationery, etc., and Sundries 234 0 4 2 Special closi expenditure re temporary ng of Hospital, Feb., 1930* 228 0 4 1 Totals, excluding rent, rates, taxes, insurance and loan charges 5,512 4 17 5 Rent, Rates and Insurance 79 0 1 5 Loan Charges 1,384 1 4 5 Gross cost £6,975 £6 3 3 Income "Pupil Midwives (including training grant) 260 0 4 7 Patients' Payments 2,762 2 8 10 Other 31 0 0 7 Net cost £3,922 £3 9 3 * Fees to other Hospitals for patients, grants, &c., to Pupil Midwives, Nurses and Maids for board and lodging. District Midwifery Service. During 1929 there were 124 cases attended in their own homes by the District Midwife as compared with 137 in the previous year, a decrease of 13 cases. Particulars relating to this Service during the year are set out below:— Total number of cases attended in the district 124 Average number of visits to each case ... ... ... 18 Number of cases delivered by :— (a) Midwife 120 (b) Doctors (including 1 privately engaged) ... 4 38 Number of cases where medical assistance was called for, with reasons for requiring assistance :— (a) Ante-Natal—Nil. (b) During Labour—3. Prolonged labour—forceps delivery (1 ruptured perineum) 3 (c) After Labour—6. Ruptured perineum 2 Varicose veins 1 Influenza 1 Inflamed breast 1 Poor general condition and cough 1 6 (d) For Infant—10. Prematurity 3 Dangerous feebleness 2 White asphyxia 1 Extended breech 1 Congenital heart 1 Abscess 1 Spina bifida and talipes 1 10 Number of cases of— Puerperal sepsis — Maternal deaths Still births 2 Death of infants within 10 days (prematurity, spina bifida and congenital heart) 3 Dental Clinic. During 1929 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 1929 is summarised as follows:— Women. Children. Total. Sessions held 150 47 197 No. of patients treated 358 145 503 No. of new patients 210 100 310 No. of patients referred to hospital 5 17 22 Total attendances 2,067 477 2,544 39 Work carried out:— Extractions— Women. Children. Total. Ordinary - - - With local anaesthetic 129 l 130 ,, general anaesthetic 295 68 363 Total 424 69 493 No. of teeth extracted 1,263 167 1,430 Scaling and polishing 21 1 22 Fillings 56 14 70 Upper dentures 47 — 47 Lower dentures 61 — 61 Denture visits 520 — 520 Dressings and treatment to gums 63 15 78 Repairs to dentures 12 — 12 Advice 893 350 1,243 The estimated cost of dental treatment (Maternity and Child Welfare) in the financial year 1929-30 was £606 16s. 6d. This sum includes £219 13s. 9d. paid for dentures supplied, the cost of which is distributed as under :— £ s. d. Contributed by patients 119 14 3 Grants from British Dental Hospital 13 2 0 Grants from Saturday and Sunday Hospital Funds 52 19 0 Grants from other philanthropic agencies 25 9 6 Contribution by the Council 8 9 0 £219 13 9 The net cost of this service during 1929-30 was £395 1 Is. 9d. Solarium. The Light Treatment Centre which is briefly referred to in the Annual Report for 1928, was established at Southlands during the year, and was formally opened by the Mayor of Battersea (Councillor Joseph Edwards, j.p.) on the 9th November, 1929. The Centre is housed in a portion of the Southlands Building which has been specially adapted and equipped for the purpose. The equipment consists of :— 2 carbon arc lamps. 2 mercury vapour lamps. 4 general radiation lamps. 4 couches. Clocks, goggles, etc. From the date of opening to the end of the year 18 sessions were held, 14 patients attending (9 Welfare, 5 Tuberculous). The total attendances numbered 138, the average number per session being 7.7. 40 Notifiable Infectious Diseases. During 1929 under the Notification Clauses ot the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 2,910 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 2, acute poliomyelitis 1, enteric fever 1, small-pox 2, encephalitis lethargica, 3. The following is a list of the diseases compulsorily notifiable in Battersea : Small-pox. Cholera. Diphtheria. Membranous croup. Erysipelas. Scarlet fever. Typhus fever Typhoid or enteric fever. Relapsing fever. Continued fever. Puerperal fever. Puerperal pyrexia Ophthalmia neonatorum. Cerebro-spinal fever. Acute polio-myelitis. Acute polio-encephalitis. Glanders. Anthrax. Hydrophobia Acute influenzal pneumonia. Acute primary pneumonia. Malaria. Dysentery. Plague. Acute encephalitis lethargica. Measles. Whooping cough. 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 1,603 cases which occurred in 1,374 houses. Of these cases 1,168, or 72.9 per cent., were removed to the Isolation Hospitals of the Metropolitan Asylums Board or to other Institutions and 435, or 27-1 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. ERRATUM. Page 41. For " Polio-encephalitis " read " Continued Fever." 41 Notifications of Infectious Diseases, 1929, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox — — — — — 2 — — — — 2 — 2 Diphtheria 45 68 82 31 59 82 16 29 33 179 184 82 445 Erysipelas 14 9 2 10 4 8 4 12 6 34 13 22 69 Scarlet Fever 50 80 48 29 79 93 17 37 33 182 194 90 466 Enteric (Typhoid) Fever — — — — — 1 — — — — 1 — 1 Ophthalmia Neonatorum 15 2 5 2 2 8 2 6 1 21 13 9 43 Puerperal Fever — — 1 1 — 1 — 1 — 1 2 1 4 Puerperal Pyrexia 4 8 3 2 1 3 — 3 1 16 5 25 Polio-myelitis — — — — — — — 1 — — — 1 1 Polio-encephalitis — — — — — 1 — — 1 — 1 Encephalitis Lethargica — 2 — — — — — — 1 2 — 1 3 Cerebro-Spinal Meningitis 1 1 — — — — — — — 2 — — 2 Malaria 1 — — — — — — 1 — 1 — 1 2 Dysentery — — — — 1 — — 1 — — 1 1 2 Acute Primary Pneumonia 82 43 53 21 63 84 15 25 11 162 182 53 397 Acute Influenzal Pneumonia 24 13 16 14 16 19 12 17 9 53 48 39 140 *Whooping Cough 127 108 116 68 142 114 39 67 43 355 312 157 824 *Measles 110 36 60 33 110 75 11 36 12 196 218 69 483 Totals 473 370 386 211 477 491 116 236 150 1,204 1,176 530 2,910 *Notifiable in Battersea from 24th April, 1922. 42 Small-Pox. Two cases of small-pox occurred in Battersea during 1929, compared with one in 1928. Previous to that year no case of small-pox had been notified since September, 1923. The two patients notified in 1929 were relations who resided in the same street but in different houses. On enquiry it was ascertained that they had attended a dance held at a school in the adjoining Borough of Wandsworth which was also attended by a resident of that Borough, who—with four other members of his family—was subsequently found to be suffering from the disease. Neither of the two Battersea patients had been vaccinated prior to attack, and in each case, the attack was of the prevailing mild character. They were immediately removed to the isolation hospital, one being discharged after three days, and the other after a fortnight. All members of the family and immediate contacts were vaccinated or re-vaccinated within a few hours of the removal of the case to Hospital. No further cases occurred in either family or amongst the Battersea contacts. During the year there were 1,930 cases of this disease recorded in London, 15 of these cases occurring in the neighbouring borough of Wandsworth and 75 in Lambeth. 500 cases occurred in Stepney, 262 in Bethnal Green, 247 in Shoreditch, 159 in Poplar and 118 in Camberwell. No cases were recorded in Chelsea, Fulham or Hampstead. The disease was also prevalent in Greater London, West Ham having a large number of cases. It is satisfactory to note that notwithstanding the prevalence of the disease in adjoining boroughs and other London districts, Battersea was comparatively free. 618 " 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, 11,022 cases of small-pox were notified during 1929. Scarlet Fever. The incidence of Scarlet Fever was slightly lower in 1929, 466 cases being notified as compared with 480 in the previous year. The case-rate per 1,000 of the population was 2-88 and 4 deaths were registered from the disease, giving a death-rate of 0.025 per 1,000 as compared with 5 deaths and a death-rate of 0.03 in 1928. Of the cases notified 460 or 98.7 per cent. were removed to hospital. The infected houses numbered 420. In 64 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 1929 was 445 as compared with 652 in 1928, 680 in 1927, 540 in 1926, and 396 in 1925. The number of deaths registered from the disease was 12, giving a death-rate of 0-074 as compared with 26 deaths and a death-rate of 0-158 in 1928, and 25 deaths and a death-rate of 0-148 in 1927. Of the 445 cases notified 440 or 98-9 per cent, were removed to hospital. The infected houses numbered 392. In 55 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 2.75 as compared with 3.97 in 1928, 4.02 in 1927, 3.14 in 1926 and 2.30 in 1925. The case-mortality was 2.70 per cent, as compared with 3.99 per cent, in 1928, 3.68 in 1927, 3.70 in 1926, and 2.53 in 1925. The incidence of the disease was highest in the Latchmere, Winstanley and Park Wards. The following table shows the incidence and mortality of diphtheria during 1929 in the Borough, the sub-districts and the wards :— Ward. Cases. Deaths. Cases per 1,000 Population. Deaths per 1,000 Population. Percentage Case Mortality. 1 45 1 1.71 .04 2.22 2 68 1 3.87 .06 1.47 3 82 2 4.44 .11 2.44 4 31 1 2 .09 .07 3.23 5 59 3 3.31 .17 5.08 6 82 1 4.12 .05 1.22 7 16 — 1.94 — — 8 29 1 1.58 .05 3.45 9 33 2 1.63 .10 6.06 E. 179 3 2.67 .04 1.68 N.W. 184 6 3.98 .13 3.26 S.W. 82 3 1.69 .06 3.66 Borough 445 12 2.75 .074 2.70 44 incidence and mortality, 1895-1929. Mean Quinquennial Rates. Period. 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 1925-1929 542.6 3.24 18.6 •111 3.32 Year 1927 680 4.02 25 •148 3.68 „ 1928 652 3.97 26 *158 3.99 ,, 1929 445 2.75 12 *074 2.70 During the year 57 phials (approximately 228,000 units) of diphtheria anti-toxin were supplied, on request, to medical practitioners practising in the Borough. Schick Test Clinic. Summary of Work Carried Out, 1929. As stated in my last annual report a Schick test clinic was established at the close of 1927. It is held weekly at the Southlands Maternity and Child Welfare Centre. The work is carried on under the supervision of Dr. F. Porter Smith, M.R.C.S., L.R.C.P. The result of the year's work is summarised as follows :— Sessions held 51 Patients attending in 1929 (new 209) 270 Attendances 800 (average per session) 15.7 Patients tested 126 Readings of tests (positive 84, negative 38, result unknown 4) 126 Patients inoculated— Without test 83 After positive test 75 — 158 Inoculations 451 Total immunised (including 54 1928 patients) 75 Patients still under treatment at end of year 147 Discontinued treatment 10 45 The total number of patients immunised or found by test to be immune is 113, out of a total of 270 patients who have attended during the year (41.9 per cent). Since the opening of the clinic 482 patients have attended, and of these 248 have been immunised or found immune by test (51.5 per cent.). Acute Polio-Myelitis and Polio-Encephalitis. There was only one case of Acute Polio-Myelitis notified in Battersea during 1929, the patient being -a boy of 6 years. A second case of Polio-Myelitis, not in the acute stage, was reported in the person of a child of 2 years. Both cases received hospital treatment. No death was recorded from the disease. At the end of the year there were 27 chronic cases under observation, 25 having been notified or reported prior to 1929. Of these 27 cases, 24 were under 5 years of age when first brought under observation. When last visited 3 were reported well, 6 were in hospital, 1 under convalescent treatment, and 7 were receiving out-patient treatment. Of the remaining 10 cases, 1 was reported to be limping slightly and 9 to be still wearing instruments. Puerperal Fever and Puerperal Pyrexia. There were 4 cases of Puerperal Fever notified in Battersea during 1929 as compared with 7 cases in 1928, 9 cases in 1927, 12 cases in 1926, and 6 cases in 1925. There were 2 deaths from the disease. The number of cases per 1,000 births was 1.53, as compared with 2.55 in 1928, 3.21 in 1927, 4-04 in 1926, and 1.88 in 1925. The notified cases were distributed as follows:— East Battersea, 1; North-West Battersea, 2; South-West Battersea, 1. The case mortality was 50.0 per cent., and the death-rate per 1,000 births was 0.76. There were 316 cases of Puerperal Fever notified in London and 2,353 in England and Wales during 1929. The number of cases of Puerperal Pyrexia notified during 1929 was 25, and the incidence per 1,000 births was 9.55. There were 775 cases of Puerperal Pyrexia notified in London and 5,573 in England and Wales during the year. Enteric Fever. During 1929 two cases of Enteric Fever were notified in Battersea. Of these 1 case was cancelled, the diagnosis not being confirmed at hospital. There was one death from this disease during 46 1929, this being a case not notified in Battersea having occurred in a mental hospital to which the patient was admitted 35 years previously. The notified case was discharged from hospital after 10 weeks but was subsequently re-admitted suffering from Continued Fever. The patient was stated to have had Enteric Fever in South Africa 30 years ago. Cerebro-Spinal Fever. During 1929 three cases of Cerebro-Spinal Fever were notified in Battersea, one of which was subsequently cancelled. One death, which occurred in Hospital, was recorded from this disease, the case being unnotified. Encephalitis Lethargica. Four cases of Encephalitis Lethargica (sleepy sickness) were notified in Battersea during 1929. In one of these cases the diagnosis was not confirmed and the notification was subsequently cancelled. One death was recorded from this disease, giving a death-rate of 0-006 for the year. One fatal (unnotified) case of this disease occurred in 1928. In 1929 the number of notified cases of this disease in England and Wales was 1,041 and in London 98. Ophthalmia Neonatorum. There were 43 cases of Ophthalmia Neonatorum notified in Battersea during 1929 as compared with 39 in 1928, 48 in 1927, 35 in 1926, and 32 in 1925. The rate per 1,000 births was 16-4, as compared with 14.2 in 1928, 17.1 in 1927, 11.8 in 1926, and 10.0 in 1925. The disease was most prevalent in the less prosperous districts of the Borough, East Battersea and North West Battersea contributing 79-1 per cent, of the total cases notified. There were 6 severe cases amongst the 43 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. During 1929 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 2,052. All cases were kept under supervision by the Health Visiting Staff, by whom 164 visits were made. 47 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 21 1,170 17.9 1924 41 3,139 13.-1 N.W. Battersea 13 831 15.6 S.W. Battersea 9 618 14.6 1925 32 3,184 100 1. Nine Elms 15 486 30.9 1926 35 2,969 11.8 2. Park 2 349 5.7 3. Latchmere 5 341 14.7 1927 48 2,801 171 4. Shaftesbury 2 184 10.9 5. Church 2 308 6.5 1928 39 2,743 14.2 6. Winstanley 8 358 22.3 7. St. John 2 106 18.9 8. Bolingbroke 6 277 21.7 Mean 9. Broomwood 1 210 4.8 1924 8 39 2,967 13.2 Borough 43 2,619 16-4 1929 43 2,619 16.4 Erysipelas. There were 69 cases of Erysipelas notified and 4 deaths were recorded from the disease during 1929 in Battersea. The casemortality was 5-80 per cent, and the death-rate per 1,000 population was 0-025. Measles. The number of cases of Measles notified or otherwise reported in 1929 was 566 and there were 5 deaths recorded from the disease. Of the 566 cases 483 were notified under the Regulations—The Battersea (Measles and Whooping-Cough) Regulations, 1922—and the remaining 83 cases were reported by the public elementary schools or from other sources. The case-mortality was 1.04 per cent, of the notified cases, compared with 1 06 per cent, in 1928. 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 L.C.C. School Nurses. 48 Whooping-Cough. During 1929 there were 824 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 493 additional cases were reported from the public elementary schools and other sources. This disease assumed epidemic prevalence in London during 1929, and the mortality rate (2.6 per 1,000 of the population) was high, there being 1,141 deaths as compared with 405 in the previous year. The mortality rate of 2.6 has not been exceeded since 1918. In Battersea there were 43 deaths registered from this disease, the death-rate being 0.266 as compared with 14 deaths and a deathrate of 0-085 in 1928, 15 deaths and a death-rate of 0 09 in 1927, 13 deaths and a death-rate of 0-08 in 1926, and 20 deaths and a death-rate of 0.12 in 1925. The total number of cases notified or otherwise reported during 1929 was 1,317 as compared with 1,228 in 1928, 749 in 1927, 1,210 in 1926, and 1,320 in 1925, the increase in 1929 compared with 1928 being 7.2 per cent. The age distribution of the 1,317 cases notified or otherwise reported, and the deaths and case-mortality are shewn in the following table:— Age (Years). Total Cases. Deaths. Case Mortality (per cent.) 0-1 126 15 11.9 1-2 167 12 7.2 2-3 184 7 3.8 3-4 181 4 2.2 4-5 175 3 1.7 5 up 484 2 0.4 1,317 43 3.3 The disease, with measles, was made compulsorily notifiable in Battersea in 1922, and having regard to the epidemic prevalence of the disease during 1929, special precautionary measures were taken in view of the danger to life in the case of younger children. TUBERCULOSIS. During 1929 there were 330 cases of Tuberculosis (all forms) notified in Battersea as compared with 301 in 1928, 308 in 1927, 344 in 1926, and 335 in 1925. 49 In the following table is shown the distribution of the notifiec 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 53 34 32 28 28 38 7 24 31 128 82 65 NonPulmonary 6 5 9 6 9 10 1 4 5 20 24 11 Totals 59 39 41 34 37 48 8 28 36 148 106 76 The Borough : Pulmonary 275 l^on-Pulmonary 55 Total 330 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 1929 :— Ward. Ages: Total, all ages. Grand Total. Rate per 100,000 population. Under 1 yr. 1-5 5-15 15-25 25-45 45-65 65 up M. F. 1 1 6 24 21 6 1 27 32 59 224 2 - 3 1 14 14 6 1 20 19 39 222 3 1 5 16 12 7 21 20 41 222 4 . 3 10 11 7 3 21 13 34 229 5 _ 2 8 9 13 5 - 26 11 37 207 6 2 8 18 12 8 24 24 48 241 7 1 2 4 1 4 4 8 97 8 2 14 8 4 14 14 28 153 9 1 1 1 7 16 8 2 22 14 36 178 Boro' 3 9 34 114 111 52 7 179 151 330 204 E. 1 3 13 54 50 22 5 78 70 148 221 N.W. 1 4 17 37 31 16 — 59 47 106 229 S.W. 1 2 4 23 30 14 2 42 34 76 157 Rate per 10 0,000 population in eac h age group Boro' 121 97 119 386 214 163 80 236 176 204 — In the table on pp. 58-59 is shown the information required by the Ministry of Health in regard to notifications. 50 The localisation of the disease in the 330 cases notified in 1929 is summarised below :— Localisation of Disease. Pulmonary (275) Bones and Joints (14) Genito-urinary (1) Lungs 267 Ankle 3 Renal Tract 1 Lungs and Larynx 3 Elbow1 Lungs and Abdomen 2 Knee 1 Lungs and Skin 1 Shoulder 1 Lungs and Lip 1 Spine 5 Skin (2) Larynx 1 Tarsus 1 Unspecified 2 Brain (7) Meninges 7 Tibia 1 Wrist 1 Glands (25) General (1) Generalised 1 Cervical 20 Abdominal (5) Abdominal 2 Peritoneum 4 Unspecified and Intestines 1 Various 3 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 4 years 1926-1929 :— Year. Not notified (dead). Notified after Death. Primarily Notified on Form C or D. (Form a not received). Reported from Other Sources Total. 1926 13 10 4 7 34 1927 12 14 — — 26 1928 8 10 2 3 23 1929 13 13 1 7 34 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 1929. Deaths from Tuberculosis. The death-rate from Tuberculosis was markedly higher in 1929 than in the previous year, being 127.3 per 100,000 population, as compared with 98.1 in 1928 and 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 1929 Wards. Rate per 100,000 population. Ages :— Total, All Ages. Totals. Grand Total. Pulmon ary. NonPul mon•ry. 0-1 1-5 5-15 15-25 25-45 45-65 65- M. F. 1 159 1 1 3 16 14 6 1 20 22 37 5 42 2 159 - 2 — 7 9 8 2 15 13 26 2 28 3 141 2 - 2 4 8 9 1 19 7 24 2 26 4 135 - - - 8 6 6 - 9 11 20 - 20 5 140 — 3 3 3 9 4 3 21 4 22 3 25 6 121 _ — 3 7 9 4 1 11 13 21 3 24 7 97 _ 1 _ I 6 _ _ 4 4 7 1 8 8 87 _ - - 5 7 3 1 9 7 14 2 16 9 84 1 - — 4 6 5 1 11 6 15 2 17 E. 142 1 3 4 30 31 22 4 48 47 87 8 95 N. 143 2 3 7 13 23 14 4 44 22 59 7 66 S. 93 1 1 - 12 20 9 2 27 18 40 5 45 — 127 4 7 11 55 74 45 10 119 87 186 20 206 Rate per 100,000 popultn. 161 75 39 186 144 141 114 157 101 115 12 127 The death-rates per 100,000 of the population during the 25 years ended 1925 in quinquennial averages and in individual years from 1926 to 1929 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 1926 82.0 14.6 96.6 1927 89.4 14.2 103.6 1928 84.1 14.0 98.1 1929 115.0 12.3 127.3 52 During 1929 there were 206 deaths from Tuberculosis registered as belonging to the Borough of Battersea. Of this number 186 (i.e. 90-3 per cent.) were due to pulmonary tuberculosis, 9 (i.e. 4.4 per cent.) to tubercular meningitis and 11 (i.e. 5.3 per cent.) to other forms of the disease. In 1928 the number of deaths from tubercular diseases was 161. The increase in the death-rate is accounted for, to some extent at least, by the prevalence of Influenza and other respiratory diseases during the first part of the year, which, as pointed out in other parts of this Report, was mainly responsible for the higher general death-rate as compared with previous years. Of the 206 deaths registered from Tuberculosis during the year 25 cases were not notified until one month before death ; in 13 cases the notifications were received after death, and in 13 cases no notification was received. Of the 13 cases in respect of which no primary notification was received 10 (6 pulmonary, 4 non-pulmonary) were patients who died in hospitals or infirmaries. Of the remaining cases 2 (1 pulmonary, 1 non-pulmonary) were under treatment by private medical practitioners, and one (pulmonary) was certified by the Coroner after a post-mortem examination. Two of the cases had been notified to the Medical Officer of Health of another Borough. In one case notified posthumously, the death, which was the subject of a coroner's inquest, was certified as being due to glioma and miliary tuberculosis, and is therefore, not included in the above total. In one case (unnotified) the death originally certified as due to Basal Meningitis was allocated to Tuberculous Meningitis on subsequent enquiry, and in a further case in which no notification had been received the death (being certified as due to Tuberculous Meningitis and Pertussis) was ascribed to the latter cause. Of the 13 cases notified after death, 9 (7 pulmonary, 2 nonpulmonary) were from Poor Law Institutions and 4 non-pulmonary were from other hospitals. Shelters. It was decided to provide shelters in the grounds of Southlands Health Services for the use of patients recently returned from Sanatorium, to enable them to bridge over the period between Sanatorium treatment and taking up their employment. These shelters are in addition to those which have for some years been loaned to patients for use in their gardens, in cases in which it is considered desirable to provide separate sleeping accommodation. 53 TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1929. The transfer of the Dispensary from less suitable premises was effected in June, 1928. The report of the Tuberculosis Medical Officer is set out in the appendix (pp. 116-124). 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. 121. 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. 121-4. Dental facilities for tuberculosis patients were first provided by the Council in 1922. A weekly session is held at the Dental Centre, Southlands, and patients requiring treatment or the provision of 54 dentures are referred to the Clinic by the Tuberculosis Medical Officer. The number of sessions held during 1929 was 49, and 311 attendances were made, the average attendance per session being 6-35. The cost to the Council for this service was £141 16s. 6d., less contributions from patients and other sources amounting to £40 0s. Od. Full details of the work carried out are given in the report on the work of the Dispensary in the Appendix (p. 121.) 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 principal work carried out at the Dispensary during 1929 is summarised as follows :— Patients and Attendances. The number of new patients was 709 (555 adults, 154 children), and the number of contacts examined 192 (72 adults, 120 children). There were 22 patients transferred from other areas during the year who subsequently attended the Dispensary, making a total of 923 new patients or contacts. Of these 923 new patients and contacts 258 were found tuberculous, including 3 previously " doubtful " cases, and 4 new cases discovered amongst the 192 contacts examined. The total number of attendances at the Dispensary during the year was 3,967. Visits to the homes of dispensary patients were made by the Tuberculosis Officer in 167 instances, and 4,531 visits were made by the Dispensary Nursing Staff. The number of deaths of dispensary patients was 146. Thirty-eight of the patients were discharged as " cured " or " disease arrested " during the year, and 54 others ceased to attend, in addition to 56 patients who removed to other districts. Institutional Treatment. The number of patients who received Institutional treatment under the L.C.C. Tuberculosis Scheme was 186, and the average length of stay was 112 days. The average period of waiting before admission was 15 days. Definite improvement as a result of institutional treatment was shown in 82 cases. Forty-nine patients discharged themselves while undergoing institutional treatment. The number of dispensary patients admitted to St. James's Hospital during the year was 31. Contributions of patients undergoing institutional treatment were collected by the Dispensary and remitted to the L.C.C. to the amount of £774 7s. 9d. 55 Examinations and Reports. Sputum examinations made during the year numbered 1,592, of which 619 were received from Medical practitioners, and 399 from St. James's Hospital. The number of positive examinations was 305 or 19.16 per cent. Reports to public bodies were made to the number of 1,208. Consultations with medical practitioners at the houses of patients and reports made on patients sent to the Dispensary totalled 1,011, while reports received in respect of insured persons numbered 86 (Form G.P. 36, 86, form G.P. 17, nil). There were 202 patients referred to hospitals, including 179 sent to St. Thomas's for X-ray examination. In the Appendix (pages 113 to 115) 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 1929, 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 1929, arranged according to the years (from 1921 to 1929) 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 1929 the number of new cases notified (including 7 notified after death) and not attending the Tuberculosis Dispensary was 94 (women 57, children 37). There were in addition 7 cases among women and children which came to the knowledge of the Medical Officer of Health either upon registration of the deaths or by information as to the removal of the patients into the Borough. Of the notified 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 30 deaths (including 9 of tubercular meningitis) recorded amongst these 94 notified cases. In 12 cases death had occurred prior to the first visit and 18 deaths were subsequently recorded during the year. In addition there were 5 deaths of unnotified cases, not included in the above 94 cases. 56 The following table gives the age and sex distribution of the 94 women and children (non-dispensary cases) notified to be suffering from Tuberculosis (all forms) during 1929:— Age and Sex Distribution. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 upwards All ages Pulmonary M. 1 1 3 2 - - - - - - - 7 F. 1 - 1 1 13 10 10 4 7 1 2 50 Tubercular Meningitis M. 1 3 - 3 - - - - - - - 7 F. - - 5 - - - - - - - - 5 Other Forms M. - 2 2 4 2 - - - - - - 10 F. 1 3 2 1 2 3 1 - - 1 1 15 Total M. 2 6 5 9 2 - - - - - - 24 F. 2 3 8 2 15 13 11 4 7 2 3 70 Grand Total 4 9 13 11 17 13 11 4 7 2 3 94 The home conditions of 87 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 6 cases, however, the conditions were found to be unsatisfactory the patient's family occupying only a single room. Of the new cases notified during the year 59 were receiving hospital, sanatorium, or other form of institutional treatment at the time of notification. At the end of 1929 there were 192 women and children nondispensary patients (a decrease of 232 as compared with 1928), including new cases notified during the year, on the register, and 1,248 visits were paid by the female Sanitary Inspector (Miss J. Round) to the homes of these patients, including a number of those removed from the Register during the year (many of these having been written off as recovered, vide p. 57). Efforts are made, in as many cases as possible, to induce non dispensary patients to attend the Tuberculosis Dispensary, and during the year, 55 cases were transferred, 33 of these being new cases. Adult Male Patients. There were 124 adult male patients not on the Dispensary roll on the register at the end of 1929. There were 77 new cases notified during 1929, and of these 23 died during the year. 57 The following table gives particulars of the non-dispensary new (male) cases notified in 1929:— Age Distribution. All ages. 16-20 20-25 25-35 35-45 45-55 55-65 65 up Pulmonary 4 10 18 15 14 8 2 71 Tubercular Meningitis — — — — 1 — — 1 Other tubercular Diseases 3 2 — — — — — 5 Total 7 12 18 15 15 8 2 77 The homes of all these patients were systematically visited during the year by the District Sanitary Inspectors, and 591 visits, including 74 first visits to new cases were paid. Eight of the new cases notified were found to have died on the first visit. Of the new cases 42 received institutional treatment and 27 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. Revision of Tuberculosis Register. During 1929 a revision of the cases on the Tuberculosis Register was carried out, the records relating to many hundreds of patients who had been notified between the years 1909 and 1924 being examined. As a result the names of 367 patients whose medical history indicated that they were no longer suffering from the disease, were removed from the register. Many of these cases had been on the register for years, and on investigation the disease was found to have been cured or arrested. Efforts were made to get the patients to attend the Tuberculosis Dispensary where possible, prior to the removal of their names from the register. 58 Public Health (Tuberculosis) Regulations 1912. Summary of Notifications during the period from the 30th December, 1928, to the 28th December, 1929, 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 — 3 3 16 25 33 28 30 8 3 150 198 — — — — — 41 148 Females 1 — 3 3 24 29 31 17 10 4 2 124 164 — — — — — 34 93 N on-Pulmonary— Males — 7 5 6 7 3 1 — — — — 29 36 — — — — — — 15 Females 1 2 9 2 4 4 1 — — 1 2 26 34 — — — — — — 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 among the "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 1929. 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. Notifications of Tuberculosis which are made by Naval, Military or Air Force Medical Authorities in pursuance of § 5 (b) of the Local Government (Emergency Provisions) Act, 1916, should be included in the table above as if they were notifications made on Form A. [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 n 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 shall 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 30th December, 1928, to the 28th December, 1929, otherwise than by formal notification under the Public Health (Tuberculosis) Regulations, 1912* or by notification in pusuance of § 5 (b) of the Local Government (Emergency Provisions) Act, 1916. 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 — — — — 4 1 4 2 3 15 „ Females — — — — 1 1 2 — 1 — 1 6 Non-pulmonary Males 1 3 — 2 — — — — 2 1 — 9 „ Females — 1 1 — — — 2 — — — — 4 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. N on-pulmonary. Death Returns (from Local Registrars, 4 P. 2 N.P.; transferable deaths from Registrar General, 4 P. 3 N.P.) 8 5 Post-humous Notifications 7 6 " Transfers " from other areas (other than transferable deaths) 5 2 Forms C and D (in respect of cases not previously known to the M.O.H.) 1 — Other sources — — *Note.—New cases of tuberculosis first coming to knowledge otherwise than by formal notification under the 1912 Regulations 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 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 diarrhæa. The deaths from these causes in 1929 numbered 95, as compared with 111 in 1928, a decrease of 14.4 per cent. There was a corresponding decrease in the zymotic death-rate from 0.676 in 1928 to 0.587 in 1929. The mean death-rate from each of the principal zymotic diseases for the ten years 1909-1918, and for the ten years 19191928, are compared with the corresponding rates for 1928 and 1929 in the following table:— Zymotic Diseases. Number of Deaths from each of the principal Zymotic Diseases in 1928 and 1929, with corresponding Death Rates for those years and for the 10 years 1909-18 and 1919-1928. No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase (+) or Decrease ( - ), 1929 over 1928. 1929. 1928. 1929. 19091918. 19191928. Previous year. 19191928. Small Pox - - - - - •001 - -•001 Measles 36 5 •219 •031 •479 •172 -•188 -•141 Scarlet Fever 5 4 •030 •025 •042 •033 -•005 -•008 Diphtheria 26 12 •159 •074 •123 •189 -•085 -•115 Whooping-cough 14 43 •085 •266 •265 •110 +•181 +•156 Enteric fever 1 1 •006 •006 •026 •008 - -•002 Diarrhoea and enteritis 29 30 •177 •185 •642 •221 + •008 -•036 Total 111 95 •676 •587 1•577 •734 -•089 -•147 NON-NOTIFIABLE INFECTIOUS DISEASES. Chicken-Pox. During 1929 there were 441 cases of chicken-pox reported, as compared with 632 in 1928, 671 in 1927, 375 in 1926, and 853 in 1925. Diarrhœa. During 1929 the total number of deaths from diarrhœa of children under 2 years of age was 22, equivalent to a fatality-rate of 0•14. In 1928 there were 26 deaths and a fatality-rate of 0•16. The rate per 1,000 registered births in 1929 was 8•40, as compared with 9•48 in 1928. 61 Influenza. There were 138 deaths registered as being due to Influenza during 1929 as against 14 in 1928, 83 in 1927, 25 in 1926, and 36 in 1925. The mortality-rate was 0.85, as compared with 0 085 in 1928, 0.49 in 1927, 0.15 in 1926, and 0.21 in 1925. Influenzal Pneumonia was much more prevalent in 1929 than in the previous year, 140 cases being notified as against 51 in 1928. The death-rate was 0.39 per 1,000 of the population, as compared with 0.02 in 1928, 0.24 in 1927, 0.07 in 1926, and 0.09 in 1925. Cancer. During 1929 the number of deaths of Battersea residents from Cancer was 243 (males 112, females 131) as compared with 247 in 1928, 252 in 1927, 263 in 1926, and 236 in 1925. The death rate from the disease per 1,000 of the population was 1 -50, as compared with 1 -51 in 1928, 1 -49 in 1927, 1 -53 in 1926, and 1 -37 in 1925. 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 1929 1.50 The following table shews the localisation of the disease in the case of the 243 deaths recorded in 1929. Localisation. No. of deaths. Total. % of Total. Male Female Buccal cavity 6 1 7 2.88 Stomach, liver, etc. 36 34 70 28.81 Peritoneum, intestines and rectum 22 26 48 19.75 Female genital organs — 31 31 12.76 Breast — 24 24 9.88 Skin 1 1 2 0.82 Other and unspecified organs 47 14 61 25.10 Total 112 131 243 100.00 Bacteriological Examinations. During 1929 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 2,485. This number is exclusive of the Tuberculosis specimens, the examination of which was carried out at the Tuberculosis Dispensary. 62 The following table gives particulars of the bacteriological examinations carried out during the year:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 284 2,191 2,475 Enteric fever - 10 10 Total 284 2,201 2,485 The cost of these examinations, which in 1929 amounted to £320 11s. 4d., is borne by the Council. 63 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1929. Total Sanitary Operations 71,028 Number of house inspections 39,039 House to house inspections 1,071 Bakehouse inspections 282 Bakehouse nuisances abated 40 Urinals—inspections 122 Do. altered, repaired or water laid on 20 Intimations served under Sec.3 3,979 Notices served under Sec.4,&c. 1,504 Notices served under Sees. 62 & 65 2,926 Complaints received and attended to 3,858 Number of premises disinfected 2,175 Houses supplied with disinfectants 710 Overcrowding abated 25 Premises improved, cleansed and repaired 3,009 Drains tested ... By smoke 581 Do. ... „ water 1,312 Drains cleansed and repaired 301 Drains relaid 119 Frontage drains constructed or re-constructed 30 Soil pipes and drains ventilated 114 Sink and rain-water pipes disconnected or repaired 297 Water closets cleansed and repaired 793 Cesspools abolished 1 Mews and stables drained and paved — Yards and forecourts paved and repaired 271 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 27 Dust receptacles provided 639 Leaky house-roofs and gutters repaired 744 Houses supplied with water and fittings repaired 196 Houses let in separate tenements on register 60 No. of inspections of do. 957 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 71 Cisterns covered, cleansed and repaired 115 Additional water supplies to upper floors 39 Keeping of animals in unfit state discontinued 7 Smoke observations 23 Certificates of disinfection granted 3,637 Houses inspected and certificates granted (Sec. 48) 30 Proceedings ordered by Council and Health Committee 4,019 Summonses issued 59 Magisterial Orders obtained and enforced 34 Factories, Workshops, &c., inspections 3,541 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 82 Underground sleeping rooms : Use discontinued — Defects remedied 12 Gipsy van inspections 37 Drains laid to new houses and tenements 30 Samples taken under the Food and Drugs Adulteration Act 1,200 Miscellaneous 1,464 64 Legal Proceedings. Legal proceedings in connection with nuisances were taken by the Council in 51 cases during 1929. 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 12 Ponton Street Failure to comply with Orders of the Court to abate nuisances at 6, 7, 11, 13 and 15 Orville Road. (Seven summonses.) (1) Nuisance at 2 Patmore Street (2) Neglect to provide dustbin at same premises Nuisance at 24 York Road Nuisance at 172 Meyrick Road Nuisance at 6 Belleville Road Nuisance at 8 Ponton Street Nuisance at 27 Latchmere Street Nuisance at 104 Stewarts Road The like at 4 Seymour Street The like at 6 Seymour Street The like at 40 Ponton Road The like at 19 Beauchamp Road Nuisance at 32 and 34 Alfred Street. (Two summonses) Result of Proceedings. Order made for nuisance to be abated within seven days, and for payment of £1 1s. Od. costs. In each case fined £2 0s. 0d. and £1 1s. Od. costs (£14 0s. 0d. fine and £7 7s. 0d. costs in all). (1) Order made for nuisance to be abated within fourteen days and for payment of £1 1s. 0d. costs. (2) Summons adjourned sine die. Order made for nuisance to be abated within twenty-four hours, and for payment of £1 1s. 0d. costs. Order made for nuisance to be abated within twenty-one days. Order made for nuisance to be abated within forty-eight hours. Order made for nuisance to be abated within seven days and for payment of £1 1s. 0d. costs. Nuisance having been abated, summons dismissed on payment of £1 1s. 0d. costs. Order made for nuisance to be abated within fourteen days and for payment of £1 1s. 0d. costs. The like. The like. Nuisance having been abated, summons dismissed on payment of £1 1s. 0d. costs. Order made for nuisance to be abated within seven 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. 0d. in all). 65 Legal Proceedings under the Public Health (London) Act, 1891— continued. Nature of Offence or Claim. Application ex parte for warrant authorising the Council to enter the premises 150 New Road, for the purpose of examining as to the existence of a nuisance Nuisances at 19, 25 and 61 Longhedge Street. (Three summonses) Nuisance at 35 Bridge Road West Nuisance at 22 Oberstein Road Nuisance at 6 Belleville Road Nuisance at 55 Landseer Street Nuisance at 28 York Road Nuisances at 5, 6, 13 and 17 Orville Road. (Four summonses) Defective yard paving at 8, 9 and 17 Orville Road. (Three summonses) Defective w.c.'s at 13 and 17 Orville Road. (Two summonses) Defective w.c.'s at 114 High Street (Two summonses) Nuisances at 142 and 144 Meyrick Road. (Two summonses) (1) Nuisance and (2) defective dustbin at 27 Belfour Street. (Two summonses) Result of Proceedings. Warrant granted. In each case, order made for nuisance to be abated within fourteen days, and for payment of £1 1s. 0d costs (£3 3s. Od. in all). Order made for nuisance to be abated within fourteen days. Works required to abate nuisance having been practically completed, summons dismissed on payment of £1 1s. 0d. costs. Order made for nuisance to be abated within twenty-one days. Order made for nuisance to be abated within twenty-one days. Order made for nuisance to be abated within fourteen days, and for payment of £1 1s. 0d. costs. In each case Order made for nuisance to be abated within fourteen days and for payment of £2 2s. 0d. costs. (£8 8s. 0d. in all.) In each case fined £2 0s. 0d. and £2 2s. 0d. costs. (£6 0s. 0d. fine, and £6 6s. 0d. costs in all.) Defects having been remedied, each summons dismissed on payment of £2 2s. 0d. costs. (£4 4s. 0d. in all.) Defects having been remedied, and defendant by her solicitor having undertaken to pay £1 1s. 0d. costs, summonses withdrawn with permission of Court. Nuisances having been abated, summonses dismissed on payment of £2 2s. 0d. costs in each case (£4 4s. 0d. in all). Nuisance having been abated and new dustbin supplied, summonses withdrawn on payment of £2 2s. 0d. costs each (£4 4s. 0d. in all). 66 Legal Proceedings under the Public Health (London) Act, 1891— continued. Nature of Offence or Claim. (1) Nuisance, and (2) insufficient water supply at 171 High Street. (Two summonses against each defendant) Nuisance at 115 Winstanley Road Nuisance at 135 Speke Road Nuisance at 142 Meyrick Road Nuisances at 146 148 and 150 Stewarts Road. (Three summonses) Nuisance at 26 Acanthus Road Nuisances at 55 and 59 Speke Road. (Two summonses) Result of Proceedings. (1) Most of the works necessary to abate the nuisance having been completed, summonses for that matter against both defendants adjourned sine die. (2) Sufficient water supply having been provided, summonses for that matter against first defendant dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. 0d. costs, and that against second defendant withdrawn. Nuisance having been abated, summons withdrawn on payment of £2 2s. 0d. costs. Order made for nuisance to be abated within seven days and defendant fined £3 0s. 0d. and £2 2s. 0d. costs. The like. Nuisances having been abated, summonses dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. 0d. costs in each case. (£6 6s. 0d. in all). Order made for nuisance to be abated within seven days. Orders made for nuisances to be abated within twenty-eight days. Costs £1 11s. 6d. allowed on each summons. Food and Drugs (Adulteration) Act, 1928. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 617 Milk 8% extraneous water Fined £1 and £1 1s. costs. 10 Vinegar 10% deficient in acetic acid Fined 10s. 781 Condensed Milk 8% deficient in milk fat Fined £3 and £2 2s. costs. (Warranty defence unsuccessfully pleaded). Summons against employee withdrawn. 67 Food and Drugs (Adulteration) Act, 1928.—Continued. No. of Sample Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 102 Condensed Milk 12% deficient in milk fat Fined £2 and £3 3s. costs. 91 Milk 3% deficient in milk fat Dismissed under Probation of Offenders Act, 1907, on payment of £3 3s. costs in each case (£6 6s. in all) 136 Milk 18% deficient in milk fat (taken at place of delivery) 184 Milk 10% deficient in milk fat (Sample taken at place of delivery) Dismissed under Probation of Offenders Act, 1907, on payment of £2 2s. costs. 441 Camphorated oil 16.5% deficient in camphor Dismissed under Probation of Offenders Act, 1907, on payment of £3 3s. 0d. costs 499 Vinegar 11% deficient in acetic acid Dismissed under Probation of Offenders Act, 1907, on payment of £3 3s. costs 585 Raisins Containing excess of sulphite preservative Dismissed under Probation of Offenders Act, 1907, on payment of £1 1s. 0d. costs Public Health (Preservatives &c. in Food) Regulations. No. of Sample. Nature of Offence. Results of Proceedings. 254 Selling sausages containing (i.) sulphite preservative without label, and (ii.) boron preservative. (Two summonses) Dismissed under Probation of Offenders Act, 1907, on payment of £3 3s. costs in each case (£6 6s. in all). 402 Selling bacon containing boron preservative. (Sample taken at place of delivery) Fined £15 and £3 3s. costs. 68 Milk and Dairies Order, 1926. Nature of Offence or Claim. Result of Proceedings. Delivering milk in bottle which had not been filled and closed on registered premises One defendant not appearing, summons against him not proceeded with. Other defendants fined £1 each (i.e. £2 for the employer and £1 for the employee) The like Employer fined £2. Summons against employee withdrawn. The like Employer fined £1 and employee 10s. The like Employer fined £3 and employee 10s. The like Summonses against both defendants dismissed under Probation of Offenders Act, 1907, employer to pay £1 1s. costs. Housing Act, 1925. Nature of Offence or Claim. Result of Proceedings. Failure to have name and address of landlord in rent book of 30 Millgrove Street Rent book having been put right, summons dismissed under Probation of Offenders Act, 1907, on payment of 15s. costs. Failure to have name and address of Medical Officer of Health and of landlord in rent book of 88 Taybridge Road Rent book having been put right, summons dismissed under Probation of Offenders Act, 1907, on payment of 10s. 6d. costs Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 69 cases during 1929. Acts and Regulations under which Proceedings taken. Persons Prosecuted including employees. Convictions Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and the bylaws made thereunder 33 21 26 0 0 71 8 0 Food and Drugs (Adulteration) Act, 1928 10 4 6 10 0 22 1 0 Public Health (Preservatives &c., in Food) Regulations. 2 1 15 0 0 9 9 0 Milk and Dairies Order, 1926 12 8 10 0 0 1 1 0 Housing Acts 2 — — 1 5 6 Total 59 34 57 10 0 105 4 6 69 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 96 new buildings, or additions to existing buildings, and the drains of 119 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. During 1929, 15 claims made by the owners that the Council were liable for the reconstruction of some portion of the drainage systems of their premises were dealt with. In five cases liability was admitted by the Council, and the expenditure incurred by them under this head amounted to £179 17s. 3d. towards which a contribution of £26 was made by the owner of Nos. 149 and 151, Lavender Road. In seven cases, liability was repudiated, and in three other cases the claims made by the respective owners were subsequently withdrawn. The total number of plans of proposed drainage work deposited during 1929, as compared with 1928, was as under:— 1929 1928 Re-construction or repair of existing drains 77 74 New buildings or additions to existing buildings 57 72 134 146 70 In five 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. During the year 1929, 581 drains were tested by smoke of which 93 were found defective. The water test was applied on 1,312 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 114 instances. Water closets were provided in 71 cases and existing closets repaired in 793 cases. The total number of drains relaid during the year was 119. Those cleansed and repaired numbered 301. Sanitary Conveniences attached to Licensed Premises. During 1929 the number of public-house urinals under inspection was 119. In 78 instances the accommodation is accessible to the general public as well as the users of the houses, and in 41 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 24 notices were served to remedy defects discovered. Smoke Nuisances. During the year 37 observations were made and 18 complaints received. Twelve preliminary and two statutory 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. No action was found necessary during the year with regard to nuisance from effluvium. Water Supply. During 1929 applications were received for certificates of water supply in respect of 30 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 39 cases additional water supply was provided to the upper floors of tenement houses, as required by the Borough Council 71 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 1929 was 67. In the following table are set out the situations of the dwellings and number of occupants:— Situation of Vans. No. of Vans. No. Occupants. m. f. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 4 Mills' Yard, adjoining 80 Sheepcote Lane 7 9 9 1a Weybridge Street (rear of 91 Culvert Road) 1 1 1 Haines' Yard, Falcon Road 7 9 8 Manley's Yard, Cabul Road 30† 25 33 Mills' Yard, Culvert Road 18* 16 23 Van dwellings are frequently inspected, and during the year one of the vans was found to be slightly overcrowded. Four vans were unoccupied. Model Dwellings—Lighting of Staircases. The provisions of the London County Council (General Powers) Act, 1927, with regard to the lighting by natural or artificial means of the staircases of tenement buildings, occupied by the working classes, are referred to in the Annual Report for 1928. Of the 170 buildings of this class in Battersea all but two had, so far as practicable, been rendered in compliance with the provision of the Act at the end of 1928, and in these two cases artificial lighting was installed during 1929. Rag Flock Acts, 1911 and 1928. These Acts were 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 these Acts in Battersea during 1929. *Including one shed. t Including one cottage. 72 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 1929 the work carried out under the Council's Rat Repression Scheme is summarised as follows :— Premises visited 1,525 Contracts made or renewed 12 Poison baits used 28,800 Dead rats found 2,800 Value of contracts £176 10 0 Cash for poison bait £14 2 0 Total expenditure (financial year 1929-30) £532 14 6 Income (financial year 1929-30) £169 5 6 Drains were tested at 54 premises in connection with this work, and in 26 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. Fouling of Footways by Dogs. The Council, in 1929, on the recommendation of the Health Committee, decided to renew the following By-law with regard to the fouling of public footways by dogs:— "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this By-law shall be liable to a penalty not exceeding 40s." This By-law was originally made in 1927, and on the application of the Council, the Home Secretary sanctioned the renewal of the By-law. No proceedings were taken under this By-law during the year. 73 Personal Cleansing Station. During the year 1929, there were 4,335 children and 278 adults cleansed and treated at the station. Of the 4,335 children attending, 557 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 4,308 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 an increase in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. 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 1929 278 4,335 927 400 14,696 62,382 £9,710 £5,101 * Financial year ending 31st March. 74 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1929. Total premises disinfected 2,175 Rooms disinfected 3,175 Staircases disinfected 176 Schools disinfected 29 Number of articles laundered 27,038 „ „ destroyed 1,624 „ verminous, etc., persons (including 4,308 school children) 4,613 „ infectious disease contacts 1,021 „ Library books collected 422 Articles. No. Weight. Tons. . cwts. qrs. lbs. Bedding, &c., disinfected 55,246 118 15 0 10 „ lent 1,185 3 13 0 0 Verminous clothing, &c. Articles from Welfare 9,136 2 12 3 8 Centres 2,956 (not weighed) Total 68,523 125 0 3 18 Propaganda Work. In order to bring to the notice of and to interest the inhabitants of the Borough in health matters, in addition to their other publicity work, a cinema film was prepared by order of the Council to illustrate the work of the Public Health Department. The subjects included in the film were descriptive of the general health and sanitary services of the Borough ; the Maternity and Child Welfare Scheme of the Council; the measures for the protection of the food supply, &c. By the courtesy of the Finance Committee, the use of the Grand Hall has been granted free to the Health, Housing and Maternity and Child Welfare Committees to enable the Film to be exhibited. The attendances have been satisfactory and indicate the increasing interest of the public in the public health activities of the Council. 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 1929 are as under:— Dr. F. Porter Smith, M.R.C.S., L.R.C.P., was appointed in charge of the Diphtheria Immunisation Clinic in the place of Dr. Mabel Brodie, M.B., Ch.B., D.P.H., who resigned her appointment in January. 75 Miss J. Gibson resigned her appointment as Matron of the Borough Maternity Hospital in December, 1928, and was replaced by Miss M. Fevyer, who took up duty in March, 1929. Miss V. Ventris was appointed additional Health Visitor in December. Mr. J. T. Baxter, Sanitary Inspector for No. 5 District was superannuated after 31 years' service with the Council, in December, and the appointment thus rendered vacant had not been filled at the end of the year. Mr. J. A. H. Brownlow was appointed Food Inspector, filling the vacancy left by the retirement of Mr. A. Chuter in the previous year. Mr. F. Pedrick, office youth, was appointed Junior Clerk in July. 76 Coroner's Court and Mortuary. Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1929 are set out in the following table :— Usual Place of Residence. Total Battersea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court ; post— mortem at Mortuary 39 24 3 7 73 Inquest at Coroner's Court ; post— mortem elsewhere 36 85 24 1 146 Inquest at Coroner's Court; no post— mortem 12 13 7 — 32 Total inquests at Coroner's Court 87 122 34 8 251 Post-mortem at Mortuary ; inquest elsewhere 2 _ _ — 2 Post-mortem at Mortuary ; no in— quest (Dr's. Certificate) 1 1 Post-mortem at Mortuary; no inquest (Coroner's Certificate) 75 11 1 87 Bodies received for sanitary reasons 4 — — — 4 Other bodies received on which no inquest held at Mortuary— 3 4 — — 7 Total bodies received 172 137 35 8 352 2nd postmortem held at Mortuary — 1 1 — — 2 Total post-mortems at Mortuary 118 36 4 7 165 VERDICTS AT INQUESTS HELD— Natural causes 28 21 1 2 52 Accidental Death— Anaesthesia— 1 2 — — 3 Asphyxia (food)— 1 — — — 1 Burns and scalds 5 3 — — 8 Coal Gas poisoning— — — — — — Accident due to Epileptic fit 2 — — — 2 Fall 16 32 11 — 59 Silicosis — 1 — — 1 Railway and street accidents 14 37 16 — 67 Septicaemia following injury 1 1 — — 2 Cellulitis, &c., following injury — 3 — — 3 Other accidents 3 2 1 — 6 Open Verdict— Fall — — — — — Found drowned — — 1 1 2 Septicaemia (following miscarriage) — 1 — — 1 Stillborn — — — 2 2 Want of attention at birth — — 1 2 3 Suicide— Cut throat 1 1 — — 2 Drowning 1 1 1 — 3 Jump under moving train 1 2 — — 3 Jump from high place 2 — — — 2 Hanging and strangulation 1 1 — — 2 Poisoning—Coal gas 8 3 1 — 12 „ Drugs, etc. 1 10 1 1 13 Homicide. Abortion — 1 — — 1 Infanticide 1 — — — 1 Grand Total 87 122 34 8 251 77 Protection of 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 1929 :— Food. Quantity. Food. Quantity. Fish. Fruit & Vegetables (fresh). Catfish 1 box. Beans 99 cases. Escallops 1 bag. Cherries 56 baskets. Haddock 5 boxes. Gooseberries 10 boxes. Herrings 1 box. Onions 9 bags. Kippers 1 box. Tomatoes 17 bundles. Mackerel 1 box. Roes 3 boxes. Meat & Poultry. Roker wings 2 stone. Beef 22 lbs. Sole 1 box. Chicken 2 cases (18 lbs) Whiting 4 boxes. Ox liver 1 case (13 lbs.) Winkles 1 sack (6 gals). Pigs' collars 14 pieces. Pigs' heads 15. Pigs' lights 2 sets. Pigs' plucks 5. Pork 63 lbs. Rabbits 23 lbs. Cow-houses. There is now no licensed cow-house in the Borough. Slaughter-houses. There are only two slaughterhouses remaining in the Borough. These premises are kept under systematic inspection, and during the year 1929, 110 inspections were made by the Council's inspector. The carcases of 60 animals (calves 3, sheep 39, and pigs 18) were examined after slaughter. The provisions of the Public Health (Meat) Regulations, 1924, have been brought to the notice of the occupiers of these slaughter— houses, and no contravention of the Regulations or By-laws in regard to slaughterhouses were reported during the year. 78 Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1929 was 96. One new shop was opened during the year, making a total of 97 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 1,598 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. No legal proceedings were taken during the year with regard to the Public Health (Meat) Regulations, 1924. Food and Drugs (Adulteration) Act, 1928. During 1929 the new Food and Drugs (Adulteration) Act, 1928, came into force on the 1st January. The main provisions relating to the composition and description of food are :— (a) Statutory provisions :— The Food and Drugs (Adulteration) Act, 1928. Section 4 of the Milk and Dairies (Amendment) Act, 1922. (b) Orders and Regulations made under repealed Acts and continued in force by the Food and Drugs (Adulteration) Act, 1928:— Order as to Registration of Margarine Factories, &c., 1900 ; Order as to Registration of Butter Factories, &c., 1907 ; Regulation as to Competency of Analysts, 1900 ; Sale of Milk Regulations, 1901 and 1912 ; Sale of Butter Regulations, 1902. (c) Regulations made under the Public Health (Regulations as to Food) Act, 1907 :— Public Health (Condensed Milk) Regulations, 1923 and 1927 ; Public Health (Dried Milk) Regulations. 1923 and 1927; Public Health (Preservatives, &c., in Food) Regulations, 1925 to 1927. From the above it will be seen that progress has been made towards securing a greater measure of control over the composition and description of food and drugs supplies. The total number of samples taken under the Act during 1920 was 839, of which 22 or 2-6 per cent, were certified by the Public Analyst to be adulterated. In addition to the foregoing, 361 informal samples were procured, of which 15 (or 4-1 per cent.) were reported by the Public Analyst as being adulterated or con— taining preservative. 79 The percentage of samples reported by the Public Analyst to be adulterated during the 5 years 1924-28, and in 1929, was as follows:— Year. Formal Samples, (per cent.) Informal Samples, (per cent.) 1924 3.9 11.5 1925 4.4 2.8 1926 4.3 3.7 1927 4.5 0.8 1928 2.6 1.4 Mean 3.9 4.0 1929 2.6 4.1 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. Infor— mal. Total. Formal. Infor— mal. Total. Bread , — 10 10 — 0 0 Butter 40 34 74 0 0 0 Cheese 18 — 18 0 — 0 Cocoa 3 4 7 0 0 0 Cofiee 9 — 9 0 — 0 Confectionery (Sweets) and Jam — 10 10 0 0 0 Cream 1 15 16 0 0 0 Flour — 2 2 — 0 0 Self-raising — 8 8 — 0 0 Margarine 20 38 58 0 0 0 Milk 603 8 611 11 5 16 ,, Machine Separtd. 1 — 1 0 — 0 „ Condensed (Full Cream) 2 11 13 2 3 5 ,, „ (Machine Skimmed) — 21 21 — 0 0 Mustard — 14 14 — 0 0 Sugar — 15 15 — 0 0 Tea — 13 13 — 0 0 Vinegar 51 — 51 4 — 4 Malt 1 — 1 0 — 0 Drugs 2 26 28 1 3 4 Other Articles 88 132 220 4 4 8 Total 839 361 1200 22 15 37 80 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bicarbonate of Soda — 3 3 — 0 0 Camphorated Oil 2 9 11 1 2 3 Cream of Tartar — 7 7 — 0 0 Paregoric (Tine. camph. co.) — 4 4 — 1 1 Zinc Ointment — 3 3 — 0 0 Total 2 26 28 1 3 4 TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Arrowroot 7 7 0 0 Bacon 1 — 1 1 — 1 Baking Powder — 6 6 — 0 0 Barley, Pearl 3 — 3 0 — 0 Brawn 2 — 2 0 — 0 Cake, Sponge — 16 16 — 0 0 Coffee Mixture 3 — 3 0 — 0 Cordials — 3 3 — 0 0 Custard Powder — 6 6 — 0 0 Dripping — 3 3 — 0 0 Fish Paste 7 2 9 0 0 0 Fruits, Dried 4 18 22 1 1 2 Ginger (Ground) — 6 6 — 0 0 Honey — 6 6 — 0 0 Lard 4 15 19 0 0 0 Lemon Curd — 1 1 — 0 0 Lentils — 3 3 — 0 0 Meat, Canned 1 — 1 0 — 0 Mustard (Condiment) — 1 1 — 0 0 Olive Oil 15 — 15 0 — 0 Peel, Candied — 7 7 — 0 0 Pepper — 9 9 — 0 0 Rice 22 4 26 0 0 0 Sago 1 3 4 0 1 1 Sausages 12 8 20 2 2 4 „ Breakfast 1 — 1 0 — 0 „ Luncheon 4 — 4 0 — 0 „ Preserved 5 — 5 0 — 0 Spice, Mixed — 8 8 — 0 0 Wines (non-alcoholic) 3 — 3 0 — 0 Total 88 132 220 4 4 8 81 Milk. Of the 612 samples of milk (including 8 informal samples and 1 formal sample of separated milk) submitted during the year, 16 (11 formal and 5 informal) or 2-6 per cent., were reported as adulterated, 8 of these samples (3 formal and 5 informal) being deficient in milk fat and 8 (all formal samples) containing extra— neous water. The deficiency in milk fat varied from 25 per cent, to 3 per cent., and the proportion of extraneous water from 8 per cent, to 1 per cent. In the 5 years 1924-28, and in 1929 the percentage of adul— terated (formal) samples of milk was as under :— Year. Samples taken. Adulterated. No. Percentage. 1924 721 25 3.4 1925 1926 808 738 40 32 4.9 4.3 1927 696 37 5.3 1928 668 21 3.2 Mean 726 31 4.3 1929 603 11 1.8 It will be seen that the number of milk samples submitted for analysis during the year is under the average of the preceding five years, and that the percentage of adulteration is the lowest yet recorded. This latter result, having regard to the value of milk as an article of diet, especially for infants and invalids, must be regarded as highly satisfactory. The average composition of the 595 samples (including 3 informal samples) reported as genuine proved to be as under:— Per cent. Total milk solids 12.33 Milk fat 3.55 Non-fatty solids 8.78 82 The content of fat in these 595 samples ranged as follows :— 4 per cent, and over 31 samples or 5.2 per cent. Between 3-9 and 4-0 per cent. 19 „ ,, 3.2 ,, 3-8 „ 3-9 , 30 „ „ 5.0 3-7 „ 3-8 „ 73 „ „ 12.3 3-6 „ 3-7 93 „ „ 15.6 3-5 „ 3-6 117 „ „ 19.7 3-4 „ 3-5 „ 103 „ „ 17.3 3-3 „ 3-4 „ 63 „ „ 10.6 3-2 „ 3-3 31 „ „ 5.2 3-1 „ 3-2 24 „ „ 4.0 3-0 „ 31 11 „ „ 1.9 Under 3-0 per cent — „ — 595 100.0 All samples were systematically tested for the presence of pre— servatives and colouring matter. In no case, however, was a posi— tive result obtained. Milk sampling was carried out on 5 Sundays during the year, and 26 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 55 were taken during the year. Most of these samples were taken at Clapham Junction or South Lambeth (G.W.) Railway Stations. Samples of milk to the number of 87 were taken in course of delivery to hospitals and elementary schools in the borough. In addition 15 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 Sees. 21 and 29 and the Second Schedule of the Food and Drugs (Adulteration) Act, 1928, which permit the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. During the year advantage was also taken of these provisions by 8 milk purveyors in regard to 24 samples of milk all of which were reported by the Public Analyst to be genuine. Proceedings with regard to adulteration were taken in 4 instances—fat abstraction, 3 ; extraneous water, 1, particulars relating to which will be found set out in the tables on pages 66 and 67. Condensed Milk. Of the 13 samples of full-cream condensed milk submitted to the Public Analyst during the year, 5 (2 of which were formal samples) were reported against as containing a percentage of milk fat below 9 per cent., the minimum amount required under the Public Health (Condensed Milk) Regulations, 1923 and 1927. Proceedings were instituted in regard to the 2 formal samples, the result being set out on pages 66 and 67. In one case warranty was pleaded, but unsuccessfully. 83 Cheese. Eighteen samples of cheese were submitted for analysis during the year, all of which were procured formally. The samples proved genuine. Butter. The total number of samples of butter taken during the year was 74. Of these 34 were submitted informally. All these samples were reported as genuine and were found to be free from preservatives other than salt. The average moisture content of the 74 samples amounted to 14-5 per cent. Margarine. Fifty-eight samples of margarine were purchased and submitted to the Public Analyst for examination, 38 of which were procured informally, and in no case was adulteration certified. The average moisture content of the 58 genuine samples was 13-9 per cent. Sausages, Bacon, Preserved Meats, &c. Thirty-two samples, viz. :—1 formal sample of canned meat ; 1 formal sample of bacon ; 22 formal samples of sausages (including 4 of liver or luncheon sausage, 1 of breakfast sausage and 5 samples labelled " Preserved Sausage ") and 8 informal samples of sausage were submitted to the Public Analyst during the year. Two of the formal and two informal samples of sausages were certified to be adulterated, the remainder being reported as 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 this preserva— tive must be indicated on the label, or by a general notice displayed in a conspicuous position in the shop. The two formal samples reported against by the Public Analyst were both certified to contain preservatives, in one case both sulphite and boron preservatives being present. Proceedings were instituted against the vendor in this case and he was ordered to pay £6 6s. costs (vide p. 67). In the second case, the preservative present was of the kind and within the quantity allowed, but the sausages bore no label indicating the presence of the preservative. As, however, a notice was exhibited in the shop that sausages sold in the establishment contained preservative, no proceedings could 84 be instituted. On the instructions of the Committee the attention of the Ministry of Health was drawn to the matter and to the desirability of amending the Public Health (Preservatives, etc., in Food) Regulations so as to require the labelling of all foods which contain preservatives. The sample of bacon which was taken in course of delivery by a wholesale merchant, was certified by the analyst to contain a boron preservative equivalent to 7.7 grains crystallised boric acid per lb. of bacon. The use of boron preservatives is prohibited by the Public Health (Preservatives, etc., in Food) Regulations, and proceedings were by direction of the Health Committee taken against the vendors, who were fined £15 and £3 3s. costs. Flour. Two samples of flour and 8 samples of self-raising flour submitted for analysis were all reported as genuine. These samples were all taken informally. Rice. Twenty-six samples of rice (22 formal and 4 informal) were procured and submitted to the Public Analyst and all were reported as genuine. One sample was found to be polished by the aid of talc, and was found to contain 0.44 per cent, of this substance. It is satis— factory to note that only one sample was found to be treated in this manner, the object of which is to improve the appearance of the rice for the purpose of sale. The polishing matter used, namely talc, is deleterious and the Council some years ago, directed a circular letter to be addressed to all dealers in rice, which apparently has had useful results. Sago. Four samples of sago, three of which were informal samples, were examined during the year and one (informal) sample was reported as consisting entirely of tapioca, obviously a mistake in the article served. Vinegar. Fifty-two samples of vinegar, including 1 of malt vinegar, were procured formally and submitted to the Public Analyst. Four (7.7 per cent.) of these were reported to be deficient in acetic acid to the extent of 4 per cent. (2 samples), 10 per cent., and 11 per cent, respectively. Proceedings were instituted against the vendors in the 2 last-mentioned cases (vide pp. 66 and 67), and the vendors of the 2 remaining samples were cautioned. 85 Dried Fruits. The Public Health (Preservatives, &c. in Food) Regulations allow dried fruits to be preserved with sulphur dioxide to a limit of 750 parts per million in the case of raisins and sultanas, and 2,000 parts per million in the case of apricots, peaches, nectarines, apples and pears. During the year 22 samples were submitted to the Public Analyst comprising 10 of dried apricots, 2 of sultanas, 2 of currants, and 8 of raisins. The dried apricots were all found to contain a sulphite preservative ranging from 1,820 parts of sulphur dioxide per million to a trace. The 2 samples of sultanas contained 512 parts per million in one case and none in the other. The currants were found to be free. All the samples of raisins were free from sulphite preservative with the exception of 2, one an informal sample and one formal (arising from this informal sample). The amount of preservative reported present in this formal sample was 1,060 parts of sulphur dioxide per million, or 310 parts in excess of the permissible quan— tity. Proceedings were instituted in this instance against the vendor, but the summons was dismissed under the Probation of Offenders Act, on payment of £1 Is. Od. costs (vide p. 67). Drugs. The number of samples of drugs submitted to the Public Analyst for analysis during the year was 28 (26 of which were informal samples), and comprised 5 varieties. Of these, 3 samples of camphorated oil (1 formal), and 1 of paregoric (informal) were reported against as not being in accordance with the requirements of the British Pharmacopoeia. The action taken in regard to the formal sample of camphor— ated oil is set out on page 67. Ice Cream. There are 151 premises in the borough from which ice cream is sold, 23 of these being occupied by Italian vendors. Section 29 of the London County Council (General Powers) Act, 1928, which is set out below, came into operation on 1st January, 1929. (1) Any premises used or proposed to be used for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale shall be registered by the 86 owner or occupier thereof with the sanitary authority and no premises shall be used for the purposes aforesaid or any of them unless the same are registered as aforesaid. (2) Any person offending against the provisions of this section shall be liable to a penalty not exceeding 40s., and to a daily penalty not exceeding 20s. (3) This section shall not apply to any premises occupied as a factory or workshop respecting which notice is required by sub-section (1) of section 127 (Notice of occupation of factory or workshop) of the Factory and Workshop Act, 1901, to be given and shall not in any way affect the operation of that Act. (4) This section shall not apply to any premises used as a hotel restaurant or club. It is to be regretted that the person as well as the premises should not be required to be registered (as in the case of Milk), and furthermore that the Council should not have the power to refuse to register where the premises are found to be unsuitable on sanitary grounds. Applications for the registration of 151 premises were granted by the Council during the year. In one case the application was not granted, the premises being regarded as unsuitable for the purpose, on sanitary grounds. There was, therefore, no change in the number of premises compared with 1928. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under daily inspection during the season. During the year 312 inspections were made and 4 notices (including 1 statutory notice), were served to remedy defects found on inspection. The improvement in the manner in which this commodity is now prepared and sold, referred to in previous annual reports, is on the whole being maintained. 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 of the Medical Officer of Health for 1926, were enforced by the Council's Officers during the year under report. Proceedings were taken in 5 cases where milk roundsmen were observed to fill milk bottles in the street, contrary to the provisions of the Order. The result of the proceedings in each case is set out on page 68. 87 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 1929 licences were issued as follows :— Certified milk 10 Grade A (Tuberculin tested) milk (in— cluding 1 supplemental) 51 Grade A milk 1 Pasteurised milk 13 Two licences to bottle Grade A (T.T.) milk and one licence to pasteurise milk were granted and are included in the above figures. During the year six samples of Certified 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 six samples. The bacterial content of the samples per 1 c.c. ranged from 110 to 1,263, the average number being 618. Milk Shops. The number of premises registered in Battersea for the sale of milk is 132 (including 5 wholesalers' premises). Five new premises (including 1 wholesale depot) were registered during the year for the sale of milk, and in 3 cases (including 1 wholesale depot) the sale of milk from registered premises was discontinued. In 14 cases registration was transferred on account of change of proprietorship. All milk shops are kept under inspection and during the year 461 inspections were carried out and 25 notices (20 Intimation and 5 Statutory) were served to remedy defects found on inspection. These mainly referred to dirty and unsuitable premises and minor defects. In addition to the above there are 106 persons registered in respect of premises in which milk in sealed bottles only is sold. 19 vendors whose licensed premises 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. 88 Preservatives in Food. The provisions of the Public Health (Preservatives, etc., in Food) Regulations are referred to in the Report for the year 1928. During 1929, contraventions of the Regulations were reported in the case of 7 samples, viz., raisins 2 (1 informal); sausages 4 (2 informal) and bacon 1. In three cases (sausages) a permitted preservative was present in the article purchased, but its presence was not indicated on the label; in 2 cases (bacon 1, sausages 1) a prohibited preservative was found ; and in 2 cases (raisins) the permitted preservative was found in excess of the quantity allowed. The action taken in the case of these samples is referred to in the preceding pages. Agricultural Produce (Grading and Marking) Act, 1928. Further Regulations under this Act were made by the Minister of Agriculture and Fisheries during 1929 dealing with the grading and marking of apples and pears, tomatoes and cucumbers, wheat flour, beef, malt flour and malt extract and potatoes. No action was found necessary during the year under review in regard to the various Orders made under the Act. Merchandise Marks Act, 1926. A further Order in Council, namely, the Merchandise Marks (Imported Goods) No. 4 Order, 1929, was made during the year dealing with the sale of imported tomatoes. The Medical Officer of Health and the staff of sanitary inspectors have been authorised by the Council to enforce the provisions of the various Orders made under the Act. No offences were reported during 1929. Artificial Cream Act, 1929. This Act came into force on the 1st June, 1929. The Act defines " Artificial Cream " to be— " an article of food resembling cream and containing no ingre— dient which is not derived from milk except water or any ingredient or material which by virtue of the proviso to sub— section (2) of section two of the Food and Drugs (Adulteration) Act, 1928, may lawfully be contained in an article sold as cream." The provisions of the Act require (with certain exceptions) the registration of all premises where artificial cream is stored or exposed or kept for sale for human consumption. Such premises are to be registeied by the Food and Drugs Authority, whose officers are empowered to enter and inspect them. Every receptacle 89 used for.the conveyance or containing artificial cream when exposed for sale shall be labelled " Artificial Cream." During the year one application for registration of premises for the sale of artificial cream was granted. 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 74. All these premises are kept under systematic inspection. One hundred and ninety inspections were made during 1929 and 23 notices were served for various defects found on inspection. Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1929 was 118, 15 having been added. During the year 261 inspections were carried out and in 29 cases it was found necessary to serve notices (including 6 statutory notices) to remedy defects, mainly for lack of cleanliness. Street Stalls for Sale of Food. There are 248 street stalls in the borough for the sale of food— stuffs of varied character, namely: Coffee 17, vegetables and fruit 153, fish and poultry 29, meats and rabbits 7, sweets 13, and other foods 29. Eleven notices were served for defective and insanitary con— ditions of premises used by street vendors for the storage of their stocks. 90 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. Prosecu— tions. Factories (including Factory Laundries) 765 91 — Workshops (including Workshop Laundries) 708 104 _ Workplaces (other than Out— workers' premises included in the Table on page 96) 1,530 82 — Total 3,003 277 — 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 102 102 — Want of Ventilation 5 5 — Overcrowding — — — Want of drainage of floors 2 2 — Other nuisances 99 99 — Sanitary accommodation Insufficient 7 7 — Unsuitable or defective 73 73 — 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 96) — — — Total 290 290 — — 91 3.—-Registered Workshops. Workshops on Register (Section 131) at end of 1929 :— Bakehouses 21 Bootmakers 38 Dressmakers 17 Laundries 3 Milliners 10 Tailors 38 Other Trades 199 Total number of workshops 326 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 3 Notified by H.M. Inspector 10 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 1929 :— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 48 188 34 42 18 Barge builder 2 26 — — — Bootmaker 28 62 5 — — Builder 4 126 16 — — Butter blender 1 180 30 50 40 Chaff & forage 3 39 — 8 — Chemical works 4 208 13 72 10 Coach 2 21 1 1 — Cycle maker 2 6 1 — — Dyer 3 48 2 52 4 Engineer 24 1,052 104 — — Firewood cutter 13 34 8 24 — Flour mills 2 135 5 12 — Foundry 1 50 4 — — Lift maker 2 27 6 — — Mason 6 433 2 — — Mineral water 2 36 — 28 — Motor repairs 20 223 25 6 — Printer 18 82 27 20 8 Steam laundry 16 76 23 480 206 Other trades 93 3,975 554 1,093 693 Total 294 7,027 860 1,888 979 92 The duties of sanitary authorities in relation to the sanita— tion of factories are few, and are limited mainly to the enforce— ment of suitable and sufficient sanitary accommodation for factory employees. Thirty-five new factory premises were added to the register during the year, dealing with various trades, and 15 were removed. During the year 78 preliminary and 13 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 1929 :— Trade. No. of Work— shops. No. of Work— rooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 21 30 34 2 — — Blind maker 2 3 6 — — — Bootmaker 38 38 54 2 1 — Carpenter 7 8 11 — — — Coach builder 7 10 33 2 — — Cycle maker 9 13 20 2 4 — Dressmaker 17 21 — — 44 10 Embroiderer 1 2 — — 15 — Farrier & smith 10 10 19 1 — — Firewood cutter 5 6 7 2 — — Laundry 3 9 2 — 8 — Mason 3 3 6 1 — — Milliner 10 10 — — 33 — Motor repairs 21 22 65 4 — — Musical instru— ment 4 7 29 9 4 — Photographer 2 2 2 — 2 — Picture framer 6 6 11 1 — — Rag sorter 23 24 44 6 13 — Saddler 1 1 1 — — — Tailor 38 50 57 11 30 2 Upholsterer 14 19 25 5 11 — Other trades 84 98 201 31 33 13 Totals 326 392 627 79 198 25 93 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 1929 the number of inspections amounted to 42. Seventy-nine intimation and 25 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, one intimation notice was served by the female inspector. Fifty-four new workshops were added to the register, dealing with the following trades:— Bootmaker 13 Carpenter 2 Cyclemaker 1 Firewood cutter 2 Motor repairer 8 Photographer 1 Picture framer 2 Rag sorter 5 Tailor 9 Upholsterer 4 Other trades 7 The following are particulars relating to workshops in which "protected persons " were employed, notice of which was duly sent to H.M. Inspector during 1929:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Bootmakers 1 - 1 1 Tailoring 2 - 3 3 Outworkers. During 1929, 467 names and addresses of outworkers were received in 99 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 136 names and addresses relating to 83 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:— 94 Number on Register. Persons Trade. , Employed. Premises. I Workrooms Bootmaking ... ... 36 36 45 Gloveraaking ... ... 1 1 1 Tailoring ... ... ... 40 43 93 Other Trades 3 3 5 Totals 80 83 144 Five new male outworkers' premises (not previously registered) were registered during the year, and 17 were removed from the register. There were 106 inspections made of male outworkers' premises during 1929, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 9 cases to remedy sanitary defects found on inspection, viz. :—Defective w.c. 3; defective roof 3; cleansing 2; other defects 1. No case of infectious disease was notified during 1929 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 29 35 47 Millinery 1 1 1 Embroidery 38 38 41 Fancy goods 4 4 4 Fancy boxes 7 7 7 Fine needlework 4 4 5 Glovemaking 2 2 2 Knitting and crochet 5 5 5 Tailoring 27 30 44 Underclothing 5 5 6 Other trades 25 25 25 Total 150 160 194 95 The number of new female outworkers' premises (not pre— viously registered) registered during the year was 29, and there were 41 removed from the register. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 432. It was found necessary in 4 cases to serve notices under the Public Health (London) Act, 1891, to remedy defects. Five cases of infectious disease, viz. : diphtheria 2, scarlet fever 1, acute primary pneumonia 2, were notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in these cases. Bakehouses. There were 69 bakehouses on the register at the end of 1929. Of these 48 use power, and are therefore technically factories. Forty-three of the bakehouses are above ground, and 26 are under ground. Three premises were removed from the register, they being no longer used as bakehouses. Inspections made during the year were 282, and 23 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. Warehouses and Wharves. At the end of 1929, there were 51 premises on the register, including railway yards. These premises were systematically inspected during the year, and 91 inspections were made. Five intimation and 2 statutory notices were served to remedy nuisances found on inspection. Home Work, 1929. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Secs. 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workers. Contractors. Workers. Wearing Apparel- (1) Making 38 11 146 2 6 l 48 — — 13 13 5 — — (2) Cleansing & Washing 2 — 4 — — — 2 — — — — — — — — Furniture and Up— holstery 4 — 10 — — — 4 — — — — — — — — Other Trades 2 — 47 2 — 16 8 — — — — — — — — Total 46 11 207 4 6 17 62 — — 13 13 — 5 — — 96 Note—Of the 241 names included in this table, only 120 were of work people residing in Battersea, the remaining names being those of workers residing outside the Borough. The names of 141 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were therefore 261 Battersea home-workers named in the lists. 97 Housing. New Houses. The difficulties arising from the lack of adequate housing accommodation, referred to in previous annual reports, continued to prevail, although to some small extent additional accommodation has been secured, mainly through the London County Council in accordance with an arrangement made by them with the Metropolitan Borough Councils. There is a reasonable prospect, however, that under the new Housing Act there will be a speeding up of the provision of housing accommodation for the less prosperous class of the population, who, owing to the inability to pay rents on the existing scale, have hitherto been unsuccessful in their application for better housing conditions. During the year the Council had under consideration the purchase of St. John's College, which, with its grounds, comprises a site of 4f acres, on which they propose to erect some 300 dwellings. This will be a valuable addition to the work which the Council has already accomplished in relieving some of the more urgent cases of hardship which have come to their notice. The Council also have in contemplation the purchase of another site in the Borough which would further assist in the same direction. During the year a portion of what is known as the Battersea Rise Estate, which had been reserved for the erection of a Church, was made available for the building of dwelling houses. The Council, having regard to the high cost of the scheme and the restrictions contained in the title, reluctantly decided not to proceed with the purchase of the land, on which six houses were subsequently erected by private enterprise. Apart from the Plough Road Improvement Scheme and the Plough Road Extension Scheme (vide pp. 101), no new workmen's dwellings were erected by the Council in 1929. 98 Under private enterprise the following additional accommodation was erected during the year:— Belle Vue Parade, Belle Vue Road 5 flats. Culmstock Road 6 houses. Lavender Gardens 1 „ Sudbrooke Road 1 „ Taybridge Road 5 „ Total 18 dwellings. 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 difficulties in Battersea. As pointed out in previous Annual Reports, owing to the remoteness of the newly-built London County Council bouses from their work, and their inability to pay the rents charged, there is a reluctance on the part of the inhabitants of the Borough to accept accommodation on these estates. It is interesting to note in this connection that the method which I understand is applied by the London County Council as a guide for ascertaining the approximate amount of rent which a family can reasonably afford for housing accommodation on their Estates, is that the income of the family should be from four to five times as much as the rent they would have to pay for the accommodation. The rents charged for three-roomed and four-roomed dwellings on the London County Council Estates are approximately 16s. and 18s. per week respectively, and on this basis a family of six would require an income of at least £3 4s. 0d. to £4 0s. 0d., whilst a family of eight persons would need an income of at least £3 12s. 0d. to £4 10s. 0d. to pay these rents. When it is appreciated that the average income of the poorer working class families is under £3 per week, it will be realised that until dwellings are provided at a much lower rental than is at present charged, no serious diminution of the overcrowding problem in Battersea can be expected. During 1929 the Downham and Watling Housing Estates of the London County Council were completed, and consequently the number of cases referred to the London County Council with a view to special consideration being given thereto on the grounds 99 of overcrowding or hardship were in the main confined to accommodation on the Becontree Estate where the rents are lower, but which is very remote from this Borough. The following table shows the result of such action during the year. Referred in previous years but not then Referred Total, dealt with. in 1929. Families accommodated 20* 16 36 Offer declined by applicant or applicant otherwise suited 2 6 8 Recommendation not accepted by London County Council — 13 13 Still under consideration 58 18 76 Total 80 53 133 * Includes 3 cases in which the recommendation had been previously not accepted by the London County Council. 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. 104 and 105. 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 the Housing Act, 1925, in securing the re-conditioning of seriously defective house property continues to be fully justified. In the case of five houses in Woodgate Street, in default of compliance by the owner with the notices served under Section 3 of the Housing Act 1925, arrangements were made for the Council's Works Department to enter and carry out the necessary works of repair to render the premises in all respects reasonably fit for habitation. The freeholders, however, commenced action in the Chancery Division of the High Court under Section 30 of the Housing Act 1925 against the "Owner" to terminate the leases and any derivative under leases, and joined the Council as respondents. 100 The action came before the Court on several occasions and was adjourned from time to time upon the Respondents other than the Council undertaking to proceed expeditiously with the work required under the notices, and to complete such work to the satisfaction of the Council. Eventually on the 9th April it was reported to the Court that the notices had been complied with and accordingly no order was made on the motion except that the Council's costs should be paid in the first place by the applicants, and that the respondents other than the Council should pay the applicants' costs including those they had to pay to the Council. Appeals. It is satisfactory to record that during 1929 the right of appeal by owners against notices under Section 3 of the Housing Act, 1925, was not exercised. Closing Orders. No Closing Orders under Section 11 (l) of the Housing Act, 1925, were made by the Council during 1929. Demolition Orders. A Closing Order was made by the Council in respect of the premises No. 7 Darien Road—an empty house—in May, 1920, and in due course a demolition order in November, 1920. Having regard to the fact that this house is one of a terrace and that its removal might give rise to risk of injury to the adjoining houses which otherwise would have to be shored up and that the expense involved would exceed the value of the property (freehold) the Committee did not feel justified in proceeding with the demolition of the house. These premises had fallen into such a derelict condition that the matter was again brought to the notice of the Housing Committee, who, on the report of the Medical Officer of Health recommended the Council to make and seal an Order for the demolition of the premises. After hearing the representations of the owner this Order was made and sealed by the Council on the 27th November, 1929. Underground Rooms. No Closing Orders were made by the Council in respect of underground rooms during 1929. Increase of Rent, etc., Acts. During 1929, 7 applications were received from tenants for the certificate, and 2 from owners for the report of the Sanitary Authority under the above-mentioned Acts. The application for a certificate was granted in 5 cases and refused in 2 cases; those for reports were granted in both cases. 101 Action under Section 5 of the Housing Act, 1925. During 1929, 49 cases relating to 76 houses were reported to the Housing Committee for contravention of Section 5 of the Housing Act, 1925, which requires the rent book to be kept in the prescribed form. In all cases notice was given to the owners concerned and in 47 cases, satisfactory explanations having been received and the requirements of the section complied with, cautionary letters were, by order of the Committee, sent to the offenders. In two cases proceedings were taken, the results of which will be found set out on page 68. Insanitary Areas. No insanitary areas were represented to the Council during 1929. The Plough Road Improvement Scheme, as approved by the Ministry of Health, was completed during the year, and as a result eleven blocks, each containing six tenements, have replaced the old, worn-out, generally dilapidated houses which formerly stood on the site. As described in the Annual Report for 1928, the Council, by the acquisition of other properties by negotiation, were able to extend the scheme and so make provision for three more blocks (eighteen tenements). Of these one block was completed during 1929. With regard to the Savona Street area which was represented as an Insanitary Area in 1920 but was not proceeded with, the Council took advantage of an opportunity which arose to purchase three houses, Nos. 18, 20 and 22 Savona Street, adjoining the tenements already erected by the Council. In order that it might be possible when circumstances permitted to pull down these old houses and erect on the site a block of six tenements, the Council also purchased No. 24 Savona Street. 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 1929. 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 1929. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District. Belfour Street 1 New Road 16 , Savona Street 10 Linford Street 29 St. Andrews St. 1 Total:—5 streets, 57 houses. 102 Street. Houses dealt with. Street. Houses dealt with. Street. House dealt with. No. 2 District. Havelock Terrace 22 Oulton Street 1 Total:—2 streets, 23 houses. No. 3 District. Balfern Street 1 Green Lane 1 Stanmer Street 2 Castle Street 2 High Street 1 Surrey Lane 1 Frances Street 1 In worth Street 1 Total:—8 streets, 10 houses. No. 4 District. Afghan Road 1 Heaver Road 1 Musjid Road 1 Barmore Street 12 Kambala Road 2 Patience Road 2 Benfield Street 18 Lavender Road 3 Pearson Street 2 Darien Road 1 Lavender Terrace 1 Shillington Street 3 Duffield Street 1 Lubeck Street 1 Winstanley Road 2 Este Road 2 Mantua Street 1 York Road 1 Gwynne Road 1 Meyrick Road 2 Total:—20 streets, 58 houses. No. 5 District. Culvert Road 1 Eversleigh Road 1 Shirley Grove 1 Eland Road 1 Latchmere Road 2 Wickersley Road 8 Total:—6 streets, 14 houses. No. 6 District. Auckland Road 1 Mallinson Road 1 North Side Darien Road 1 Maysoule Road 7 Wandsworth Cn. 1 Didcot Street 14 Newcomen Road 1 St. Johns Hill 1 Grant Road 1 Usk Road 113 Total:—10 streets, 141 houses. No. 7 District. Freke Road 1 Lavender Hill 1 Total:—2 streets, 2 houses. No. 8 District. Chatham Road 1 Total:—1 street, 1 house. Summary. No. 1 District 5 streets 57 houses. „ 2 „ 2 „ 23 „ „ 3 „ 8 „ 10 „ „ 4 ,, 20 „ 58 „ „ 5 ,, 6 „ 14 „ „ 6 „ 10* „ 141 „ „ 7 „ 2 „ 2 „ „ 8 ,, 1 „ 1 „ Totals 53*streets 306 houses * Including Darien Road, partly in No. 4 District also. 103 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 1928. Street. House dealt with. Street. House dealt with. Street. House dealt with. No. 1 District. Acre Street 2 Everett Street 7 New Road 53 Belfour Street 6 Linford Street 28 Woodgate Street 5 Etruria Street 3 Total:—7 streets, 104 houses. No. 2 District. Blondel Street 38 Oulton Street 1 Total:—2 streets, 39 houses. No. 3 District. Parkham Street 7 Total:—1 street, 7 houses. No. 4 District. Creek Street 18 Mantua Street 1 Stainforth Road 3 Duffield Street 1 Meyriclc Road 1 Thibet Street 5 Kerrison Road 1 Musjid Road 1 Verona Street 1 Lavender Road 2 Shillington Street 2 Wye Street 1 Lithgow Street 1 Total:—13 streets, 38 houses. No. 5 District. Eland Road 1 Mossbury Road 1 Tipthorpe Road 2 Total:—3 streets, 4 houses. No. 6 District. Maysoule Road 65 Winstanley Road 1 Total :—2 streets, 66 houses. Nos. 7 and 8 Districts. Nil. Summary. No. 1 District 7 streets 104 houses. „ 2 „ 2 „ 39 „ „ 3 „ 1 „ 7 „ „ 4 „ 13 „ 38 „ „ 5 „ 3 „ 4 „ „ 6 „ 2 „ 66 „ „ 7 „ — — „ 8 ,, — — Totals 28 streets 258 houses. 104 Statistics for the year ending 31st December, 1929. 1. General. (a) Estimated population 161,800 (b) General Death Rate 14.2 per 1,000 popln. (c) Death rate from tuberculosis 1.27 per 1,000 (d) Infantile mortality rate 62.6 per 1,000 births (e) Number of premises used as habitations by all classes 27,928 (f) Estimated number of working class dwelling- houses 25,039 (g) Number of new working class dwellings erected 30* 2. Unfit Dwelling-Houses. (a) Inspection— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,224 (b) Number of dwelling-houses which were inspected and recorded under Part IV of the Housing (Consolidated) Regulations, 1925 4,229 (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 4,029 (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 426 (c) Action under statutory powers— (I.) Proceedings under section 3 of the Housing Act, 1925 (a) Number of dwelling-houses in respect of which notices were served requiring repairs 37 (b) Number of dwelling-houses which were rendered fit:— (i.) By owners 29 (ii.) Work commenced by local authority but workmen subsequently withdrawn and work completed by owner Nil * Includes 6 tenements erected under Plough Road Improvement Scheme, and 6 under the Plough Road Improvement (Extension) Scheme. 105 (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 3,723 (b) Number of houses in which defects were remedied. (i.) By owners 3,359 (ii.) By local authority in default of owners 8† (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 One (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). † Includes 2 cases of frontage drains, in which the respective owners declined to pay for the cost of the work. 106 TABLE i. (Requied by minister of health to be used in the annual report of the medical officer of health) Vital statistics of whole district during 1929 and previous years. Year. 1 Population estimated to middle of each Year. 2 Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. Number. 6 Rate. * 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. Number. 4 Rate.* 5 Number 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate.* 13 1919 165,960 B. † 2,765 3,075 18.5 2,409 15.1 730 382 228 74 2,061 12.9 159,316 D. † 1920 166,093 B. † 4,218 4,669 28.1 2,393 14.4 700 386 386 83 2,079 12.5 165,664 D. † 1921 169,200 3,580 3,742 22.1 2,445 14.5 800 415 276 74 2,060 12.2 1922 169,200 3,577 3,665 21.7 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 1929 161,800 2,877 2,619 16.2 3,314 20.5 1,400 380 164 63 2,294 14.2 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, 6.7 (Census Report 1921). *Rates calculated per 1,000 of estimated population. † Registrar General's estimated population for purposes of calculating:—(B). birth-rate ; (D) death-rate. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Diseases notified during the Year 1929 107 (Requied by the minister of health to be used in the annual report of the medical officer of health) Cases of infetious disease notified during the year 1929. 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 2 ... ... ... 2 ... ... ... 2 ... ... 2 ... Diphtheria 445 8 151 226 41 18 1 179 184 82 179 182 79 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 69 2 ... 8 4 47 ... 34 13 22 15 4 8 Scarlet Fever 466 3 98 291 44 30 ... 182 194 90 180 194 86 Enteric Fever 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... Continued Fever 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... Puerperal Fever 4 ... ... ... 1 3 ... 1 2 1 1 1 1 Puerperal Pyrexia 25 ... ... ... 9 16 ... 16 5 4 11 2 2 Meningococcal Meningitis 2 1 ... 1 ... ... ... 2 ... ... 2 ... ... Ophthalmia Neonatorum 43 43 ... ... ... ... ... 21 13 9 1 3 3 Polio-myelitis, &c. 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 Encephalitis Lethargica 3 ... ... 2 ... 1 ... 2 ... 1 2 ... 1 Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 2 ... ... ... ... 2 ... 1 ... 1 1 ... ... Dysentery 2 ... 2 ... ... ... ... ... 1 1 ... 1 1 Acute Influenzal Pneu 140 2 10 15 18 71 24 53 48 39 17 10 11 Acute Primary Pneu 397 29 112 55 40 129 32 162 182 53 73 69 23 Totals 1,603 88 373 599 159 319 65 653 646 304 482 470 216 Tuberculosis— Pulmonary 275 2 ... 12 96 160 5 128 82 65 ... ... ... Non-Pulmonary 55 1 9 22 18 3 2 20 24 11 ... ... ... Totals (Tuberculosis) 330 3 9 34 114 163 7 148 106 76 ... ... ... Totals 1,933 91 382 633 273 482 72 801 752 380 482 470 216 Whooping-cough* 824 91 479 250 3 1 ... 355 312 157 53 32 12 Measles* 483 43 183 223 34 ... ... 196 218 69 25 27 5 Grand Totals 3,240 225 1,044 1,106 310 483 72 1,352 1,282 606 560 529 233 * Notifiable in Battersea from 24th April, 1922. 108 TABLE iii Causes of and ages at, Death During the year 1929. CAUSES OF DEATH Nett Deaths at subjoined aces of " Residents" whether Occurring within or without the District. Total Deaths of "Residents" and "NonResidents" in Institutions in the District. 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 5 1 1 3 ... ... ... ... ... 1 4. Scarlet Fever 4 ... ... 2 1 1 ... ... ... 1 5. Whooping-cough 43 15 12 14 2 ... ... ... ... 28 6. Diphtheria 12 2 1 5 4 ... ... ... ... 2 7. Influenza 138 1 2 ... 2 4 11 48 70 46 8. Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... 1 9. Meningococcal Meningitis 1 1 ... ... ... ... ... ... ... 3 10. Tuberculosis of respiratory system 186 1 1 2 4 53 74 42 9 140 11. Other tuberculous disease 20 3 ... 4 7 2 ... 3 1 22 12. Cancer 243 ... ... 1 ... 2 21 114 105 236 13. Rheumatic Fever 9 ... ... ... 3 3 2 1 ... 8 14. Diabetes 20 ... ... ... ... ... 2 6 12 18 15. Cerebral Hæmorrhage, etc. 76 ... ... ... ... ... 2 20 54 90 16. Heart Disease 505 ... ... ... 8 9 28 114 346 572 17. Arterio-sclerosis 55 ... ... ... ... ... ... 8 47 12 18. Bronchitis 160 5 5 1 ... ... 7 34 108 83 19. Pneumonia (all forms) 201 33 30 12 4 9 14 49 50 220 20. Other respiratory diseases 30 1 1 ... ... 3 6 8 11 17 21. Ulcer of Stomach or Duodenum 29 ... ... ... ... ... 6 15 8 32 22. Diarrhoea, &c. 30 20 2 4 ... 1 2 ... 1 33 23. Appendicitis and Typhlitis 8 ... ... ... ... 2 2 3 1 18 24. Cirrhosis of Liver 7 ... ... ... ... ... 3 3 1 11 25. Acute and Chronic Nephritis 66 ... ... 1 3 8 4 17 33 80 26. Puerperal Sepsis 2 ... ... ... ... ... 2 ... ... 5 27. Other diseases of Pregnancy 3 ... ... ... ... ... 3 ... ... 10 28. Congenital Debility and Malformation, Premature Birth 60 57 ... 1 1 1 ... ... ... 60 29. Suicide 21 ... ... ... ... 1 9 8 3 13 30. Other deaths from Violence 70 2 1 2 5 9 10 25 16 109 31. Other Defined diseases 288 22 5 8 11 8 23 94 117 355 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... All Causes M. 1154 97 29 35 28 48 133 359 425 1145 F. 1140 67 32 25 27 68 98 254 569 1081 Totals 2294 164 61 60 55 116 231 613 994 2226 109 East Battersea TABLE IV. Infant mortality, 1929. 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 ... ... ... ... ... ... ... ... ... 1 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 2 ... 4 3 7 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 2 2 3 3 1 8 7 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 ... 2 3 8 5 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 1 4 3 ... 1 ... ... ... ... 5 5 1 ... ... ... ... ... ... ... 6 5 Congenital Malformation ... 2 2 ... ... 1 ... ... ... ... 2 3 ... ... ... ... ... ... ... ... 2 3 Congenital Debility ... ... 1 ... ... 1 ... ... 1 ... 2 1 1 ... ... ... ... ... ... ... 3 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 2 2 1 ... ... ... 1 ... ... ... 4 2 ... ... ... ... ... ... ... ... 4 2 Atelectasis & Asphyxia Neonatorum ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Lack of Care 1 2 ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 2 Convulsions ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Homicide ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 4 10 9 3 ... 3 1 ... 1 1 15 17 6 1 6 5 12 5 5 10 44 38 Totals 14 12 3 1 2 32 7 11 17 15 82 Nett Births in the year. Legitimate. Illegitimate. Total. 1133 37 1170 Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. 75 7 82 110 North-West Battersea. TABLE IV.-(contd) Infant mortality, 1929. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 4 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 Pneumonia, all forms ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 6 ... 5 1 12 3 Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 ... 1 ... ... ... 5 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 2 ... ... 2 ... ... ... ... ... ... 2 2 1 ... ... ... ... ... ... ... 3 2 Congenital Malformation ... ... 1 2 ... 1 ... ... ... ... 1 3 1 1 ... ... ... ... ... ... 2 4 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis and Asphyxia Neonatorum 1 ... 1 1 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... 1 ... ... ... 1 ... 1 ... 3 ... 1 ... ... ... ... 1 ... 1 4 2 Totals 3 ... 3 5 ... 1 1 ... 1 ... 8 6 6 4 5 1 7 4 7 3 33 18 3 8 1 1 1 14 10 6 11 10 51 Nett Births in the year. Legitimate. Illegitimate. Total. 804 27 831 Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. 50 1 51 111 South-West Battersea. TABLE IV.-(contd.) Nett deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIOD 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Pneumonia, all forms ... ... ... ... 1 1 ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... 2 1 Infarct Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sarcoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 ... 1 1 2 1 1 ... ... ... 5 2 1 1 ... ... ... ... ... ... 6 3 Congenital Malformation 1 2 1 ... ... 1 1 ... ... ... 3 3 ... ... ... ... ... ... ... ... 3 3 Congenital Debility ... ... ... ... 1 ... 1 ... ... ... 2 ... ... ... 1 ... ... ... ... ... 3 ... Icterus Neonatorum ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis & Asphyxia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 1 ... ... ... 4 ... Totals 2 2 2 1 4 4 3 ... 1 ... 12 7 2 1 5 1 1 1 ... 1 20 11 4 3 8 3 1 19 3 6 2 1 31 Nett Births in the year. Legitimate. Illegitimate. Total. 591 27 618 Nett Deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. 30 1 31 112 Borough of Battersea. TABLE IV.-(contd.) Infant mortality,1929. 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 3-6 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 0.61 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0.61 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 5 ... 6 3 12 9.15 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 1.22 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.61 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.61 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.61 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.61 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 1.23 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 1 ... ... ... ... 4 1 3.05 Pneumonia (all forms) ... ... ... ... 1 1 ... ... ... ... 1 1 3 3 2 2 8 3 8 2 22 11 20.12 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.61 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 3 5 ... 2 3 13 7 12.19 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.61 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 1 5 6 2 2 1 ... ... ... 12 9 3 1 ... ... ... ... ... ... 15 10 15.24 Congenital Malformation 1 4 4 2 ... 3 1 ... ... ... 6 9 1 1 ... ... ... ... ... ... 7 10 10.36 Congenital Debility ... ... 1 ... 1 1 1 ... 1 ... 4 1 1 ... 2 ... ... ... ... ... 7 1 4.88 Icterus Neonatorum ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0.61 Injury at Birth 2 2 1 ... ... ... 1 ... ... ... 4 2 ... ... ... ... ... ... ... ... 4 2 3.66 Atelectasis & Asphyxia Neonatorum 1 1 1 1 ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... 2 2 2.44 Lack of Care 1 2 ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 2 1.83 Convulsions ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 0.61 Homicide ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0.61 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.61 Other Causes ... ... 1 ... ... ... 1 ... 2 ... 1 ... 1 ... 2 ... 3 1 ... 1 10 2 7.32 9 12 14 9 4 8 5 ... 3 1 35 30 14 6 16 7 20 10 12 14 97 67 100.00 Totals 21 23 12 5 4 65 20 23 30 26 164 — Percentage of Total 12.8 14.0 7.3 3.1 2.4 39.6 12.2 14.0 18.3 15.9 M.59.1 F.40.9 Nett Births in the year. Legitimate. Illegitimate. Total. M. 1,271 45 1,316 F. 1,257 46 1,303 Totals 2,528 91 2,619 Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. 92 5 97 63 4 67 155 9 164 113 Form T 53. TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary (or Dispensaries) during the year 1929. 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 the year (excluding contacts):— (a) Definitely tuberculous 106 77 — 4 7 11 10 3 113 88 10 7 (b) Doubtfully tuberculous — — — — — — — — 36 35 23 14 (c) Non-tuberculous — — — — — — — — 117 150 48 37 B.—Contacts examined during the year:— (a) Definitely tuberculous — 4 — — — — — — — 4 — — (b) Doubtfully tuberculous — 1 4 6 2 (c) Non-tuberculous — — — — — — — — 25 38 56 56 C.—Cases written off the Dispensary (a) Cured 6 6 1 3 2 2 9 7 8 8 10 10 (6) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 172 224 137 112 D.—Number of Persons on Dispensary Register on December (a) Diagnosis completed 337 220 45 51 40 41 106 66 377 261 151 117 (b) Diagnosis not completed — — — — — — — — 17 12 8 4 1. Number of persons on Dispensary 9. Number of patients to whom Dental Register on January 1st 99 Treatment was given, at or in connection with the Dispensary 23 2. Number of patients transferred from other areas and of "lost sight 10. Number of consultations with medical of" cases returned 28 . practitioners:— (a) At Homes of Applicants 37 (b) Otherwise* 394 3. Number of patients transferred to other areas and cases lost sight 11. Number of other visits by culosis Officers to Homes 130 4. Died during the year 147 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary 5. Number of observation cases under purposes ,531 A (b) and B (b) above in which period of observation exceeded 13. Number of 12\ 2 months 23 (a) Specimens of sputum, &c., (&871 examined outside) 6. Number of attendances at the Dis(b) X-ray examinations made 179 pensary (including Contacts) 3,967 in connection with Dispensary work 7. Number of attendances of non-pul14 Number of Insured Persons on monary cases at Orthopaedic Out- pensary Register on the 31st stations for treatment or super- December 520 vision — 15. Number of Insured Persons under 8. Number of attendances, at General Domiciliary Treatment on the Hospitals or other Institutions December 125 approved for the purpose, of patients for 16. Number of reports received during the year in respect of Insured («) " Light treatment 259 Persons (b) Other special forms of treatment 221 (a) Form G.P. 17 — (b) Form G.P. 36 86 114 TUBERCULOSIS SCHEME OF THE METROPOLITAN BOROUGH COUNCIL OF BATTERSEA. Form 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 1929, 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. 1929. Class T.B minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus & T.B. minus) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus.) alive. Discharged as cured. Adults M. — — — — 53 4 1 - - 1 - - - - - - - - - - - - - - - - - - - - F. — — — - 60 4 - - - - - - - - - - - - - - - - - - - - - - - - Children M. — — — - 104 1 - - - - - - - - - - - - - - - - - - - - - - - - F. — — — - 109 2 1 - - 1 - - - - - - - - - - - - - - - - - - - - Disease arrested. Adults M. 6 6 5 — 17 7 4 5 1 10 2 - - - 1 - - - - 1 - - - - - - - - - - F. 1 2 3 — 6 6 1 3 - 4 1 - - - - - - - - - - - - - - - - - - - Children M. 15 — — — 15 5 1 - - 1 1 - - - - - - - - - - - - - - - - - - - F. 12 1 — — 13 3 - - - - - - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults M. 9 13 5 - 27 7 14 27 — 41 3 4 12 3 19 8 6 11 2 19 12 9 29 2 40 23 19 37 9 65 F. 3 3 5 - 11 8 6 9 3 18 2 3 7 2 12 4 - 12 2 14 10 2 19 4 25 23 8 22 15 45 Children M. 4 — — - 4 2 - 1 - 1 1 - - - - 1 - 1 - 1 2 - - - - 1 - — - - F. 7 2 - - 9 6 - 1 - 1 1 - - - - 2 - - - - - - - - 3 - 1 1 2 Condition not ascertained during the Year. 26 4 — 1 31 16 6 1 — 7 5 — 2 3 5 5 — 2 1 3 3 — 6 6 12 - - - - - Lost sight of or otherwise removed from Dispensary Register. — — — — 559 75 38 82 33 153 12 4 16 5 25 14 2 21 1 24 6 5 7 4 16 3 — 4 3 7 DEAD. Adults m. — — — — 240 20 18 103 126 247 2 2 19 26 47 1 2 18 22 42 4 1 10 17 28 - 1 5 19 25 F. — — — - 181 7 12 53 91 156 4 - 10 17 27 5 - 15 18 33 5 - 4 23 27 1 - 4 6 10 Children m. — — - - 11 3 - 2 3 5 - - - - - 1 - - - - - - - - - - - - - - F. - - — - 30 5 1 4 1 6 - - - 2 2 - — 1 — 1 1 — — — — — — — — — TOTALS — — — 1,480 181 103 291 258 652 34 13 67 58 138 41 10 82 46 138 43 17 75 56 148 54 28 73 53 154 (b) Non-Pulmonary Tuberculosis. Form t 56. 115 (b) Non-Pulmonary Tuberculosis. Form T 56, 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 1929, 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 last record made during the year to which the Return relates. Previous to 1921. 1921—5. 1926. 1927. 1928. 1929. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. ALIVE. Discharged as cured. Adults M. 1 — i 1 3 - - - 2 2 - - - - - - - - - - - - - - - - - - - - F. — — — — — 1 — — 1 2 - - - - - - - - - - - - - - - - - - - - Children M. 1 - — 10 11 3 2 — 12 17 - - - - - - - - - - - - - - - - - - - - F. 4 2 2 9 17 2 2 — 11 15 - - - 2 2 - - - - - - - - - - - - - - - Disease arrested. Adults M. 1 - - - 1 - 1 3 1 5 — 1 — - 1 2 - — - 2 - - — - - - - - - — F. - - - - - 1 1 — 1 3 1 — — 2 3 1 - - - 1 - - - - - - - - - - Children M. 2 - - 4 6 6 1 1 16 24 1 — 1 4 6 1 1 1 - 3 1 - - - 1 - — - - - F. - - — 5 5 3 2 - 9 14 - - - - - - - 1 1 2 - - - - - - - - - - Disease not arrested. Adults M. 1 - 1 — 2 1 — 1 — 2 2 — 1 — 3 2 — — 3 5 1 1 1 - 3 1 2 — 4 7 F. - - - 1 1 2 — 4 — 6 — — - 2 2 - - 1 2 3 1 1 1 1 4 6 - 1 4 11 Children M. - - - - - 2 2 - 13 17 3 1 1 6 11 - 1 2 - 3 1 - - 3 4 1 1 i 8 11 F. — - - 3 3 1 1 — 7 9 2 — — 5 7 1 2 1 5 9 1 1 1 - 3 - - — 3 3 Transferred to Pulmonary - - - - - - 1 - - 1 - - 1 - 1 - - - - - - - - - - - - - - - Condition not ascertained during the Year. 1 — 2 3 6 7 4 3 13 27 1 1 1 3 2 — — 2 4 3 — 1 3 7 — — — — — Lost Sight of or otherwise removed from Dispensary Register. 19 8 13 46 86 16 2 5 41 64 3 3 2 6 14 2 1 1 4 8 1 1 1 3 6 - - - - - DEAD. Adults M. 1 - - - 1 4 - - - 4 - - - - - 1 - - - 1 - - - - - - - - - - F. 1 1 - 3 5 1 4 2 7 - - - - - - - - - - - - - - - - - - - - Children m. - - - - - 2 - - 1 3 - - 1 - 1 - - - - - - - - - - - - - - - F. 1 — - 8 9 — 1 — 2 3 — — — — - - - - - - - - 1 - 1 - - - - - TOTALS 33 11 19 93 156 51 21 21 132 225 13 6 7 28 54 12 5 7 17 41 9 4 6 10 29 8 3 2 19 32 116 APPENDIX. BATTERSEA TUBERCULOSIS DISPENSARY. ANNUAL REPORT, 1929. To the Medical Officer of Health. TUBERCULOSIS. I beg to report on the work carried out at the Tuberculosis Dispensary for the year ending 31st December 1929. During the year the personnel of the Staff remained the same as for the previous twelve months. An Artificial Light Department was established at Southlands during the year and treatment by artificial light commenced in November. This form of treatment is given to patients attending the Tuberculosis Dispensary who are suffering from non-pulmonary Tuberculosis and to children who are attending the Council's Maternity and Child Welfare clinics and who are recommended by the Medical Officers in charge of those clinics. The Department has not been opened sufficiently long to enable an opinion to be expressed as to the results of such treatment. It is not intended that treatment by artificial light should be offered as an alternative to institutional treatment in cases of non-pulmonary Tuberculosis but rather that it should be used in cases where institutional treatment is not considered essential, e.g., in cases with small sinuses from enlarged tuberculous glands and in cases with small patches of Lupus, &c. The routine work of the Dispensary has been carried on as in previous years. The Dispensary continues to act as a centre for diagnosis and as a clearing house rather than as a centre for treatment. The desirability of the early recognition of Tuberculosis both from the point of view of treatment and prevention has been stressed in previous reports but, unfortunately, it is found that a large number of the patients who attend the Dispensary for the first time are suffering from pulmonary Tuberculosis in a more or less advanced form. Such cases do not derive the greatest benefit from sanatorium treatment and it is idle to hope for permanent arrest of the disease in the majority of such cases as a result of institutional treatment. Moreover, no effective measures for the prevention of the spread of infection can be instituted until the case comes to the knowledge of the Public Health Department. I am of the opinion that the main cause of the failure to find the early case of pulmonary Tuberculosis rests with the patient himself who, owing to the slight discomfort caused by the disease in its 117 early stages and possibly through fear and ignorance, does not consult his own doctor soon enough. The facilities for diagnosis at the Tuberculosis Dispensary are utilised to a very large extent by the general practitioners and it is to a great extent by the co-operation of the doctors in the area that an institution such as this can fulfil its proper functions. It is gratifying to note, therefore, that of the 709 new patients attending the Dispensary during the year (excluding transfer cases) 478 were sent to the Dispensary for an opinion or advice by their own doctors. In addition 619 specimens of sputum were sent to the Dispensary for examination by doctors. The Dispensary is affiliated to St. Thomas's Hospital and much help is derived from the Tuberculosis Department there in seeing Battersea patients and sending them for X-ray examination and to the throat department of the hospital for a specialist's opinion. Such assistance is very valuable in doubtful cases. Several patients have been admitted to the wards of the Tuberculosis Officer at the Hospital for artificial pneumo-thorax treatment and have derived much benefit from this form of treatment. The London County Council is responsible for the provision of institutional treatment for patients suffering from Tuberculosis, pulmonary and non-pulmonary. During the year 186 patients were sent away to various institutions under the London County Council's Scheme. Of these, 118 were discharged during the year and 68 were still in institutions on December 31st. The average length of stay of the 118 patients was 112 days and the average waiting period between recommendation for admission and admission was 15 days. 82 patients showed definite improvement as a result of institutional treatment; 49 patients were discharged at their own request. In addition to the institutional treatment provided by the London County Council 31 patients were admitted during the year to St. James's Hospital, Balham. In some of those cases admission to one or other of the Council's institutions had been refused and in others it was considered desirable that they be admitted to St. James's Hospital prior to entering one of the Council's institutions. During the year 731 new patients, including 22 transfer cases from other areas, attended the Dispensary, being an increase of 90 over the previous year. Of the 731 new patients, 222 were found to be suffering from Pulmonary Tuberculosis and 36 from Non-Pulmonary Tuberculosis. In Table I the Pulmonary cases are grouped under two headings:— (1) Group T.B. Minus. In those cases Tubercle Bacilli have never been found to be present in the sputum. (2) Group T.B. Plus. In those cases Tubercle Bacilli have been found in the sputum at some time. 118 Group T.B. Plus is sub-divided under three headings:— Group I—early cases. Group II—intermediate cases. Group III—advanced cases. The table shows the age period of the new patients. Table I. Pulmonary Tuberculosis. Years. 0-5 5-10 10-15 15-25 25-35 35-45 45-55 55-65 over 65 Total. Group T.B. minus — 2 2 28 13 2 7 — 1 55 Group T.B. plus Group I — — — 13 8 4 4 — — 29 167 Group ii — — 1 23 17 19 16 2 1 79 Group iii — — 1 21 12 13 7 4 1 59 Total — 2 4 85 50 38 34 6 3 222 Table II. Non-Pulmonary Tuberculosis. Years. 0-5 5-10 10-15 15-25 25-35 35-45 45-55 55-65 over 65 Total. Bones and Joints — 2 — 3 2 1 — — 1 9 Abdominal — — 2 3 — — — — — 5 Peripheral Glands 4 6 2 5 1 1 — — — 19 Skin and Other Organs — — 1 1 1 — — — — 3 Total 4 8 5 12 4 2 — — 36 From the above two tables it will be seen that the incidence of Tuberculosis both in the pulmonary and non-pulmonary groups is very much higher in the young adult age period between the ages of 15 and 25 years than in any other period. It is also in this age period that the highest mortality occurs. In young adults the disease is more frequently of the acute actively progressive type. It is, in my opinion, at this period of life that the value of "contact" examination is most useful, but unfortunately, the young adult is most unwilling to offer himself or submit to examination. I think there can be little doubt that the strain of work, coupled in some cases with the disregard of nature's laws of health, is responsible to a large extent for the onset of pulmonary Tuberculosis at this time of life. 119 Table III. Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 116 52.25 "Influenza" 16 7.21 Pleurisy 13 5.86 Pleurisy with effusion 5 2.25 Haemoptysis 21 9.46 Other modes 51 22.97 Total 222 100.00 Cough is the commonest mode of onset in pulmonary Tuberculosis but it should be noted that cough may be entirely absent until the disease is well advanced. It is also important to realise that the first clinical manifestation of Tuberculosis may be a pleurisy with or without effusion or that the disease may be ushered in with a brisk haemoptysis (blood-spitting). So-called "Influenzal" attacks may be and no doubt often are, merely manifestations of pulmonary Tuberculosis. Table IV. Occupations in the 222 Cases of Pulmonary Tuberculosis. Occupation. No. of Patients. Occupation No. of Patients. Housewives 34 Lens maker 1 Domestic Servants 8 Upholsterer 1 Laundry Workers 3 Steel Erector 1 Household duties (various) 4 Painters and Decorators 5 Waitress 1 Asphalter 1 Clerks and Typists 22 Book Binders 2 Stenographer 1 Sign Writer 1 Shop Assistants 14 Joiner 1 Factory Workers 14 Stonemason 1 Packers 6 Rivetter 1 Machinists 3 Plumber 1 Tailors, Dressmakers, &c. 10 Carriage Cleaners 2 Nurses 2 Bus Conductors, Railway Guards & Engine Drivers 7 Teacher 1 Students 2 Insurance Inspector 1 Civil Servant 1 Record Inspector 1 Post Office workers 3 Engineers & Electricians 4 Oil Chemist 1 Hall Porters and Cinema Attendants 4 School Children 3 Milk Roundsmen 2 Sailor 1 Meat Carrier 1 Travellers and Agents 6 Chef 1 Dancer 1 Butcher 1 Rag Sorter 1 Barmen 3 Surveyor's Assistant 1 Hairdressers 3 Dental Mechanic 1 Cooper 1 Outdoor Workers (Unclassified) 10 No occupation 7 General Labourers 14 120 Table V. Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. 81 22 155 Of the 258 cases, therefore, a history of Tuberculosis in a near relative was elicited in 31.4 per cent. and in a remote relative 8.5 per cent. In all 39.9 per cent. gave a family history of Tuberculosis. "Contacts."—192 "contacts" were examined during the year, 72 being adults and 120 children. Of this number four were found to be suffering from Tuberculosis. The majority of the "Contacts" who attend the Dispensary are children of school age and it is uncommon to find pulmonary Tuberculosis of the adult type in children of this age. As has already been pointed out it is found difficult to persuade the young adult "contact" to submit himself for examination. It is at this period of life that the incidence of the disease and the mortality rate is highest and, no doubt, the results of "contact" examination would be more valuable if the young adult could be persuaded to attend. The total number of attendances at the Dispensary during the year was 3,967 compared with 3,912 in the previous year. 167 visits were paid by the Tuberculosis Officer to the homes of patients and 4,531 by the Dispensary Nursing Staff. Number of Dispensary patients who died during 1929 146 Number of Dispensary patients discharged as "cured" or disease arrested 38 Number of Dispensary patients who ceased to attend 54 Number of Dispensary patients who removed to other districts (and transferred to the Medical Officer of Health of the district concerned) 56 The number of sputum examinations carried out at the Tuberculosis Dispensary during 1929 was 1,592 or 194 more than in the previous twelve months. In 305 specimens or 19.16 per cent. Tubercle Bacilli were found to be present. Of the total number of specimens examined 619 were sent by medical practitioners and 399 were examined for St. James's Hospital. It is the routine procedure at the Dispensary to examine the sputum of each new patient who attends if a specimen can be obtained and in many 121 cases repeated examinations are undertaken before a definite diagnosis is arrived at. The number of reports sent to public bodies during 1929 was 1,208. Consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 1,011. The number of reports received during the year in respect of insured persons was:— (a) Form G. P. 17 Nil (b) Form G. P. 36 86 202 patients were referred to hospitals, 179 of whom were sent to St. Thomas's Hospital for x-ray examination. Springwell House Open-Air School. Accommodation 125 Number on roll 31st December, 1929 138 Average attendance during 1929 121.5 Admitted during 1929 40 Discharged during 1929 48 Reasons for discharge. Fit for elementary school 4 Fit for work 30 Transferred to Hospital or Sanatorium 5 Removed from district 5 Transferred to special school - Discharged for other reasons 4 Tuberculosis Dental Treatment. Total attendances 311 Sessions held 49 Average attendance per session 6.3 Extractions 70; scalings 9; fillings 25; dentures supplied—whole sets 7, partial sets 5; repairs to dentures 7; dressings 37; advice 97; (average per session 5.2) Total 257 The Tuberculosis Care Committee. The Care Committee met weekly during 1929 and the following is a summary of the work carried out by the Committee:— Battersea Borough Council—extra nourishment 118 Wandsworth Board of Guardians—financial assistance 5; dentures 3; clothing 4; extra nourishment 7; other assistance 4 23 122 Charity Organisation Society—financial assistance 11; dentures 1; clothing 6; other assistance 5 23 United Services Fund—financial assistance 6; clothing 7; other assistance 5 18 Other Agencies—financial assistance 7; clothing 1; dentures 1; other assistance 4 13 Training and Employment, Five patients were referred to different agencies, etc., for this purpose. 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 £774 7s. 9d. The following are some illustrations of the work done by the Care Committee throughout the year:— C.K., aged 25. This patient who has had both her legs amputated and who is suffering from Tuberculosis of the elbow joints and neck was living with her grandmother and doing all her housework. Her parents had died some years ago and the Guardians were granting out-relief to her and to the grandmother. The patient though not requiring active treatment needed a complete rest and change. The Committee took up the matter with the Guardians who agreed to bear the cost of sending the patient away and arrangements were then made for her to be sent to a bungalow near Brighton where she received every care and attention. She remained there for a period of two months and returned to her home greatly benefited by the complete change. The Committee arranged for the patient's sister to travel down with her and bring her back and they paid the patient's fare and provided her with pocket money. On her return the Committee again approached the Guardians, who agreed to grant her a special invalid chair to get about in. J.C., aged 37. This patient who had always been self-supporting, became ill and was found to be suffering from Tuberculosis and was recommended for Sanatorium treatment. He needed some articles of clothing which he could not afford to purchase and he was averse to applying for assistance. The Committee obtained the necessary clothing for him and he completed five months' treatment and was discharged as fit for work. After a short interval he was able to resume work with his old employers, but during this interval there was financial strain and the Committee sanctioned a grant for extra nourishment and also a loan to enable the family to carry on. This loan was returned in full after a short period as the man was able to work full time. 123 P.E., aged 27. Man was working as an engine cleaner and had to give up work and was recommended for Sanatorium treatment. His Approved Society were deducting 7s. Od. per week from his insurance benefit as he was unable to produce one of his stamped cards which had been destroyed when his overall was boiled. The Committee approached the Society and they finally agreed to allow the man to stamp a fresh card. The Committee advanced the money to enable the stamps to be purchased and referred the case to the Railway Benevolent Fund for financial assistance for the family during the time the patient was away. Considerable help was obtained from this fund and the wife was able to repay the loan from the Committee and the patient was able to complete his treatment which lasted for a period of over ten months during which he received full rate of sickness, and later disablement, benefit. M.O'G., aged 28. This patient, a married woman, was sent to Sanatorium and advised to remain four months, but she became restless and wished to return home and go to work as her husband was unemployed and unable to visit her. The rent and insurances were in arrears and her wedding ring and other articles were in pawn and unless redeemed within a short time were to be put up for sale. Relief was being given by the Guardians but chiefly in kind and the man had not sufficient money to pay the current rent and insurances, &c. The Committee arranged for the man's fare to be paid to enable him to see his wife, they also arranged for the arrears of rent and insurance to be paid and for the articles to be redeemed from pawn and as a result of their recommendation the Guardians altered the relief, giving the man sufficient money to pay rent, gas and insurance, and the patient was thus enabled to complete her treatment. G.S., aged 28. This man, who was working as a barman, was found to be suffering from Tuberculosis and was recommended for sanatorium treatment. He was advised to give up work, but he stated that he was unable to do this as he would then only have his National Health Insurance Benefit coming in and he had a wife and two children to keep. The Committee were able to obtain immediate financial assistance in this case and the patient was then able to give up work ; he was provided with extra nourishment and suitable clothing and whilst undergoing treatment in Sanatorium his wife was assisted to remove to the country. Difficulties arose over the payment of insurance benefit and the Committee by taking up the matter with the Approved Society were able to have these difficulties removed. T.Y., aged 36. Widow of an ex-officer. Had been ill and off work for five months before attending the Dispensary. She was recommended for Sanatorium treatment but could not see her 124 way to accepting treatment. Her mother who was also a widow and unable to work was entirely dependent upon her and the only income was 12s. 0d. per week National Health Insurance Benefit. Relatives had been assisting but were unable to continue. The Committee were able to obtain financial assistance for the patient, she was granted extra nourishment and provided with suitable clothing and after a short period admitted to Sanatorium. Financial assistance was also obtained for her mother and is still continuing. The patient was thus enabled to complete five months' Sanatorium treatment. She returned showing great improvement and has now removed to the seaside and become self-supporting again.