C.I. Don 4874 BAT 29 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1930. BY G. QUIN LENNANE, M.C., 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. I. 43 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1930. by G. QUIN LENNANE, M.C., F.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. 1 Health Committee. 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, As constituted 10th November, 1930. Chairman: Councillor E. W. Coles. His Worship the Mayor. (Councillor J. Hendrick, j.p.). Alderman J. R. Archer. Councillor Mrs. K.S. D. Baker. „ Rev. E. J. Daly. „ Mrs. M. A. Hendrick. „ Miss G. S. Jacob, r.r.c. P. E. Molloy. „ R. Moore. „ J. Morgan. „ Mrs. E. R. Rf.ed. „ Mrs. M. J. Robinson. „ Mrs. M. H. Rose. „ C. A. Warner.* Maternitp and Child welfare Committe. 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. As constituted 10th November, 1930. Chairman: Councillor Mrs. M. J. Robinson. His Worship the Mayor. (Councillor J. Hendrick, j.p.). The Health Committee, as above. Housing Committee. 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. As constituted 10th November, 1930. Chairman: Councillor H. Harling. His Worship the Mayor. (Councillor J. Hendrick, j.p.). Councillor S. Booth. ,, J. A. Campbell. ,, Rev. E. J. Daly. ,, C. S. King. ,, W. J. McIver. ,, G. F. Meecham. ,, J. Morgan. ,, E. S. Strange, j.p. Alderman I. O. Thomas. Councillor H. G. White. „ C. H. Young, j.p. Committee to issue certificate and reports under the Rent and Morttage Interest (Ristrictions) acts, 1920 and 1925, as to the condition of melling houses. 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. Alderman G. Fineran. Councillor E. S. Strange, j.p. ,, H. G. White. * Appointed 23rd December, 1930, As constituted 10th November, 1930. Chairman: Councillor H. Harling. His Worship the Mayor. (Councillor J. Hendrick, j.p.). Councillor C. Barrington. Alderman G. Fineran. Councillor E. S. Strange, j.p. „ H. G. White. in place of Mrs. M. H. Rose, deceased. 2 Tuberculosis Committee. The Health Committee, as above. Tuberculosis Care Committee. 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. Representatives of the Wandsworth Guardians:Mrs. F. E. Mills. * Mrs. F. Young. * Representative of the London Insurance Committee: Mr. G. W. Tatler. 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). As constituted 10th November, 1930. Chairman—Alderman J. R. Archer. Councillor Mrs. K. S. D. Baker. Alderman G. Fineran. Councillor R. Moore. „ Mrs. E. R. Reed. Other Members: Mrs. E. W. Coles. Mrs. F. Young. Representative of the London Insurance Committee: Mr. G. W. Tatler. Members of the late Dispensary Committee: Mrs. A. Dermott. Mr. G. J. W. Gilder. 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 War Pensions Committee (Mr. T. Jones). Representative of the Invalid Children's Aid Association. Lady Almoner, St. Thomas's Hospital (Miss C. Morris). Lady Almoner, Victoria Hospital (Miss E. W. White). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, King's College Hospital (Miss Edmonds). Represeentative 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, 1930). Deputy M. O. H. and Tuberculosis Officer— G. MACDONALD, M.A., M.B., Ch.B., D.P.H. Assistant Tuberculosis Officer(part time)—(Mrs.) M. T. O'FLYNN, B.A., MB., B Ch., B.A.O.(N.U.I.). 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. Consultant Obstetrician, Borough Maternity Hospital— F. ROQUES, M.S., F.R.C.S. Consultant Medical Officer, Ante-natal (V.D.) Clinic— H. CORSI, F.R.C.S., M.A., M.B., B.Ch., L.R.C.P. Dental Surgeon (by arrangement with British Dental Hospital)— J. RHYS HERBERT, L.M.S.S.A., L.D.S., R.C.S. 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 Mr. H. H. May, Cert. San. Inst. 4. Mr. F. H. Chuter, San. Insp. Board's Cert. & Meat Insp. Cert. 5. Mr. J. R. Holloway, San. Insp. Board's Cert. 6. Mr. C. Binding, San. Insp. Board's Cert. and Meat Insp. Cert. 8. Mr. G. Weeks, Cert. S.I.E.J.B, and Meat Insp. Cert. Two temporary inspectors. 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 (resigned October, 1930). 4 Clerical Staff— Chief Clerk—Mr. F. E. Ward. Mr. J. W. Brown (Statistical). Mr. E. Cole. Mr. W. Halstead. Mr. H. C. Godfrey. Mr. H. Graham. Miss G. E. Newton. Miss R. Dove. Mr. F. Pedrick. Two temporary clerks. Office youths. Miss M. A. Weller(M. & C.W. Records). Maternity Home— Matron—Miss M. Fevyer, Cert. C.M.B. Sister—Miss J. Brown—4 Staff Nurses. Borough Midwife (District Service)—Miss A. L. Barker. 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. Woodhousr. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer—See page 13. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Battersea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health and Sanitary state of the Borough for the year 1930. I regret that owing to my long illness the Report is very much overdue. Owing to the growth of the various Departments in recent years, the accommodation at the Town Hall has been greatly congested, and it was decided by the Council to remove the Public Health to more commodious premises at Electric House, Lavender Hill. The department took up its new quarters in April, 1930. It is satisfactory to be able to record that the vital and morbid statistics for the year under report are satisfactory, and that the temporary increase in the death rates, General and Infantile, due to the prevalence of Influenza and Respiratory diseases in the early part of 1929, is not apparent in the figures for 1930, showing that the steady progress of recent years is being well maintained. The birth-rate remains stationary in Battersea, but the downward tendency in this direction continues to be a disturbing factor in the view of those who, like myself, regard a high birth-rate to be a useful index of the virility and progress of a nation. The general death-rate (11.5) is a satisfactory feature of the year's statistics, and the same may be said of the infant mortality rate (54.7). These figures may be regarded as being all the more satisfactory when the economic condition existing and the consequent regrettable extent of unemployment are taken into account. The prevalence of dangerous epidemic disease has not been, it is satisfactory to record, a marked feature of the year's morbid statistics. A very few cases of the mild form of Small-pox, which has been very prevalent in other parts of London and Greater London during the past few years, have occurred, the source of which has been traceable to infection from outside Battersea. The Maternity and Child Welfare work of the Council has proceeded with undiminished activity during the year and a new Centre has been opened at Gideon Road School, the London County Council having leased to the Borough Council for the purpose, a part of the disused School buildings. This is a very desirable addition to the scheme, as the South East Area of the Borough was 6 too far away from the other Centres. The new Centre has become very popular and it has been necessary for the Council to appoint an extra Health Visitor to deal with the increased work. The ante-natal side of the Maternity and Child Welfare scheme has received a greater stimulus by the erection of the new outpatient wing at the Borough Maternity Hospital which was opened early in the Spring of the year. It is now possible to cope with the pressure of the work and to increase its efficiency. The only regrettable feature of the year's report has been the temporary closure of the Borough Maternity Hospital owing to an outbreak of mild sepsis amongst the patients. It is satisfactory however, to be able to state that the steps taken to deal with the outbreak were rapidly successful and that only a comparatively brief interruption in the useful work carried out at the Hospital resulted. A report of this unfortunate occurrence will be found on pages 45 to 48. The housing activity of the Council continued during the year and the purchase of St. John's College and grounds was completed and the plans and lay-out of this estate were being rapidly proceeded with by the end of the year. It is proposed to erect a considerable number of working-class dwellings on the site, and it is to be hoped that some at least of these will be reserved for the re-housing of dispossessed tenants in conection with the clearance and improvement areas which, under the provisions of the new Housing Act, it is the intention of the Council to proceed with as soon as circumstances permit. I have pleasure in recording my appreciation of the support and assistance accorded me by the Mayor, Chairmen of the various Committees and Members of the Council. I have also to acknowledge, as in past years, the valuable help which I have received from my colleagues, the Chief Officers of the Council, and to the staff of the Public Health Department, my thanks are also due for their efficient and loyal services. (Signed) G. QUIN LENNANE, Medical Officer of Health. Electric House. Lavender Hill, S.W. 11. October, 1931. 7 CONTENTS. General. Page. Introduction 5-6 Constitution of Committees 1-2 Staff 3,14,68 Summary of Statistics 9,24,129 Natural and Social Conditions 10 Hospitals in Borough 10 Clinics and Treatment Centres 12 Acts and By-laws, Local 12 Health Propaganda 12 Registration of Births and Deaths 13 Vaccination 13 Births, Marriages and Deaths. Vital Statistics 15,129 Population 15,129 Marriages 17 Births and Birth-rates 15,22,129 Illegitimate Infants—Number of Births 17 ,, „ Deaths 22 Deaths in Borough 17,129 Deaths in Public Insitutions and Senile Mortality 19,20 Comparative Table of Births, Deaths, &c. (1857-1930) 24 Infant Mortality 20,25,132-135 Comparative Statistics, Metropolitan Boroughs 23 Notification of Births Act and Still-Births Registration 22 Maternity and Child Welfare Scheme 26-53 Centres and Work done thereat 26-29 Hospital Provision and Ambulance Service 30,55 Southwark Diocesan and Convalescent Homes 31,34 Home Helps 32 Milk and Dinners for necessitous persons 32 Day Nurseries 30 Midwives 34 Nursing Facilities and Service 34,35 Nursing Homes in Borough 34 Health Visiting Staff and Statistics of Visits 3,28 Test-feeding (St. Thomas's Cornwall Babies' Hostel) 35 Ante-Natal Work, Municipal and Voluntary 27,36-42 Visiting Work for Hospitals 40 V.D.—Report of Consultant 40 Maternal Mortality 43 Maternity Hospital 44-51 District Midwifery Service 51 Dental Clinic 52 Solarium 53,70 Infectious Diseases—(i.) Notifiable 54-75 List of Diseases Notifiable 54 Summary of Notifications 56, 130 Bacteriological Examinations 70,78 Contacts 54,57,69 Incidence of the Several Notifiable Diseases 57-64 Diphtheria Prophylaxis (Schick Clinic) 60 Tuberculosis 64-75, 120, 136-140 Cases Notified 64,74-75 Localisation of Disease 66 Non-notification and notification after death 66 Deaths from Tuberculosis 64-66 Shelters 68 Dispensary Staff 68 Sputum Examination, X-ray Examination 70, 124 Institutional and Artificial Sunlight Treatment 70,125 Open-Air School (Day Sanatorium) 125 Tuberculosis Dental Clinic 69,126 Care Committee 2,126 Non-Dispensary Patients 71-72 8 Infectious Diseases—continued. Page County of London (Tuberculosis) Regulations, 1930 73 Public Health (Tuberculosis) Regulations 1930 73 Revision of Register 73 Dispensary Report and Summary Tables 68,120, 136-140 Zymotic Deaths 76 (ii.) Non-Notifiable Diseases 76-78 Sanitary Circumstances. Summary Table 79 Legal Proceedings 80-83 Common Lodging Houses 84 Drainage Work 84 Scavenging and House Refuse Collection 85 Premises Controlled by By-laws 85 Licensed Premises (Sanitary Conveniences) 86 Smoke and Effluvium Nuisances 86 Water Supply 86 Houses Let in Separate Tenements 85 Van Dwellings 87 Rag Flock Acts, 1911 and 1928 87 Rats and Mice Destruction Act 87 Fouling of Footways by Dogs 88 Personal Cleansing Station 89 Disinfecting Department 90 Coroner's Court and Mortuary 91 Protection of the Food Supply. Inspection and Supervision 92 Unsound Food 92 Cow-Houses, Slaughter-Houses and Butchers' Shops 92 Public Health (Meat) Regulations, 1924 93 Food and Drugs Adulteration Act, 1928 93 Results of Analysis 94-99 Ice Cream 100 Milk Orders and Milk Shops 100, 101 Public Health (Preservatives, &c., in Food) Regulations 101 Agricultural Produce and Merchandise Marks Acts101, 102 Artificial Cream Act, 1929 102 Fish Shops, Restaurant Kitchens, Street Stalls 102 Factories, Workshops, &c.—General Tables 103 Factories and Workshops 104-106 Outworkers and Home Work 106-107,109 Bakehouses, Warehouses and Wharves 108 Housing. General—Housing Act, 1930 110, 111 New Houses 111 Overcrowding 113 Repair of Unfit Houses 114 Appeals 115 Closing and Demolition Orders 115 Underground Rooms 115 Increase of Rent, &c., Acts 115 Action under Section 5, Housing Act, 1925 115 Insanitary Areas 115 Insanitary Houses 116 Statistics and Summary of Housing Work 117-119 Appendices. Annual Report of Tuberculosis Medical Officer 120-128 Table I. Summary of Vital Statistics 129 ,, II. Infectious Disease Notifications 130 „ III. Causes of, and Ages at, Death 131 IV. Infant Mortality 132-135 Tuberculosis Scheme of the Borough Council— Return of Work of the Dispensary 136-140 9 Summary of Statistics 1930. 1. General. Area of Borough— (Including land and inland water) acres 2,163 (Excluding water) acres 2,139.9 Population— (Registrar-General's estimate, mid-year 1930) 160,700 Number of private families (Census 1921) 42,988 Structurally separate occupied dwellings (Census, 1921) 27,191 Rateable value (average 1930) £988,164 Sum represented by a penny rate (including Government grant) £4,640 2. Extracts from Vital Statistics of the Year. Births— (Males, 1,393; females, 1,259) 2,652 Legitimate births (1,332 males ; 1,196 females) 2,528 Illegitimate „ (61 males; 63 females) 124 Birth-rate 16. Deaths— (Males, 955; females, 891) 1,846 Percentage of total Deaths occurring in Public Institutions (Battersea deaths only) 54.9 Death-rate 11.5 Number of women dying in or in consequence of childbirth— From sepsis 4 Other causes 6 Death-rate of infants under 1 year per 1,000 live births. Legitimate 49.4 Illegitimate 161.3 54.7 Deaths from Measles (all ages) 38 „ Whooping-cough (all ages) 7 „ Diarrhoea (under 2 years of age) 21 3. Census— Population (1911) 167,743 (1921) 167,739 Census, 1931—preliminary report 159,542 Number of inhabited houses (1911), 24,321 (1921) 27,191 10 Natural and Social Conditions. The Metropolitan Borough of Battersea, created in November, 1900, under the provisions of the London Government Act, 1899, was formed from the old parish of Battersea after some re-arrangement between the two districts of Battersea and Wandsworth to define the boundary line. Up to comparatively modern times Battersea was a small hamlet on the Thames. It was not until late in the nineteenth century that it began to emerge from its rural environment, and some idea of its rapid growth will be gathered when it is known that so late as 1857 the population was only 16,000. The Borough as now constituted is bounded on the north by the Thames and on the west, south and east by the neighbouring boroughs of Wandsworth and Lambeth. It has an area (excluding water) of 2,139 acres, and a population of 160,700 (mid-year, 1930). There are about 24,000 houses, including 27,000 separate tenements. The rateable value is £988,164, and a penny rate yields over £4,640. There are two Parliamentary Divisions (North and South). The status of the population is in the main working-class. The manufactures carried on are comparatively few, so that the larger element of the population goes to work outside the Borough, and it is, therefore, mainly a dormitory or residential working-class district of London. The chief occupations of male workers in Battersea are transport, building and allied trades, metal works and clerks, draughtsmen, etc. Amongst female workers (excluding those engaged in domestic duties) the principal employments are personal service, clerical, typists, dressmaking, embroidery, etc. Battersea is fortunate in the possession of fine open spaces, Battersea Park in the north, and Clapham and Wandsworth Commons in the south-and south-west contributing greatly to the healthiness and natural amenities of the district. The Borough is low-lying in the north, where in parts it lies below high-water mark of the river, and in the past this area has been much liable to flooding in times of heavy storm. On the south and south-west the ground rises to a considerable height towards Clapham and Wandsworth Commons to the Balham plateau. The soil is chiefly clay with outcrops of gravel and isolated banks of sand or sandy loam. Along the river front there is a belt of alluvium laid down by the river where it formerly overflowed its banks, and what is now the site of Battersea Park and much of the Nine Elms district was mainly marsh land. Hospitals. There are five hospitals situate within the Borough, three of which are controlled by publicly-elected bodies, and two by voluntary associations. The three former are:— 11 St. James's Hospital, Ouseley Road, S.W. 12. This fine general hospital was, notwithstanding much opposition from outside public bodies, erected as a result of the representations of the Borough Council in the year 1910. It contains 746 beds, but additional buildings are shortly to be erected which will largely increase the accommodation available. It is a General Hospital under the control of the London County Council and serves the area of the former Wandsworth Board of Guardians which included Battersea. St. John's Hospital, St. John's Hill, S.W. 11. This hospital was formerly known as the St. John's Hill Infirmary, and until the erection of St. James's Hospital was the only Poor Law Hospital serving this and the adjoining district of Wandsworth. It contains six hundred and thirty-seven beds, is also controlled by the London County Council and serves the same area as the St. James's Hospital. The Borough Maternity Hospital, 19 and 20 Bolingbroke Grove, S.W. 11.—Vide page 44. Voluntary Hospitals in the Borough. The Bolingbroke Hospital (Incorporated), Bolingbroke Grove, S.W. 11. This is a general hospital, containing 121 beds for general medical, surgical and accident cases, a large out-patient department, an X-ray department and special clinics for nose, throat and ear cases, etc. In addition to the resident medical staff, it has a panel of visiting surgeons and consultants. The hospital serves the Boroughs of Battersea and Wandsworth. The Battersea General Hospital, Battersea Park, S.W. 11. This is a general hospital of 46 beds and six cots for general medical, surgical and accident cases. It is being extended by the provision of new buildings at a cost of approximately £25,000, and when the extensions are complete will contain 54 beds and 20 cots. There is a panel of consultants in addition to the resident medical staff. The patients are drawn from the Borough and the adjoining Boroughs of Wandsworth, Chelsea and Fulham. The Borough is also served by numerous hospitals in adjacent districts, chief among which are:— St. Thomas's Hospital, S.E. St. George's Hospital, S.W. Westminster Hospital, S.W. South London Hospital for Women, Clapham Common. 12 Victoria Hospital for Children, Tite Street, Chelsea (Vide pages 26, 30 and 31). Belgrave Hospital for Children, Clapham Road. Clinics and Treatment Centres. The following clinics and centres are held in the Borough:— Maternity and Child Welfare—See pages 26-28. Ante-Natal Clinics—See pages 36-42. District Maternity Service of the Clapham Maternity Hospital, 33 Albert Bridge Road. Post-Natal Clinic—See page 44. Dental Clinic—See page 52. Protection against Diphtheria (Schick) Clinic—See page 59. Tuberculosis Dispensary—See page 68. School Clinics (L.C.C.) at Queens Road, and Caius Hall, Harroway Road. V.D. Centre (Maternity and Child Welfare) Borough Maternity Hospital—See page 40. Local Acts and By-laws. There are no local Acts of Parliament in force which affect the work of the Public Health Department. The following by-laws have been made by the Council and their predecessors the late Vestry from time to time:— Made under the Public Health (London) Act, 1891— (Sec. 16(1)) For the prevention of Nuisances (1893). (Sec. 39(2)) For the keeping of water-closets supplied with sufficient water (1893). (Sec. 50) For securing the cleanliness and freedom from pollution of cisterns, etc. (1893). (Sec. 45) With regard to Public Conveniences (1901). (Sec. 88) For the management of the Mortuary (1902). (Sec. 95) With regard to Tents, Vans, etc. (1904). Made under the Housing, Town Planning Act, 1909. In respect of Underground Rooms habitually used as sleeping places (1911). Made under the London Government Act, 1899. As to nuisances by dogs on public footways (1927). Health Propaganda. The cinematograph film referred to in the Annual Report for 1929, which illustrates the progress of health and the work of the Public Health Department, was again exhibited at Public meetings held in the Town Hall on two occasions in 1930. 13 A grant of £10 was made to the Central Council for Health Education during the year. The Council have also entered into a contract with the publishers of the journal "Better Health" (which is issued under the auspices of the Central Council for Health Education), under which certain space in the journal is reserved for local matter dealing with health subjects. 2,000 copies of the journal are supplied monthly and are issued to the public through the maternity centres, public libraries, etc. Registration of Births and Deaths. Under the provisions of the Local Government Act, 1929, the Registrars of Births, Deaths and Marriages were transferred to the control of the Borough Council. On the transfer coming into effect the Superintending Registrar and the Registrars for the N.W. and S.W. Districts resigned their office as from Lady Day, 1930, and the Council made the following appointments:— Superintending Registrar—Mr. R. R. Pawsey (clerk and deputy, Mr. W. G. Walden). E. District—Mr. W. T. L. Bray. N.W. District—Mr. G. D. A. Colbourne (deputy, Miss P. I. Keevil). S.W. District—Mr. D. W. Constable (deputy, Mr. J. G. Desborough). Vaccination. Under the Local Government Act, 1929, the functions relating to Vaccination in Battersea were transferred from the Guardians of the Wandsworth Union to the Council as from 1st April, 1930. The Council entered into fresh contracts with the existing Public Vaccinators, who were as follows:— District. Station. Public Vaccinator. No. 1 342 Wandsworth Road Dr. C. E. McDade, 114 Clapham Common North Side. No. 2 Relief Station, Dr. M. Lurie, Latchmere Road 347, Queens Road. No. 3 do. Dr. C. E. McDade. No. 4 do. Dr. J. J. Oakman, The Priory, Battersea Square. No. 5 31 Severus Road Dr. W. Walsham, 61 Clapham Common West Side. No. 6 Relief Station, Dr. C. E. McDade. Latchmere Road No. 7 do. Dr. M. Lurie 14 District. Station. Public Vaccinators. St. James's Ouseley Road Dr. W. L. Maccormac Hospital (Medical Superintendent). St. John's St. John's Hill Dr. E. F. W. Nixey Hospital (Deputy Medical Superintendent). The Vaccination Officer, Mr. T. C. P. Asbey, was also transferred to the control of the Council. Staff of the Public Health Department. The staff of the Public Health Department at 31st December, 1930, is set out on pages 3 and 4. During the year the following changes in personnel took place— Dr. G. Macdonald, m.a., m.b., ch.b., d.p.h., Tuberculosis Officer, in November, 1930, was appointed also part-time Assistant Medical Officer of Health and, subject to the approval of the Ministry of Health, Deputy Medical Officer of Health to act in case of the illness or absence of the Medical Officer of Health. Dr. (Mrs.) M. J. O'Flynn, b.a., m.b., b.ch., b.a.o.(n.u.i.), was appointed Assistant Tuberculosis Officer (part-time) in November. Mr. G. Weeks was appointed Sanitary Inspector in January, filling the vacancy caused by the retirement of Mr. J. T. Baxter in the previous year. Mr. W. C. Turner relinquished his appointment as Clerk in the General Office in March. Mr. H. Renham, Rat Officer, was superannuated after 10 years' service in October, and the vacancy thus created had not been filled by the end of the year. Messrs. E. Saphier and W. E. Anstee were appointed temporary Sanitary Inspectors in December. 15 Vital Statistics. The estimated mid-year population* based upon the RegistrarGeneral'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 E timated Mid-Year Population, 1930. Males. Females. Total. East Battersea 31,962 33,818 65,780 North-West Battersea 22,427 23,406 45,833 South-West Battersea 21,785 27,302 49,087 Total 76,174 84,526 160,700 Wards. No. 1. Nine Elms 12,632 13,009 25,641 No. 2. Park 8,173 8,923 17,096 No. 3. Latchmere 8,606 9,360 17,966 No. 4. Shaftesbury 7,349 7,711 15,060 No. 5. Church 8,613 8,754 17,367 No. 6. Winstanley 9,831 10,320 20,151 No. 7. St. John 3,546 4,820 8,366 No. 8. Bolingbroke 8,373 10,163 18,536 No. 9. Broomwood 9,051 11,466 20,517 Total 76,174 84,526 160,700 BIRTHS. The number of births registered in the Borough during 1930 was 2,880 (1,485 males, 1,395 females), an excess of 90 males. Of this number, 617 were transferred out, the permanent residence of the parents being outside the Borough, and 389, registered outside the Borough, were transferred here, giving on balance a total of 2,652 births relating to Battersea residents, and a corrected birth-rate of 16.5 per 1,000 of the population. This is a slight increase on that of 1929, when the birth-rate was the lowest recorded in Battersea with the exception of that of 1918 when it was 16.1. The preliminary report of the Census taken on the 26/27th April, 1931, issued by the Registrar General, shows the population of Battersea to be 159,542 as compared with the Census population of 1921, namely 167,739, a reduction of 8,197. 16 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 1930. Sub-Districts. Estimated Population, 1930. Number of Births. Birthrate. East Battersea 65,780 1,115 17.0 North-West Battersea 45,833 838 18.3 South-West Battersea 49,087 699 14.2 Wards. No. 1, Nine Elms 26,541 443 17.3 No. 2, Park 17,096 332 19.4 No. 3, Latchmere 17,966 333 18.5 No. 4, Shaftesbury 15,060 194 12.9 No. 5, Church 17,367 288 16-6 No. 6, Winstanley 20,151 385 191 No. 7, St. John 8,366 141 16.9 No. 8, Bolingbroke 18,536 264 14.2 No. 9, Broomwood 20,517 272 13.3 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1930, and during the previous decennium 1920-1929:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North West Battersea. South-West Battersea. 1920 28.1 29.8 32.0 21.8 1921 22.1 23.8 26.6 15.5 1922 21.7 2.0 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 1929 16.2 17.5 18.0 12.7 Average 1920-1929 19.6 21.2 22.4 14.5 1930 16.5 17.0 18.3 14.2 Erratum. P.17. Marriage rate 18.0 (Not 1.80) 17 The birth-rate shows a decline in four Wards of the Borough and an increase in the remaining Wards. The birth rate in Battersea is 3.1 per 1,000 lower than the average for the previous decennium 1920-1929. 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 124 or 4'68 per cent. of the total live 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 1930, 103 stillbirths were registered as belonging to Battersea, the total number notified being 99 i.e., 96.1 per cent. of the total registered. MARRIAGES. The marriages registered in Battersea during 1930 numbered 1,444. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 1.80. Year. Marriages. Marriage-Rate. 1925 1,382 16.1 1926 1,304 15.2 1927 1,428 16.9 1928 1,354 16.5 1929 1,376 17.0 Mean, 1925-29 1,369 16.3 1930 1,444 18.0 DEATHS. The number of deaths registered in the Borough during 1930 was 2,716. Of these 1,227 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 357 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,846 (males 955, females 891). This gives a recorded death-rate of 11.5 compared with 11.6 for London, and 11.4 for England and Wales. According to the factor supplied by the Registrar-General, for correction of death-rate in reference to age and sex distribution, the corrected death-rate for Battersea during 1930 was 11.1. 18 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 1930. Number of Deaths. Deathrate. East Battersea 65,780 766 11.6 North-West Battersea 45,833 508 11.1 South-West Battersea 49,087 572 11.7 Wards. No. 1, Nine Elms 25,641 281 11.0 No. 2, Park 17,096 214 12.5 No. 3, Latchmere 17,966 225 12.5 No. 4, Shaftesbury 15,060 182 12.1 No. 5, Church 17,367 191 11.0 No. 6, Winstanley 20,151 206 10.2 No. 7, St. John 8,366 74 8.8 No. 8, Bolingbroke 18,536 210 11.3 No. 9, Broomwood 20,517 263 12.8 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1930:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 87 42 13 8 38 107 280 380 955 F 58 32 12 10 43 92 205 439 891 Ttls. 145 74 25 18 81 199 485 819 1,846 %of Total 7.9 4.0 1.3 1.0 4.4 10.8 26.3 44.4 100.0 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 292 254 546 Second quarter 209 203 412 Third quarter 202 201 403 Fourth quarter 252 233 485 955 891 1,846 19 The death rate, after a temporary rise in 1929 to 14.2, declined to 11.5 in 1930. The increase in the rate in the former year was accounted for chiefly by the increased number of deaths from respiratory diseases and influenza. The death-rate was lowest in the St. John Ward (8.8), and highest in Broomwood Ward (12.8). The deaths of persons over 65 years numbered 819 or 44.4 per cent, of the total deaths. The average age at death was 53.7 years, as compared with 53.0 in 1929. Decreased death-rates were recorded in all Wards. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 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 1929 14.2 13.8 14.2 14.6 Average 1920-29 12.1 12.1 12.4 11.7 1930 11.5 11.6 11.1 11.7 The natural increase of population (that is the excess of births over deaths) was 806 in 1930 as compared with 325 in 1929. Deaths in Public Institutions. During 1930 the deaths of Battersea residents occurring in Public Institutions numbered 1,014. Of this number 712 occurred within and 302 outside the Borough. Of the total Battersea deaths in Institutions 660 occurred in Public Assistance Institutions. 20 Senile Mortality. During 1930 the deaths of 819 residents of Battersea aged 65 years and upwards were registered. 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 93 62 58 72 9 17 160 151 311 N.W. Battersea 52 52 26 40 8 14 86 106 192 S.W. Battersea 61 69 57 83 16 30 134 182 316 Borough of Battersea 206 183 141 195 33 61 380 439 819 Infant Mortality. During 1930 the deaths of 145 infants were registered as belonging to Battersa. The total number of births registered during the year was 2,652, giving an infant mortality rate of 54.7 per 1,000 births, as compared with 62.6 in 1929, 64.2 in 1928, and 53.5 in 1927. It will be noted that the Infant Mortality rate was considerably lower during 1930 than in the previous year. The distribution of the 145 infant deaths and the infant mortality-rates for the registration sub-districts and the wards, are shown in the following table:— Registration Sub-District. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. M. F. TOTAL. East Battersea 1,115 35 22 57 51.1 North-West Battersea 838 32 19 51 60.9 South-West Battersea 699 20 17 37 52.9 The Borough 2,652 87 58 145 54.7 Ward. 1. Nine Elms 443 12 5 17 38.4 2. Park 332 14 8 22 66.3 3. Latchmere 333 14 5 19 57.1 4. Shaftesbury 194 7 7 14 72.2 5. Church 288 9 12 21 72.9 6. Winstanley 385 12 5 17 44.2 7. St. John 141 5 4 9 63.8 8. Bolingbroke 264 6 6 12 45.5 9. Broomwood 272 8 6 14 51.5 21 It will be noted that in the sub-districts the rate was lowest in East Battersea (511), and highest in North-West Battersea (60.9). In the Wards, Nine Elms showed the lowest rate (38.4) and Church Ward the highest (72.9). The infant mortality rate in the County of London and in England and Wales during 1930 was 59.2 and 59.7 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 703 45 64.0 Second quarter 713 47 65.9 Third quarter 655 27 41.2 Fourth quarter 581 26 44.8 The infant death-rate was 42.9 during the last 6 months of the year, as compared with 65.0 in the first 6 months. There were 74 deaths of infants during the first four weeks of life (or 51.0 per cent. of the total infant deaths) as compared with 65 deaths (or 39.6 per cent.) in 1929 and a percentage for the quinquennium (1925-1929) of 45.1. Measles accounted for 7 infant deaths during the year. The deaths from developmental diseases were 72 as compared with 57 in 1929. 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 1925 to 1930. 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 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 1929 21 23 21 65 39.6 Total 1925-9 118 146 122 386 — Mean do 23.6 29.2 24.4 77.2 45.1 1930 24 35 15 74 51.0 22 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Diphtheria - — — — — - Measles — — 4 3 7 4.83 Influenza — — — — - - Erysipelas 1 — — — - 0.69 Whooping Cough 1 — 2 1 4 2.76 Meningococcal Meningitis - 1 - - 1 0.69 Diarrhœa and Enteritis 5 6 5 4 20 13.79 General Tuberculosis — — — 1 1 0.69 Tuberculous Meningitis - - - - - - Pulmonary Tuberculosis — — — 1 1 0.69 Pneumonia 7 4 7 — 18 12.41 Bronchitis 2 — — - 2 1.38 Other Respiratory Diseases - - - - 4 2.76 Prematurity 51 — — — 51 35.17 Marasmus 1 1 — — 2 1.38 Icterus Neonatorum 1 — — - 1 0.69 Congenital Malformations 10 3 — 1 14 9.65 Injury at Birth 4 — — — 4 2.76 Syphilis 1 — 1 — 2 1.38 Convulsions — — — — — — Atelectasis& Asphy xiaN. 2 — — — 2 1.38 Lack of Care 1 — — — 1 0.69 Rickets — — — 1 1 0.69 Accident and Homicide — — — — — — Miscellaneous 4 2 4 2 12 8.28 Total 91 17 23 14 145 100.0 Percentage of Total 62.8 11.7 15.9 9.6 — 100.0 Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1930 was 161-3 per 1,000 births, as compared with 98.9 in 1929, 73.2 in 1928, 89.9 in 1927, and 162.2 in 1926. The corresponding deathrate of legitimate children in 1930 was 49.4, the ratio of the mortality rate of illegitimate infants to that of legitimate being 3.27 to 1. Notification of Births Act. During 1930 the number of notifications of live births received was 2,506. The corrected number of births registered during the year in Battersea was 2,652. The proportion of notified to registered births was, therefore, 94.5 per cent. There were 241 living and 14 still-births of Battersea children born outside the Borough notified from the districts in which these births-occurred. 23 The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926. During 1930 there were 130 still births registered in Battersea, of which 44 were of non-resident, and 86 of Battersea parents. Seventeen still births occurring outside the Borough were registered as belonging to Battersea, making 103 in all. This total represents a still birth-rate of 37.4 per 1,000 births (live and still) registered. Of the 103 still births 9 (8.74 per cent.) were registered as illegitimate. 99 still births (85 from within and 14 from without the Borough), were notified under the Notification of Births Acts during the year as belonging to Battersea, the number notified being 96.1 per cent, of the total Battersea still births registered, and 3.59 per cent, of the total births registered. Notified births are visited and revisited by the Council's official Health Visitors or 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 the Notification of Births Act, 1907. Comparative Statistics, Metropolitan Boroughs. Table showing the birth-rates, death-rates and infant mortalityrates in the 29 Metropolitan Cities and Boroughs for the year 1930:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 Births. 1. Shoreditch 20 1 1. Lewisham 9 5 1. Chelsea 40 1 2. Poplar 19 4 2. Greenwich 10 4 2. Woolwich 41 6 3. Finsbury 18 3 3. Poplar 10 7 3. Lewisham 42 6 4. Bermondsey 18 2 4. Wandsworth. 10 7 4 City of London 44 4 5. Stepney 18 0 5. Fulham 10 8 5. Greenwich 47 5 6. Be thnal Green. 17 8 6. Woolwich 10 9 6. Hackney 49 5 7. Islington 17 6 7. Camberwell 11 0 7. Camberwell 51 7 8. Southwark 17 1 8. Hackney 11 0 8. Wandsworth. 54 2 9. Battersea 16 5 9. Bethnal Green 11 1 9. StokeNewington 54 6 10. Hackney 16 3 111. Hampstead 11 3 10. Poplar 54 6 11. Deptford 16 2 11. Battersea 1 1 5 11. Battersea 54 7 12. Lambeth 16 1 12. Deptford 11 5 12. Fulham 57 1 13. Hammersmith. 16 0 13. Stepney 11 7 13. Southwark 57 4 14. St. Pancras 15 9 14. Hammersmith 11 8 14. Lambeth 57 5 15. Greenwich 15 9 15. Islington 12 0 15. Hampstead 57 8 16. Fulham 15 5 16. St. Marylebone 12 0 16. Bethnal Green 60 4 17. Paddington 15 2 17. StokeNewington 12 1 17. Deptford 60 8 18. Camberwell 15 0 18. St. Pancras. 12 2 18. Westminster 60 8 19. Woolwich 14 9 19. Shoreditch 12 3 19. St. Pancras 61 2 20. Kensington 14 7 20. Lambeth 12 4 20 St. Marylebone 61 8 21. Lewisham 14 6 21. Westminster 12 5 21. Finsbury 63 5 22. StokeNewington 14.4 22. Southwark 12 7 22. Bermondsey 63 7 23. Chelsea. 13 4 23. Paddington 12 8 23. Hammersmith 64 4 24. Wandsworth. 13 4 24. Kensington 12 8 24. Shoreditch 64 9 25. St. Marylebone 12 8 25. Bermondsey 13 1 25. Kensington 68 6 26. Hampstead 11 6 26. Chelsea 13 1 26. Islington 68 8 27. Holborn 11 2 27. Finsbury 13 2 27. Stepney 76 4 28. Westminster. 1 1 0 28. City of London 13 5 28. Paddington 78 4 29. City of London 8 8 29. Holborn 13 8 29. Holborn 88 9 County of London. 15 8 County of London 11 6 County of London 59 2 England and Wales 16 3 England and Wales 11 4 England and Wales 59 7 These rates are based upon the estimate furnished by the Registrar General of the population of each Borough at the middle of 1930. 24 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 90,161 1,140 37.8 669 22 1 129 471 1865 33,688 1,357 40.3 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21 .3 122 864 1868 44,267 1,975 44 6 1,046 23-6 194 929 1869 47,749 2,096 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40 4 1,472 26. 8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19. 9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19 8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19. 7 383 2,055 1881 108,342 4,452 41. 8 2,033 18 7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20. 0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34. 6 2,854 19.3 543 2,251 1891 150,880 5,237 34. 7 2,697 17 .9 898 2,540 1892 153,778 4,990 32.4 2,782 18 .1 439 2,208 1893 156,719 5,225 33 .3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16. 1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2,303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31 .7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901 169,100 5,025 29 .7 2,766 16 .3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 342 2,282 1906 179,622 4,654 25 9 2,384 13 .2 321 2,270 1907 181,736 4,574 25. 1 2,406 13.2 243 2,168 1908 183,873 4,629 25 1 2,272 12-3 228 2,357 1909 186,036 4,450 23.9 2,417 12.9 237 2,033 1910 188,222 4,489 23 .7 2,124 11.3 209 2,365 1911 167,765 4,381 26 1 2,404 14 .3 331 1,977 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 2,700 161 — — — — D* 149,951 — — 2,809 18.7 204 -109† 1919 B* 165,960 3,075 18.5 — — — — D* 159,316 — — 2,061 12.9 95 1,014 1920 B* 166,093 4,669 28.1 — — — — D# 165,664 — — 2,079 12.5 188 2,590 1921 169,200 3,742 22. 1 2,060 12 .2 173 1,682 1922 169,200 3,665 21 .7 2,227 13.2 192 1,438 1923 170,600 3,434 20.1 1,839 10 .8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,805 10.5 64 1,379 1926 171,900 2,969 17.3 1,960 11.4 119 1,009 1927 169,000 2,801 166 2,065 12.2 57 736 1928 164,100 2.743 167 1.954 119 111 789 1929 161,800 2,619 16.2 2,294 14.2 95 325 1930 160,700 2,652 16.5 1,846 11.5 89 806 Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. Decrease. Census years in heavy type. 25 Chart Showing Birth, Death and Infant Mortality Rates in Battersea from 1858 to 1930. 26 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. Maternity and Child Welfare Centres. For administrative purposes, the Borough is divided into districts, for each of which a Health Visitor is made responsible. There are nine Maternity and Child Welfare Centres (Municipal, 6 ; Voluntary, 3). The situation and times of opening of the Centres, municipal and voluntary, are set out in the table on page 27. Other ancillary services included in the Scheme are:— (1) St. Mary's Hostel, Macaulay Road, Clapham Common (vide page 31). (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road (vide page 30). It has been the practice for many years past in addition to the grant received by the Voluntary Bodies from the Ministry of Health, to subsidise them in order to keep their work efficient and in uniformity with that of the Municipal Maternity Centres and Clinics. Upon the passing into law of the Local Government Act, 1929, a letter was received from the Ministry of Health enclosing a copy of a financial scheme under which new financial arrangements were authorised. Under this scheme the Council are required, for a period of three years, from the 1st April, 1930, to make annual payments to the Voluntary Bodies linked up with the Council's Maternity and Child Welfare Scheme as follows :— The Battersea School for Mothers £513 The Women's League of Service for Motherhood £546 The Chislehurst Mission £28 The St Margaret's Day Nursery and Guest House £555 These amounts are equivalent to the grants hitherto paid by the Council, and those paid by the Ministry direct to the Associations. The Council also made additional contributions in 1930 in connection with their Maternity and Child Welfare Scheme as under:— Invalid Children's Aid Association £40 St. Thomas's Cornwall Babies Hostel £100 Victoria Hospital for Children £100 27 Name and Situation of Centre. Times of Opening. Monday. Tuesday. Wednesday. Thursday. Friday. Municipal Centres. Southlands, High Street 9.30 a.m.s.L. — 9.30 a.m.s.L. — 9.30 a.m.s.L. 2.0 p.m. — †2.0 p.m. *2.0 p.m. *10.0 a.m.a.N. — — ‡2.30 p.m. — — Southlands (Dental Clinic) — §10.0 a.m. 11.0 a.m. — 11.0 a.m. 2.0 p.m. 2.0 p.m. — ||2.0 p.m. All Saints' Parish Hall, Prince of Wales Road — **10.0 a.m.a.N. — 2.0 p.m. — — *2.0 p.m. — — — Plough Road Institution *1.30 p.m. — — *10.0 a.m.A.N. 1.30 p.m. — — — 1.30 p.m. Chatham Hall, Chatham Road — 2.0 p.m. 2.0 p.m. — *2.0 p.m. Gideon Road, L.C.C. School — — *1.30 p.m. — 2.0 p.m. Maternity Hospital, Bolingbroke Grove (out- — *2.0 p.m.A.N. *10.0 a.m.A.N. *10.45 a.m.A.N. — patient department) — *10.0 a.m.p.N. *2.0 p.m.A.N. — — (Special Clinic) Voluntary Centres. Battersea School for Mothers, 55 Mundella Road *2.0 p.m *2.0 p.m. — 2.15 p.m. — Women's League of Service, Southlands, High St. 2.0 p.m. **2.30 p.m. *2.30 p.m. — — — **2.30 p.m.a.n. — — — Chislehurst Mission, St. James's Hall, Ponton Rd. — — — — **2.0 p.m. * A Medical Officer attends these Sessions. ** A Medical Officer attends alternate weeks, a.n. Ante-natal clinic, p.n. Post-natal clinic. s.l. Sunlight treatment clinic, † Mothers only. ‡ Protection against diphtheria (Schick test clinic). § Children only. || Tubercular patients only. 28 At each of the Centres a clinic is held, a woman Medical Officer and a nurse being in attendance. Each centre is under the supervision of a trained Health Visitor and voluntary helpers assist in the work of these centres. The Voluntary Centres are conducted on similar lines to those of the Municipal Centres. The additional Centre referred to in the Annual Report for 1929 was opened at the Gideon Road L.C.C. School, on 9th April, 1930, to meet the needs of the populous area of the South Eastern portion of the Borough. The Centre has proved a very useful addition to the work, for reasons set out in my previous report. An additional session was also opened at the Plough Road Institution during 1930. The table on page 29 gives a summary of the work carried out at the Centres in 1930. Health Visitors. The Health Visiting Staff consists of 10 full time Health Visitors. Two of these are partly employed as Women Sanitary Inspectors. Facilities are granted by the Council to students of recognised Training Bodies for practical instruction and training as Health Visitors 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 Council have, for the past few years, granted permission, so far as the exigencies of the work of the Department allow, to their Health Visiting Staff to attend the Winter School for Health Visitors organised by the Women's Public Health Officers Association. In 1930 two of the Health Visitors were given leave of absence for the purpose. The home visiting carried out during 1930 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:— Visits. C'cl. Vol. Total. To Expectant Mothers 2,460 362 2,822 To Notified Births 8,758 1,741 10,499 To Still Births 95 11 106 To Children aged 1-5 years 4,035 2,603 6,638 To enquire into Infant Deaths 129 21 150 To cases of Notifiable Infectious Disease 6,904 793 7,697 Re prevention of Measles 913 — 913 To cases of Non-Notifiable Disease 256 153 409 Re prevention of Diphtheria 144 40 184 Re Summer Diarrhoea 1,049* 710 710 To Dental Cases 61 3 64 To V.D. Cases 2 — 2 Other Visits 1,129 612 1,741 24,886 7,049 31,935 * These visits, having been made in conjunction with visits on other matters already enumerated, are not included in the total. 29 Summarised Statistics Relating to Infant Welfare Centres, 1930 "Southlands " Plough Road Municipal. Voluntary. Grand Total. East Battersea Chatham Road Gideon Road Total. Battersea School for Mothers. Chislehurst (St James's) Mission. Women's League of Service. Total. Municipal and Voluntary Sessions held 113 111 99 143 71 537 95 50 73 218 755 Average attendances per session 35 48 45 44 43 43 34 29 24 30 39 Average ditto weekly 75 102 86 121 59 442 62 28 34 124 566 First attendances 221 406 273 339 192 1,431 208 55 117 380 1,811 Doctor's attendances 64 49 47 49 38 247 95 26 73 194 441 Babies seen by Doctor 1.137 1,384 1,193 1,134 859 5,707 2,425 287 1.238 3,950 9,657 Average ditto per attendance 18 28 25 23 23 23 26 11 17 20 22 Weights recorded 3,585 4,650 3,955 5,273 2,838 20,301 3,223 1,346 1,679 6,248 26,549 Advice only 322 640 509 1,001 216 2,688 9 107 67 183 2,871 Attendances 3,907 5,290 4,464 6,274 3,054 22,989 3,232 1,453 1,746 6,431 29,420 30 Day Nurseries. The only Day Nursery in the Borough is the St. Margaret's Day Nursery at 8 and 10 Cambridge Road, which has accommodation for about 25 children. There is a guest house attached for the reception of boarders. The staff consists of an honorary Medical Officer, matron, three nurses, nine probationers and a kindergarten teacher. The Nursery, which forms a component part of the Council's Maternity and Child Welfare Scheme, receives an annual grant from the Council and is controlled by a Committee (upon which the Council is represented) of the National Society of Day Nurseries. Towards the end of the year the Committee took steps to acquire the adjoining premises, No. 6, for the purpose of staff quarters. Under the Local Government Act, 1929, the Nursery, in common with other similar voluntary associations, ceased to receive a direct grant from the Ministry of Health but a larger grant was made by the Council (vide page 26). During 1930 the attendances at the Nursery totalled 3,677. Ambulance Service. For some years past facilities have been afforded free of charge by the London County Council for the conveyance by their ambulance service of maternity cases of an urgent nature either by day or night and for non-urgent cases between the hours of 11 p.m. and 8 a.m. As a result of representations made to them by this and other Metropolitan Borough Councils, the London County Council in August, 1930, intimated that they were prepared to extend this service to the conveyance of non-urgent cases between the hours of 8 a.m. and 11 p.m. provided that :— (i.) the Borough Council would undertake to pay an agreed sum for the use of the ambulance and (ii) the service was limited to cases approved by the Medical Officer of Health. The Council desired to avail themselves of these additional facilities and an agreement was entered into with the London County Council early in 1931. 31 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 35), 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 institutiofts. The following is a list of the 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 1930:— St. Thomas's Hospital 31 Victoria Hospital, Chelsea 296 St. James's Hospital 21 Bolingbroke Hospital 9 Borough Tuberculosis Dispensary 3 Fulham Babies' Hospital 2 St. Thomas's Cornwall Babies' Hostel 342* Invalid Children's Aid Association 6 Moorfields Eye Hospital 1 Guy's Hospital (dental cases) 22 Vincent Square Hospital 2 735 Southwark Diocesan Homes. For some years past the Council has contributed towards the cost of the maintenance during the period before and after confinement of unmarried mothers resident in the 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 £100 per annum. * Of this number 258 actually attended. 32 The number of cases in St. Mary's House, during the financial year 1930-31, to the maintenance of which the Council contributed, was 5, the cost to the Council being £129 8s. 9d. In the case of other homes, the number of cases during the financial year was 11, and the additional contribution of the Council amounted to £100. Home Helps. The arrangements referred to in the Annual Report for 1929 for the provision in suitable cases of assistance in the home during the mother's lying-in period were continued during 1930. So far as this Borough is concerned, the facilities have not been availed of to the extent anticipated. Some of the difficulties associated with the provision of Home Helps have been previously referred to, chief among which is the disinclination on the part of mothers to have a strange woman in their homes. The provision by the Council of a Maternity Hospital and complete Midwifery Service has, however, to some extent obviated the need for Home Helps where home conditions are otherwise undesirable. When, however, the advantages of Home Helps are recognised, and the prejudice of the mothers has been overcome, it is anticipated that more use will be made of the service. The present arrangements are that a list of suitable women recognised for this service is kept by the Health Visiting Staff, and applicants for the service are allowed to choose a woman from this list. She is paid at the usual rates for her period of service. During the year two Home Helps were provided in two cases for a period of 4 and 6 weeks respectively. Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, Grade A (Tuberculin tested) and dried 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 :— 33 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 1930 138 (73) 3,006 1,277 (73) 171,367 2,956 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. The provision of milk to necessitous mothers and children has increased during the past year, probably owing to the increase in unemployment. The value, however, of this service cannot be over-estimated, and it is hoped that the present economic situation will not necessitate any reduction of this useful form of assistance. Every care is taken by the Maternity and Child Welfare Committee to see that there is no abuse made of the facilities provided, and the fullest investigations are made by the Committee into the financial circumstances of applicants. Grade A (Tuberculin Tested) Milk is supplied in sealed bottles by licensed purveyors in the Borough, and the recipients are given their choice of dairymen from this list. In addition to the above, dinners to the number of 154 were supplied during 1930 to necessitous expectant and nursing mothers and children at a cost of £3 lis. 7d., by arrangement with the Women's League of Service. Six mothers were also referred from the Welfare Centres to the kitchen of the Invalid Kitchens' Association in Henley Street. Convalescent Homes. During 1930, accommodation was provided for 26 mothers and 25 children attending the various Maternity and Child Welfare 34 Clinics. Of these, 20 mothers and children were sent to Littlestoneon-Sea Convalescent Home, 22 to the Burnett Cottage Home, Heme Bay, and 9 to two other homes. The cost incurred by the Council amounted to £36 7s. 0d., the mothers and a voluntary association contributing the balance of £19 10s. Od. 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. Midwives. At the end of the year there were about 21 registered midwives practising in the Borough, apart from those employed in the Council's institution. In addition to these private midwives and the District service of the Council (vide page 51) the eastern portion of the Borough is served by the district midwifery services of the General Lying-in Hospital, York Road, and St. Thomas's Hospital. The question of employment of and/or subsidising midwives in private practice in the case of those mothers who are unable to meet the usual fees was under consideration at the end of the year. Nursing Homes. There are eight nursing homes registered in the Borough under the Nursing Homes Registration Act, 1927. Four of these have been approved for the reception of maternity patients. All these homes are under the supervision of the London County Council. Nursing Facilities. The Council have made arrangements with the South London District Nursing Association of 109 Clapham Common North Side, for the nursing of mothers and children under the powers contained in the Maternity and Child Welfare Act of 1918, and also of patients suffering from certain infectious illnesses. A payment of 8d. per visit is made in respect of this service. During 1930 the total number of attendances made by the nurses of the District Nursing Association in connection with the Council's Scheme was :— 35 Nursing Service, 1930 Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 121 2,631 - - 121 2,631 Measles 97 1,144 20 269 117 1,413 Whooping Cough 9 112 1 26 10 138 Diarrhoea & Vomiting 7 46 1 12 8 58 Chicken Pox 1 8 1 11 2 19 Pemphigus 72 Neonatorum 3 72 — — 3 Puerperal Pyrexia — — 1 17 1 17 Pneumonia 48 788 74 1,506 122 2,294 Influenza 1 34 8 122 9 156 Erysipelas 2 20 2 20 Totals 287 4,835 108 1,983 395 6,818 The cost of the nursing service in 1930 was £227 5s. 4d. as compared with £189 10s. 0d., in the previous year. 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 1930. The results of the year's work have been satisfactory and are summarised below:— A. Test Feeds. Number of cases, 200, comprising: Mothers, 200; babies, 205. Number of attendances, 508. (250 mothers and 258 babies). 8 of these cases received in-patient treatment. B. In-Patient Treatment. 25 Battersea cases received, made up of— 9 mothers and 14 babies sent by Council. 1 mother and 1 baby sent from other sources. Period of stay. 23 cases sent by Council—9 mothers and 14 babies, 908 days ; Average 39-5 days 2 other cases—mother and babe, 17 days each. 36 ANTE-NATAL WORK. The Ante-Natal Clinics provided by the Council are under the control and supervision of a Consultant Gynaecologist (Miss Alice Bloomfield, m.d., f.r.c.s.), who attends the central clinic held at the Borough Maternity Hospital on Tuesdays and Wednesdays, and at the Southlands Centre on Friday. There are subsidiary clinics at the Plough Road and East Battersea Centres which are attended by the Assistant Medical Officer of Health (M. & C.W.), and the Women's League of Service also hold a clinic at their Southlands premises (vide p. 38). Each mother who books for the Borough Maternity Hospital or the District Midwifery Service is required to attend the Ante-Natal clinic monthly before her confinement, and is seen at least once by the Consultant Gynaecologist. Cases are also referred by private medical practitioners to the Clinics, and reports are furnished to them. Miss Alice Bloomfield, M.D., F.R.C.S., Consultant-in-charge of the Ante-Natal Clinics, reports:— Tuesday Afternoon ("Special") Clinic.—In all the total attendances at this Clinic numbered 763, including 702 new cases. Blood for the Wasserman reaction was taken in 700 instances, giving a positive reaction in only 5 cases or .7 per cent. Other types of case attending the clinic are shown in the following table, and numbered 35 :— 35 cases. { 15 required no treatment; 10 cases {were treated, in 9 of which a film 25 cases of , {examination was made, and in 4 cases vaginal { of severe discharge in pregnancy, daily discharge {vaginal douching was ordered for a time. 10 " other cases," e.g. prolapse, for diagnosis of pregnancy or gynaecological disorder. It is also after the Tuesday afternoon clinic that the various examinations under anaesthesia—e.g. for version—are carried out. These numbered 11 in 1930 (see later). Wednesday and Thursday Morning Clinics.—The total attendances at these Clinics numbered 2,128, or an average attendance of 20-5 patients per clinic. Total new patients numbered 434 or 4.2 per clinic. Booking date with reference to period of pregnancy :— Before or up to the 3rd month 301 patients. „ 6th „ 127 „ After the 8th „ 6 „ 37 Abnormal Ante-Natal Cases. Albuminuria. 41 cases of albuminuria were seen and treated, of whom 9 were admitted to the Home in the Ante-Natal period. Cardiac Disease (excluding the functional or hæmic murmurs so common in pregnancy), 4, of whom 1 case required admission to the Battersea Maternity Home. Cases referred to Tuberculosis Dispensary, 1. Cases requiring Institutional treatment in the ante-natal period, 36. To the Battersea Maternity Home, 22 For induction, 11; albuminuria, 9 ; ante-partum haemorrhage, 1 ; cardiac disease, 1. Cases referred elsewhere for admission, opinion or special pathology, 12 :—Cardiac disease, debility, phlebitis, exophthalmic goitre, (?) diabetes, epilepsy, &c. Southlands (Friday Morning) Clinic.—Total attendances here numbered 736, with an average attendance of 14.7 ; 254, i.e. more than one-third of the total attendances, were new cases, an average of 5. 1 per session. Date of booking woth reference to the period of pregnancy :— Before or up to the 3rd month 163patients. " "6th „ 72 " After the 8th „ 18 „ Not pregnant 1 ,, Abnormal cases treated at the Clinic:— Albuminuria, 2 cases, of whom one required admission to the Battersea Maternity Home. Cardiac Disease—nil. Cases referred to Tuberculosis Dispensary—1. Cases referred for dental treatment—93. Cases requiring institutional treatment in the ante-natal period—5 :—5 cases to Battersea Maternity Home (1 albuminuria. 3 for version, 1 for induction). Other, nil. Cases referred to private doctors—5 :—2 chest condition; 1 varicose veins and septic phlebitis ; 1 threatened miscarriage. Remarks.—There is a slight drop in the total numbers attending the clinics as compared with 1929. This may be explained by the temporary closing of the Borough Maternity Home in the early months of the year, with the consequent necessary diminution in the numbers of cases which could be booked. 38 Patients, on the whole, attend most regularly and well, and seem anxious in every way to benefit from the advice and help given them at the ante-natal clinics. The number of cases referred up by doctors and midwives still remains small; on the other hand every effort is made in the case of patients suffering from non-obstetric complaints to induce the patients to attend and take the advice of their own doctors. Borough Maternity Hospital (In Patients).—The following is a table of cases supplied from the records of the Battersea Maternity Hospital, which are of interest in relation to the work of the Antenatal Department:— I. Cases of Albuminuria recommended admission, 11. Results—Mothers—good (1 case of eclampsia) ; Babies 9—good (2 still-born). II. Cardiac cases recommended admission 1. Result—Satisfactory. III. Ante-partum haemorrhage, 5. IV. Inductions. No. of cases, 19. Bougie 3. Result—Mother, satisfactory ; child, satisfactory. Drug 16. Result—Mother, satisfactory ; child, satisfactory. V. Forceps deliveries, 14 (9 uterine inertia, 5 foetal distress). Results—2 still births. VI. Examinations under anaesthesia, 11. For version, 7 (successful 5, unsuccessful 2). For estimation of fit of head, 2. For diagnosis (?), 2 (? twins, ? transverse and placenta praevia). VII. No. of cases delivered as breech at term, 4. Diagnosed, 1 ; undiagnosed, 3. VIII. No. of cases Caesarean Sections, 5. 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 from the Council to enable the work to be carried out to the standard of efficiency of the Council's Scheme (vide page 26). * The general work of this Centre is shewn in the table on page 29. 39 Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports :— Ante-natal Work.—The sessions continue to be held fortnightly. The average attendance at each session has been 8.5 and the total number 195. 20 mothers were confined at the Borough Maternity Hospital. 1 „ was ,, by the Borough Midwife. 10 „ were „ by Private Midwives. 6 ,, „ ,, at St. James's Hospital. 2 „ „ „ at other Hospitals. 5 ,, ,, „ by the Albert Bridge Road Nurses. Infant Welfare Work.—Five cases referred to hospital:—1 for special splints at Victoria Hospital for Children ; 2 for circumcision at Victoria Hospital for Children; 1 for pneumonia at St. James's Hospital; 1 for digestive trouble at Evelina Hospital. Nine cases have had sunlight treatment under the Borough. The results have been excellent. We sent 16 mothers and 17 children for a free holiday during the summer. Two children remained away several months through the aid of the C.O.S. The District Nurses did good work in visiting the children in their own homes for special dressings and discharging ears. Dinners for Toddlers (from 1-5 years).—The children have derived great benefit from these dinners and the numbers attending have increased. Dinners for Mothers.—These are very beneficial in helping mothers to continue breast feeding. The Samaritan Fund, supported by voluntary contributions, has been largely drawn upon during the year. BATTERSEA SCHOOL FOR MOTHERS. The Ante-natal work at this Centre is transferred to the Ante-Natal Clinic at the Borough Maternity Hospital, all cases being referred to the central clinic there for examination and report. The Mundella Road Centre of the Battersea School for Mothers, which has been in operation since 1918, serves a very large, populous working-class area in the Nine Elms District, which is one of the two important areas served by the Voluntary Associations linked up with the Council's scheme. 40 The Association receives a grant of £513 per annum, under the Scheme referred to on page 26. The extent of the work carried out at this Centre may be seen in the table on page 29. In addition to the Ante-Natal work carried out under the Maternity and Child Welfare Scheme of the Council a considerable amount of visiting and reporting of cases is done by the Council's Health Visiting Staff for the Obstetric and Gynaecological Departments of the larger Hospitals in connection with Battersea patients attending these institutions. The following is a summarised statement showing the Hospitals and the visiting and reporting work carried out for them during 1930. Ante-natal and postnatal. Other. Total. St. Thomas' Hospital 262 159 421 Charing Cross Hospital 5 — 5 General Lying-in Hospital 243 — 243 King's College Hospital 7 — 7 St. George's Hospital 51 — 51 Westminster Hospital 39 — 39 Victoria Hospital, Chelsea — 77 77 St. James's Hospital — 39 39 Bolingbroke Hospital — 2 2 Elizabeth Garrett Anderson Hospital 2 — 2 Queen Charlotte's Hospital 3 — 3 612 277 889 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 1930 is summarised in the table on page 42. Mr. Corsi reports :— In 1930 the number of new patients upon whom a Wasserman test was made was 704. Five proved positive ; four received antenatal treatment; one was transferred elsewhere. A number of other patients were examined, but treatment in these cases (mostly of vaginal discharge) was considered unnecessary. 41 Of six babies born in 1930, one was still-born on account of difficult labour. Four were healthy babies with negative Wasserman. One baby was not tested; but it has remained perfectly healthy during the first year of its life. Post Natal Treatment.—This is important, firstly, to prevent infection.during lactation, and secondly in the interests of any future pregnancies. The mothers require very careful handling to ensure their attendance after confinement. That only one failed to attend is reasonably satisfactory. The low percentage of positive Wassermans in the district is more than remarkable; it is probably unparalleled in any published statistics. It will be interesting to see if it can keep at this low level. 42 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1930. Year. Number of expectant mothers tested by W.R. Number giving positive W.R. Per cent. Number of expectant mothers with positive W.R. treated during pregnancy. Babies. Healthy Neg. W.R. Healthy looking. Not yet tested. Positive W.R. Still-born. 1922 - - - 1 1 0 0 0 1923 — — — 8 5 2 1 0 1924 517 18 3.5 15 11 3 0 1* 1925 653 14 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 1930 704 5 0.7 4 3 0 0 1* * Not syphilitic. 43 Maternal Mortality. During 1930 there were 10 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 3-77 per 1,000 births. Six of these deaths occurred in hospital and four at home. The causes of death were certified as being :— Puerperal sepsis 4 Post-partum Haemorrhage 2 Embolism and Thrombosis 2 Eclampsia 1 Laceration of Uterus 1 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1925. 1926. 1927. 1928. 1929. Mean 1925-9 1930. Deaths from Puerperal Sepsis Deaths from other causes connected with child-birth 3 3 1 3 2 2.4 4 3 7 5 4 3 4.4 6 Total Maternal Deaths connected with child-birth 6 10 6 7 5 6.8 10 Rate per 1.000 births— Puerperal Sepsis 0.94 1.01 •36 1.09 0.76 0.83 1.51 Other Maternal deaths 0.94 2.36 1.78 1.46 1.15 1.54 2.26 Rate per 1,000 births all Maternal deaths in child-birth 1 .88 3.37 2.14 2.55 1.91 2.37 3.77 Rate per 1.000 population— Puerperal Sepsis .017 .017 .006 .018 .012 .014 .025 Other Maternal deaths .017 .041 .030 .024 .019 .026 .037 Rate per 1,000 population all Maternal deaths in childbirth .034 .058 .036 .042 .031 .040 .062 It will be noted that there has been an increase in the Maternal Mortality Rate in Battersea during 1930, as compared with previous years. The causes of these maternal deaths are set out above. The Maternity and Child Welfare Committee have taken steps to see that the views expressed by the Ministry of Health in their circular letters with regard to the maternal mortality so far as Battersea is concerned, are being complied with. In addition to the measures already in force to deal with the question the Maternity Hospital has been recently equipped with a modern, out-patients' department with extended accommodation. The extension of the hospital was opened early in 1930. 44 The value of the Maternity Services of the Council is illustrated by a comparison of the Maternal Mortality Rate among women confined in the Borough Maternity Hospital and on the District Midwifery Service with that of the Borough as a whole. In the ten years 1921-30, during which the Hospital has been open, only 8 deaths have occurred in the Hospital from puerperal causes, giving a mortality rate of 1-6, as compared with a rate for the Borough as a whole of 2.78, and on the District Midwifery Service only 1 death has occurred. These results are most satisfactory and encouraging, and strikingly illustrate the value of the Council's Maternity Service. 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 1930 there were 46 sessions held and 421 attendances were made, 420 being new cases. The average attendance per session was 9.2. It is regretted that the services of Dr. J. S. Fairbairn, Consultant Obstetrician, who has retired from the position of Senior Obstetric 45 Surgeon for St. Thomas's Hospital, are no longer available, nor those of his deputy Mr. A. H. Richardson. Arrangements however, have been made for Mr. F. S. Roques, M.S., F.R.C.S., of the staff of the Middlesex Hospital, to act as Consultant Obstetrician and his services are available in cases of grave emergency. It was found necessary to call in the services of the Consultant Obstetrician in 14 cases during the year as compared with 20 cases in 1929. Temporary Closure of Hospital. A number of cases of Sepsis of a mild type occurred at the Hospital in October and November, 1929. The symptoms simulated for the most part influenza colds with slight temperature and a herpetic eruption on the lips. During December the outbreak subsided. Two of these cases who were more severely attacked were removed to Hospital and eventually recovered. Prior to this, early in September a patient was confined after a difficult instrumental labour with severe lacerations. Septic infection developed and she was removed to the Metropolitan Asylums Board Hospital where she died several weeks later. Towards the end of December a case was admitted with a bad ante-natal history. In view of her serious condition Caesarian operation was performed. Owing to her dangerous condition after the operation she could not be removed to a special hospital for several days. She was subsequently removed to St. James's Hospital, and died there a few days later. It is not improbable that this case may have had some bearing on the subsequent recrudescence of infection in January and February. Fifty-nine cases were admitted to the Hospital in January, and two cases (in addition to the fatal one) were removed to the Metropolitan Asylums Board Special Hospital. In February the infection became more prevalent amongst the patients. Three cases were removed to the Isolation Hospital owing to the development of septic infection and a fourth for other reasons. Other patients developed evidence of mild infection, but were retained in this Hospital under such isolation as was practicable pending evacuation. Investigation showed that in this secondary outbreak mothers, children and nurses were affected, children with sore fingers, sticky eyes and abscesses, and nurses with sore fingers. Drastic steps, therefore, became imperative, and the Hospital on the advice of the Medical Officer of Health, was, on the authority of the Maternity and Child Welfare Committee, closed for one month on the 17th February. 46 Arrangements were made meanwhile for the admission of patients to other Institutions, St. James's Hospital and the Clapham Maternity Hospital taking most of the cases. Permission was also given to any applicant accepted for admission to the Borough Maternity Hospital to make other arrangements if desired while the Hospital was closed, but in very few instances was this permission availed of. There were 22 cases in the Hospital on the date of closing, and these were gradually evacuated to the Isolation Hospital or discharged to their own homes. The Hospital was entirely cleared of patients by the 23rd February. The staff were medically examined and, with the exception of a nucleus to work the Hospital, were sent away for a holiday, and not allowed to return until after further medical inspection and the bacteriological examination of swabs. During the period the Hospital was closed the closest investigations were made into the causes responsible for the outbreak. Swabs were taken from the throats and noses of the medical and nursing staff, and in some instances the presence of organisms of a haemolytic streptococcal strain was disclosed on bacteriological examinations. In no case was there any clinical evidence of infection, but as a precautionary measure those showing positive results present were sent away for a time and not permitted to return to duty until found on consecutive bacteriological tests to be negative. One of the nursing staff, a pupil midwife, had contracted tonsillitis about the middle of November, 1929. She was isolated at the top of the administrative side of the Hospital (Elmhurst). She declined to be removed to a general hospital and as her home was in the north of England, her condition at the time did not permit of her being sent home. Precautions were taken to keep her isolated, but although there does not appear to have been any strong evidence connecting this case with the subsequent serious outbreak of Sepsis in January and February, it would have been better, as is the invariable rule of the Hospital, to have sent this case to an appropriate institution. Some of the nurses and pupil midwives developed sore fingers and in one or two instances styes on the eyelids. Several infants also developed sore fingers during the latter part of January and the beginning of February. It is probable that these minor infections among the nursing staff were not disclosed early enough, probably as being too trivial in the early stages to be reported to the Matron and Doctor. This, there is reason to believe from my investigation in at least one instance, may have been the probable source of infection, especially as the type of infection was not (excluding these two fatal cases, in one of which death was inevitable in any case) virulent. Apart from these two cases the majority of the patients were not severely attacked, and all these, including the cases 47 removed to the Metropolitan Asylums Board Hospital, eventually made good recoveries. In fact the infected cases retained in hospital after it was closed pursued a normal course, and all were discharged before the period of closure had elapsed. There is, I think, no doubt, however, that the earlier infection of October and November which had subsided during November had never entirely cleared up, and the recrudescence in January and February was probably assisted by the increased number of patients admitted in that month and the early part of February, and by the consequent pressure on the staff and the lack of adequate isolation provision at the Hospital. The attention of the Council had been drawn inter alia to this lack of adequate isolation accommodation, and the Council had been for some considerable time in negotiation with the Ministry of Health for an extension of the Hospital buildings. Unfortunately the plans for the new addition had to undergo considerable modification at the request of the Ministry for economic reasons. Delay, therefore, arose in the erection of the new extension. It was pointed out by the Council that, owing to the great increase in the past three or four years in the number of patients admitted to the Hospital annually, it was very important that this provision, amongst other necessary measures, was imperative, and in the light of the lesson learned it is regrettable that their earlier proposals were not accepted by the Ministry, leading to serious delay in relieving the pressure on the Hospital accommodation and the staff. A full report was submitted to the Maternity and Child Welfare Committee by the Medical Officer of Health, in which, after recounting the steps which had been taken to deal with the outbreak it was recommended that the opportunity should be taken to thoroughly overhaul, cleanse and redecorate the Hospital buildings during the period of closure, and to stop the admission of cases living outside the Borough until the pressing need of additional isolation accommodation was met. The Committee agreed to this and the work of redecoration, etc., was put in hand forthwith. On the 17th March the work had been completed and all patients in hospital had been evacuated or discharged before that date and the hospital was re-opened for the admission of patients. The work on the extension of the Maternity Hospital was commenced on the 16th August, 1929, and was pressed forward rapidly. It was not, however, carried out to the full plan originally approved, for reasons already stated. The new building is of two stories, the lower being devoted entirely to the Out-Patients Ante-Natal Department. This floor contains Waiting Room, Consultant's Room, Examination Room, etc. 48 The upper floor contains a large nursery (with open verandahs on two sides) and a ward of three beds for observation and isolation. A four-bedded ward in Elmhurst was also allocated for observation purposes for patients shewing slight temperatures or showing other departure from the normal, and the six-bedded ward in that building was reserved for convalescent cases, that is, patients at their 8th or 9th day after confinement. These additions and alterations again enabled the beds to be fully occupied by patients. The work was completed on 3rd April, 1930. The additional accommodation provided by the new building will prove a useful factor in securing increased efficiency. Conclusions.—The lessons to be learned from this outbreak are that a Maternity Hospital requires constant vigilance on the part of all concerned with its administration in securing the most rigid surgical asepsis, and the immediate isolation of cases presenting the slightest departure from the normal. The Borough Maternity Hospital was opened early in 1921, and during the 9 years previous to this unfortunate occurrence had enjoyed a remarkable immunity from untoward incidents, and this in itself, may have tended to cause the hospital to be regarded as invulnerable and to give rise to a relaxation of that vigilance and minute attention to details by those responsible which are ever necessary and imperative in a lying-in hospital. Consisting as it does of two adapted dwelling houses, it was not such an easy matter to reconstruct, fit and equip as if it had been a new building erected for the purpose. Every effort was, however, at the time made to bring it up to modern requirements as far as was practicable. As its popularity grew and the pressure on its beds increased, the need for increased accommodation for isolation and observation, and incidentally for the nursing staff as well, owing to the large numbers of pupil midwives undergoing their training there, became pressing. The outbreak of cases with slight temperatures and herpetic eruptions in October and November, for instance, which from the mildness of symptoms were not regarded as of serious import, might have been limited or entirely avoided had such cases been immediately removed to the isolation ward for observation, pending removal to the isolation hospital where necessary or desirable. It is gratifying to record, however, that the measures taken to deal with the emergency were rapidly successful in checking the outbreak, and that with the exception of the two fatal cases referred to, and in regard to which grave conditions were present requiring serious surgical operative treatment, there were no other fatalities. The Medical Officer of Health desires to record the valuable assistance he received from Officers of the Ministry of Health in the investigation of the outbreak and from Dr. Maccormac of St. James's 49 Hospital and Dr. Annie McCall of the Clapham Maternity Hospital in finding accommodation for patients in their Institutions during the period the Borough Maternity Hospital was closed. During 1930, 516 cases were admitted to the Hospital as compared with 605 cases in 1929, 653 in 1928, 634 in 1927, 625 in 1926, and 560 in 1925. Particulars relating to the admissions during 1930 are set out as follows:— Total number of cases admitted 516 Average duration of stay 14 days Number of cases delivered by midwives 467 Number of cases delivered by doctors (including 2 delivered by own doctors) 32 Number of cases born before arrival 3 Of the above cases, 14 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.—42 Albuminuria 11 Heart 1 Contracted pelvis 3 42 Induction 19 Malpresentation 3 Placenta prævia 5 (b) During Labour—99. Adherent placenta 1 Ruptured perineum 56 Foetal distress 3 Post-partum haemorrhage 2 Forceps deliveries 14 Heart disease 1 99 Prolonged labour 3 Retained membranes 19 (c) After Labour—14. Influenza 4 Post Eclamptic Fits 1 Pain in groin, &c. 1 Strange in manner 1 Rash on face 1 Chest condition 2 14 Varicose veins 1 Constipation 3 (d) For Infant—60. Blisters and septic fingers 20 Convulsions 1 Eruptions on face and body 3 Artificially fed 1 Cyanosis 2 Supplementarily fed 6 Feebleness 7 60 Sticky eyes 9 Watery eyes 10 Ophthalmia neonatorum 1 50 Number of maternal deaths 1 Number of cases in which temperature rose above 100-4° F. for 24 hours with rise of pulse rate 11 Number of cases notified as Ophthalmia Neonatorum with result of treatment 1 (Not cured. Permanent damage to eyes.) Number of cases with discharge from eyes however slight 9 Number of infants not entirely breast fed 6 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia 11 Number of foetal deaths (13 still-born, 14 within 10 days of birth) and their causes 27 Still Birth- Breech presentation 2 Macerated—albuminuria in mother 3 Prematurity (I born before arrival) 2 Mongolian 2 Ante-partum haemorrhage 2 Forceps delivery 2 13 Died within 10 days— Congenital heart disease 4 Premature 7 Asphyxia pallida 2 Heart failure 1 14 The Consultant Obstetrician was called in in 14 cases of grave emergency, particulars of which are set out below:— Forceps delivery 2 Post eclamptic fits 1 Ante-partum hæmorrhage 1 Uterine inertia 1 Caesarean section 5 Albuminuria 1 Puerperal pyrexia 3 Cost of Maternity Hospital. 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, 1931:— Maternity Hospital, 1930-1931. Total beds (excluding isolation beds), 29; total cases, 505. number of weeks spent in Institution by such patients, 1,004. 51 Statement showing expenditure for the year ended 31st March 1931, in respect of the Maternity Hospital. Item. Total. Per Patient Week. £ £ s. d. Salaries Medical 402 0 8 0 Nursing 671 0 13 4 Domestic and other 573 0 11 5 Provisions 798 0 15 11 Drugs and other Medical Requisites 136 0 2 8 Heating and Lighting 494 0 9 10 Laundry 371 0 7 5 Repairs and renewals Domestic 273 0 5 5 Structural *1,174 1 3 5 Miscellaneous items— Telephones, Water, Stationery, etc., and Sundries 192 0 3 10 Totals, excluding rent, rates, taxes, insurance and loan charges 5,084 5 1 3 Rent, Rates and Insurance 85 0 1 8 Loan Charges 1,386 1 7 8 £6,555 £6 10 7 Gross cost 306 0 6 1 Income 'Pupil Midwives (including training grant) Patients' Payments 2,243 2 4 8 Other 13 0 0 3 Net cost £3,993 £3 19 7 * Includes £750 expenditure on extension of hospital charged to revenue account. District Midwifery Service. During 1930 there were 112 cases † attended in their own homes by the District Midwife as compared with 124 in the previous year, a decrease of 12 cases. Particulars relating to this Service during the year are set out below :— Total number of cases attended in the district 112 Average number of visits to each case 18 Number of cases delivered by:— (a) Midwife 110 (b) Doctors 2 † Early in 1931 this service showed evidence of rapid increase, probably due to the closing of the district service conducted at St. John's House, Albert Bridge Road, the Out-Patients' Branch of the Clapham Maternity Hospital. 52 Number of cases where medical assistance was called for, with reasons for requiring assistance:— (a) Ante-Natal—1 Dangerous varicose veins 1 (b) During Labour—3. Prolonged labour — forceps deliveries 3 (c) After Labour—6. Ruptured perineum (including 2 born before arrival) 3 Post-partum haemorrhage 3 6 (d) For Infant—4. Dangerous feebleness 1 White asphyxia 1 Rash on face 1 Ophthalmia Neonatorum 1 4 Number of cases of— Puerperal sepsis - Maternal deaths — Still births — Deaths of infants within 10 days — Dental Clinic. During 1930 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. In view of the increasing number of patients attending the clinic, the Council, with the sanction of the Ministry of Health, decided to establish an additional session. This session was first held on 17th June, 1930. 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 1930 is summarised as follows:— Women. Children. Total. Sessions held 175 49 224 No. of patients treated 479 165 644 No. of new patients 320 104 424 No. of patients referred to hospital 8 14 22 Total attendances 2,386 653 2,939 53 Work carried out:— Extractions— Women. Children. Total. Ordinary 7 l 8 With local anaesthetic 179 4 183 ,, general anaesthetic 467 144 611 Total 653 149 802 No. of teeth extracted 1,850 340 2,190 Scaling and polishing 54 — 54 Fillings 84 14 98 Upper dentures 54 — 54 Lower dentures 48 — 48 Denture visits 405 — 405 Dressings and treatment to gums 102 8 110 Repairs to dentures 15 — 15 Advice 1,033 470 1,503 The estimated cost of dental treatment (Maternity and Child Welfare) in the financial year 1930-31 was £767 13s. l0d. This sum includes £224 4s. l0d. paid for dentures supplied, the cost of which is distributed as under:— £ s. d. Contributed by patients 167 6 2 Payments by Chelsea Health Society 15 10 0 Grants from British Dental Hospital 8 12 2 Grants from Saturday and Sunday Hospital Funds 26 4 0 Grants from other philanthropic agencies 4 15 0 Contribution by the Council 1 17 6 £224 4 10 The net cost of this service during 1930-31 was £545 6s. 6d. Solarium. The Light Treatment Centre was established at Southlands in 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. During the year 145 sessions were held, the number of patients on the roll at the end of the year being 28 (25 from the Maternity and Child Welfare Centres and 3 from the Dispensary). The total attendances numbered 1,854, the average number per session being 12.8. 54 Notifiable Infectious Diseases. During 1930 under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 4,883 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 2, acute poliomyelitis 1, enteric fever 3, small-pox 7, encephalitis lethargica, 1, and polio-encephalitis, 1. In 1929 the total was 2,910, the increase in 1930 being wholly due to the epidemic of measles (vide page 62.) The following is a list of the diseases compulsorily notifiable in Battersea:— Small-pox. Acute polio-myelitis. Cholera. Acute polio-encephalitis. Diphtheria. Glanders. Membranous croup. Anthrax. Erysipelas. Hydrophobia Scarlet fever. Acute influenzal pneumonia. Typhus fever Acute primary pneumonia. Typhoid or enteric fever. Malaria. Relapsing fever. Dysentery. Continued fever. Plague. Puerperal fever. Acute encephalitis lethargica. Puerperal pyrexia Measles. Ophthalmia neonatorum. Whooping cough. Cerebro-spinal fever. Tuberculosis. The distribution of the cases notified in the registration subdistricts and the wards is shown in the table on p. 56. Excluding tuberculosis, measles and whooping cough, there were 1,575 cases which occurred in 1,327 houses. Of these cases 1,213, or 77 per cent., were removed to the Isolation Hospitals of the London County Council or to other Institutions and 362, or 23 per cent., remained under treatment at home. Full particulars of all notifiable infectious diseases will be found in the form required by the Ministry of Health (Table II.) in the Appendix (vide page 130). Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 55 Hospital, Ambulance, &c., Services. The provision of ambulances for the removal, and of isolation hospitals for the reception and treatment of patients suffering from the notifiable forms of infectious disease is, in London, carried out by the London County Council. Patients are removed at any hour of the day or night on the application by telephone of the medical practitioner who notifies the case, or the Medical Officer of Health. Patients from Battersea are usually removed to the nearest isolation hospital having accommodation available for the type of disease from which he is suffering, and the majority of Battersea cases are therefore treated at the South Western Hospital, Landor Road, Stockwell, the Grove Hospital, Tooting, or the Western Hospital, Fulham. In addition to the ambulance service for maternity cases referred to on page 30, the County Council also maintain a similar service for street accidents, one of the stations for this service being situate within the Borough. 56 Notifications of Infectious Diseases, 1930, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox 1 4 - - - 2 - - - 5 2 - 7 Diphtheria 88 80 85 34 63 82 14 20 23 247 184 58 489 Erysipelas 11 9 11 12 10 10 1 7 5 37 26 13 76 Scarlet Fever 114 98 59 32 79 71 36 44 33 275 177 114 566 Enteric (Typhoid) Fever — 1 1 — — 1 — — — 2 1 — 3 Puerperal Fever 4 — 2 1 — — — 1 1 6 1 2 9 Puerperal Pyrexia 3 4 1 3 1 1 1 4 2 11 2 7 20 Ophthalmia Neonatorum 6 5 5 1 1 7 3 1 5 15 10 9 34 Cerebro-Spinal Meningitis 2 - - - - - - - - 2 - - 2 Polio-myelitis 1 - - - - - - - - 1 - - 1 Polio-encephalitis — — — 1 — — — — — 1 — — 1 Encephalitis Lethargica - - 1 - - - - - - 1 — — 1 Malaria — — 1 — 1 — — — — 1 1 2 Dysentery — — — — — — — — — — — — — Acute Primary Pneumonia 72 35 50 22 35 65 11 21 10 150 129 42 321 Acute Influenzal Pneumonia 4 6 6 9 — 3 3 9 3 20 7 16 43 Whooping Cough 42 51 51 15 45 86 14 39 56 120 165 114 399 Measles 457 447 385 234 365 411 129 264 217 1,328 960 621 2,909 Tuberculosis (all forms) 41 29 34 30 33 26 13 34 46 113 79 94 286 Totals 846 769 692 394 633 765 225 444 401 2,335 1,744 1,090 5,169 * Notifiable in Battersea from 24th April, 1922. 57 Small-Pox. Seven cases of small-pox occurred in Battersea during 1930 compared with 2 in 1929. Two other cases were notified, but were subsequently cancelled, the diagnosis not being confirmed on removal to hospital. Only two of the Battersea patients had been vaccinated (in infancy) prior to attack, and in each case the attack was of the prevailing mild character known as variola minor. All the cases were immediately removed to the isolation hospital, the average duration of isolation being 18 days. All members of the family and immediate contacts were vaccinated or re-vaccinated by the Public Vaccinator or private medical practitioners within a few hours of the removal of the case to hospital. No further cases occurred amongst the Battersea contacts. During the year there were 5,165 cases of this disease recorded in London, 8 of these cases occurring in the neighbouring borough of Wandsworth and 46 in Lambeth. 958 cases occurred in Stepney, 962 in Bethnal Green, 788 in Shoreditch, 635 in Poplar and 306 in Camberwell. The disease was also prevalent in Greater London, West Ham having 851 cases. It is satisfactory to note that notwithstanding the prevalence of the disease in adjoining boroughs and other London districts, Battersea was comparatively free. 626 "contacts" with cases of small-pox occurring in other districts were reported to the Medical Officer of Health, and were visited daily for 19 days. This involved much extra work for the Sanitary Inspectorial Staff. In England and Wales, 11,855 cases of small-pox were notified during 1930. No vaccinations were performed by the Medical Officer of Health during the year under report. Scarlet Fever. The incidence of Scarlet Fever was higher in 1930, 566 cases being notified as compared with 466 in the previous year. The case-rate per 1,000 of the population was 3.52 and 2 deaths were registered from the disease, giving a death-rate of 0.012 per 1,000 as compared with 4 deaths and a death-rate of 0.025 in 1929. Of the cases notified 531 or 93.8 per cent. were removed to hospital. The infected houses numbered 479. In 41 of the notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at hospital. 58 Diphtheria. The number of cases of Diphtheria notified in Battersea during 1930 was 489 as compared with 445 in 1929, 652 in 1928, 680 in 1927, and 540 in 1926. The number of deaths registered from the disease was 15, giving a death-rate of 0.093 as compared with 12 deaths and a death-rate of 0.074 in 1929, 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 489 cases notified 488 or 99.8 per cent. were removed to hospital. The infected houses numbered 421. In 49 cases notified (not included in the above total) the diagnosis of Diphtheria was not confirmed at hospital. The case rate per 1,000 population was 3.04 as compared with 2.75 in 1929, 3.97 in 1928, 4.02 in 1927, and 3.14 in 1926. The case-mortality was 3.07 per cent. as compared with 2.70 per cent. in 1929, 3.99 per cent. in 1928, 3.68 in 1927, and 3.70 in 1926. The incidence of the disease was highest in the Latchmere, Park and Winstanley Wards. The following table shows the incidence and mortality of diphtheria during 1930 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 88 6 3.43 .23 6.82 2 80 — 4.68 — — 3 85 — 4.73 — — 4 34 — 2.26 — — 5 63 2 3.63 .12 3.17 6 82 4 4.07 .20 4.88 7 14 1 1.67 .12 7.14 8 20 1 1.08 .05 5.00 9 23 1 1.12 .05 4.35 E. 247 6 3.76 .09 2.43 N.W. 184 6 4.01 .13 3.26 S.W. 58 3 1.18 .06 5.17 Borough 489 15 3.04 .09 3.07 59 Incidence and Mortality, 1895-1930. Period. Mean Quinquennial Rates. Case mortality percent. Mean No. of cases per annum. Mean case rate. Mean No. of deaths per annum. Mean deathrate. 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 1930 481 3.04 15 .093 3.07 Diphtheria anti-toxin, in accordance with the recommendations of the Ministry of Health, is supplied free of charge on the request of any registered medical practitioner, at any hour of the day or night. During the year 44 phials (approximately 226,000 units) of anti-toxin were supplied, on request, to medical practitioners practising in the Borough. Schick Test Clinic. Summary of Work Carried Out, 1930. The Schick test clinic, established at the close of 1927, 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 52 Patients attending in 1930 (new 130) 249 Attendances 768 ,, (average per session) 14.8 Patients tested 97 Readings of tests (positive 73, negative 16, result unknown 8) 97 Patients inoculated— Without test 34 After positive test (1930 patients) 73 „ (1929 „ ) 43 — 150 Inoculations 363 Total immunised (including 1 patient (1928) ) 129 Patients still on Register at end of year 99* Discontinued treatment 43 * Includes 3 patients (1929) negative after 1st test, and 7 patients (1930) negative after 1st test who are to attend again for re-test. 60 The total number of patients immunised or found by test to be immune is 145, out of a total of 249 patients who have attended during the year (58.2 per cent.). Since the opening of the clinic 612 patients have attended, and of these 393 have been immunised or found immune by test (64.2 per cent.). Acute Polio-Myelitis and Polio-Encephalitis. There was only one case of Acute Polio-Myelitis notified in Battersea during 1930, the patient being a boy of 2 years. Two other cases of Polio-Myelitis, not in the acute stage, were reported. No death was recorded from the disease. At the end of the year there were 25 chronic cases under observation, 23 having been notified or reported prior to 1930. Of these 25 cases, 19 were under 5 years of age when first brought under observation. When last visited 3 were reported well, 3 were in hospital, 1 under convalescent treatment, and 14 were receiving out-patient treatment. Of the remaining 4 cases, 1 was reported to be limping slightly and 2 to be still wearing instruments. One case of Acute Polio-Encephalitis was notified during 1930, the patient being a girl aged 17 months. The case was fatal and the notification was made after post-mortem examination. Puerperal Fever and Puerperal Pyrexia. There were 9 cases of Puerperal Fever notified in Battersea during 1930 as compared with 4 cases in 1929, 7 in 1928, 9 in 1927, and 12 in 1926. There were 4 deaths from the disease, including an un-notified case occurring in St. James's Hospital, in which the cause of death, after post-mortem examination, was found to be Sepsis following abortion. The number of notified cases per 1,000 births was 3.39, as compared with 1.53 in 1929, 2.55 in 1928, 3.21 in 1927, and 4.04 in 1926. The case mortality was 40.0 per cent. of all cases, notified or reported, and the death-rate per 1,000 births was 1.5. There were 295 cases of Puerperal Fever notified in London and 2,547 in England and Wales during 1930. The number of cases of Puerperal Pyrexia notified in Battersea during 1930 was 20, and the incidence per 1,000 births was 7.54. There were 761 cases of Puerperal Pyrexia notified in London and 5,605 in England and Wales during the year. 61 Under the provisions of the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, the Council have appointed a consultant to assist medical practitioners in the diagnosis of these diseases, and have provided facilities for the examination of lochia or specimens from patients, and for the nursing of cases where required. Hospital accommodation is provided by the London County Council in their isolation hospitals. Enteric Fever. During 1930 three cases of Enteric Fever were notified in Battersea. Two other cases notified were subsequently cancelled, the diagnosis not being confirmed at hospital. There was no death from this disease during the year. Cerebro-Spinal Fever. During 1930 two cases of Cerebro-Spinal Fever were notified in Battersea, both patients dying in hospital. A third notification was received, but was subsequently cancelled, the diagnosis not being confirmed. Encephalitis Lethargica. One case of this disease was notified during 1930, the notification being made after post-mortem examination. A second case was also notified, but the notification was subsequently cancelled. Three deaths from the disease were recorded, viz., the notified case above mentioned, a case originally notified in 1921, and one (un-notified) in which death occurred in hospital after an operation for appendicitis. In London the number of cases notified was 65, and in England and Wales 740. Ophthalmia Neonatorum. There were 34 cases of Ophthalmia Neonatorum notified in Battersea during 1930, as compared with 43 in 1929, 39 in 1928, 48 in 1927, and 35 in 1926. The rate per 1,000 births was 12.8, as compared with 16.4 in 1929, 14.2 in 1928, 17.1 in 1927, and 11.8 in 1926. The disease was most prevalent in the less prosperous districts of the Borough, East Battersea and North West Battersea contributing 73.5 per cent. of the total cases notified. There were 5 severe cases amongst the 34 notified, all of which were removed to St. Margaret's (M.A.B.) Hospital for treatment, and three cases received in-patient treatment at other hospitals. In only one case, which was still under treatment at the end of the year, was danger threatened of permanent damage to the sight. 62 During 1930 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 2,631. All cases were kept under systematic supervision by the Health Visiting Staff, by whom 157 visits were made. 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 15 1,115 13.5 1925 32 3,184 10.0 N.W. Battersea 10 838 11.9 S.W. Battersea 9 699 12.9 1926 35 2,969 11.8 1. Nine Elms 6 443 13.5 1927 48 2,801 17.1 2. Park 5 332 15.1 3. Latchmere 5 333 15.0 1928 39 2,743 14.2 4. Shaftesbury 1 194 5.2 5. Church 1 288 3.5 1929 43 2,619 16.4 6. Winstanley 7 385 18.2 7. St. John 3 141 21.3 8. Bolingbroke 1 264 3.8 Mean 9. Broomwood 5 272 18.4 1925. 9 39 2,863 13.6 Borough 34 2,652 12.8 1930 34 2,652 12.8 Erysipelas. There were 76 cases of Erysipelas notified and 3 deaths were recorded from the disease during 1930 in Battersea. The casemortality was 3.95 per cent. and the death-rate per 1,000 population was 0.019. Measles. The number of cases of Measles notified or otherwise reported in 1930 was 3,355 and there were 38 deaths recorded from the disease. Of the 3,355 cases 2,909 were notified under the Regulations—The Battersea (Measles and Whooping-Cough) Regulations, 1922—and the remaining 446 cases were reported by the public elementary schools or from other sources. The case-mortality was 1.31 per cent. of the notified cases, compared with 1.04 per cent. in 1929, and 1.13 per cent. of the total incidence, as compared with 0.88 per cent. in 1929. During the latter portion of 1929 the disease had begun to assume epidemic form, and in 1930 the number of cases occurring rose rapidly to a maximum in March, afterwards declining until 63 by June the epidemic had ceased. The two years 1929-30 show a total of 3,921 cases, either notified under the Regulations or otherwise reported, and 43 deaths, giving a case-mortality rate of 1.10 per cent. These figures may be compared with the previous epidemic years 1927-8:—4,197 cases, 37 deaths, case-mortality 0.88 per cent.; and 1925-6:—5,000 cases, 47 deaths, case mortality 0.94 per cent. During the Measles epidemic of 1930 a special scheme of control was arranged by the London County Council in co-operation with the Medical Officers of Health of the Metropolitan Boroughs, with a view to reducing mortality from the disease. The scheme was applied especially to schools situated in insanitary or overcrowded areas. In Battersea 21 schools were brought under it, and two schools which though not actually in Battersea are attended by large numbers of children from the Borough. Under the scheme the Health Visitors of the Council were to work in close co-operation with the School Nurses, who were to supply daily to the Medical Officer of Health lists of the names and addresses of cases of measles coming to their notice, and also the names and addresses of absentees in affected classes or of children under 5 years of age absent from school owing to suspicious illness or for unknown reasons. These cases were to be immediately visited by the Health Visitor and in this way delay avoided. The Scheme on the whole was found to work satisfactorily in this Borough, although it was difficult to prevent a certain amount of overlapping and unnecessary visiting. The scheme is to receive a further trial, and modifications of its details are under consideration. Whooping-Cough. During 1930 there were 399 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 138 additional cases were reported from the public elementary schools and other sources. This disease assumed epidemic prevalence in London during 1929, with a mortality rate of 2.6 per 1,000 of the population. In 1930 the number of deaths in London fell to 131 and the mortality rate to 0.03. In Battersea there were 7 deaths registered from this disease, the death-rate being 0.044 as compared with 43 deaths and a death, rate of 0.266 in 1929, 14 deaths and a death-rate of 0.085 in 192815 deaths and a death-rate of 0.09 in 1927, and 13 deaths and a death-rate of 0.08 in 1926. 64 The total number of cases notified or otherwise reported during 1930 was 537 as compared with 1,317 in 1929, 1,228 in 1928, 749 in 1927, and 1,210 in 1926, the decrease in 1930 compared with 1929 being 59.2 per cent. The disease, with measles, was made compulsorily notifiable in Battersea in 1922. Precautionary measures continued to be taken in view of the danger to life in the case of younger children. TUBERCULOSIS. During 1930 there were 286 cases of Tuberculosis (all forms) notified in Battersea as compared with 330 in 1929, 301 in 1928, 308 in 1927, and 344 in 1926. In addition 25 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making 311 cases in all. The following table (required by the Ministry of Health) shows the age and sex distribution of the 311 cases of Tuberculosis notified or otherwise reported during the year ended 3rd January, 1931 (53 weeks) and the 162 deaths from the disease. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary Non. Pulmonary. M. F. Total M. F. Total M. F. Total M. F. JTotal 0 1 - 1 1 - 1 1 - 1 1 - 1 1 2 2 5 4 9 — 3 2 5 5 1 1 2 8 3 11 — 1 1 1 1 2 10 3 3 6 3 4 7 2 2 1 1 15 16 16 32 2 3 5 3 9 12 1 1 2 20 27 26 53 4 7 11 9 12 21 2 1 3 25 34 29 63 3 1 4 20 9 29 3 — 3 35 30 11 41 — 5 5 12 15 27 2 2 4 45 22 9 31 1 — 1 15 7 22 — — — 55 15 3 18 1 1 2 13 4 17 — 2 2 65 and upwards 3 2 5 1 — 1 4 1 5 1 1 2 Totals 154 100 254 29 28 57 77 60 137 15 10 25 Deaths from non-pulmonary forms of tuberculosis formed 15.4 per cent. of the total deaths from the disease. 65 The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population of the 311 cases notified or otherwise reported, and of the 162 deaths. SubDistrict. New Cases. Deaths. Pulmonary Non-Pulmonary Total Rate per 100,000 populn. Pulmonary Non-Pulmonary Total Rate per 100,000 populn. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. East 55 43 98 14 14 28 69 57 126 192 45 25 70 5 5 10 50 30 80 122 N.W. 42 29 71 9 7 16 51 36 87 190 22 22 44 7 4 11 29 26 55 120 S.W. 57 28 85 6 7 13 63 35 98 200 10 13 23 3 1 4 13 14 27 55 Ward 1 17 17 34 6 7 13 23 24 47 183 19 11 30 3 2 5 22 13 35 136 2 16 8 24 3 6 9 19 14 33 193 12 2 14 1 2 3 13 4 17 99 3 17 15 32 2 2 4 19 17 36 200 11 10 21 1 1 12 10 22 122 4 15 12 27 4 1 5 19 13 32 212 8 10 18 1 1 2 9 11 20 133 5 21 10 31 2 4 6 23 14 37 213 11 6 17 3 4 7 14 10 24 138 6 11 11 22 6 1 7 17 12 29 144 6 11 17 3 — 3 9 11 20 99 7 6 4 10 2 2 4 8 6 14 167 2 2 4 2 2 4 48 8 21 10 31 2 2 4 23 12 35 189 3 1 4 2 2 5 1 6 32 9 30 13 43 2 3 5 32 16 48 234 5 7 12 1 I 2 6 8 14 68 Boro' 154 100 254 29 28 57 183 128 311 194 77 60 137 15 10 25 92 70 162 101 Rate per 100,000 populn. 202 118 158 38 33 36 240 151 194 — 101 71 85 20 12 16 121 83 101 - 66 In the table on pp. 74 and 75 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 286 cases notified in 1930 is summarised below:- Localisation of Disease. Pulmonary (240) Bones and Joints (13) Genito-urinary (4) Lungs 227 Ankle 1 Kidneys 2 Lungs and Larynx 6 Cervical Vertebrae 1 Kidneys and Bladder 1 Lungs and Leg 1 Hip 5 Larynx 2 J aw 1 Testicle 1 Pleura 4 Knee 2 Shoulder 1 Brain (5) Spine 1 Skin (2) Meninges 5 Wrist 1 Lupus 2 Glands (17) Abdominal (5) Cervical 14 Peritoneum 3 General (0) Abdominal 1 Intestines 1 Generalised 0 Unspecified and various 2 Unspecified 1 Total 286 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 5 years 1926-1930:— 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 1930 10 12 1 2 25 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 1930. Deaths from Tuberculosis. The death-rate from Tuberculosis was markedly lower in 1930 than in the previous year, being 100.8 per 100,000 population, as compared with 127.3 in 1929, 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. 67 The allocation of the deaths in 1930 according to age and sex, and in the Wards and Sub-Districts is shown on pp. 64 and 65. During 1930 162 deaths from Tuberculosis were registered as belonging to the Borough of Battersea. Of this number 137 (i.e. 84.6 per cent.) were due to pulmonary tuberculosis, 9 (i.e. 5.5 per cent.) to tubercular meningitis and 16 (i.e. 9.9 per cent.) to other forms of the disease. In 1929 the number of deaths from tubercular diseases was 206 and it will be noted that there was a marked decline in 1930 in the mortality from Tuberculosis as compared with the previous year. Of the 162 deaths registered from Tuberculosis during the year 18 cases were not notified until one month before death; in 12 cases the notifications were received after death, and in 10 cases no notification was received. Of the 10 cases in respect of which no primary notification was received 6 (2 pulmonary, 4 non-pulmonary) were patients who died in hospitals or infirmaries. Of the remaining cases 1 (pulmonary) was under treatment by a private medical practitioner, and 3 (pulmonary) were certified by the Coroner after a postmortem examination. Of the 12 cases notified after death, 9 (5 pulmonary, 4 nonpulmonary) were from a Public Assistance Institution and 3 (2 pulmonary, 1 non-pulmonary) were from other hospitals. The death-rates per 100,000 of the population during the 30 years ended 1930 in quinquennial averages and in individual years from 1926 to 1930 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 1926-1930 91. 1 14.2 105.3 Average (30 years) 115.7 32.0 147.7 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 1930 85.2 15.6 100.8 68 Shelters. In addition to the shelters 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, the Council have installed an open-air shelter in the grounds of Southlands adjoining the Dispensary, for the use of patients recently returned from sanatoria. In this shelter, which is open to the air on three sides, the patient is able to recline or sit. He is supplied with a meal. TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1930. The report of the Tuberculosis Medical Officer is set out in the appendix (pp. 120-128). Staff Engaged on Tuberculosis Work. The staff engaged in Tuberculosis work at the Tuberculosis Dispensary is as follows:— 1. Chief Administrative Tuberculosis Officer—The Medical Officer of Health. 2. Tuberculosis Medical Officer—Dr. George Macdonald. 3. Part-time Assistant Tuberculosis Medical Officer—Dr. Mary J. O'Flynn. 4. 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. 5. Clerical Staff—At Dispensary: Secretary, two clerks. At Public Health Department ; one clerk (part time). 6. Laboratory Assistant (dispenser). 7. Caretaker. During the year it was found necessary to appoint a parttime assistant Tuberculosis Officer, and Dr. Mary J. O'Flynn, b.a., m.b., b.ch., b.a.O., was appointed, regard being had by the Committee to the qualifications, experience and training of the candidates for the appointment. 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. 69 The Dispensary treatment of school children is carried on in close co-operation with the School Medical Service, and the Springwell House Open Air School on Clapham Common North Side, has, in this connection, carried on useful work during the year, particulars of which will be found in the report of the Tuberculosis Medical Officer on p. 125. The Tuberculosis Care Committee, the constitution of which will be found on p. 2, met weekly at the Tuberculosis Dispensary during the year, and details of the work of the Committee will be found set out on pp. 121 and 126. 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 dentures are referred to the Clinic by the Tuberculosis Medical Officer. The number of sessions held during 1930 was 49, and 274 attendances were made, the average attendance per session being 5.59. The cost to the Council during the financial year 1930-31 for this service was £134, less contributions from patients and other sources amounting to £23. Full details of the work carried out are given in the report on the work of the Dispensary in the Appendix (p. 126). 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 1930 is summarised as follows:— Patients and Attendances. The number of new patients was 623 (435 adults, 188 children), and the number of contacts examined 153 (50 adults, 103 children). There were 21 patients (adults) transferred from other areas during the year who subsequently attended the Dispensary, making a total of 797 new patients or contacts. Of these 644 new patients 233 were found tuberculous, and 2 new cases discovered amongst the 153 contacts examined. The total number of attendances at the Dispensary during the year was 3,621. Visits to the homes of dispensary patients were made by the Tuberculosis Officer in 165 instances, and 4,292 visits were made by the Dispensary Nursing Staff. The number of deaths of dispensary patients was 96. Twenty-eight of the patients were discharged as "disease arrested" or "diagnosis not confirmed" during the year, and 39 others ceased to attend, in addition to 82 patients who removed to other districts. 70 Institutional Treatment. The number of patients who received Institutional treatment under the L.C.C. Tuberculosis Scheme was 135, and the average length of stay was 95 days. The average period of waiting before admission was 16½ days. Definite improvement as a result of institutional treatment was shown in 49 cases. Twenty-eight patients discharged themselves while undergoing institutional treatment. The number of dispensary patients admitted to St. James's Hospital during the year was 44. Contributions of patients undergoing institutional treatment were collected by the Dispensary and remitted to the L.C.C. to the amount of £791 0s. 5d. Examinations and Reports. Sputum examinations made during the year numbered 1,305, of which 433 were received from medical practitioners, and 460 from St. James's Hospital. The number of positive examinations was 288 or 22.06 per cent. Reports to public bodies were made to the number of 1,087. Consultations with medical practitioners at the houses of patients and reports made on patients sent to the Dispensary totalled 820, while reports received in respect of insured persons numbered 132 (Form G.P. 36, 131, form G.P. 17, 1). There were 151 patients referred to hospitals, including 130 sent to St. Thomas's for X-ray examination. Artificial Sunlight Treatment. During the year 10 patients (9 children, 1 adult) received treatment for surgical tuberculosis at the Council's artificial sunlight treatment centre at Southlands (vide page 53). In 6 cases treatment was completed; 1 patient removed from the district, and the 3 remaining were still under treatment at the end of the year. The average period of treatment in the 6 completed cases was 90 days, and the result of the treatment in these cases is shown on p. 125. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. In the Appendix (pages 136 to 140) 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 1930, 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 1930, arranged according to the years (from 1921 to 1930) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. 71 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 1930 the number of new cases notified (including 7 notified after death) and not attending the Tuberculosis Dispensary was 82 (women 57, children 25). There were 8 other cases among women and children which came to the knowledge of the Medical Officer of Health, 6 upon registration of the deaths and 2 by information as to the removal of the patients into the Borough. There were 30 deaths (including 6 of tubercular meningitis) recorded amongst these 90 cases. In 17 cases death had occurred prior to the first visit and 13 deaths were subsequently recorded during the year. The following table gives the age and sex distribution of the 90 women and children (non-dispensary cases) notified or otherwise reported to be suffering from Tuberculosis (all forms) during 1930:— 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 1 3 - - - - - - - 6 F. - - 2 1 7 12 13 5 8 1 2 51 Tubercular Meningitis M. - 2 1 1 - - - - - - - 4 F. — 2 - - - - - - - - - 2 Other Forms M. 1 2 4 2 - - - - - - - 9 F. - 2 1 3 2 4 1 4 - 1 — 18 Total M. 2 5 6 6 - - - - - - 19 F. - 4 3 4 9 16 14 9 8 2 2 71 Grand Total 2 9 9 10 9 16 14 9 8 2 2 90 The home conditions of these 90 cases were investigated. In the majority of cases the sanitary state of the home was found to be satisfactory, the average number of persons per room being 1.4. In 8 cases, however, the conditions were found to be unsatisfactory the patient's family occupying only a single room. 72 Of the new cases notified during the year 54 were receiving hospital, sanatorium, or other form of institutional treatment at the time of notification. At the end of 1930 there were 161 women and children nondispensary patients (a decrease of 31 as compared with 1929), including new cases notified during the year, on the register, and 1,224 visits were paid by the female Sanitary Inspector (Miss J. Round) to the homes of these patients. Efforts are made, in as many cases as possible, to induce nondispensary patients to attend the Tuberculosis Dispensary, and during the year, 58 cases were transferred, 37 of these being new cases. Adult Male Patients. There were 138 adult male patients not on the Dispensary roll on the register at the end of 1930. There were 89 new cases notified and 4 otherwise reported during 1930, and of these 27 died during the year. The following table gives particulars of the 93 non-dispensary new (male) cases notified in 1930:— Age Distribution. All ages. 16-20 20-25 25-35 35-45 45-55 55-65 65 up Pulmonary 5 11 21 15 16 13 2 83 Tubercular Meningitis 1 1 — — — — - 2 Other tubercular Diseases 1 3 - 1 1 1 1 8 Total 7 15 21 16 17 14 3 93 The homes of the patients were systematically visited during the year by the District Sanitary Inspectors, and 330 visits, including 86 first visits to new cases were paid. Twelve of the new cases were found to have died on the first visit. Of the new cases 45 received institutional treatment and 42 were transferred to the Dispensary. Public Health (Prevention of Tuberculosis) Regulations, 1925. The case of a milk roundsman who, in 1929 was notified to be suffering from Tuberculosis, was considered by the Health Committee and the Council. 73 The patient received a period of sanatorium treatment, after which his health improved sufficiently to enable him to follow his occupation, but on examination at the Tuberculosis Dispensary the disease was found to be still active. He was duly informed of the provisions of the above-named Regulations, which prohibit any person suffering from Tuberculosis of the respiratory tract entering upon "any employment or occupation in connection with a dairy which would involve . . . the handling of vessels used for containing milk." The patient thereupon agreed not to resume his former occupation, and the formal notice prescribed by the Regulations was not served upon him. The Council, on the recommendation of the Health Committee, decided to compensate this man for the loss of his employment, and granted him a sum of £200, which he accepted. Revision of Tuberculosis Register. As mentioned in the Annual Report for 1929, theTuberculosis Register, in accordance with the suggestion of the Ministry of Health, was subjected to a thorough revision, the names of 367 patients who were found to be no longer suffering from the disease being removed from the Register. During 1930 the names of 54 additional patients were, after medical examination and consideration of their history, removed from the Register. The Public Health (Tuberculosis) Regulations, 1930. These Regulations, which are dated 8th July, 1930, and came into force on 1st January, 1931, rescinded the previous Regulations of 1912, 1921 and 1924, but consolidated and re-enacted their provisions with some slight amendments. An accompanying circular letter, No. 1107, drew the attention of Local Authorities to the importance of their duties in relation to Tuberculosis, and in accordance with the request of the Ministry the attention of local medical practitioners was called by circular letter to the requirements of the Regulations. The County of London (Tuberculosis) Regulations, 1930. These Regulations, dated 26th March, 1930, came into force on 1st April, 1930. They empowered the London County Council to arrange for the maintenance, otherwise than in their own homes, of children living in houses where, owing to overcrowding or otherwise, they are, in the opinion of the County Medical Officer, in danger of being infected with tuberculosis, or whose parents are receiving residential treatment for tuberculosis and for whose care adequate arrangements cannot otherwise be made. 74 Public Health (Tuberculosis) Regulations 1912. Summary of Notifications during the period from the 29th December, 1929, to the 27th December, 1930, 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 1 3 14 26 32 30 20 14 2 143 205 - - - - - 45 103 Females — — — 2 15 26 29 10 8 3 1 94 125 — — — — — 30 52 Non-Pulmonary— Males 3 8 2 1 3 2 1 1 21 25 20 Females — 4 2 4 3 7 1 3 — 1 — 25 28 — — — — — — 8 (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 1930. 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 in Cols. (2-13) if on Form A, or in Cols. (15-18), if on Form B. Subsequent notifications should be included in Col. (14) if on Form A or in Col. (19), if on Form B.] Col. (14). All notifications on Form A whether duplicate or not should be included in this column. Col. (19). All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B should be included in this column. Col. (21). In the case of an institution belonging to the Council of a County Borough, formal notifications on Form C may not be made to the Medical Officer of Health in respect of patients from the County Borough. If such is the case, the totals of the weekly admissions of such patients during the year should be shown in brackets in Col. (21) (according to the classification in Col. (1)), and these figures shall be regarded as additional to the figures showing the number of formal notifications on Form C in this column. 75 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 29th December, 1929, to the 27th December, 1930, otherwise than by formal notification under the Public Health (Tuberculosis) Regulations, 1912* or by notification in pursuance 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. „ Females — — 1 1 1 — — 1 1 — 1 6 Non-pulmonary Males 1 2 — 1 1 1 1 — — — 1 8 „ Females — — 1 — — — — 2 — — — 3 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death Returns from Local Registrars 3 3 Transferable deaths from Registrar General 1 3 Posthumous notifications 7 4 "Transfers" from other areas (other than transferable deaths) 1 1 Forms C and D (in respect of cases not previously known to the M.O.H.) 1 — Other sources if any (specify) — — *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 M.O.H., it should be recorded in Cols. (2-13) or (15-18) of the Summary of Notifications overleaf, and NOT in the supplemental return UNLESS such formal notification was improperly made, e.g., after death of the person. In the event of a formal notification being received in respect of a person recorded in the supplemental returns for a previous year, such notification should NOT be recorded in Cols. (2-13) or (15-18), of the Summary overleaf, but ONLY in Col. (14) or Col. (19), whichever is appropriate. No case should be included both in the Summary of Notifications and in the Supplemental return for the same year. 76 Deaths from Zymotic Diseases. The principal zymotic diseases are small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping-cough, enteric fever and diarrhoea. The deaths from these causes in 1930 numbered 89, as compared with 95 in 1929, a decrease of 6.3 per cent. There was a corresponding decrease in the zymotic death-rate from 0.587 in 1929 to 0.554 in 1930. The mean death-rate from each of the principal zymotic diseases for the ten years 1910-1919, and for the ten years 19201929, are compared with the corresponding rates for 1929 and 1930 in the following table:— Zymotic Diseases Number of Deaths from each of the principal Zymotic Diseases in 1929 and 1930, with corresponding Death Rates for those years and for the 10 years 1910-19 and 1920-1929. No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase ( + ) or Decrease (-), 1930 over 1930. 1929. 1930. 1929. 19101919. 19201929. Previous year. 19201929. Small Pox - - - - - .001 - - .001 Measles 38 5 .237 .031 .439 .163 + .206 + .074 Scarlet Fever 2 4 .012 .025 .039 .034 - .013 - .022 Diphtheria 15 12 .093 .074 .122 .184 +.019 - .091 Whooping-cough 7 43 .044 .266 .233 .133 - .222 - .089 Enteric fever — 1 — .006 .023 .007 - .006 - .007 Diarrhœa and enteritis 27 30 .168 .185 .608 .212 - .017 - .044 Total 89 95 .554 .587 1.464 .734 - .033 - .180 NON-NOTIFIABLE INFECTIOUS DISEASES. The chief source from which information is gained as to the occurrence of the non-notifiable forms of infectious disease is the returns made by the head teachers of elementary schools which show the absences of scholars which are attributed to illness, and the nature of the disease. 77 All cases of infectious illness shown on such returns are immediately visited by the Sanitary Inspectorial and Health Visiting staff, and such steps as may be desirable or necessary are taken to prevent the spread of infection. Chicken-Pox. During 1930 there were 469 cases of chicken-pox reported, as compared with 441 in 1929, 632 in 1928, 671 in 1927, and 375 in 1926. Diarrhœa. During 1930 the total number of deaths from diarrhœa of children under 2 years of age was 21, equivalent to a fatality-rate of 0.13 per 1,000 of the population. In 1929 there were 22 deaths and a fatality-rate of 0.14. The rate per 1,000 registered births in 1930 was 7.92, as compared 8.40 in 1929, and 9.48 in 1928. Influenza. There were 14 deaths registered as being due to Influenza during 1930, as against 138 in 1929, 14 in 1928, 83 in 1927, and 25 in 1926. The mortality-rate was 0.09, as compared with 0.85 in 1929, 0.08 in 1928, 0.49 in 1927, and 0.15 in 1926. Influenzal Pneumonia was not so prevalent in 1930 as in the previous year, 43 cases being notified as against 140 in 1929, and 51 in 1928. The death-rate was 0.04 per 1,000 of the population, as compared with 0.39 in 1929, and 0.02 in 1928. Cancer. During 1930 the number of deaths of Battersea residents from Cancer was 242 (males 134, females 108) as compared with 243 in 1929, 247 in 1928, 252 in 1927, and 263 in 1926. The death rate from the disease per 1,000 of the population was 1.51. The deaths from cancer constitute 13 per cent. of the total Battersea deaths during the year. The following gives the comparative average death-rates from Cancer in Battersea for quinquennial periods since 1896:— 1896-1900 0.52 1926-30 1.51 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 1921-25 1.33 1930 1.51 78 The following table shews the localisation of the disease in the case of the 242 deaths recorded in 1930. Localisation. No. of deaths. Total. % of Total. Male Female Buccal cavity 10 - 10 4.13 Stomach, liver, etc 45 21 66 27.27 Peritoneum, intestines and rectum 27 18 45 18.60 Female genital organs — 30 30 12.40 Breast — 23 23 9.50 Skin 5 3 8 3.31 Other and unspecified organs 47 13 60 24.79 Total 134 108 242 100.00 Bacteriological Examinations. The bacteriological examination of clinical material (with the exception of specimens of sputum, which are dealt with at the Tuberculosis Dispensary, vide pp. 70, 124) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1930 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 2,624 (exclusive of the Tuberculosis specimens). The following table gives particulars of the bacteriological examinations carried out during the year:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 281 2,331 2,612 Enteric fever 1 11 12 Total 282 2,342 2,624 The cost of these examinations, which in 1930 amounted to £338 19s. 9d., is borne by the Council. 79 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1930. Total Sanitary Operations 71,330 Leaky house-roofs and gutters repaired 1,122 Number of house inspections 37,723 House to house inspections 1,052 Houses supplied with water and fittings repaired 93 Bakehouse inspections 246 Bakehouse nuisances abated 28 Houses let in separate tenements on register 62 Urinals—inspections 182 Do. altered, repaired or water laid on 28 No. of inspections of do. 353 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 75 Intimations served under Sec.3 3,588 Notices served under Sec.4,&c. 1,398 Notices served under Secs. 62 & 65 4,368 Cisterns covered, cleansed and repaired 98 Complaints received and attended to 4,078 Additional water supplies to upper floors 22 Number of premises disinfected 2,335 Houses supplied with disinfectants 591 Keeping of animals in unfit state discontinued 25 Overcrowding abated 37 Smoke observations 7 Premises improved, cleansed and repaired 3,240 Certificates of disinfection granted 5,168 Drains tested By smoke 599 Houses inspected and certificates granted (Sec. 48) 25 Do. ,, water 1,547 Drains cleansed and repaired 380 Proceedings ordered by Council and Health Committee 3,635 Drains relaid 134 Frontage drains constructed or re-constructed 45 Summonses issued 39 Magisterial Orders obtained and enforced 19 Soil pipes and drains ventilated 86 Sink and rain-water pipes disconnected or repaired 291 Factories, Workshops, &c., inspections 3,944 Water closets cleansed and repaired 740 Sanitary conveniences pro vided or improvements effected in Factories and Workshops (Sec. 38) 107 Cesspools abolished — Mews and stables drained and paved - Underground sleeping rooms: Use discontinued 10 Yards and forecourts paved and repaired 370 Defects remedied ... 8 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 17 Gipsy van inspections 74 Drains laid to new houses and tenements 25 Samples taken under the Food and Drugs Adulteration Act 1,200 Dust receptacles provided 892 Miscellaneous 1,705 80 Legal Proceedings. Legal proceedings in connection with nuisances, &c., were taken by the Council in 37 cases during 1930. Particulars with regard to each case are set out below. Legal Proceedings under the Public Health (London) Act, 1891. Nature of Offence or Claim. Result of Proceedings. Nuisance at 172 Battersea Bridge Road Order made for nuisance to be abated within seven days, and for payment of £2 2s. 0d. costs. Nuisance at 6 Berkeley Street Work necessary to abate nuisance having been done, summons withdrawn on payment of £1 1s. 0d. costs. Neglect to maintain in proper condition of repair the dust receptacle at 48 Havelock Terrace Fined 10s. and £2 2s. 0d. costs. Non-compliance with nuisance orders re 55 and 59 Speke Road Work having been completed the two summonses dismissed on payment of £1 11s. 6d. costs on each summons. Smoke nuisance from factory chimneys Summons dismissed on defendants, through their Solicitor, giving an undertaking that they would do everything in their power to prevent a recurrence of the nuisance, and on payment of £4 4s. 0d. costs. Nuisance at 171 High Street Order to abate the nuisance (except two stoves which were to be repaired within a reasonable time) within 35 days. Nuisance at 4 Orbel Street Order to abate nuisance in 14 days and to pay £2 2s. 0d. costs. Carriage of noxious matter through streets in an unsuitable vehicle Defendant fined £1 and £1 1s. 0d. costs. The like. Defendants fined £2 0s. 0d. and £2 2s. 0d. costs. The like. Defendants fined £5 0s. 0d. and £2 2s. 0d. costs. Nuisance at 26 Belfour Street Work having been done summons withdrawn on payment of £1 1s. 0d. costs. Failure to notify infectious disease. Defendant having fully explained the omission, and having undertaken to take greater care in future, summons withdrawn on payment of 10s. 6d. costs. 81 Legal Proceedings under the Public Health (London) Act, 1891 — continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at 24 York Road Order for nuisance to be abated within fourteen days, and £2 2s. 0d. costs. Nuisance at 6 Stockdale Road Summons adjourned sine die upon defendant giving undertaking to do the work in the terms of the Statutory notice by the end of January. Nuisance at 38 Creek Street. Order for nuisance to be abated within fourteen days, and £2 2s. 0d. costs. Housing Act, 1925. Nature of Offence or Claim. Result of Proceedings. Failure to have name and address of Medical Officer of Health and of Landlord in rent book of 12 Beaufoy Road Rent book having been put right, summons withdrawn on payment of 5s. costs. Non-compliance with notice served under Section 3 and obstruction (150 New Road) (1) Obstruction—fined £1 0s. 0d. and £3 3s. 0d. costs. (2) Order to permit work to be done. Portion of work having been done summons adjourned sine die upon defendant, through his solicitor, undertaking to proceed with work expeditiously according to the notice. At adjourned hearing order made on defendant to permit Council to carry out work, and to pay £5 5s. 0d. costs. Failure to comply with Magistrate's Order dated 8th July, 1930 (150 New Road) Defendant fined £5 0s. 0d. and £2 2s. 0d. costs. 82 Food and Drugs (Adulteration) Act, 1928. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 758 Milk 10% deficient in milk fat Warranty having been proved, summons dismissed. 810 Milk 11% deficient in milk fat Summons dismissed on payment of £3 3s. 0d. Costs. 828 Milk 20% deficient in milk fat Summons dismissed on payment of £3 3s. 0d. costs 833 Milk 7% extraneous water Summons dismissed on payment of £3 3s. 0d. costs. 118 Pepper 40% added rice flour Defendant fined £1 0s. 0d. and £1 1s. 0d. costs. 288 Milk 7% deficient in milk fat Dismissed under Probation of Offenders Act, 1907, on payment of £5 5s. 0d. costs. 463 Condensed Milk 6% deficient in milk fat Warranty pleaded, which was held to be efficient, and the case was dismissed. (Proceedings subsequently taken against warrantors—see below.) 535 Milk 16% deficient in milk fat Dismissed under Probation of Offenders Act, 1907, on payment of £3 3s. 0d. costs. - Condensed Milk Giving a false warranty in writing Dismissed under the Probation of Offenders Act, 1907, on payment of £26 5s. 0d. costs. 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 Defendants cautioned not to repeat offence, and summons adjourned sine die. The like. The two defendants fined 20s. each. Removing disc from milk bottle filled on registered premises before delivering same to customer Employee fined 7s. 6d. Summons against employer dismissed under Probation of Offenders Act. 83 Factory and Workshop Act, 1901. Nature of Offence or Claim. Result of Proceedings. Failure to send in list of outworkers List having been supplied, summons dismissed on payment of £1 1s. 0d. costs. London Government Act, 1899. Nature of Offence or Claim. Result of Proceedings. Contravention of by-law as to fouling of footway by dogs Defendant fined 2s. 6d. The like Defendant fined 2s. 6d. The like Defendant fined 6s. The like Defendant fined 5s. The like Defendant ordered to pay 2s. costs. Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 37 cases during 1930. Acts and Regulations under which Proceedings taken. Persons prosecuted including employees. Cases. Convictions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and by-laws made thereunder 11 15 9 8 10 0 25 14 6 Housing Acts 2 4 3 6 0 0 10 15 0 Factory and Workshop Act 1 1 — — 1 1 0 Food and Drugs (Adulteration) Act, 1928 15 9 1 1 0 0 45 3 0 Milk and Dairies Order, 1926 6 3 2 2 7 6 — London Government Act, 1899 5 5 4 0 16 0 0 2 0 Total 40 37 19 18 13 6 82 15 6 84 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 67 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. The by-laws made by the London County Council under the Metropolis Management Acts with regard to drainage, and also those relating to water-closets, &c., were amended and revised by that body, after consultation with the Metropolitan Borough Councils. The amended by-laws, after allowance by the Ministry of. Health, came into force in 1930. During the year new drains were constructed to 87 new buildings, or additions to existing buildings, and the drains of 134 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. During 1930, 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 7 cases liability, wholly or in part, was admitted by the Council, and the expenditure incurred by them under this head amounted to £267 17s. 8d. In 8 cases, liability was repudiated, but in 2 of these the Council executed certain work in default of the owner, and the cost had not been recovered at the end of the year. The total number of plans of proposed drainage work deposited during 1930, as compared with 1929, was as under:— 1930 1929 Re-construction or repair of existing drains 71 77 New buildings or additions to existing buildings 65 57 136 134 85 In seven 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 offenders to be cautioned. During the year 1930, 599 drains were tested by smoke of which 101 were found defective. The water test was applied on 1,547 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 86 instances. Water closets were provided in 75 cases and existing closets repaired in 740 cases. The total number of drains relaid during the year was 134. Those cleansed and repaired numbered 380. Scavenging and Collection of House Refuse. The cleansing of the streets and the collection of house refuse is, in Battersea, under the direction of the Highways and Works Committee. The Council in 1930 purchased 6 motor-vans, 4 of 10, and 2 of 7 cubic yard capacity for the removal of house refuse. These vans have separate covered compartments for the reception of refuse and are, sanitarily, a great improvement on the horsedrawn carts, which are gradually being dispensed with. Premises Controlled by By-laws, &c. The premises in respect of which special by-laws or enactments are in force are referred to under appropriate headings on the pages named:— Houses let in separate tenements page 85 Tents, vans, sheds and similar structures „ 87 Underground rooms ,, 79, 115 Bakehouses ,, 108 Milk Shops ,, 101 Cowhouses and Slaughterhouses „ 92 Factories and Workshops ,, 103-106 Outworkers' premises ,, 106-109 Houses Let in Separate Tenements. By-laws with regard to houses let in separate tenements were made by the London County Council in 1925 under the provisions of the Housing Act, 1925. 86 Some of the more important provisions of these By-laws, however, will not come into operation until the expiration of the Increase of Rent and Mortgage Interest (Restriction) Acts. These By-laws, so far as they are applicable, are being enforced by the Council. There are 62 premises in Battersea registered as houses let in separate tenements and 353 inspections of these premises were made in 1930; 2 of the 62 premises were placed on the Register during the year. Sanitary Conveniences attached to Licensed Premises. During 1930 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, 39 notices were served to remedy defects discovered, and were duly complied with. Smoke Nuisances. During the year 7 observations were made and 4 complaints received. Seven preliminary and one statutory notice were served by the Council under the provisions of the Public Healt (Smoke Abatement) Act, 1926, to abate smoke nuisances. Proceedings were instituted against one firm, the summons being dismissed on payment of £4 4s. costs. Effluvium, &c., Nuisances. No action was found necessary during the year with regard to nuisance from effluvium. Water Supply. During 1930 applications were received for certificates of water supply in respect of 25 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 22 cases additional water supply was provided to the upper floors of tenement houses, as required by the Borough Council under the provisions of Section 78 of the London County Council (General Powers) Act, 1907, and Section 48 of the Public Health (London) Act, 1891. Except in a few instances each dwelling house in the Borough has its separate supply of water from the mains of the Metropolitan 87 Water Board, the supply being within the curtilage of the premises. In the older houses on the Council's Latchmere Estate, however, the water supply is drawn from deep artesian wells and pumped into storage tanks. This water is of a high degree of purity, and unlike that of the Metropolitan Water Board, requires no preliminary treatment by filtration, subsidence tanks or chlorination. These houses, however, have a reserve supply from the mains of the Board in case of break-down. Van Dwellings. The number of van dwellings in the Borough in 1930 was 69. 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 7 6 1a Weybridge Street (rear of 91 Culvert Road) 1 - - Haines' Yard, Falcon Road 6 8 6 Manley's Yard, Cabul Road 33† 29 38 Mills' Yard, Culvert Road 18* 18 24 Van dwellings are frequently inspected. Eight vans were unoccupied. 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 1930. 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. * Including one shed. †Including one cottage. 88 During 1930 the work carried out under the Council's Rat Repression Scheme is summarised as follows:— Premises visited 1,474 Contracts made or renewed 12 Poison baits used 22,473 Dead rats found 1,386 Value of contracts £164 12 0 Cash for poison bait £6 18 3 Total expenditure (financial year 1930-31) £478 18 7 Income (financial year 1930-31) £178 12 0 Drains were tested at 54 premises in connection with this work, and in 35 cases were found to be defective. Most of these defective drains were in private houses. The presence of rats in houses is usually regarded as prima facie evidence of drain defects. The work of the Rat Officer therefore is carried on in close co-operation with that of the district Sanitary Inspectors. As in previous years an intensive effort for the repression of rats was organised during "Rat Week" (3rd to 8th November). Bait was laid in the sewers, and was supplied to all applicants during the week free of charge. The co-operation of the public was invited by posters and advertisements and other forms of propaganda including the exhibition of the rat film lent by the Ministry of Agriculture and Fisheries at a local cinema. The results were good, many hundreds of rats being found dead, and the interest of the public in the necessity for rat repression being stimulated. 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 following by-law was made by the Council in 1927 and renewed in 1929:— "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." During 1930 5 persons found offending against this by-law were summoned at the South Western Police Court, and fines ranging from 2s. 6d. to 6s. were inflicted in 4 cases, the fifth defendant being ordered to pay 2s. costs (vide page 83). 89 Personal Cleansing Station. During the year 1930, there were 3,901 children and 263 adults cleansed and treated at the station. Of the 3,901 children attending, 413 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,818 attended from the public elementary schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's sanitary staff. There was a decrease in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. Number of Baths, &c. Year. Adults. Children. * Expenditure. Amount Contributed.* Verminous and Scabies. Verminous and Scabies. £ £ 1906 141 2 29 1907 504 113 42 1908 1,011 656 82 1909 1,373 321 91 1910 1,583 341 88 1911 1,459 191 93 13 1912 1,351 841 237 65 1913 1,323 1,090 118 69 1914 1,050 1,602 132 78 1915 648 1,273 125 78 1916 475 1,773 143 94 1917 320 2,620 169 140 1918 291 3,179 237 187 1919 366 3,214 287 169 1920 419 4,213 456 331 1921 340 4,607 561 400 1922 274 4,444 584 400 1923 212 4,949 779 487 1924 311 5,394 912 488 1925 261 4,724 879 459 1926 229 4,371 916 425 1927 256 4,360 960 418 1928 221 3,769 863 400 1929 278 4,335 927 400 1930 263 3,901 856 400 14,959 66,283 £10,566 £5,501 *Financial year ending 31st March. 90 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1930. Total premises disinfected 2,335 Rooms disinfected 3,415 Staircases disinfected 198 Schools disinfected 35 Number of articles laundered 32,038 „ „ destroyed 2,103 „ verminous, etc., persons (including 3,818 school children) 4,164 „ infectious disease contacts 1,019 „ Library books collected 456 Articles. No. Weight. Tons. cwts. qrs. lbs. Bedding, &c., disinfected 73,575 123 14 3 14 „ lent 1,275 3 19 1 20 Verminous clothing, &c. 7,414 1 14 1 27 Articles from Welfare Centres 2,483 (not weighed) Total 84,747 129 8 3 5 91 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 1930 are set out in the following table:— Usual Place of Residence. Total Battersea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court; postmortem at Mortuary 30 36 6 6 78 Inquest at Coroner's Court; postmortem elsewhere 29 63 28 1 121 Inquest at Coroner's Court; no postmortem 10 22 14 — 46 Total inquests at Coroner's Court 69 121 48 7 245 Post-mortem at Mortuary; inquest elsewhere - - - - - Post-mortem at Mortuary; no inquest (Coroner's Certificate) 67 19 2 - 88 Bodies received for sanitary reasons 2 — — — 2 Other bodies received on which no inquest held at Mortuary — 2 1 — 3 Total bodies received 138 142 51 7 338 Total post-mortems at Mortuary 97 55 8 6 166 VERDICTS AT INQUESTS HELD— Natural causes 20 21 2 1 44 Accidental Death— Anaesthesia 1 1 2 Asphyxia (mechanical) — 1 — — 1 Burns and scalds 3 3 1 - 7 Accident due to epileptic fit 2 — — — 2 Fall 13 27 10 1 51 Silicosis — 1 1 Railway and street accidents 16 30 23 1 70 Septicæmia following injury 1 1 — — 2 Cellulitis, &c., following injury 1 — — — 1 Other accidents 1 4 1 - 6 Open Verdict— Blow — 1 — — 1 Coal Gas poisoning 1 1 — — 2 Knocked down on railway — 1 — — 1 Found drowned — - 3 1 4 Abortion 1 1 - - 2 Stillborn — - — 2 2 Narcotic poisoning — 1 — — 1 Want of attention at birth — — — 1 1 Unknown cause 1 - - - 1 Suicide— Burns — - 1 - 1 Cut throat 3 4 — - 7 Drowning — — 2 — 2 Jump under moving train — 2 — — 2 Jump from high place 1 2 — — 3 Hanging and strangulation — — 1 — 1 Poisoning—Coal gas 4 12 1 — 17 „ Drugs, etc. 1 4 2 — 7 Wound in stomach — 1 — - 1 Homicide. Manslaughter — 1 — — 1 Murder — 1 — — 1 Grand Total 69 121 48 7 245 92 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 1930:— Food. Quantity. Food. Quantity. Fish. Fruit &• Vegetables (fresh). Fillet (Smoked) 2 boxes. Cabbage 6 crates. Haddock 1 trunk. Cauliflower 5 crates. Herrings 1½ boxes. Cherries 8 baskets. Mussels ½ bag. Potatoes 8 tons. Prawns 2 tins. Tomatoes 8 cases. Skate wings 1 case. Winkles 1 bag. Meat & Poultry. Fowls 4 Rabbits 16 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 1930, 140 inspections were made by the Council's inspector. The carcases of 48 animals (calves 7, sheep 4, and pigs 37) were examined after slaughter. The provisions of the Public Health (Meat) Regulations, 1924, have been brought to the notice of the occupiers of these slaughterhouses, and no contravention of the Regulations or By-laws in regard to slaughterhouses were reported during the year. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1930 was 97. One shop was closed during the year leaving a total of 96 butchers' premises carrying on business at the end of the year. 93 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 1,302 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. The new Food and Drugs (Adulteration) Act, 1928, came into force on the 1st January, 1929. 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. The analysis of samples of food and drugs procured under the provisions of the above-mentioned Act, or informally (i.e., without following in detail the procedure prescribed by the Act in the case of formal samples) is carried out by the Public Analyst for the Borough, (Mr. Charles Hackman, F.I.C., at the laboratory at 325 Kennington Road, S.E.) The bacteriological examination of samples (mainly milk) is conducted by the Clinical Research Association, Ltd., at Watergate House, Strand, W.C. The total number of samples taken under the Act during 1930 was 794, of which 21 or 2.6 per cent. were certified by the Public Analyst to be adulterated. In addition to the foregoing, 406 informal samples were procured, of which 9 (or 2.2 per cent.) were reported by the Public Analyst as being adulterated or containing preservative. 94 The percentage of samples reported by the Public Analyst to be adulterated during the quinquennia 1920—1924 and 1925—1929, and in each year from 1925 onwards, is given in the following table. It will be seen that there has been a distinct improvement in the state of the food supply during the past five years. Year. Formal Samples. (per cent.) Informal Samples. (per cent.) Mean 1920—1924 6.9 8.9 1925 4.4 2.8 1926 4.3 3.7 1927 4.5 0.8 1928 2.6 1.4 1929 2.6 4.1 Mean 1925—1929 3.7 2.6 1930 2.6 2.2 The following tables give details of the articles of which samples were obtained for the purpose of analysis:— Main Statement. TABLE I. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread - 4 4 - 0 0 Butter 20 56 76 0 0 0 Cheese 4 — 4 0 — 0 Cocoa — 16 16 — 0 0 Coffee — 8 8 — 0 0 Confectionery and Jam — 24 24 — 0 0 Cream — 13 13 — 0 0 Flour, Self-raising — 9 9 — 0 0 Margarine 5 44 49 0 0 0 Milk 707 1 708 18 1 19 ,, Separated 2 — 2 0 — 0 „ Condensed (Full Cream) 1 10 11 1 1 2 „ „ (Machine Skimmed) - 8 8 0 0 Mustard — 12 12 — 0 0 Sugar — 12 12 — 0 0 Tea — 29 29 — 0 0 Vinegar 16 — 16 0 — 0 „ Malt 1 — 1 0 — 0 Drugs 1 26 27 0 1 1 Other Articles 37 134 171 2 6 8 Total 794 406 1200 21 9 30 95 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Acid, tartaric - 4 4 - 0 0 Bicarbonate of Soda — 3 3 — 0 0 Camphorated Oil — 3 3 — 0 0 Cream of Tartar — 4 4 — 0 0 Ointment, Zinc 1 5 6 0 1 1 Tincture of Iodine — 7 7 — 0 0 Total 1 26 27 0 1 1 TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground — 3 3 — 0 0 Arrowroot — 4 4 — 0 0 Baking Powder — 13 13 — 0 0 Cake, Sponge — 12 12 — 0 0 Custard Powder — 13 13 — 0 0 Dripping — 16 16 — 0 0 Fish Paste 2 4 6 0 0 0 Honey 5 — 5 0 — 0 Ice cream powder — 1 1 — 0 0 Lard 4 12 16 0 0 0 Oatmeal - 4 4 - 0 0 Olive Oil 1 8 9 1 1 2 Peas, Tinned - 4 4 - 0 0 Peel, Candied — 3 3 — 0 0 Pepper 1 22 23 1 2 3 Raisins 3 10 13 0 3 3 Rice 10 - 10 0 - 0 Sausages 3 — 3 0 — 0 „ Luncheon 3 — 3 0 — 0 „ Preserved 5 - 5 0 - 0 Spice, Mixed — 3 3 - 0 0 Sultanas — 2 2 — 0 0 Total 37 134 171 2 6 8 96 Milk. Of the 710 samples of milk (including 1 informal sample and 2 formal samples of separated milk) submitted during the year, 19 (18 formal and 1 informal) or 2-7 per cent., were reported as adulterated, 12 of these samples (11 formal and 1 informal) being deficient in milk fat and 7 (all formal samples) containing extraneous water. The deficiency in milk fat varied from 20 per cent. to 1 per cent., and the proportion of extraneous water from 7 per cent. to 1 per cent. In the 5 years 1925-29, and in 1930 the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1925 808 40 4.9 1926 738 32 4.3 1927 696 37 5.3 1928 668 21 3.2 1929 603 11 1.8 Mean 703 28 3.9 1930 707 18 2.5 A great improvement in the quality of the milk supply is shown by the above figures. A considerable portion of the milk supply of London is received at Clapham Junction and the Nine Elms Goods Station of the Great Western Railway, and samples are frequently taken on the arrival of the milk at these two Stations. Such samples are included in the return on page 94. The average composition of the 689 samples (all formal) reported as genuine proved to be as under:— Per cent. Total milk solids 12.37 Milk fat 3.55 Non-fatty solids 8.82 97 The content of fat in these 689 samples ranged as follows :— 4 per cent, and over 40 samples or 5.8 per cent. Between 3.9 and 4.0 per cent. 33 „ „ 4.8 „ „ 3.8 „ 3.9 „ 46 „ „ 6.7 „ „ 3.7 „ 3.8 „ 70 „ „ 10.2 „ „ 3.6 „ 3.7 „ 103 „ „ 14.9 „ „ 3.5 „ 3.6 106 „ „ 15.4 „ ,, 3.4 ,, 3.5 ,, 118 „ „ 17.1„ „ 3.3 „ 3.4 „ 87 „ „ 12.6 „ „ 3.2 „ 3.3 „ 47 „ „ 6.8 „ „ 3.1 „ 3.2 „ 26 „ „ 3.8 „ „ 3.0 „ 31 „ 13 „ „ 1.9 „ Under 3.0 per cent. - „ „ — 689 100.0 All samples were systematically tested for the presence of preservatives and colouring matter. In no case, however, was a positive result obtained. Milk sampling was carried out on 5 Sundays during the year, and 28 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 43 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 100 were taken in course of delivery to hospitals and elementary schools in the borough. The supply of milk to hospitals and institutions is kept under careful supervision and samples are periodically taken not only for chemical analysis for adulteration or sophistication, but also to ascertain its bacteriological condition and cleanliness. No samples were taken in course of delivery during the year at the request of the Medical Officers of Health of neighbouring boroughs under the provisions of Sees. 21 and 29 and the Second Schedule of the Food and Drugs (Adulteration) Act, 1928, which permits the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. During the year advantage was however taken of these provisions by 14 milk purveyors in regard to 19 samples of milk. Seventeen of these samples having been certified to be genuine no action was necessary on the request. In the two remaining cases (Samples Nos. 758 and 288), in which adulteration had been certified, further samples were taken in accordance with the request, but both were certified to be genuine. Proceedings with regard to adulteration were taken in 6 instances (including the 2 cases just mentioned)—fat abstractions, 5; extraneous water, 1, particulars relating to which will be found set out in the tables on page 82. 98 Condensed Milk. During the year, 19 samples of condensed milk were submitted to the Public Analyst, of which 11 were described as "full cream" and 8 as "machine separated.". Of the former, one formal sample and one informal sample were certified to be deficient in milk fat to the extent of 6 per cent. and 2 per cent. respectively. Legal proceedings were instituted in regard to the formal sample, but the defendant successfully pleaded a warranty. Subsequently proceedings in respect of false warranty were taken against the wholesale firm, and the case was dismissed under the Probation of Offenders Act on payment of 25 guineas costs (vide p. 82). Cheese. Four 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 76. Of these 56 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 76 samples amounted to 14.6 per cent., the maximum amount permitted being 16.0 per cent. Margarine. Forty-nine samples of margarine were purchased and submitted to the Public Analyst for examination, 44 of which were procured informally, and in no case was adulteration certified, nor were preservatives, other than common salt, found. The average moisture content was 13.8 per cent. Sausages, Bacon, Preserved Meats, &c. Eleven formal samples of sausages (including 3 of liver or luncheon sausage and 5 samples labelled "Preserved Sausage") were submitted to the Public Analyst during the year. All the samples of sausages were certified to be genuine, and in the case of those labelled "Preserved Sausage" the preservative present was within the limits allowed by the Public Health (Preservatives, etc., in Food) Regulations. Flour. Nine samples of self-raising flour submitted for analysis were all reported as genuine. These samples were all taken informally. 99 Rice. Ten formal samples of rice were procured and submitted to the Public Analyst and all were reported as genuine. Vinegar. Seventeen samples of vinegar, including 1 of malt vinegar, were procured formally and submitted to the Public Analyst, and all were reported to be genuine. Pepper. Twenty-three samples (1 formal, 22 informal) of pepper were examined, and the formal sample and 2 of the informal samples were found to contain rice flour. In the case of the formal sample the adulteration amounted to 40 per cent. Proceedings were taken against the vendor, and a penalty of £1 0s. Od. fine and £1 1s. Od. costs was imposed (vide p. 82). Olive Oil. Nine samples (of which 8 were informal) of olive oil were procured and submitted to the Public Analyst. The formal sample and one informal sample from the same vendor were found to consist entirely of arachis oil. In view of the circumstances associated with the purchase of these samples, the Committee directed the vendor to be cautioned. Dried Fruits. During the year 15 samples, of which 12 were informal samples, of dried fruits, viz., sultanas 2, raisins 13, were purchased and submitted to the Public Analyst. In the case of 3 of these informal samples (raisins) a sulphite preservative was reported to be present in excess of the quantity permitted by the Public Health (Preservatives, etc., in Food) Regulations, viz., 750 parts of sulphur dioxide per million. Formal samples subsequently procured from the same vendor were reported to be genuine. Drugs. The number of samples of drugs submitted to the Public Analyst for analysis during the year was 27 (26 of which were informal samples), and comprised 6 varieties. Of these, 1 (informal) sample of zinc ointment was found to be deficient in zinc oxide to the extent of 12.8 per cent. A subsequent formal sample purchased from the same vendor was found to be genuine. 100 Ice Cream. There are 168 premises in the borough from which ice cream is sold, 23 of these being occupied by Italian vendors. Applications for the registration of 17 premises were granted by the Council during the year. There was, therefore, an increase of 17 in the number of premises compared with 1929. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 208 inspections were made and 1 notice was served to remedy defects found on inspection. The improvement in the manner in which this commodity is now prepared and sold in Battersea, referred to in previous annual reports, is on the whole being maintained. Milk and Dairies Order, 1926. The provisions of the above-named Order continued to be enforced by the Council's Officers during the year under report. It was found necessary in three cases to institute legal proceedings for breaches of the requirements of the Order with regard to the filling of milk bottles on registered premises. In two cases the offence consisted of filling the bottles in the street, and in the third, the opening of a bottle already filled and sealed. The results of the proceedings are set out on page 82. 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 1930 licences were issued as follows :— Full. Supplemental. Certified milk 9 1 Grade A (Tuberculin tested) milk 49 2 Grade A milk 1 1 Pasteurised milk 17 1 76 5 Two licences to bottle Grade A (T.T.) milk and one licence to pasteurise milk were granted and are included in the above figures. 101 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. The Bacillus coli was not found in any of the six samples. The bacterial content of the samples per 1 c.c. ranged from 285 to 1,776, the average number being 779. Milk Shops. The number of premises registered in Battersea for the sale of milk is 128 (including 5 wholesalers' premises). One wholesale depot was registered during the year for the sale of milk, and in 5 cases (including 1 wholesale depot) the sale of milk from registered premises was discontinued. In 15 cases registration was transferred on account of change of proprietorship. There are also 8 premises registered for the sale of cream only. All milk shops are kept under inspection and during the year 509 inspections were carried out and 30 notices (21 Intimation and 9 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 118 persons registered in respect of premises in which milk in sealed bottles only is sold. 16 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. The observations on page 96 with regard to the results of the analysis of milk apply generally to the conditions of premises in the Borough in which milk is sold or stored. These have all been brought to a satisfactory sanitary standard. Preservatives in Food. The provisions of the Public Health (Preservatives, etc., in Food) Regulations are referred to in the Report for the year 1928. All samples submitted to the Public Analyst are examined for the presence of preservatives and during 1930 contraventions of the Regulations were reported in the case of 3 informal samples of dried fruits (raisins) only (vide p. 99). Agricultural Produce (Grading and Marking) Act, 1928. Further regulations under the Agricultural Produce (Grading and Marking) Act were made by the Minister of Agriculture and Fisheries during 1930 dealing with the grading and marking of the following articles, viz.:— Broccoli. Certain canned fruits, peas and beans. Cherries produced in England or Wales. Cider. Dressed poultry. Glasshouse-grown tomatoes and cucumbers. Strawberries. 102 No legal action was found necessary during the year under review in regard to the various Orders made under the Act. Merchandise Marks Act, 1926. 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. A few offences were reported during 1930 which were dealt with by cautioning the offenders. Artificial Cream Act, 1929. Only one shop is registered under the provisions of this Act for the sale of artificial cream. These premises are periodically inspected. 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 76 (two more than at the end of 1929). All these premises are kept under systematic inspection. Two hundred and eighty-eight inspections were made during 1930 and 27 notices (21 intimation and 6 statutory) 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 1930 was 116, 9 having been added and 11 removed. During the year 293 inspections were carried out and in 32 cases it was found necessary to serve notices (including 4 statutory notices) to remedy defects, mainly for lack of cleanliness. Street Stalls for Sale of Food. There are 212 street stalls in the borough for the sale of foodstuffs of varied character, namely: vegetables and fruit 147, refreshments (coffee stalls) 8, fish and poultry 21, meats and rabbits 4, sweets 6, and other foods 26. Inspections numbering 239 were made of the premises used by street vendors for the storage of their stocks, and 55 intimation and 11 statutory notices were served to remedy defects found. 103 Factories, Workshops, Workplaces and Homework. 1.—Inspections of Factories, Workshops and Workplaces (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances). Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 801 80 - Workshops (including Workshop Laundries) 772 95 - Workplaces (other than Outworkers' premises included in the Table on page 109) 1,615 168 _ Total 3,188 343 - 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 125 125 Nil. - Want of Ventilation 2 2 - Overcrowding _ _ _ Want of drainage of floors _ _ Other nuisances 58 58 _ Sanitary accommodation Insufficient 6 6 _ Unsuitable or defective 99 99 - Not separate for the sexes 2 2 - 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 109) - - - Total 292 292 - - 104 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1930:— Bakehouses 16 Bootmakers 33 Dressmakers 17 Laundries 3 Milliners 7 Tailors 41 Other Trades 181 Total number of workshops 298 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 7 Notified by H.M. Inspector 13 Underground Bakehouses (Section 101), in use at end of the year 22 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1930 :— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 47 187 28 32 20 Barge builder 3 32 — — — Bootmaker 34 69 3 — — Builder 4 122 7 — — Butter blender 1 175 25 50 35 Chaff & forage 2 36 — 8 — Chemical works 4 172 8 78 10 Coachbuilder 3 20 — — — Cycle maker 2 5 2 — — Dyer 3 46 2 53 6 Engineer 23 958 174 15 8 Firewood cutter 14 37 6 28 — Flour mills 2 125 5 12 — Foundry 2 48 3 — — Lift maker 2 15 3 — — Mason 7 431 6 — — Mineral water 2 34 — 30 — Motor repairer 23 273 15 — — Printer 17 79 29 19 6 Steam laundry 17 63 16 463 187 Other trades 102 3,960 585 1,120 631 Total 314 6,887 917 1,908 903 105 The duties of sanitary authorities in relation to the sanitation of factories are few, and are limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. Thirty-one new factory premises were added to the register during the year, dealing with various trades, and 11 were removed. During the year 68 preliminary and 12 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 1930:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 16 16 26 - - - Blind maker 2 3 6 — — — Bootmaker 33 33 46 2 — — Carpenter 5 5 6 — — — Coach builder 5 8 22 — — — Cycle maker 7 11 12 2 2 — Dressmaker 17 19 1 — 40 11 Embroiderer 1 2 — — 15 — Farrier & smith 10 10 17 — — — Firewood cutter 4 4 5 — — — Laundry 3 9 2 — 7 — Mason 2 2 2 — — — Milliner 7 7 — — 26 2 Motor repairer 19 21 43 10 — — Musical instru- ment maker 4 7 13 1 2 — Photographer 2 4 3 — — — Picture framer 5 5 8 — — — Rag sorter 22 25 42 4 6 — Saddler 1 1 1 — — — Tailor 41 49 58 8 54 1 Upholsterer 17 21 28 5 11 — Other trades 75 97 160 17 29 14 Totals 298 359 501 49 192 28 106 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 1930 the number of inspections amounted to 217. Eighty-one intimation and 14 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 27 intimation notices and one statutory were served by the female inspector. Thirty-three new workshops were added to the register, dealing with the following trades:— Bootmaker 1 Rag sorter 4 Dressmaker 3 Tailor 9 Milliner 3 Upholsterer 2 Motor repairer 2 Other trades 8 Photographer 1 The following are particulars relating to workshops in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector during 1930:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Dressmaker 3 4 2 6 Florist 1 1 1 2 Milliner 3 5 2 7 Motor repairer 1 — 1 1 Tailor 4 5 1 6 Waste paper sorter 1 1 — 1 Outworkers. During 1930, 468 names and addresses of outworkers were received in 89 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 94 names and addresses relating to 53 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:— 107 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaker 27 27 29 Tailor 37 38 70 Other Trades 2 2 4 Totals 66 67 103 Three new male outworkers' premises (not previously registered) were registered during the year, and 17 were removed from the register. There were 118 inspections made of male outworkers' premises during 1930, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 6 cases to remedy sanitary defects found on inspection, viz.:—Defective w.c. 1; cleansing 5. No case of infectious disease was notified during 1930 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 Blousemaker 4 5 8 Dressmaker 26 29 39 Milliner 1 1 1 Embroiderer 36 36 39 Fancy goods 4 4 4 Fancy boxes 8 8 8 Fine needlework 4 4 5 Glovemaker 2 2 2 Knitting and crochet 4 4 4 Tailor 24 26 40 Underclothing 6 6 7 Other trades 19 19 19 Total 138 144 176 108 The number of new female outworkers' premises (not previously registered) registered during the year was 28, and there were 40 removed from the register. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 638. It was found necessary in 6 cases to serve notices under the Public Health (London) Act, 1891, to remedy defects. Seven cases of infectious disease, viz.: diphtheria 3, scarlet fever 3, encephalitis lethargica 1, were notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in these cases. Legal proceedings were instituted against a firm who failed to send in the list of outworkers employed by them at the period prescribed by the Act, vide p 83. Bakehouses. There were 63 bakehouses on the register at the end of 1930. Of these 47 use power, and are therefore technically factories. Forty-one of the bakehouses are above ground, and 22 are under ground. Six premises were removed from the register, they being no longer used as bakehouses. Inspections made during the year were 246, and 22 intimation and 2 statutory notices were served, mainly for failure to carry out the half-yearly lime-whiting of the bakehouses within the statutory period. Warehouses and Wharves. At the end of 1930, there were 52 premises on the register, including railway yards. These premises were systematically inspected during the year, and 73 inspections were made. Nine intimation and 3 statutory notices were served to remedy nuisances found on inspection. 109 Home Work, 1930. 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 42 23 100 2 — 4 48 — 1 12 12 — 7 — — (2) Cleansing & Washing 2 — 4 - - - 2 - - - - - - - - Furniture and Upholstery 4 — 9 — - — 4 - — — — - — - - Other Trades 4 - 67 - - - 8 - — — — - - - - Total 52 23 180 2 — 4 62 i 12 12 — 7 — — Note.—The 207 names in this table include only 104 workpeople residing in Battersea, the remaining names being either duplicates or those of workers residing outside the Borough. The names of 72 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were, therefore, 176 Battersea home-workers named in the lists. 110 Housing. The difficulties arising from the lack of adequate housing accommodation, referred to in previous Annual Reports, continued to prevail, although, perhaps, to a lesser extent. There is no real overcrowding in the Borough as a whole, but amongst that class of the population who are unable to pay an economic rent there is considerable congestion and in some cases serious overcrowding, especially in the lower Wards of the Borough. It has been possible to secure a larger measure of housing accommodation through the London County Council, especially on the St. Helier Estate, Morden, but this, as pointed out, only affects the more prosperous elements of the population. Moreover, in many cases, applicants are unwilling to accept accommodation outside the Borough because of their desire to reside near their work. The negotiations for the purchase of St. John's College, referred to in the annual report of the Medical Officer of Health for 1929, were completed during 1930. Plans and lay-out have been prepared, but the scheme has to some extent been delayed by the difficulty raised in connection with the preservation of the Principal's House, which was considered by the Ministry of Health, in accordance with the provisions of section 38 of the Housing Act, 1930, to be a work of architectural, historic or artistic interest. The Borough Council were anxious to utilise the ground on which this building stood to the best possible advantage for working class dwellings, and considerable correspondence passed between the Ministry and the Council on the subject, the Council being of the opinion that the retention of this building was of less importance than the provision of housing accommodation for the working classes. The old buildings, apart from the Principal's House, are in course of demolition, and it is hoped that at an early date the erection of the new buildings will be commenced*. It is proposed to build two quadrangles and two blocks, each of four storeys, containing in all some 300 tenements, and provision has been made for housing families of varying sizes. Further consideration was given to the purchase of another site in the Borough on which it would be practicable to provide for the erection of 96 tenements and this matter is still receiving the attention of the Council. * The work on these new tenements was commenced in June, 1931. 111 Apart from the Plough Road Improvement Extension Scheme (vide p. 115) no new workmen's dwellings were erected by the Council in 1930. Nineteen houses were erected by private enterprise during the year as under:— Gowrie Road 2 houses Holmside Road 7 ,, Nightingale Lane 6 „ Thurleigh Avenue 4 „ Total 19 „ Housing Act 1930. The Housing Act, 1930, came into operation on the 16th August, 1930, and the following is a brief resume of a memorandum on the Act issued by the Ministry of Health. The Act has as its main objects the simplification of procedure and the facilitating of slum clearance (Clearance Areas) and the prevention of the creation of new slums by arresting the deterioration of other areas (Improvement Areas). The definition of a Clearance Area is substantially the same as that of an Unhealthy Area under previous legislation. The area is to be cleared by (i) requiring the owners to demolish the buildings, or (ii) by the Local Authority purchasing the Area and then arranging for demolition. The first method, which is a novel one, is designed to enable a local authority to secure the clearance of a slum area without being obliged to incur the heavy capital expense of purchase and clearance and one which may often be found convenient if the site is not required for rehousing. In such a case the local authority may make a Clearance Order which requires confirmation by the Minister of Health. The cleared site will remain the property of the owners but it may not be used for building purposes or otherwise developed except subject to such restrictions and conditions, if any, as the local authority may impose. The Act, moreover, provides that if the site is not developed in accordance with plans previously approved by the local authority, within 18 months after the Clearance Order becomes operative, the right to purchase the land by the Local Authority is reserved. The procedure in the case of Clearance Areas dealt with under the second method has been simplified. There is now no necessity for a formal scheme. The local authority is enabled to buy the area, either by agreement or by compulsion, but in the latter case confirmation by the Minister of Health is required. Having acquired the property the local authority must proceed with the demolition of the buildings. They may, however, dispose of the site as cleared, or, subject to a require- 112 ment that it would be forthwith cleared, or, subject to ministerial approval, they may utilise the land for some purpose for which they have statutory powers. In a clearance area all the buildings are required to be demolished either because they are (a) unfit for human habitation on account of disrepair or sanitary defects or (b) dangerous or injurious to health of the inhabitants of the area by reason of their bad arrangement or the narrowness or bad arrangement of the streets. Properties which do not fall within these categories cannot be included in an area. Property included in a clearance area can be purchased at site value subject, where the site is to be used for rehousing, to a reduction, whereas a modified market value must be paid for property surrounded by or adjoining a clearance area and which is reasonably required to secure an area of convenient shape and size. New and important provisions have been included in the Act for what are termed "Improvement Areas." These relate to areas in which the houses are not in such a bad condition as to justify the demolition of all the houses in the area. Great improvement, it is pointed out, can be effected by the removal of the worst houses and obstructive buildings; by the carrying out of necessary repairs; and by re-housing the surplus population elsewhere. It will, of course, be necessary to ensure that the area is not allowed to again become in a bad state. Part II. of the Act deals with the repair of individual unfit houses. A sharp distinction is drawn between those which can and those which cannot be rendered fit at a reasonable cost. In the former case the person having control of the house is required to repair it and in default the local authority may themselves do the work and recover the cost. In the latter the house is to be demolished unless the owner undertakes that either the house shall cease to be used for habitation or alternatively that he is prepared to carry out the work which the local authority consider necessary to render it fit within a specified time. It is an essential part of any action taken by a local authority in regard to either clearance or improvement areas or individual unfit houses that accommodation shall be available for the persons displaced. In this connection financial assistance is offered by the Government at a rate which it is suggested will enable the local authority to re-house the displaced persons at a rental which they can afford. The part of the Act dealing with Improvement Areas, which is entirely new, appears to be the most promising part of the Act in dealing with old, worn out property. There are many such areas in the Borough containing this class of property which it is desirable to pull down, repair or otherwise deal with. Except in the case of small areas the authority for dealing with Improvement Areas, so far as London is concerned, is the 113 London County Council who are also required to frame by-laws for preventing and abating overcrowding and securing the improvement of the housing conditions, and the subsequent maintenance of a proper standard of housing conditions. These bylaws (except those relating to stability of buildings and prevention of or safety from fire) are to be enforced by the borough council who are also required to serve and enforce any necessary notices requiring the execution of works, or the demolition of individual dwelling houses or the closing of parts of buildings in the area. Amongst the variations arising from the new Act in the procedure hitherto adopted is that appeals against notices, orders or demands now lie to the County Court. This, in my opinion, is a weakness in the Act. Hitherto such appeals were heard by the Ministry and so far as this Borough is concerned, no delay has been experienced in dealing with them. It is to be feared that appeals to the Law Courts which, according to the public press, are usually very congested, will result in difficulty and delay owing to the large volume of work which may be expected in connection with the hearing of such appeals. The Ministry have for several years heard appeals and their decisions have been upheld in the highest Court of the Realm. The Council strove strenuously to secure that appeals should continue to be made to the Minister of Health, but they were unsuccessful. Under Section 31 (3) (a) of the Act the London County Council is required to carry out such reviews of housing conditions and submit to the Minister such proposals for the provision of new houses and such quinquennial statements of measures proposed to be taken, as are required by this part of the Act, but before preparing any such proposals or statement the County Council must consult with the councils of the various metropolitan boroughs, and shall include in any such statement particulars of any new houses which those councils propose to provide during the quinquennial period and the council of every metropolitan borough are required to furnish such information as may be reasonably required by the County Council for this purpose. Such information was requested by the County Council and following an interview by a deputation from the Housing Committee with the Chairman of the Housing Committee of the County Council estimated approximate figures relating to the schemes which might be undertaken during the ensuing five years were supplied and a survey of the borough is now being carried out in order that a definite programme can be formulated. Overcrowding. It is to be regretted that a considerable amount of local 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 114 out in previous Annual Reports owing to the remoteness of the newly-built London County Council houses from their work, and their inability to pay the rents charged, there is a reluctance on the part of those inhabitants mostly in need of better housing conditions, to accept accommodation on these estates. During the year the London County Council commenced the erection of houses on the St. Helier (Morden) Estate, which is— unlike the Becontree, Watling and Downham Estates—reasonably accessible from this Borough. It has been possible, therefore, to refer to the County Council an increased number of applications with a view to special consideration being given thereto on the grounds of overcrowding or hardship. The following table shows the results of such action during the year:— Referred in previous years but not then dealt with. Referred in 1930. Total. Families accommodated 10* 71 81 Offer declined by applicant or applicant otherwise suited — 14 14 Recommendation not accepted by the London County Council 2 34 36 Still under consideration 67 42 109 Totals 79 161 240 * Includes 3 cases in which the recommendation had been previously not accepted by the London County Council. Repair of Unfit Houses. As in past years a good deal of useful work in the repair and reconditioning of unfit houses was carried out during the year 1930, under the provisions of the Housing and Public Health Acts, details of which will be found summarised on pp. 118-119. The work of the Council 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 Acts in securing the reconditioning of seriously defective house property continues to be fully justified. In only one case was it found necessary for the Council's Works Department to enter and carry out, in default of the owner, the necessary repairs in compliance with a notice served under the Housing Acts. Considerable difficulty was experienced in enforcing the Council's powers in this case and it became necessary on more than one occasion to proceed against the owner for obstruction (vide p. 81). Eventually the premises were put into repair. 115 Appeals. An appeal was made by the owner of the premises 26 Shirley Grove against a notice served under section 3 of the Housing Act 1925. This notice was complied with except in regard to one item. The owner, in lieu of re-instating a ceiling with the materials specified used asbestos cement sheets with wooden fillets covering the joints. In view of the circumstances the Council were prepared to waive their requirement on the understanding that it was not to be regarded as a precedent and the appeal of the owner was withdrawn. Closing Orders. No Closing Orders under Section 11 (1) of the Housing Act, 1925, were made by the Council during 1930. Demolition Orders. No Demolition Orders were made by the Council during 1930. Underground Rooms. No Closing Orders were made by the Council in respect of underground rooms during 1930. Increase of Rent, etc., Acts. During 1930, 14 applications were received from tenants for the certificate, and 7 from owners for the report of the Sanitary Authority under the above-mentioned Acts. The application for the certificate was granted in 12 cases and refused in 2 cases; that for the report were granted in 6 cases and refused in one case. Action under Section 5 of the Housing Act 1925. During 1930, in 41 cases (relating to 44 houses) reports were made to the Housing Committee as to the collection of rent in 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 39 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 instituted. The result of one case will be found set out on page 81. In the other the proceedings were abandoned owing to the demise of the owner concerned. Insanitary Areas. No insanitary areas were represented to the Council during 1930. In connection with the Plough Road Improvement Scheme, as stated in the Annual Report for 1928, the Council, by the acquisition by negotiation of other properties in the original area represented, were able to extend the scheme and so make provision for three more blocks (eighteen tenements). Of these the second block was completed during 1930 and the third was nearing completion at the end of the year. 116 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, or under section 17 of the Housing Act, 1930, during 1930. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 3—con td. District No. 4—cotid. Belfour Street 1 Harley Street 1 Winstanley Road 2 Corunna Road 1 Home Road 1 Wye Street 1 Foots Row 6 Hyde Lane 1 District No. 5. Mundella Road 51 Inworth Street 1 Ponton Street 2 Octavia Street 1 Beaufoy Road 1 Power Street 1 Stanmer Street 3 Culvert Road 1 Roundell Street 3 District No. 4. Latchmere Road 3 Savona Place 3 Wickersley Road 25 Savona Street 10 Afghan Road 2 District No. 6. Stewarts Road 1 Currie Road 18 Thessaly Square 1 Darien Road 9 Cologne Road 1 District No. 2. Grant Road 2 Grant Road 2 Heaver Road 2 John Street 9 Austin Road 1 Ingrave Street 2 Livingstone Road 6 Battersea Pk. Rd. 1 Khyber Road 1 Mallinson Road 1 Longhedge Street 6 Knox Road 14 Sewell Road 2 Weybridge Street 2 Lavender Road 4 Speke Road 4 District No. 3. Livingstone Rd. 7 Steelworks Road 15 Lubeck Street 1 Winstanley Road 1 Battersea Bridge Mantua Street 3 York Road 1 Road 1 Meyrick Road 8 District No. 7. Castle Street 1 Musjid Road 1 Church Road 3 Newcomen Road 2 Nil. Edna Street 2 Rowena Crescent 1 Elcho Street 3 Speke Road 1 District No. 8. Frances Street 3 Stainforth Road 1 Chatham Road 1 Summary. District No. 1 11 streets 80 houses. „ „ 2 4 „ 10 „ „ „ 3 12 „ 21 „ „ „ 4 20 „ 82 „ „ „ 5 4 „ 30 „ „ „ 6 10* „ 42 „ „ „ 7 - — „ „ „ 8 1 „ 1 „ Totals 58 streets 266 houses. * Including Grant Road, Livingstone Road, Speke Road, Winstanley Road. Partly in No. 4 District. 117 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 1929. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 4. District No. 6. Belfour Street 1 Benfield Street 15 Auckland Road 1 Linford Street 25 Creek Street 6 Darien Road 1 New Road 2 Este Road 1 Didcot Street 1 Savona Street 10 Gwynne Road 1 Grant Road 1 District No. 2. Kambala Road 1 Maysoule Road 3 Lavender Road 2 N. Side W. Com. 1 Nil. Newcomen Road 1 St. Johns Hill 1 District No. 3. Pearson Street 1 Usk Road 20 Shillington St. 2 District No. 7. Balfern Street 1 Winstanley Road 2 Castle Street 1 District No. 5. Lavender Hill 1 Frances Street 1 District No. 8. High Street 1 Culvert Road 1 Stanmer Street 2 Latchmere Road 2 Nil. Shirley Grove 1 Statistics for the Year ended 31st December, 1930. Number of New Houses erected during the year :— (a) Total (including numbers given separately under (b) ). (1) By the Local Authority 6 (2) By other Local Authorities Nil (3) By other bodies and persons 19 Summary. District No. 1 4 streets 38 houses. „ „ 2 - „ - „ „ „ 3 5 „ 6 „ „ „ 4 10 „ 32 „ ,, ,, 5 3 „ 4 „ „ „ 6 8 „ „ 29 „ „ „ 7 1 „ 1 „ „ „ 8 - „ - „ Totals 31 streets 110 houses. 118 (b) With State assistance under the Housing Acts :— (1) By the Local Authority. (а) For the purpose of Part II. of the Act of 1925 Nil (б) For the purpose of Part III. of the Act of 1925 6 (c) For other purposes Nil (2) By other bodies or persons Nil 1. Inspection of Dwelling-Houses during the Year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,718 And the number of inspections made (including re-inspections) 31,381 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,455 And the number of inspections made (including re-inspections) 23,968 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,372 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 282 3. Action under Statutory Powers during the Year:— (a) Proceedings under section 3 of the Housing Act, 1925, and under section 17 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 15 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 29 (b) By Local Authority in default of owners 1 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil 119 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,614 (3,312 intimation notices) (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,677 (3,555 intimation notices complied with) (b) By Local Authority in default of owners *2 (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925, or Sections 19-21 of the Housing Act, 1930— (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 4. Number of Houses owned by the Local Authority distinguishing those built in the last two years and held under (1) Part III. of the Housing Act, 1925, (2) Part II. of the Housing Act, 1925, and (3) Other Powers. Held Under. Total at 31st Dec., 1928. Erected in 1929 and 1930. Total. Part III. of Housing Act, 1925 109 12 121 Part II. of Housing Act, 1925 60 6 66 Other powers 343 Nil 343 Total 512 18 530 * Includes 2 cases of frontage drains, in respect of which the respective owners declined to pay for the cost of the work. 120 APPENDIX. TUBERCULOSIS DISPENSARY. ANNUAL REPORT, 1930. To the Medical Officer of Health. I beg to submit a report on the work carried out at the Tuberculosis Dispensary for the year ending 31st December, 1930. Dr. Mary J. O'Flynn was appointed part-time Tuberculosis Officer during the year, and commenced her duties on the 1st December, 1930. Otherwise the personnel of the staff remained the same as for the previous twelve months. The routine work of the Dispensary has been carried on as in previous years. The Artificial Light Department which was established at "Southlands" in November, 1929, was in operation during the whole of 1930, and the results of treatment are set out below. 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 on the recommendation of the Medical Officers in charge of those clinics. Treatment by artificial light is not given as an alternative to institutional treatment in cases of Non-Pulmonary Tuberculosis but is used in cases where such treatment is not considered essential. It appears to be particularly useful in cases of lupus and in enlarged tuberculous glands with discharging sinuses. The Tuberculosis Dispensary acts as a centre for diagnosis and a clearing house, and the work is carried out in close co-operation with the doctors in the area. The majority of the new patients who attend the Dispensary are sent by their own doctors for an opinion and advice, and with a view to getting them sent away for a period of institutional treatment under the London County Council's Tuberculosis Scheme. On the patient's return from an institution a full report of his condition on discharge is sent to the doctor, and in the case of an insured patient who is on domiciliary treatment a written report is required from the doctor as to the patient's progress at three monthly intervals. The co-operation of the family doctor with the Staff of the Tuberculosis Dispensary is of the first importance if the Tuberculosis Dispensary is to function satisfactorily. The importance of the early diagnosis of Tuberculosis both from the point of view of treatment and prevention has been frequently emphasised and in this connection the co-operation of the Doctor with the Dispensary Staff is most essential. Every effort is made to reach a definite diagnosis at as early a date as possible in the case of new patients who are sent to the Dispensary for consultation and, as in previous years, doubtful cases of Tuberculosis are sent to St. Thomas's Hospital for X-ray examination and for a further opinion. Institutional treatment is provided by the London County Council on the recommendation of the Tuberculosis Officers. 121 During the year the Tuberculosis Care Committee has met weekly at "Southlands," and much valuable work has been done in this connection by way of assisting patients and their families in various ways. Extra nourishment has been supplied to patients as an aid to treatment in necessitous cases on the recommendation of the Care Committee, and patients have been referred to various charitable organisations for financial and other assistance. As in previous years it has been found a matter of the greatest difficulty to find employment for tuberculous patients who are out of work, and with but few exceptions the efforts of the Care Committee in this direction have been unavailing. During the year 644 new patients, including 21 transfer cases from other areas, attended the Dispensary, the figures for five years (1926-1930) being:- 1926 1927 1928 1929 1930 707 656 647 731 644 Of the 644 new patients 192 were found to be suffering from Pulmonary Tuberculosis and 41 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. Group T.B. Plus is sub-divided under three headings:— Group I—early cases. Group II—intermediate cases. Group III—advanced cases. Table I 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 1 2 1 23 12 12 2 3 — 56 Group T.B. plus Group I — — — 11 10 3 1 1 — 26 136 Group ii — — — 26 21 15 9 4 — 75 Group iii — — 1 12 9 5 5 3 — 35, Total 1 2 2 72 53 34 17 11 — 192 122 Table II. Non-Pulmonary Tuberculosis. Years. 0-5 5-10 10-15 15-25 25-35 35-45 45-55 55-65 Total Bones and Joints — 3 3 3 1 1 1 — 12 Abdominal — 3 2 2 — — — — 7 Peripheral Glands 4 4 1 6 1 1 — — 17 Skin and Other Organs 1 1 1 2 — — — — 5 Total 5 11 7 13 2 2 1 — 41 It will be noted that as in previous years, the incidence of Tuberculosis (both in the Pulmonary and Non-Pulmonary groups) is much higher in the young adult age periods between 15 and 25 years than in any other period. It is also in this age period that the highest mortality occurs. Table III. Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 81 42.19 "Influenza" 5 2.60 Pleurisy 19 9.90 Pleurisy with effusion 7 3.65 Haemoptysis 26 13.54 Other modes 54 28.12 Total 192 100.00 123 Table IV. Occupations in the 192 cases of Pulmonary Tuberculosis. Occupation. No. of Patients. Occupation. No. of Patients. Housewives 24 Plate Layer 1 School Children 4 Gas Fitter 1 Domestic Servants 8 Plasterer 1 Cooks and Confectioners 3 Marble Polisher 1 Waiters and Waitresses 6 Pianoforte Maker 1 Warehouseman 2 Chemical Worker 1 Porters 2 Carbon-brush Maker 1 Messengers 3 News vendor 1 Carmen 2 Sailor 1 Packers 3 Cinema Operator 1 Laundry Workers 5 Licensed Victualler 1 Factory Workers 10 Public House Manager 1 Watchmen 2 Commissionaire 1 Motor Drivers 9 Wood Tyer 1 Shop Assistants 9 Milkman 1 Tailors, Dressmakers, &c. 6 Cellar man 1 Printers 4 Pedlar 1 Clerks, Typists, &c. 28 Butcher 1 Travellers and Agents 2 Nurse 1 Labourers 10 Draughtsman 1 Engineers and Electricians 5 Medical Student 1 Builders and Decorators 2 Actor 1 Carpenters 4 Artists' Model 1 Stoker 1 Police Constable 1 Plumber 1 Teacher 1 Bricklayer 1 Nil 11 Table V. Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. 66 9 158 Of the 233 cases, therefore, a history of Tuberculosis in a near relative was elicited in 28.3 per cent., and in a remote relative in 3.86 per cent. In all 32.19 per cent, gave a family history of Tuberculosis. 124 "Contacts."—153 "contacts" were examined during the year, 50 being adults and 103 children. Of this number two were found to be suffering from Tuberculosis. The total number of attendances at the Dispensary during the year was 3,621. For the five years (1926-1930) the attendances were:— 1926 1927 1928 1929 1930 4,686 4,180 3,912 3,967 3,621 Domiciliary Visits:— 1926 1927 1928 1929 1930 Doctors 180 186 181 167 165 Nurses 5,294 5,434 4,865 4,531 4,292 The number of sputum examinations carried out at the Tuberculosis Dispensary during 1929 was 1,305. In 288 cases or 22.06 per cent. Tubercle Bacilli were found to be present. Of the total number of specimens examined 433 were sent by medical practitioners and 460 were examined for St. James's Hospital. Sputum examinations:— 1926 1927 1928 1929 1930 1,504 1,435 1,398 1,592 1,305 The number of reports sent to public bodies during 1930 was 1,087. Consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 820. The number of reports received during the year in respect of insured persons was:— (a) Form G. P. 17 1 (b) Form G. P. 36 131 151 patients were referred to hospitals, 130 of whom were sent to St. Thomas's Hospital for X-ray examination. Definite cases marked off the Dispensary books:— Number of Dispensary patients who died during 1930 96 Number of Dispensary patients who ceased to attend 39 Number of Dispensary patients who removed to other districts (and transferred to the Medical Officer of Health concerned) 82 Number of patients discharged from Dispensary register as disease arrested 27 Number of patients discharged as diagnosis not confirmed 1 125 During the year 135 patients were sent away to various institutions under the London County Council's Scheme. Of those 80 were discharged during the year and 55 were still away on December 31st. The average length of stay of the 80 patients was 95.36 days and the average waiting period between recommendation for admission and admission was 16.5 days; 49 patients showed definite improvement as a result of institutional treatment; 28 patients were discharged at their own request. During the year 44 patients were admitted to St. James's Hospital, Balham, which is now under the control of the London County Council. Artificial Light Treatment. Tuberculosis Patients. Name. Age. Condition. Period of Treatment. Condition on Discharge or at 31/12/30. d. s. 6 T.B. glands of neck 9/4/30—9/7/30 Improved. B. R. 9 T.B. glands of neck 16/12/29—28/2/30 Improved. G. F. 2 T.B. glands of neck 10/2/30—18/7/30 Improved. H. B. 10 T.B. glands of neck 21/2/30—7/3/30 Glands removed by operaton. Left district. j. h. 12 Lupus Vulgaris (face) 27/8/30— Quiescent. V. P. 23 Discharging sinus after removal of kidney 24/10/30—3/12/30 Sinus healed. G. P. 6 T.B. glands of neck 2/4/30—16/7/30 Stationary. E. G. 15 Lupus Vulgaris (face) 12/2/30— Stationary. E. J 5 T.B. Peritonitis 24/3/30—7/5/30 5/11/30—28/11/30 Improved. N. R. 10 Lupus Vulgaris (face) 3/12/30— Stationary. Springwell House Open-Air School. Accommodation 150 On Roll 31/12/30 146 Average attendance 120.6 Admitted during 1930 55 Discharge during 1930 47 Reasons for discharge:— Fit for elementary school 5 Fit for work 29 Transferred to Hospital or Sanatorium 7 Removed from district 2 Transferred to Special School 1 Discharged for other reasons 3 126 Tuberculosis Dental Treatment. Total attendances 274 Sessions held 49 Average attendance per session 5.59 Extractions, 58; scalings, 5; fillings, 28; dentures supplied—whole sets, 8; partial sets, 4; repairs to dentures, 4; dressings, 15; advice, 89 (average per session, 4.3) Total 211 The Tuberculous Care Committee. The following is a summary of the work carried out by the Committee during 1930:— Battersea Borough Council—extra nourishment, 137; dentures, 6 143 Wandsworth Board of Guardians (later Public Assistance Committee)—financial assistance, 4; clothing, 7; other assistance, 1 12 Charity Organisation Society—financial, 9; dentures, 1; clothing, 5 15 United Services Fund—financial, 9; clothing, 8 17 Other Agencies—financial, 3; clothing, 1; dentures, 2; other assistance, 4 10 Training and Employment—suitable agencies, 13; previous employers, 2; Health Committee, 1 16 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 £791 0s. 5d. The following are some illustrations of the work done by the Care Committee throughout the year:— M.B., aged 33. This patient who was a married woman with five children, had received Sanatorium treatment previously, but had broken down and had to be sent away for a further period of treatment. The Committee were able to arrange for the boarding out of her children, to obtain suitable clothing for her, and in view of the crowded home conditions to obtain a house on one of the London County Council estates to which she removed on her discharge from hospital. H.R., aged 23. Attended the Dispensary and was found to be suffering from Tuberculosis. He had then only his National Health Insurance benefit to keep himself and his wife, and he had to pawn the only suitable clothing he had for going away. His wife was expecting her first baby, and had made arrangements to go into the Maternity Home, but she had been unable to keep up her payments towards the cost of her maintenance. The Committee were able to obtain financial assistance at once, also to obtain some new clothing for the patient and to 127 redeem the articles in pawn. He was admitted to Sanatorium in due course, and whilst away he was found to require artificial dentures. These were provided at the Sanatorium and the Committee obtained a grant for the balance of the cost after the grant had been received from his Approved Society. Whilst he was away the Committee kept in constant touch with his wife and she was admitted to the Home in due course, and the Committee were able to arrange for the payments to be held over until the Maternity Benefit was received. A.M., aged 27. This man was sent to the Dispensary for examination by his doctor, as his father was in hospital suffering from advanced tuberculosis. He was also found to be tuberculous and was advised to accept sanatorium treatment, but he was definitely unwilling to go away as it meant giving up his rooms. He had been working as a newsvendor and was not insured, and had no income when he ceased work, and was thus unable to pay the rent for his rooms. His mother was dead and it meant that he would have to sell up his furniture, and he would have had no place to return to on his discharge. The Committee took up the matter with a Benevolent Association, who promised to pay for the rent of the rooms if the patient agreed to go away. The man then agreed to go and he was admitted in due course, and the rent was paid for the whole period he was away. The Committee granted extra nourishment whilst he was awaiting admission, and also on his discharge pending his resuming work. D.McG., aged 45. This case was brought to the notice of the Committee as the patient had been offered a vacancy at Lowestoft, but he needed some articles of clothing before he could be sent away. The Committee were able to obtain these for him, and they kept in touch with the family during the whole time he was away; and later, when the need arose, financial assistance was obtained for the family. The wife found it impossible to pay the fare to go and see him, and after he had been away for some time the Committee arranged for her expenses to be paid to Lowestoft to visit him. Whilst away the man was worried about his son, who had been at sea and had lost his post owing to missing his boat through failure to catch the train connection. The Committee took up the matter with the company after investigation, with the result that the boy was re-instated and placed on the next outgoing ship. A.M., aged 34. This patient, who is a widow and has no children, was living alone in lodgings, supporting herself by dressmaking. She developed tuberculosis and had to give up her work and was recommended for Sanatorium treatment. An early vacancy was obtained for her, and the Committee were able to grant help for a few days pending her admission. She had two small dogs to whom she was devoted, and she left them in the care of her landlady. The patient's only income was her National Health 128 Insurance benefit of 7s. 6d., and from this she had to pay 5s. 0d. per week for her room to be kept on, and the balance she agreed to pay to the landlady for looking after her dogs. This left her with no pocket money and she was worried and anxious about the care of her dogs. The Committee were able to obtain financial assistance for the support and care of the dogs during the patient's absence, and later to defray the cost of their licences, and this enabled the patient to have a little weekly pocket money which made all the difference to her stay in sanatorium. F.T., aged 55. Ex-service man found to be suffering from Tuberculosis and unfit for work. He was recommended for sanatorium treatment and granted extra nourishment by the Committee pending his admission, and financial assistance was obtained for his family whilst he was away. On his return the Committee considered the question of employment for him, and found that he had received training in basket making and had worked for a period at this trade and was anxious to resume, but he had no tools. The Committee were able to obtain a grant for this and he was thus enabled to start again and supplement his pension. (Signed) G. MACDONALD. Tuberculosis Officer. 129 TABLE I. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole District during 1930 and Previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Rate. * of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. * Number. Number Rate per 1,000 Nett Births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1920 166,093 B.† 165,664 D.† | 4,218 4,669 28.1 2,393 14.4 700 386 386 83 2,079 12.5 1921 169,200 3,580 3,742 22.1 2,445 14.5 800 415 276 74 2,060 12.2 1922 169,200 3,577 3,665 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 1930 160,700 2,880 2,652 16.5 2,716 16.9 1,227 357 145 55 1,846 11.5 Area of District in acres (land and inland water), 2,163 acres. Total population at all ages, 159,542 (Census, 1931, preliminary report); number of occupied separate dwellings, 27,191 ; average number of persons per occupied separat# dwelling, 6.17 (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. 130 TABLE II. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1930. 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 7 ... ... 5 ... 2 ... 5 2 ... 5 2 ... Diphtheria 489 9 141 284 38 17 ... 247 184 58 246 184 58 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 76 4 3 4 5 53 7 37 26 13 16 9 2 Scarlet Fever 566 4 151 332 50 29 ... 275 177 114 273 175 83 Enteric Fever 3 ... ... 1 ... 2 ... 2 1 ... 2 1 ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 9 ... ... ... 2 7 ... 6 1 2 3 1 2 Puerperal Pyrexia 20 ... ... ... 7 13 ... 11 2 7 7 2 6 Meningococcal Meningitis 2 1 ... ... ... ... ... 2 ... ... 2 ... ... Ophthalmia Neonatorum 34 34 ... ... ... ... ... 15 10 9 7 ... 1 Polio-myelitis, &c. 1 ... 1 ... ... ... ... 1 ... ... 1 ... ... Encephalitis Lethargica 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... Polio-encephalitis 1 ... 1 ... ... ... ... 1 ... ... 1 ... ... Malaria 2 ... ... ... ... 2 ... 1 1 ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Influenzal Pneu 43 1 4 3 5 28 2 20 7 16 6 1 3 Acute Primary Pneu. 321 30 60 54 44 109 24 150 129 42 57 38 18 Totals 1,575 83 361 684 151 263 33 774 540 261 627 413 173 T uberculosis— Pulmonary 240 ... 1 6 82 148 3 91 67 82 ... ... ... Non-Pulmonary 46 ... 7 16 14 9 ... 22 12 12 ... ... ... Totals (Tuberculosis) 286 ... 8 22 96 157 3 113 79 94 ... ... ... Totals 1,861 83 369 706 247 420 36 887 619 355 627 413 173 Whooping-cough* 399 60 235 101 2 1 ... 120 165 114 13 19 8 Measles* 2,909 149 1,547 1,179 22 12 ... 1,328 960 621 125 84 29 Grand Totals 5,169 292 2,151 1,986 271 433 36 2,335 1,744 1,090 765 516 210 131 TABLE III Causes of, and Ages at, Death during the Year 1930. CAUSES OF DEATH. Nett Deaths at subjoined ages of "Residents" whether Occurring within or without the District. Total Deaths of "Residents" and "NonResidents" in Institutions in the District. All Ages. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years upward. 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 38 7 19 11 1 ... ... ... ... 33 4. Scarlet Fever 2 ... ... 1 1 ... ... ... ... ... 5. Whooping-cough 7 4 1 2 ... ... ... ... ... 7 6. Diphtheria 15 ... 3 7 3 ... 1 1 ... 2 7. Influenza 14 ... ... ... ... ... 2 5 7 3 8. Encephalitis Lethargica 3 ... ... ... ... ... 2 1 ... 2 9. Meningococcal Meningitis 2 1 ... ... 1 ... ... ... ... 2 10. Tuberculosis of respiratory system 137 1 ... ... 3 33 56 39 5 126 11. Other tuberculous disease 25 1 1 4 3 5 7 2 2 33 12. Cancer 242 ... ... 1 1 ... 17 108 115 248 13. Rheumatic Fever 6 ... ... ... 2 2 1 1 ... 7 14. Diabetes 11 ... ... ... ... 1 1 2 7 14 15. Cerebral Haemorrhage, etc. 62 ... ... ... ... ... 1 22 39 71 16. Heart Disease 468 ... ... ... 3 7 21 96 341 561 17. Arterio-sclerosis 52 ... ... ... ... ... 1 11 40 17 18. Bronchitis 72 2 ... 1 ... ... 3 19 47 32 19. Pneumonia (all forms) 101 18 4 4 3 1 13 30 28 89 20. Other respiratory diseases 23 ... ... 2 1 ... 2 8 10 10 21. Ulcer of Stomach or Duodenum 28 ... ... ... ... ... 3 15 10 30 22. Diarrhœa, &c. 27 20 1 ... ... ... 2 ... 4 32 23. Appendicitis and Typhlitis 13 ... ... ... 4 ... 1 4 4 23 24. Cirrhosis of Liver 8 ... ... ... ... ... 2 4 2 11 25. Acute and Chronic Nephritis 81 1 ... ... 1 ... 8 33 38 76 26. Puerperal Sepsis 4 ... ... ... ... 2 2 ... ... 6 27. Other diseases of Pregnancy 6 ... ... ... ... 2 4 ... ... 6 28. Congenital Debility and Malformation, Premature Birth 75 72 ... 1 1 1 ... ... ... 52 29. Suicide 15 ... ... ... ... 2 3 6 4 19 30. Other deaths from Violence 69 ... 1 1 7 12 15 10 23 88 31. Other Defined diseases 240 18 4 5 8 13 31 68 93 286 32. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... 1 All Causes M. 955 87 16 26 21 38 107 280 380 964 F. 891 58 18 14 22 43 92 205 439 923 Totals 1846 145 34 40 43 81 199 485 819 1887 132 East Battersea. TABLE IV. Infant Mortality, 1930. 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 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 1 ... ... 3 3 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... 1 3 1 5 4 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Premature Birth 5 6 9 2 ... ... 1 ... ... ... 15 8 ... ... ... ... ... ... ... ... 15 8 Congenital Malformation 1 ... ... ... 2 ... ... ... ... ... 3 ... ... ... 1 ... ... ... ... 1 4 1 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Atelectasis & Asphyxia Neonatorum ... ... 2 ... ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... 2 ... Lack of Care 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... 2 Totals 7 6 12 2 2 ... 1 2 ... ... 22 10 1 2 5 3 2 2 5 5 35 22 13 14 2 3 ... 32 3 8 4 10 57 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1070 45 1115 50 7 57 133 North-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1930. 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 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... 4 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 1 2 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis Tuberculous Menin- gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Pneumonia, all forms ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 1 1 ... ... 5 ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 9 1 1 ... ... ... 4 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 2 5 3 3 3 ... 1 1 ... ... 9 9 1 ... ... ... ... ... ... ... 10 9 Congenital Malformation ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... 2 1 Congenital Debility ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Icterus Neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis and Asphyxia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... 1 2 Totals 2 6 6 4 3 ... 1 1 ... ... 12 11 7 3 3 3 8 2 2 ... 32 19 8 10 3 2 ... 23 10 6 10 2 51 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 793 45 838 45 6 51 134 South-West Battersea. TABLE. IV.—(contd.) Infant Mortality, 1930. 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 Small-pox m. f. m. f. m. F. m. f. m. f. m. f. m. f. m. F. m. f. M. f. m. f. Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Menin- gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia, all forms ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... 1 1 ... ... 2 2 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 1 ... ... 4 2 Syphilis ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 2 ... 4 1 ... 1 ... ... ... 1 6 3 ... ... ... ... ... ... ... ... 6 3 Congenital Malforma- tion 1 ... ... 2 ... ... ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 2 4 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... Atelectasis & As- phyxia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lake of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 3 ... ... 1 5 Totals 3 ... 6 5 1 1 1 1 ... 1 11 8 1 3 2 1 4 5 2 ... 20 17 3 11 2 2 1 19 4 3 9 2 37 Nett Births in the year. [###}Legitimate. Illegitimate. Total.[/###} 665 34 699 Nett Deaths in the year(Infants under 1 year) [###}Legitimate. Illegitimate. Total.[/###} 30 7 37 135 Borough of Battersea. TABLE IV.—{contd.) Infant Mortality, 1930. 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 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. f. ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.69 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 1 6 1 4.83 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... 2 2 2.76 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethar- gica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Menin- gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.69 Pulmonary Tubercu- losis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 0.69 Tuberculous Menin gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.69 Bronchitis ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 1.38 Pneumonia (all forms) ... ... ... ... ... ... 1 1 ... ... 1 1 3 2 2 2 4 3 ... ... 10 8 12.41 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 3 5 1 3 2 3 1 13 7 13.79 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.69 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0.69 Syphilis ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 1.38 Premature Birth 9 11 16 6 3 1 2 1 ... 1 30 20 1 ... ... ... ... ... ... ... 31 20 35.17 Congenital Malforma- tion 2 ... 2 2 2 ... ... ... ... ... 6 2 ... 2 2 1 ... ... ... 1 8 6 9.65 Congenital Debility ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 1.38 Icterus Neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.69 Injury at Birth ... ... 3 ... 1 ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 4 ... 2.76 Atelectasis & As- phyxia Neonatorum ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... 1.38 Lack of Care 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.69 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... 2 ... ... ... 1 ... ... ... 3 1 ... ... 2 1 3 ... 1 2 9 7.59 12 12 24 11 6 1 3 4 ... 1 45 29 9 8 10 7 14 9 9 5 87 58 100.00 Totals 24 35 7 7 1 74 17 17 23 14 145 -— Percentage of Total 16.6 24.1 4.8 4.8 0.7 51.0 11.7 11.7 15.9 9.7 m. 60.0 f. 40.0 Nett Births in the year. Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M. 1,332 61 1,393 75 12 87 F. 1,196 63 1,259 50 8 58 Totals 2,528 124 2,652 125 20 145 136 TUBERCULOSIS SCHEME OF THE BATTERSEA (a) Pulmonary Annual Return showing in summary form the condition of all (or Dispensaries) at the end of 1930, arranged according to the Treatment for pulmonary tuberculosis, and their Condition at the time of the last record made during the year to which the Return relates. Previous to 1921. 1921—5. 1926. 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 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. - - - - 54 5 3 - — 3 — — — — - f. - - - - 62 5 - - - - - - - - - Children m. - - - - 108 2 - - - - - - - - - f. - - - - 111 2 1 — - 1 - - — — — Disease arrested. Adults m. 6 3 5 - 14 4 1 1 1 3 2 — 1 — 1 f. - 2 3 - 5 5 1 2 — 3 3 — — — - Children m. 11 - - - 11 5 1 1 — 2 - - - - - f. 12 - — — 12 2 - — — — — — — — — Disease not arrested. Adults m. 10 12 6 - 28 1 12 24 — 36 3 4 12 2 18 f. 4 4 1 - 9 8 7 8 2 17 1 2 5 2 9 Children m. 4 - - - 4 1 - - - - - - - - - f. 2 2 - — 4 4 — 1 — 1 1 — — — — Condition not ascertained during the Year. 17 4 1 1 23 14 3 5 1 9 4 3 2 5 Lost sight of or otherwise removed from Dispensary Register. — _ — — 572 85 43 83 33 159 14 6 17 5 28 DEAD. Adults m. - - - - 240 21 19 109 126 254 2 2 20 27 49 f. — — - - 183 7 12 54 92 158 5 — 11 18 29 Children m. - - - - 11 3 — 2 3 5 - - - - - f. - - - - 31 5 1 4 1 6 — — — 2 2 TOTALS - — - - 1,482 183 104 294 259 657 35 14 69 58 141 137 METROPOLITAN BOROUGH COUNCIL. Form T56. Tuberculosis. Patients whose case records are in the possession of the Dispensary years in which the patients first came under Public Medical classification as shown on Form A. 1927. 1928. 1929. 1930. 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). 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.) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 1 1 - 2 1 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 5 4 8 2 14 6 9 22 1 32 16 14 24 6 44 26 14 35 11 60 3 - 7 1 8 10 2 13 1 16 12 5 14 6 25 18 8 21 6 35 1 — 1 - 1 1 - - - - 1 - - — - 5 - - - - 1 - 1 — 1 - - - - - 2 - 1 1 2 - - - - - - 1 2 1 4 5 2 5 3 10 7 1 6 2 9 - - - - - 20 2 22 2 26 9 5 13 7 25 8 6 13 3 22 2 — 6 3 9 2 2 21 22 45 4 1 15 18 34 1 2 12 23 37 4 - 5 6 11 5 — 18 18 36 5 - 8 26 34 3 3 7 14 24 2 - 2 6 8 1 - - - - - - - - - - - - - - 1 - - - - - — 1 — 1 1 — — — — — — — — — - - - 1 1 41 10 82 46 138 42 19 76 56 151 51 31 77 55 163 58 22 69 33 124 138 (b) Non-Pulmonary Annual Return showing in summary form the condition of all (or Dispensaries) at the end of 1930, arranged according to the Treatment, and their classifica- Condition at the time of the last record made during the year to which the Return relates. Previous to 1921. 1921—5. 1926. 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 — — 1 3 4 — — — - - F. — — — — 1 — — 1 2 — — — — - Children m. 1 - - 10 11 3 3 — 20 26 — — — 1 1 F. 4 2 2 9 17 2 3 — 11 16 — — — 2 2 Disease arrested. Adults M. 1 — — — 1 — 1 2 — 3 1 1 — — 2 F. — — - - — 1 1 — 1 3 — — — — — Children M. 3 - - 3 6 5 1 1 8 15 — — 1 1 2 F. — - - 3 3 1 1 — 9 11 - — — — — Disease not arrested. Adults M. - - - - - - - - - - - - - - 1 F. — — 1 1 2 — — 3 — 3 — - - 2 2 Children M. — — — — — 2 2 1 13 18 2 2 1 6 11 F. - - - 3 3 1 1 — 7 9 2 — — 3 5 Transferred to Pulmonary 1 - - - 1 1 1 — — 2 — — 1 — 1 Condition not ascertained during the Year. — — — 5 5 5 2 1 12 20 4 - 1 7 12 Lost Sight of or otherwise removed from Dispensary Register. 19 8 15 47 89 22 3 7 42 74 3 3 2 6 14 DEAD. Adults M. 1 - - — 1 4 - 1 - 5 - - - - - F. 1 1 — 3 5 1 1 4 2 8 - - - - - Children M. — — — — — 2 — — 1 3 — — 1 — 1 F. 1 - - 8 9 — 1 — 2 3 — — — — — TOTALS 33 11 19 93 156 51 21 21 132 225 13 6 7 28 54 139 Tuberculosis. Form T 56. Patients whose case records are in the possession of the Dispensary years in which the Patients first came under Public Medical tion as shown on Form A. 1927. 1928. 1929 1930. 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 - - - - - - - - - - - - - - - - - - - - — — — 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3 — — — 3 2 1 - - 3 1 - - 1 2 — — — — - 1 — 1 1 3 - - - - - - - - 2 2 - - - - - 1 — — — 1 1 - - — 1 — 1 1 — 2 — — — — — — — — 1 1 1 - - - - - - - - - - - - - - 2 — — 1 3 1 - 1 - 2 - 2 - 1 3 3 1 1 1 6 — — 1 1 1 - 2 i 4 2 i 2 5 4 1 1 6 12 — 1 1 — 2 1 — — 2 3 - - - 6 6 4 2 1 4 11 — 1 1 5 7 - 1 1 1 3 - - - 2 2 2 2 2 4 10 - - - - - - - - - - - - - - - - - - - - 2 1 2 1 6 1 — — — 1 4 — — 5 9 — — — — — 2 2 2 6 12 2 2 1 6 11 1 — — — 1 — 1 — 3 4 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — — — - — 1 - 1 - - - - - - - - - - 12 5 7 17 41 10 4 6 10 30 8 3 2 19 32 13 7 5 18 43 140 Form T53. TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary (or Dispensaries) during the year 1930. 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 100 62 4 1 4 9 13 8 104 71 17 9 (b) Doubtfully tuberculous — — — - - - - - 30 31 16 16 (c) Non-tuberculous — — — — - - — — 87 103 56 54 B.—Contacts examined during the year:— (a) Definitely tuberculous — - - — - - - 2 - - - 2 (6) Doubtfully tuberculous - - - - - - - - - 1 3 3 (c) Non-tuberculous — — - — — — — — 14 35 53 42 C.—Cases written off the Dispensary (a) Cured 4 3 5 2 2 - 10 1 6 3 15 3 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 121 157 121 109 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 365 213 40 45 36 43 104 69 401 256 144 114 (b) Diagnosis not completed — — — — — — — — 17 17 12 10 1. Number of persons on Dispensary Register on January 1st 947 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 31 2. Number of patients transferred from other areas and of "lost sight of " cases returned 30 10. Number of consultations with medical practitioners :— 32 3. Number of patients transferred to other areas and cases "lost sight of" 122 (b) Otherwise 347 11. Number of other visits by Tuberculosis Officers to Homes 133 4. Died during the year 96 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,292 5. Number of observation cases under A (b) and B (6) above in which period of observation exceeded 2 months 8 13. Number of 616 (a) Specimens of sputum, &c., (& 689 outside 130 6. Number of attendances at the Dispensary (including Contacts) 3,621 (b) X-ray examinations made in connection with Dispensary work 7. Number of attendances of non-pulmonary cases at Orthopedic Outstations for treatment or supervision 14. Number of Insured Persons on Dispensary Register on the 31st December 542 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 113 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) " Light " treatment 133 16. Number of reports received during the year in respect of Insured Persons:- (b) Other special forms of treatment 204 (a) Form G.P. 17 1 (b) Form G.P. 36 131 Cured cases re-entered as new cases — Nil.