C .I. AC-4386 dept BAT 30 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1931. 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. 1. Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1931. 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 10th November, 1930. As constituted 9th November, 1931. 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. Reed. „ Mrs. M. J. Robinson. „ Mrs. M. H. Rose. C.A. warner.* Chairman : Councillor Capt. A. P. Godfrey. His Worship the Mayor. (Councillor G. H. Eaton, j.p.). Councillor J. R. Archer. ,, Mrs. K. S. D. Baker. „ Miss E. J. E. Butcher. „ Dr. H. B. Dodwell. Mrs. J. L. Eaton. „ Mrs. A. M. Gorringe. „ J. Hendrick. „ D. Jenkins. ,, Mrs. F. E. Mills. Mrs. A. M. Mossman. „ _ Mrs. M. J. Robinson. Maternity and Child Welfare Committee. 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. As constituted 9th November, 1931. Chairman : Councillor Mrs. K. S. D. Baker. His Worship the Mayor. (Councillor G. H. Eaton, j.p.). The Health Committee, as above. Mousing Committee. 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. As constituted 9th November, 1931. Chairman : Councillor J. A. Campbell. His Worship the Mayor. (Councillor G. H. Eaton, j.p.). Councillor C. Barrington. „ Miss E. J. E. Butcher. „ H. W. Carpenter, j.p. „ A. V. Clarke, a.m.i.c.e., m.i.m.e., l.c.c. „ H. Harling. W. E. Heath. „ S. B. Sanderson. „ E. S. Strange, j.p. „ E. Sullivan. Alderman I. O. Thomas. Councillor H. G. White. Committee to issue certificates and reports under the kent and Mortgage Interest(Restrictions) Acts, 1920 and 1925, as to the condition of dwelling houses. 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. As constituted 9th November, 1931. Chairman : Councillor J. A. Campbell. His Worship the Mayor. (Councillor G. H. Eaton, j.p.). Councillor H. Harling. „ R. Moore. „ E. S. Strange, j.p. H. G. White. Appointed 23rd December, 1930, in place of Mrs. M. H. Rose, deceased. 2. Tuberculosis (Committee. The Health Committee, as above. Tuberculosis (Care (Committee. 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). 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 9th November, 1931. Chairman—Councillor Mrs. K. S. D. Baker. Councillor J. R. Archer. „ Mrs. J. L. Eaton. „ Mrs. A. M. Gorringe. „ Mrs. F. E. Mills. Other Member : Mrs. E. W. Coles Representative of the London Insurance Committee : Mr. C. F. Botten. Representatives of the Local Public Assistance Committee : Mrs. E. S. Carpenter. Mrs. F. Young. Member of the late Dispensary Committee : Mrs. A. Dermott. Members of the late Voluntary Care Committee : Miss B. Home. Miss E. Morris. Consultative Members : L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas) Representative of the Invalid Children's Aid Association. Representative of the War Pensions Committee (Mr. T. Jones). Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner. King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Hamilton). Lady Almoner, St. Thomas's Hospital (Miss C. Morris). After-Care Sister, Victoria Hospital (Miss E. M. White). Representative of the S.L. District Nursing Association (Miss A. M. Stanford). Representative of the British Red Cross Society (Mrs. C. E. Peach). Health Visitor and Sanitary Inspector (Miss J. Round). 3 Staff of public Health Department. (At 31st December, 1931). Assistant M.O.H., Deputy M.O.H. in absence of M.O.H., and Tuberculosis Officer- G. MACDONALD, M.A., M.B., Ch.B., D.P.H Assistant Tuberculosis Officer (part time)—(Mrs.) M. J. O'FLYNN, B.A., M B., B Ch., B A O. 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) E. A. MOWER WHITE, M.R.C.S., L.R.C.P. Medical Officer, Diphtheria Immunisation Clinic— F. PORTER SMITH, M.R.C.S., L.R.C.P. Consultant Obstetrician, Borough Maternity Hospital— F. W. 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, SanInsp. 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. One temporary Health Visitor. Sanitary Inspectors— Mr. J. Lawrence, Cert. San. Inst, and Meat Insp. Cert. (Senior Insp.) District Inspectors. 1. Mr. W. E. Selway, Cert. S.I.E.J.B., and Meat Insp. Cert. 2. Mr. J. J. Burgess, San. Insp. Board's Cert. 3. Mr. H. H. May, Cert. San. Inst. 4. Mr. F. H. Chuter, San. Insp. Board's Cert. & Meat Insp. Cert. 5. Mr. J. R. Holloway, San. Insp. Board's Cert. 6. Mr. C. Binding, San. Insp Board's Cert, and Meat Insp. Cert. 8. Mr. G. Weeks, Cert. S.I.E.J.B, and Meat Insp. Cert. Mr. H. E. Wheeler (Housing) San. Insp. Board's Cert., and Meat Insp. Cert. One temporary Inspector. 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. A. E. Tubby. 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. R. Graham Miss G. E. Newton. Miss R. Dove. Mr. F. Pedrick. Mr. P. Brooking. Office youths. Miss M. A. Weller (M. Sc. C.W. Records). One temporary Clerk. Maternity Home—- Matron—Miss M. Fevyer, Cert. C.M.B. Sister—Miss J. Brown—4 Staff Nurses. Borough Midwife (District Service)—Miss K. Morrison. Tuberculosis Dispensary— Tuberculosis Nurses—Miss M. Schotburgh, Miss B. O'Connor, Miss C. Thompson. Secretary and Clerk—Miss L. Wadham. Dispenser—Miss E. F. Davies. Clerks—Miss C. Turner. Miss M. E. Brown. Disinfecting Station—Superintendent—C. Woodhouse. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer—-See page 53. 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, 1931. It is again my privilege to record the high position which the Borough continues to maintain as one of the healthiest in the Metropolis. The vital and morbid statistics for the year under report are satisfactory and show little deviation from the uniformly high standard of recent years. The birth-rate however, it is to be regretted, shows a slow but stead}' decline, the rate for 1931 being the lowest yet recorded. The general death-rate and the infantile mortality rate, though slightly higher than in the previous year, are nevertheless satisfactory having regard to the great industrial depression and increase of unemployment—conditions which tend to lower resistance in the individual and to predispose to ill-health and disease. Infectious disease has been remarkably non-prevalent, in the year's morbid statistics, with the exception of Tuberculosis, which shows a slight increase in mortality as compared with previous years. The Maternity and Child Welfare work of the Council has been carried on satisfactorily during the year, and the results attained have been as successful as in past years. Owing to the need for strict economy in the present financial stringency, it has not been considered opportune to attempt any further developments in this field of Public Health Activity, involving additional expenditure. The Ante-Natal side of the Maternity and Child Welfare work has been maintained at a high standard of efficiency, as will be seen from an inspection of the figures in the chapter of the Report dealing with Maternity and Child Welfare. The Housing activities of the Council were mainly concerned with the repair of unfit houses and the development of the St. John's College Housing Estate, the purchase of which was completed in 1930. The plans and lay-out of the Estate, which, when completed, will provide 272 working-class tenements on the Estate, will provide a valuable contribution to the Housing needs of the Borough. The erection of these dwellings was pressed forward towards the close of the year and the first block of 39 dwellings was expected to be ready for occupation in the Spring, and the second block of 50 tenements by the Autumn of 1932. 6 The passing into Law of the Housing Act of 1930, conferred important additional powers and duties on Local Authorities. Under the Act it is the Statutory duty of the Local Authority to make a quinquennial survey of the Housing needs of their districts and to submit a programme of their proposals for the ensuing quinquennium to the Central Authority. In accordance with the instructions of the Housing Committee a recent survey of the Borough has been carried out and a report was submitted to them early in 1932. 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. To my Colleagues, the Chief Officers of the Council, I am indebted for much valuable assistance and co-operation. To the Staff of the Public Health Department my thanks are also due for their efficient and loyal services always willingly rendered. (Signed) G. QUIN LENNANE, Medical Officer of Health. Electric House, Lavender Hill, S.W. 11. August, 1932. 7 CONTENTS. General. Page Introduction 5-6 Committees 1-2 Staff 3-4, 53, 58, 85 Vital Statistics. Summary 9, 18, 19, 21 Census—Population 10 Births—General Tables 10-12, 18, 20 Notification of Births Act: Still Births 12, 16-17, 18 Marriages 12 Deaths—General Tables ; Public Institutions ; Senile Mortality 12-15 18, 20. 123 „ Infant Mortality 15-17, 18, 20, 124-127 Maternity and Child Welfare Scheme 21-45 Centres, Municipal and Voluntary 21-24, 32-34 Health Visiting Staff and Work 3, 23, 24 Day Nursery 25 Ambulances 25 Hospitals 25, 35 Unmarried Mothers 26 Home Helps 26 Milk and Dinners for Necessitous Mothers and Children 27 Convalescent Treatment 28 Midwives 28, 42 Nursing 28-29 Test Feeding (St. Thomas's Babies Hostel) 29 Ante-natal Work 30—37 Reports of Work at Centres 30-33 V.D. Clinic 35-7 Maternal Mortality 38-9 Maternity Hospital 39-42 District Midwifery Service 42-43 Dental Clinic 43-44 Solarium 44-45, 60, 117 Infectious Diseases (Notifiable) 46-66, 122 List of Notifiable Diseases 46 Contacts 46, 48 Summary Tables 47, 122 Incidence of the several Notifiable Diseases 48-66 Diphtheria Prophylaxis (Schick Clinic) 49 Vaccinators 53 Tuberculosis 54-66, 112-120, 128-132 Notifications 54-55 Deaths and Death-rates 54-55, 57 Localisation in Notified Cases 56 Non-notification and Delayed Notification 56-57 Shelters 58 Dispensary—Staff and Work carried out 58-60 Bacteriological and X-Ray Examinations 58, 60, 112, 116 Open-air School (Springwell House) 59,117 Care Committee 2, 59, 113, 118 Dental Treatment 59, 117 Institutional and Artificial Sunlight Treatment 59, 60, 116, 117 Non-Dispensary Patients 61 Contacts 59, 112, 116 Tuberculosis Regulations, 1925 and 1930 62-63 Revision of Register 63-66 Summary Tables 64-66 Tuberculosis Officer's Report 112 Zymotic Diseases 67 8 Page Infectious Diseases (Non-notifiable) 67-69 Bacteriological Examinations 70 Sanitary Circumstances. Summary Table 71 Legal Proceedings 72-77 Common Lodging Houses 77 Drains 78 Houses Let in Tenements 79 Licensed Premises (Sanitary Conveniences) 79 Smoke and Effluvium Nuisance 79, 80 Offensive Matter, Removal of 80 Water Supply 80 Van Dwellings 80 Rag Flock Acts 81 Rats and Mice 81 Dogs—Nuisances by 81 Personal Cleansing Station 82 Disinfecting Department 83 Coroner's Court and Mortuary 83-84 Staff 85 Protection of the Food Supply. Unsound Food 86 Cow-Houses, Slaughter-Houses, Butchers' Shops 86-87 Public Health (Meat) Regulations, 1924 87 Food and Drugs (Adulteration) Act, 1928 87 Results of Analyses 88-95 Bacteriological Examinations 88,91, 95 Milk—Analysis; Imported; Condensed 90-92 Other Foods 93, 94 Milk Shops and Milk Orders 94—95 Ice Cream 94 Preservatives in Foods 95 Agricultural Produce and Merchandise Marks Acts 96 Artificial Cream Act 96 Fish Shops, Restaurants, Food Stalls 96 Factories and Workshops—General Tables 97 Factories and Workshops 98-100 Homework 100-102, 103 Bakehouses, Warehouses and Wharves 102 Housing—Generally 104-111 Overcrowding 104 Unfit Houses 105, 108 Appeals : Closing and Demolition Orders 106 Underground Rooms 107 Increase of Rent Acts; Rent Books 107 Statistics 110 Appendix. Summary Tables 121-132 Tuberculosis Officer's Report 112-120, 128-132 9 Summary of Statistics 1931. 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 1931) 159,800 Number of private families—Census 1921 42,988 Census 1931 44,618 Structurally separate occupied dwellings (Census, 1921) 27,191; Census 1931 27,219 Rateable value (average 1931) £1,040,736 Sum represented by a penny rate £4,410 2. Extracts from Vital Statistics of the Year. Births— Males, 1,233 ; females, 1,244 2,477 Legitimate births (1,180 males; 1,201 females) 2,381 Illegitimate „ (53 males ; 43 fema'es) 96 Birth-rate 15.5 Deaths— Males, 992; females, 939 1,931 Percentage of total Deaths occurring in Public Institutions (Battersea deaths only) 53.7 Death-rate 12.1 Number of women dying in or in consequence of childbirth— From sepsis 5 Other causes 10 Death-rate of infants under 1 year per 1,000 live births. Legitimate 56.3 Illegitimate 83.3 57.3 Deaths from Measles (all ages) 2 „ Whooping-cough (all ages) 5 ,, Diarrhoea (under 2 years of age) 9 3. Census— Population Inhabited houses 1921 167,739 27,191 1931 159,552 27,219 10 Vital Statistics. The revised report of the Registrar-General upon the Census taken on the 26/27th April, 1931, shows the population of Battersea to be 159,552, as compared with 167,739 at the Census of 1921, a decrease of 8,187. 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. Estimated Mid-Year Population, 1931. Males. Females. Total. East Battersea 31,249 33,337 64,586 North-West Battersea 21,933 22,783 44,716 South-West Battersea 22,441 28,057 50,498 Total 75,623 84,177 159,800 Wards. No. 1. Nine Elms 12,640 12,861 25,501 No. 2. Park 7,977 8,947 16,924 No. 3. Latchmere 8,781 9,641 18,422 No. 4. Shaftesbury 6,801 7,330 14,131 No. 5. Church 8,295 8,486 16,781 No. 6. Winstanley 9,505 9,712 19,217 No. 7. St. John 3,745 4,827 8,572 No. 8. Bolingbroke 8,390 10,120 18,510 No. 9. Broomwood 9,489 12,253 21,742 Tota 75,623 84,177 159,800 BIRTHS. The number of births registered in the Borough during 1931 was 2,788 (1,415 males, 1,373 females), an excess of 42 males. Of this number, 669 were transferred out, the permanent residence of the parents being outside the Borough. and 358, registered outside the Borough, were transferred here, giving on balance a total of 2,477 births relating to Battersea residents, and a corrected birth-rate of 15.5 per 1,000 of the population. This is a decrease on that of 1930, and the birth-rate is the lowest so far recorded in Battersea. 11 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 1931. Sub-Districts. Estimated Population, 1931. Number of Births. Birthrate. East Battersea 64,586 1,079 16.7 North-West Battersea 44,716 696 15.6 South-West Battersea 50,498 702 13.9 Wards. No. 1. Nine Elms 25,501 455 17.8 No. 2. Park 16,924 286 16.9 No. 3. Latchmere 18,422 310 16.8 No. 4. Shaftesbury 14,131 204 14.4 No. 5. Church 16,781 231 13.8 No. 6. Winstanley 19,217 314 16.3 No. 7. St. John 8,572 139 16.2 No. 8. Bolingbroke 18,510 284 15.3 No. 9. Broomwood 21,742 254 11.7 The next table shows the birth-rates in the Borough and ir the registration sub-districts in 1931, and during the previous decennium 1921-1930:— Birth-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. South-West Battersea. 1921 22.1 23.8 26.6 15.5 1922 21.7 230 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 1930 16.5 17.0 18.3 14.2 Average 1921-1930 18.4 19.9 21.1 13.7 1931 15.5 16.7 15.6 13.9 12 The birth-rate shows a decline in six Wards of the Borough and an increase in the three remaining Wards. The birth-rate in Battersea is 2.9 per 1,000 lower than the average for the previous decennium 1921-1930. The birth-rate for the County of London was 15.0 per 1,000 of the population, and for England and Wales the rate was 15.8. Illegitimate births numbered 96 or 3.88 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 1931, 66 stillbirths were registered as belonging to Battersea, the total number notified. being 61 i.e., 92-4 per cent, of the total registered. MARRIAGES. The marriages registered in Battersea during 1931 numbered 1,421. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 17.8 Year. Marriages. Marriage-Rate. 1926 1,304 15.2 1927 1,428 16.9 1928 1,354 16.5 1929 1,376 17.0 1930 1,444 18.0 Mean, 1926-30 1,381 16.7 1931 1,421 17.8 DEATHS. The number of deaths registered in the Borough during 1931 was 2,745. Of these 1,301 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 487 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,931 (males 992, females 939). This gives a recorded death-rate of 12 -1 compared with 12.4 for London, and 12.3 for England and Wales. According to the factor supplied by the Registrar-General, tor correction of death-rate in reference to age and sex distribution, the corrected death-rate for Battersea during 1931 was 11.7. 13 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 1931. Number of Deaths. Deathrate. East Battersea 64,586 799 12.4 North-West Battersea 44,716 505 11.3 South-West Battersea 50,498 627 12.4 Wards. No. 1. Nine Elms 25,501 292 11.4 No. 2. Park 16,924 236 13.9 No. 3. Latchmere 18,422 226 12.3 No. 4. Shaftesbury 14,131 167 11.8 No. 5. Church 16,781 196 11.7 No. 6. Winstanley 19,217 210 10.9 No. 7. St. John 8,572 88 10.3 No. 8. Bolingbroke 18,510 247 13.3 No. 9. Broomwood 21,742 269 12.4 The following table shows the age and sex distribution o the total deaths (corrected) in Battersea during 1931 :— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 84 28 9 6 55 99 323 388 992 F 58 31 3 7 45 84 216 495 939 Ttls. 142 59 12 13 100 183 539 883 1,931 %of Total 7.3 3.1 0.6 0.7 5.2 9.5 27.9 45.7 1000 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 343 323 666 Second quarter 236 214 450 Third quarter 179 186 365 Fourth quarter 234 216 450 Total 992 939 1,931 14 The death-rate, after falling from 14.2 in 1929 to 11.5 in 1930 increased to 12.1 in 1931. The increase in the rate was accounted for largely by the increased number of deaths from respiratory diseases and influenza. The death-rate was lowest in the St. John Ward (10.3), and highest in Park Ward (13.9). The deaths of persons over 65 years numbered 883 or 45.7 per cent. of the total deaths. The average age at death was 55.3 years, as compared with 53.7 in 1930. Decreased death-rates were recorded in three Wards. Death-rate per 1,000 Population. Year. The Borough. East Battersea. North-West Battersea. -West Battersea. 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 1930 11.5 11.6 11.1 11.7 Average 1921-30 12.0 12.0 12.2 11.7 1931 12.1 12.4 11.3 12.4 The natural increase of population (that is the excess of births over deaths) was 546 in 1931 as compared with 806 in 1930. Deaths in Public Institutions. During 1931 the deaths of Battersea residents occurring in Public Institutions numbered 1,037. Of this number 605 occurred within and 432 outside the Borough. Of the total Battersea deaths in Institutions 731 occurred in Public Assistance Institutions. 15 Senile Mortality. During 1931 the deaths of 883 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths which constituted 45.7 per cent. of the deaths at all ages 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 88 73 64 76 13 27 165 176 341 N.W. Battersea 50 66 40 45 7 6 97 117 214 S.W. Battersea 66 88 45 83 15 31 126 202 328 Borough of Battersea 204 227 149 204 35 64 388 495 883 Infant Mortality. During 1931 the deaths of 142 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,477, giving an infant mortality rate of 57.3 per 1,000 births, as compared with 54.7 in 1930, 62.6 in 1929, 64.2 in 1928, and 53.5 in 1927. It will be noted that the Infant Mortality rate was slightly higher during 1931 than in the previous year. The distribution of the 142 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 1,079 41 30 71 65.8 North-West Battersea 696 23 16 39 56.0 South-West Battersea 702 20 12 32 45.6 The Borough 2,477 84 58 142 57.3 Ward. 1. Nine Elms 455 18 12 30 65.9 2. Park 286 13 10 23 80.4 3 T atrhmprp 310 9 8 17 54.8 4. Shaftesbury 204 7 6 13 63.7 5. Church 231 8 3 11 47.6 6. Winstanley 314 11 8 19 60.5 7. St. John 139 2 4 6 43.2 8. Bolingbroke 284 10 4 14 49.3 9. Broomwood 254 6 3 9 35.4 16 It will be noted that in the Sub-Districts the rate was lowest in South-West Battersea (45 6), and highest in East Battersea (65.8). In the Wards, Broomwood showed the lowest rate (35.4) and Park Ward the highest (80.4). The infant mortality rate in the County of London and in England and Wales during 1931 was 65 and 65.9 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 641 51 79.6 Second quarter 640 26 40.6 Third quarter 609 27 44.3 Fourth quarter 587 38 64.7 The infant death-rate was 49.6 during the last 9 months of the year, as compared with 79.6 in the first 3 months. There were 68 deaths of infants during the first four weeks of life (or 47.9 per cent. of the total infant deaths) as compared with 74 deaths (or 51.0 per cent.) in 1930 and a percentage for the quinquennium (1926-1930) of 45.4. No infant death was recorded as having been due to Measles during the year. The deaths from developmental diseases were 75 as compared with 72* in 1930. 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 1926 to 1931. 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 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 1930 24 35 15 74 51.0 Total 1926-30 117 152 102 371 45.4 Mean do 23.4 30.4 20.4 74.2 — 1931 28 18 22 68 47.9 * The Registrar General's manual of the international list of causes of death was re-issued in revised form in 1931, the deaths from developmental diseases in 1930 based upon the new list were 74. 17 Certified Causes of Death. Months 0—3 Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Diphtheria — — 1 — 1 0.70 Measles - - - - - - Influenza 2 1 — — 3 2.11 Erysipelas — — 1 — 1 0.70 Whooping Cough — — 1 2 3 2.11 Meningococcal Meningitis — — — — — — Diarrhoea and Enteritis 2 1 2 2 7 4.93 General Tuberculosis — — — — — Tuberculous Meningitis — — 1 — 1 0.71 Pulmonary Tuberculosis — — — — — — Pneumonia 7 9 9 4 29 20.42 Bronchitis 2 3 1 1 7 4.93 Intussusception — — 1 — 1 0.70 Prematurity 41 — — — 41 28.88 Marasmus 3 — — — 3 2.12 Icterus Neonatorum... 1 — — — 1 0.70 Congenital Mai formations 18 2 1 — 21 14.79 Injury at Birth 1 — — — 1 0.70 Atelectasis&AsphyxiaN. 8 — — — 8 5.64 Syphilis 3 — — — 3 2.11 Convulsions — 1 I — 2 1 .41 Rickets — — 1 — 1 0.71 Lack of Care 1 — — — 1 0.70 Accident and Homicide 1 — — — 1 0.70 Miscellaneous 1 1 2 — 4 2.82 Overlying 2 — — — 2 1.41 Total 93 18 22 9 142 100.0 Percentage of Total 65.5 12.7 15.5 6.3 — 100.0 Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1931 was 83.3 per 1,000 births, as compared with 161.3 in 1930, 98.9 in 1929, 73.2 in 1928, and 89.9 in 1927. The corresponding deathrate of legitimate children in 1931 was 56.3, the ratio of the mortality rate of illegitimate infants to that of legitimate being 1.48 to 1. Notification of Births Act. During 1931 the number of notifications of live births received was 2,277. The corrected number of births registered during the year in Battersea was 2,477. The proportion of notified to registered births was, therefore, 91.9 per cent. There were 196 living and 5 still-births of Battersea children born outside the Borough notified from the districts in which these births occurred. 18 The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926. During 1931 there were 110 still-births registered in Battersea, of which 54 were of non-resident, and 56 of Battersea parents. Ten still-births occurring outside the Borough were registered as belonging to Battersea, making 66 in all. This total represents a still-birth-rate of 26.0 per 1,000 births (live and still) registered. Of the 66 still-births 5 (7.58 per cent.) were registered as illegitimate. 61 still-births (56 from within and 5 from without the Borough), were notified under the Notification of Births Acts during the year as belonging to Battersea, the number notified being 92.4 per cent. of the total Battersea still-births registered, and 2.40 per cent. of the total births registered. Notified births are visited and revisited by the Council's official Health Visitors or the health 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 1931:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 Live Births. 1. Poplar 17.5 1. Lewisham 10.2 1. Chelsea 42.2 2. Stepney 17.5 2. Greenwich 11.4 2. Lewisham 49.8 3. Bermondsey 17.4 3. Wandsworth 11.4 3. Deptford 53.3 4. Shoreditch 171 4. Hackney 11-5 4. Stoke Newington 53.9 5. Finsbury 17.1 5. Woolwich 11.6 5. Camberwell 56.2 6. Southwark 16.9 6. Hampstead 11.7 6. Bermondsey 57.2 7. Bethnal Green 16.8 7. Camberwell 11.9 7. Battersea 57.3 8. Islington 16.7 8. Deptford 12.0 8. Woolwich 59.4 9. Deptford 16.3 9. Battersea 12.1 9. Lambeth 60.4 10. Battersea 15.5 10. Hammersmith 12.2 10. Hackney 60.4 11. Hackney 15.5 11. Fulham 12.3 11. Hampstead 61.0 12. Hammersmith 15.3 12. Poplar 12.4 12. Southwark 61 .1 13. Lambeth 15.3 13. Shoreditch 12.5 13. Wandsworth 61.6 14. St. Pancras 15.2 14. Bethnal Green 12.5 14. Islington 62.9 15. Stoke Newington 15.2 15. Bermondsey ... 12.6 15. Greenwich 65.0 16. Fulham 15.1 16. Lambeth 12.7 16. St. Marylebone 65.6 17. Paddington 14.8 17. Islington 12.7 17. Finsbury 66.1 18. Greenwich 14.8 18. Stoke Newington 12.7 18. St. Pancras 67.4 19. Camberwell 14.7 19. Paddington 13.1 19. Fulham 67.5 20. Woolwich 14.6 20. St. Marylebone 13.1 20. Hammersmith 67.5 21. Kensington 14 .2 21. Stepney 13.1 21. Westminster 73.7 22. Lewisham 14.1 22. St. Pancras 13.4 22. Holborn 73.9 23. Chelsea 12.8 23. Westminster 13.6 23. Shoreditch 74.8 24. Wandsworth 12.3 24. Finsbury 14.0 24. Kensington 75.7 25. St. Marylebone 11.4 25. Southwark 14.0 25. Poplar 77.0 26. Hampstead 11.2 26. Chelsea 14.1 26. Stepney 78.1 27. Holborn 10.2 27. Kensington 14.1 27. City of London 80.6 28. Westminster 10.1 28. Holborn 14.3 28. Paddington 87.4 29. City of London 6.4 29. City of London 14.6 29. Bethnal Green 87.7 County of London 15.0 County of London 12.4 County of London 65.0 These rates are based upon the estimate furnished by the Registrar General of the population of each Borough at the middle of 1931. 19 COMPARATIVE STATISTICS OF BIRTHS, MORTALITY. &c Year. Mean population for year. Births. Birth Rate. Deaths. Death Rate. Zymotic Deaths. Natural Increase. 1857 15,970 582 36.4 343 21.4 46 239 1858 16,872 562 33.3 380 22.5 100 182 1859 17,774 685 38.5 394 22.1 96 291 1860 18,676 680 36.4 399 21.3 62 281 1861 19,582 750 38.3 505 25.7 112 245 1862 23,108 784 33.9 491 21.2 106 293 1863 26,635 1,042 39.1 522 19.5 86 520 1864 30,161 1,140 37.8 669 22.1 129 471 1865 33,688 1,357 40.3 785 23.3 177 572 1866 37,145 1,386 37.3 1,002 26.9 244 384 1867 40,741 1,734 42.5 870 21.3 122 864 1868 44,267 1,975 44.6 1,046 23.6 194 929 1869 47,749 2,096 43.9 1,121 23.4 247 975 1870 51,320 2,170 42.2 1,375 26.7 404 795 1871 54,847 2,220 40.4 1,472 26. 8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19.5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2 1,745 21.3 340 1,710 1877 87,094 3,481 39.9 1,725 19.8 280 1,756 1878 92,464 3,748 40.5 1,803 19.4 322 1,945 1879 97,834 4,001 40.8 1,980 20.2 355 2,021 1880 103,204 4,095 39.6 2,040 19.7 383 2,055 1881 108,342 4,452 41.8 2,033 18.7 381 2,419 1882 112,661 4,504 39.9 2,214 19.6 353 2,290 1883 116,980 4,711 40.2 2,344 20.0 369 2,367 1884 121,299 5,275 43.4 2,569 21.1 568 2,706 1885 125,618 4,654 37.0 2,566 20.4 432 2,088 1886 129,937 5,140 39.5 2,477 19.0 398 2,663 1887 134,256 5,186 38.6 2,451 18.2 502 2,735 1888 138,565 5,061 36.5 2,187 15.7 363 2,874 1889 142,884 5,161 36.1 2,240 15.6 366 2,921 1890 147,203 5,105 34.6 2,854 19.3 543 2,251 1891 150,880 5,237 34.7 2,697 17 .9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 159,724 5,024 31.4 2,577 16.1 526 2,447 1895 162,787 5,264 32.3 2,961 18.1 460 2.303 1896 165,309 5,358 32.4 2,994 18.1 642 2,364 1897 166,059 5,266 31.7 2,737 16.4 486 2,529 1898 166,814 5,157 30.9 2,892 17.3 531 2,265 1899 167,570 5,179 30.9 2,905 17.3 418 2,274 1900 168,339 5,161 30.6 2,978 17.6 435 2,183 1901 169,100 5,025 29 7 2,766 16.3 491 2,259 1902 171,401 4,844 28.2 2,581 15.0 367 2,263 1903 173,422 4,973 28.6 2,476 14.2 347 2,497 1904 175,465 4,849 27.5 2,543 14.4 353 2,306 1905 177,532 4,843 27.3 2,561 14.4 342 2,282 1906 179,622 4,654 25.9 2,384 13.2 321 2,270 1907 181,736 4,574 25.1 2,406 13.2 243 2,168 1908 183,873 4,629 25.1 2,272 12.3 228 2,357 1909 186,036 4,450 23.9 2,417 12.9 237 2,033 1910 188,222 4,489 23 7 2,124 11.3 209 2,365 1911 167,765 4,381 26.1 2,404 14.3 331 1,977 1912 167,589 4,255 25.4 2,052 12.2 133 2,203 1913 167,464 4,240 25.3 2,365 14.1 197 1,875 1914 167,338 4,303 25.7 2,217 13.2 142 2,086 1915 161,945 3,820 23.6 2,653 16.4 334 1,167 1916 {B* 173,432 3,774 21.8 — — — — { D*159,402 — - 2,221 13.9 160 1,553 1917 {B* 167,233 2,960 17.7 — — — — {D*150,023 — — 2,285 15.2 185 675 1918 (B* 168,014 2,700 16.1 — — — — (D*149,951 — — 2,809 18-7 204 -109† 1919 {B* 165,960 3,075 18.5 — — — — { D*159,316 — — 2,061 12.9 95 1,014 1920 {B* 166,093 4,669 28.1 - — — — {D* 165,664 — — 2,079 12.5 188 2,590 1921 169,200 8,742 22.1 2,060 12.2 173 1,682 1922 169,200 3,665 21.7 2,227 13.2 192 1,438 1923 170,600 3,434 20.1 1,839 10. 8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,805 10.5 64 1,379 1926 171,900 2.969 17.3 1,960 11.4 119 1,009 1927 169,000 2,801 16.6 2,065 12.2 57 736 1928 164 100 2.743 16. 7 1.954 11.9 111 789 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 1931 159,800 2,477 15. 5 1,931 12.1 33 546 • Population as estimated for purpose of (B) Birth-rate, (D) Death-rate, † Decrease. Census years in heavy type. 20 Chart Showing Birth, Death and Infant Mortality Rates in Battersea from 1858 to 1931. 21 Maternity and Child Welfare Scheme. The Maternity and Child Welfare Scheme of the Council includes Municipal and Voluntary effort and the activities of both are fully co-ordinated. 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 22. Other ancillary services included in the Scheme are :— (1) St. Mary's Hostel, Macaulay Road, Clapham Common (vide page 26). (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road (vide page 25). 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 1931 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 22 Name and Situation of Centre. Monday. Times of Opening. Friday. Tuesday. Wednesday. Thursday. 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. - Gideon Road, L.C.C. School - - *1.30 p.m. - 2.0 p.m. Maternity Hospital, Bolingbroke Grove (outpatient department) - *2.0 p.m. a.n. * 10.0 a.m. a.n. *10.45 a.m. a.n. - *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. 23 At each of the Centres a clinic is held, a woman Medical Officer and a nurse being in attendance. Each centre is under the supervision of a trained Health Visitor and voluntary helpers assist in the work of these centres. The Voluntary Centres are conducted on similar lines to those of the Municipal Centres. Owing to the economic situation no additional centres have been opened since 1930. The table on page 24 gives a summary of the work carried out at the Centres in 1931. 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 sixteen students from the Hygiene Department, Battersea Polytechnic, received a course of training under the Council's Maternity and Child Welfare Scheme, and on completion of their training certificates as to their work were supplied to the Polytechnic authorities. 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 1931 two of the Health Visitors were given leave of absence for the purpose. The home visiting carried out during 1931 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 2,505 422 2,927 To Notified Births 7,805 2,004 9,809 To Still-Births 79 11 90 To Children aged 1-5 years 4,062 3,047 7,109 To enquire into Infant Deaths 162 34 196 To cases of Notifiable Infectious Disease 2,706 320 3,026 To cases of Non-Notifiable Disease 808 178 986 Re prevention of Diphtheria 110 20 130 To Dental Cases 67 7 74 To V.D. Cases 14 - 14 Other Visits 933 818 1,751 Totals 19,251 6,861 26,112 24 Summarised Statistics Relating to Infant Welfare Centres, 1931 Municipal. Voluntary. Grand Total. " Southlands " Plough Road 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 99 141 99 121 100 560 94 51 72 217 777 Average attendances per session 34 47 50 50 46 46 39 29 30 34 42 Average ditto weekly 65 126 96 116 89 492 70 29 42 141 633 First attendances 200 432 316 357 234 1,539 241 42 193 476 2,015 Doctor's attendances 51 48 48 50 49 246 94 25 71 190 436 Babies seen by Doctor 909 1,389 1,351 1,363 1,156 6,168 2,420 277 1,288 3,985 10,153 Average ditto per attendance 18 29 28 27 24 25 26 11 18 21 23 Weights recorded 3,103 5,404 4,508 5,511 4.202 22,728 3.608 1,268 2,037 6,913 29,641 Advice only 268 1,160 483 540 407 2,858 37 228 152 417 3,275 Attendances 3,371 6,564 4,991 6,051 4,609 25,586 3,645 1,496 2,189 7,330 32,916 25 Day Nurseries. The only Day Nursery in the Borough is the St. Margaret's Day Nursery at 8 and 10 Cambridge Road, which since 1927 has been incorporated with the National Society of Day Nurseries. The Battersea Nursery continues, however, to be administered by a local committee upon which the Borough Council is represented. There is accommodation for about 25 children, and a guest house is attached for the reception of boarders. The Council make an annual grant of £555 to the Nursery (vide p. 21). Two small outbreaks of infectious disease, viz., chicken-pox and measles, occurred during the year among the children attending the Nursery. Prompt measures were taken to deal with the situation, with the result that the outbreaks were prevented from reaching alarming proportions. During 1931 the attendances at the Nursery totalled 4,217. 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 have agreed to extend this service to the conveyance of non-urgent cases between the hours of 8 a.m. and 11 p.m., and an agreement was entered into in 1931 under which the Council undertook responsibility for the payment of prescribed fees for the use of the service during the day time in non-urgent cases. 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 29), 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 are referred where necessary from the Ante-Natal and Child Welfare Centres to other appropriate institutions. 26 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 1931:— St. Thomas's Hospital 14 Victoria Hospital, Chelsea 335 St. James's Hospita 2 Bolingbroke Hospital 3 Battersea General Hospital 1 Borough Tuberculosis Dispensary 4 South London Hospital for Women 5 St. Thomas's Cornwall Babies' Hostel 377* Invalid Children's Aid Association 8 Chelsea Women's Hospital 1 Vincent Square Hospital 4 754 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. The number of cases in St. Mary's House, during the year 1931, to the maintenance of which the Council contributed, was 3, the cost to the Council being £121 18s. 0d. In the case of other homes, the number of cases during the year was 11, and the additional contribution of the Council amounted to £83 18s. 9d. Home Helps. Facilities are provided by the Council in suitable cases for assistance in the home during the mother's lying-in period, and a list of women recognised for the service is kept by the Health Visiting staff, from which applicants are permitted to choose a suitable woman, who is paid at the usual rates. For reasons referred to in previous Annual Reports this service has not been availed of to the extent anticipated, and during 1931 no application for the services of a home help was received. * Of this number 227 actually attended. 27 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 :— Year. Dried Milk. Fresh Milk. Persons supplied. lbs. supplied. Persons supplied. Pints supplied. Cost (after deducting payments made). £ 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 1931 173 (101) 4,209 1,706 (101) 218,310 3,796 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 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 60 were supplied during 1931 to necessitous expectant and nursing mothers and children at a cost of £1 10s. 10d. by arrangement with the Women's League of Service. Mothers were also referred from the Welfare Centres to the kitchen of the Invalid Kitchens' Association in Henley Street, where they were supplied with 153 dinners during 1931 at a cost of £4 9s. 3d. 28 Convalescent Homes. During 1931, accommodation was provided for 15 mothers and 14 children attending the various Maternity and Child Welfare Clinics. Of these, 7 mothers and 8 children were sent to Littlestone-on-Sea Convalescent Home, 6 mothers and 5 babies to the Evelyn Convalescent Home, Upper Wargrave, and 2 mothers and 1 baby to two other homes. The cost incurred by the Council amounted to £18 0s. 0d., the mothers contributing the balance of £12 5s. Od. Two other children attending the Council's Welfare Centres were sent away for a period of convalescence through the agency of the Invalid Children's Aid Association. 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 maternity services. In addition to these private midwives and the District service of the Council (vide page 42) 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 Ministry of Health, in a letter, dated 17th August, suggested that the Council might consider the desirability of contributing towards the fees in necessitous cases, of midwives practising in the Borough when employed as such, and also towards the fee of a midwife acting as maternity nurse in cases where a woman engages a doctor for her confinement. In view of the midwifery services already established by the Council it was not considerered necessary to adopt the suggestion. 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 1931 the total number of attendances made by the nurses of the District Nursing Association in connection with the Council's Scheme was :— 29 Nursing Service, 1931. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 103 2,466 - - 103 2,466 Measles 1 7 - - 1 7 Whooping Cough 2 8 - - 2 8 Diarrhcea & Vomiting 2 8 - - 2 8 Chicken Pox 3 25 2 28 5 53 Pemphigus Neonatorum 3 47 - - 3 47 Puerperal Pyrexia - - 1 30 1 30 Pneumonia 34 481 52 943 86 1,424 Influenza 3 24 21 168 24 192 Erysipelas - - 4 73 4 73 Totals 151 3,066 80 1,242 231 4,308 The cost of the nursing service in 1931 was £143 12s. 0d. as compared with £227 5s. 4d., 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 1931. The results of the year's work have been satisfactory and are summarised below:— A. Test Feeds. Number of cases, 226, comprising: Mothers, 226; babies, 227. Number of attendances, 629. 14 of these cases received in-patient treatment. B. In-Patient Treatment. 35 Battersea cases received, made up of— 12 mothers and 15 babies sent by Council. 3 mothers and 5 babies sent from other sources. Period of stay. 27 cases sent by Council—12 mothers and 15 babies, 835 days; Average—mothers 27 days, babies 34 days. 8 other cases—3 mothers and 5 babies, 230 days; average—mothers 7 days, babies 42 days. 30 • Ante-Natal Work. The Ante-Natal Clinics provided by the Council under their Maternity and Child Welfare Scheme are under the direction and supervision of the Consultant Gynaecologist (Miss Alice Bloomfield, m.d., f.r.c.s.). These Clinics are held at the new Out-patient Department of the Borough Maternity Hospital on Tuesdays and Wednesdays, and for the convenience of patients living at a distance from the Hospital a session is held at the Southlands Centre on Fridays. Subsidiary Clinics are held at the Plough Road and East Battersea Centres, which are attended by the Assistant Medical Officer (Maternity and Child Welfare), and the Women's League of Service, a voluntary organisation, whose Battersea Centre for Maternity and Child Welfare is linked up with that of the Council's Scheme, also holds an Ante-Natal Clinic at their Southlands premises. Each mother who books for admission to the Borough Maternity Hospital, or for attendance of the Borough Maternity Nursing Staff in her own home, is required to attend the Ante-Natal Clinic periodically before her confinement, and every case is seen at least once by the Consultant Gynaecologist. Doctors and private Midwives practising in Battersea are also encouraged to send their maternity patients to the Central Ante-Natal Clinic at the Borough Maternity Hospital for examination and report by the Consultant Gynaecologist. Miss Bloomfield (Consultant Gynæcologist) reports :— Tuesday Afternoon (" Special ") Clinic.—The total attendances at this Clinic numbered 930, including 810 new cases, i.e. an increase of 167 attendances, and 108 new cases over the previous year, 1930. Blood for the Wassermann Reaction was taken in 810 instances, giving a positive result in only 6 cases. Other types of case attending the Clinic were as follows:— Complaining of vaginal discharge No treatment required 2 cases Films taken 9 „ [Treatment given 18 ,, Post-natal cases 4 „ For Prolapse 5 „ For the diagnosis of pregnancy, &c. 14 „ Wednesday and Thursday Morning Clinics.—Number of Clinics held, 106. The total attendances at these Clinics numbered 2,597, with an average attendance of 24.5, as against 2,128 attendances with an average of 20.5 patients per clinic in 1930. The number of new patients attending was 469 (1930, 434). Booking date with reference to the period of pregnancy:— 1 to 6 months, 373 cases; 6 to 8 months, 95 cases ; 8 months on, 1 case. Cases referred for Dental Treatment—126. Cases referred to the Tuberculosis Dispensary—3. 31 Abnormal cases among patients attending these Clinics included Albuminurias, 19; cardiac cases, 6; skin cases, 4; herniæ, 4, and a large variety of other types including anaemias, asthma, arthritis, eye cases, etc. Cases requiring Institutional Treatment during the Ante-natal period. In the Battersea Maternity Home:—For induction, 36; albuminuria, 9; examination under anaesthesia, 20 (for version); antepartum haemorrhage, 1. Cases referred for opinion, special pathology, or treatment (excluding dental cases and cases referred to Tuberculosis Dispensary):—To St. James' Hospital, 5; South London Hospital, 7; Middlesex Hospital, 14; Battersea General Hospital, 1; Bolingbroke Hospital, 2; own doctor, 13. Return cases—67. Friday Morning (Southlands) Clinic.—Number of Clinics held —52. The total attendances at this Clinic numbered 868, with an average attendance of 16.7, i.e. an increase of 132 attendances on 1930, when the average attendance per clinic was 14.7. New cases numbered 335, an increase of 81 on the preceding year, and an average of 6.4 per Clinic. Primiparae numbered 118, multiparæ 217. Booking date with reference to period of pregnancy.—1 to 6 months, 194; 6 to 8 months, 112; 8 months on, 28. Cases referred for dental treatment—156. Cases referred to the Tuberculosis Dispensary—1. Abnormal cases among patients attending this Clinic included— Albuminuria, 4 cases; cardiac disease, 4 cases; other cases: asthma, (?) appendicitis, varicose veins, &c. Cases requiring institutional treatment during the ante-natal period:—In the Battersea Maternity Home: for albuminuria, 3 cases; induction, 2; examination under anaesthesia, 5 (for version); (?) premature labour, 1 ; antepartum haemorrhage, 1. Cases referred for opinion, special pathology or treatment (excluding dental cases and cases referred to Tuberculosis Dispensary) :—To the South London Hospital, 2 cases; Bolingbroke Hospital, 1; Battersea General Hospital, 1; St. James' Hospital, 1 ; own doctor, 5. Return cases—106. Borough Maternity Home (In-Patients).—The following is a table of cases supplied from the records of the Borough Maternity Home, and which are of interest in relation to the work of the Ante-natal Department:— Cases of Albuminuria recommended admission—12. 32 Results—Mothers—good, no cases of eclampsia. One mother died later (?) nephritis. Babies—9, good; 3 stillbirths. Inductions— Drug—36. Mothers, all good. Babies, 33 good, 2 stillbirths, 1 macerated foetus. Bougie—9. Mothers, all good. Babies, 9 good, 1 neonatal death (twin). Forceps deliveries—19. Results—Mothers, good. Babies, 1 foetal death, 1 neonatal death. Examinations under anaesthesia—25. For version—21 (successful 13, unsuccessful 8). For diagnosis of presentation—2. For estimation of fit of foetal head—2. Cases delivered as breech at term—10. Diagnosed—8. Undiagnosed—2. Caesarean sections—7 cases. General Remarks.—The figures show a considerable increase over those of the preceding year 1930, this increase being both in the number of new cases booking, and in the total attendances. Cases referred for Dental Treatment numbered 282, i.e. about a third of the new cases, proving the heavy incidence of dental caries among the patients attending the Ante-natal Clinics, and the necessity for careful examination of the mouth in every new case. An interesting figure is the number of "Return Cases," that is cases previously confined under the Battersea Borough Council's Maternity Scheme, whether in their own houses or in the Borough Maternity Home. This number is 173, out of a possible total of 429, i.e. about 40 per cent. This result is a very high recommendation, I think, for the popularity and efficiency of the Borough Maternity Scheme in Battersea. Women's League of Service. Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Ante-natal Work.—The sessions are held fortnightly. The average attendance at each session has been 13.2 and the total number 305. This shows a marked increase in the numbers of the preceding year. 33 17 mothers were confined at the Borough Maternity Home. 2 „ „ „ at St. James's Hospital. 3 „ „ „ at St. George's Hospital. 3 „ „ „ at St. Thomas's Hospital. 2 ,, ,, ,, at the General Lying-in Hospital. 20 „ „ „ by the Borough Midwife. 19 „ „ ,, by Private Midwives. 6 „ „ ,, by Private Doctors. One case was referred for treatment to the Chelsea Women's Hospital. Infant Welfare Work.—The average attendance at each session was 30-38, and the total number 2,188. Eleven cases were referred to hospitals (Victoria Hospital for Children, Belgrave Children's Hospital, and St. James's Hospital) for treatment of special conditions which included tonsils and adenoids, circumcision, bronchitis and malnutrition. Several were sent to the Battersea Borough Department for treatment by artificial sunlight and massage, with very good results. Several mothers and children were referred to the Dental Department for treatment. Many of the children attended the Schick Clinic. Holidays.—Fifteen mothers and 13 babies were sent for convalescence to Wargrave and to Tankerton. Two children were sent to the country for three months for change of air. 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. Dr. E. M. Saxton, Medical Officer in charge of the Clinic, reports as follows:— The attendances have been well maintained during the year. Eighty-nine sessions were attended by the Medical Officer. Total interviews 2,420 First attendances—Under 1 year 193 1-5 years 48 34 51 cases were referred to hospital. 259 cases were sent to massage, all showing improvement as the result of treatment where regular attendances could be maintained. Other children were referred when necessary to their own doctors for treatment. The majority of the consultations were in cases of general infant management and nutrition. Particularly interesting were one family of triplets (Mrs. R's babies, now aged 11 months and all doing well). The health of the children has been good on the whole, though there have been many absences in the last few months on account of whooping cough. There was very little severe diarrhoea during the summer months. There have been four deaths during the year among children attending the centre. One was a severe case of spina bifida who developed bronchitis ; three deaths from pneumonia, all under 1 year old. Deaths among children in the district not attending the Centre, all under 1 year, were :— 6 Premature twins. 1 Premature. 1 Premature and congenital heart disease. 1 Congenital abnormality, died 4th day in hospital. 2 Overlaying. 5 Pneumonia (one following whooping cough). Total deaths—20. Every effort is made to encourage and maintain breast feeding. In cases of difficulty the mothers are asked to attend during the week following their interview for test-feeding by the Health Visitors. With the help of the knowledge of the case thus gained, and in suitable cases by the grant of extra nourishment, it has often been possible for breast feeding to be continued. On Thursday afternoons during the year the Sewing Class . has been held and Health Talks given. The social side of the Centre has been well maintained. A Mothers' Social is held once a month in the evenings, and a Fathers' Club, at which a talk is given, once a month. A concert was held at which prizes were given to fathers and mothers for handwork done during the year. 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. 35 The following is a summarised statement showing the Hospitals and the visiting and reporting work carried out for them during 1931. Ante-natal and postnatal. Other. Total. St. Thomas's Hospital 282 158 440 Charing Cross Hospital 11 - 11 General Lying-in Hospital 239 - 239 King's College Hospital 6 - 6 St. George's Hospital 56 - 56 Westminster Hospita 31 - 31 Victoria Hospital, Chelsea - 16 16 Infants' Hospital, Vincent Square - 4 4 Middlesex Hospital 3 - 3 University College Hospital 3 - 3 St. Mary's Hospital 1 - 1 South London Hospital for Women 6 - 6 Brompton Hospital 1 - 1 Battersea General Hospital 1 - 1 640 178 818 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.) During the year a re-arrangement of the work of this clinic was made resulting in a material decrease in the cost of this service. The work carried out during 1931 is summarised in the table on page 37. Mr. Corsi reports :— Of 810 expectant mothers examined for syphilis by the Wassermann test six were found to be affected. Only one, however, had active symptoms of the disease, and these disappeared rapidly under treatment. One patient was so mildly affected that though she did not receive treatment, and the baby, born out of the Borough, has not been seen, it is unlikely to be syphilitic. The other five cases were given pre-natal treatment, and in every instance a healthy looking baby was obtained, a gratifying though expected result. 36 Certainty of the infant's escape from infection is only absolute when a blood examination has been made and found negative. The mothers do not easily allow this examination, and this year in only one instance was it possible to obtain permission to make the case complete and certain. But regarding their own treatment none of the mothers were difficult, all attending the Clinic quite happily. A number of cases were examined also for other V.D. conditions, but in every instance they were found free from disease. As I have remarked in previous reports, the percentage of positive Wassermann tests obtained in the mothers attending this Clinic has become low to an astonishing degree. This must depend originally on a diminishing incidence of V.D. in the general population of the Borough. This, coupled with ante-natal treatment of those women who are affected should in the near future make congenital venereal affections of little more than historical interest.- 37 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1931. Year. Number of expectant mothers tested by W.R. Number giving positive W.R. Per cent. Number of expectant mothers with positive W.R. treated during pregnancy. Babies. Healthy Neg. W.R. Healthy looking. Not yet tested. Positive W.R. Still-born. 1922 - - - 1 1 0 0 0 1923 - - - 8 5 2 1 0 1924 517 18 3.5 15 11 3 0 1* 1925 653 14 2.1 8 7 1 0 0 1926 658 10 1.5 9 7 2 0 0 1927 674 12 1.7 12 6 4 2 0 1928 934 12 1.3 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* 1931 810 6 0.7 5 1 4 0 0 • Not syphilitic. 38 Maternal Mortality. During 1931 there were 15 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 6.06 per 1,000 births. Twelve of these deaths occurred in hospital and three at home. The causes of death were certified as being:— Puerperal Sepsis 5 Accidental Haemorrhage 1 Embolism and Thrombosis 2 Obstructed Labour 3 Shock following instrumental delivery 1 Ruptured Ectopic Gestation 1 Shock due to partial displacement of Placenta 1 Acute Nephritis and Toxaemia 1 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1926. 1927. 1928. 1929. 1930. Mean 1926-30 1931. Deaths from Puerperal Sepsis 3 1 3 2 4 2.6 5 Deaths from other causes connected with child-birth 7 5 4 3 6 5.0 10 Total Maternal Deaths connected with child-birth 10 6 7 5 10 7.6 15 Rate per 1,000 births— Puerperal Sepsis 1.01 0.36 1.09 0.76 1. 51 0.95 2.02 Other Maternal deaths 2.36 1.78 1.46 1.15 2.26 1.80 4.04 Rate per 1,000 births all Maternal deaths in child-birth 3.37 2.14 2.55 1.91 3.77 2.75 6.06 Rate per 1,000 population— Puerperal Sepsis .017 .006 .018 .012 .025 .016 .031 Other Maternal deaths .041 .030 .024 .019 .037 .030 .063 Rate per 1,000 population all Maternal deaths in childbirth .058 .036 .042 .031 .062 .046 .094 There was, it will be noted from an examination of the above Table, a marked increase in Maternal Mortality in Battersea in 1931. In accordance with the instructions of the Ministry of Health, each of the 15 deaths of Battersea mothers was carefully investigated and reports were submitted to the Ministry in connection with the Departmental Committee which was set up in 1928 and which has presented two interim Reports. The final Report is not yet published. It will be of interest in this connection to refer to the importance of Ante-Natal examination of expectant mothers. In Battersea in 1931 there were 2,477 births registered in the Borough. Of 39 these 2,477 births during the year, 957 of the mothers attended the Ante-Natal Clinics of the Council and in the majority of cases made other arrangements with their own doctors or midwives or hospitals. The Maternal Mortality rates amongst the mothers attending the Council's Clinics was 3.13 and amongst those not attending, 7.68 per 1,000 births. It is to be regretted that greater use is not being made by Doctors and especially by the Midwives practising in the Borough, of the facilities provided by the Council for this purpose. The new Out-Patient Department at the Borough Maternity Hospital is an admirably equipped Ante-Natal Clinic to which Doctors or Midwives can refer expectant mothers for examination and report by the Consultant Specialist, who attends the clinic on three days weekly. It is unnecessary to stress the vital importance of the subject, in view of the interest aroused by the two Reports already issued by the Departmental Committee set up to investigate the causes responsible for the high maternal mortality prevailing in this country and the final Report of the Committee will therefore be awaited with increased interest by the public. The value of the Maternity Services of the Council is further 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 11 years 1921-31, during which the Hospital has been open, only 8 deaths have occurred in the Hospital during the puerperium, giving a mortality rate of 1.4, as compared with a rate for the Borough as a whole of 3.06, and on the District Midwifery Service only 2 deaths have 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 practising in Battersea, 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. 40 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 1931 there were 49 sessions held and 606 attendances were made, all new cases. The average attendance per session was 12.4. Arrangements have been made for Mr. F. W. Roques, M.S., F.R.C.S., 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 11 cases during the year as compared with 14 cases in 1930. During 1931, 555 cases were admitted to the Hospital as compared with 516 cases in 1930, 605 cases in 1929, 653 in 1928, 634 in 1927 and 625 in 1926. Particulars relating to the admissions during 1931 are set out as follows:— Total number of cases admitted 555 Average duration of stay 14 days Number of cases delivered by midwives 517 Number of cases delivered by doctors 26 Number of cases born before arrival - Of the above cases, 12 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.—60 Albuminuria 10 Ante-partum haemorrhage 2 Contracted pelvis 1 - Induction 45 60 Malpresentation 2 - (b) During Labour—113. Adherent placenta 3 Ruptured perineum 67 Foetal distress 4 Free loss 2 Forceps deliveries 18 - Heart disease - 113 Prolonged labour 13 - Retained membranes 6 (c) After Labour—9. Rash 1 Breast abscess 1 Chest condition 2 - Varicose veins 3 9 General condition 2 — 41 (d) For Infant—24 Septic fingers 6 Supplementarily fed 7 Feebleness 2 Spina bifida 1 Sticky eyes 7 - Watery eyes 2 26 Artificially fed 1 - Number of maternal deaths Nil Number of cases in which temperature rose above 100-4° F. for 24 hours with rise of pulse rate 2 Number of cases notified as Ophthalmia Neonatorum with result of treatment 5 (All cured. No damage to eyes.) Number of cases with discharge from eyes however slight 14 Number of infants not entirely breast fed 7 Number of cases notified as puerperal sepsis Nil* Number of cases notified as puerperal pyrexia 2* Number of foetal deaths (7 still-born, 11 within 10 days of birth) and their causes 18 Still Birth— Died within 10 days— Anencephalic 1 Anencephalic 1 Macerated 1 Premature 4 Hydrocephalic 1 Asphyxia pallida 5 Ante-partum haemorrhage 2 Convulsions 1 Forceps delivery 2 - 7 11 The Consultant Obstetrician was called in in 11 cases of grave emergency, particulars of which are set out below:— Forceps delivery 2 Secondary post-partum haemorrhage 2 Ante-partum hcemorrhage 1 Cesarean section 6 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, 1932 :— Maternity Hospital, 1931—2. Total beds (excluding cots, labour and isolation beds), 28; total cases, 527; average number of beds occupied during the year, excluding cots, labour and isolation beds, 19-5 ; f number of weeks spent in Institution by such patients, 10,107. * One case originally notified as Puerperal Fever discharged from hospital (13 days) as Puerperal Pyrexia. †The decrease in the number of beds occupied is mainly due to the abnormal number of cancellations of bookings. 42 Statement* showing expenditure for the year ended 31st March, 1932, in respect of the Maternity Hospital. Item. Total. Per Patient Week. Salaries £ £ s. d. Medical 340 0 6 7 Nursing 654 0 12 7 (Domestic and other 596 0 11 6 Provisions 754 0 14 6 Drugs and other Medical Requisites 142 0 2 9 Heating, Lighting and Water 450 0 8 8 Laundry 380 0 7 4 Repairs and renewals Domestic 208 0 4 0 Structural 432 0 8 4 Miscellaneous items— Telephones, Stationery, etc., and Sundries 171 0 3 3 Totals, excluding rates, insurance and loan charges 4,127 3 19 6 Rates and Insurance 80 0 1 6 Loan Charges 1,302 1 5 1 Gross cost £5,509 £5 6 1 Income Pupil Midwives (including training grant) 285 0 5 6 Patients' Payments 2,381 2 5 10 Other 14 0 0 3 Net cost £2,829 £2 14 6 43 Number of cases where medical assistance was called for, with reasons for requiring assistance :— (a) Ante-Natal—Nil. (b) During Labour—6. Ante-partum haemorrhage 1 Post-partum haemorrhage and retained placenta 1 Prolonged second stage with weak pains 2 Forceps delivery 2 6 (c) After Labour—13. Ruptured perineum 7 Post-partum haemorrhage 1 Dangerous varicose veins 2 Pain in leg 3 13 (d) For Infant—10. Dangerous feebleness 1 Discharge from eye 2 Nasal discharge 1 Prematurity 4 Anencephalus 1 Haemorrhage 1 10 Number of cases of— Puerperal sepsis - Maternal deaths - Still births - Deaths of infants within 10 days 4 (Feebleness, 1; prematurity, 2; anencephalus, 1.) Dental Clinic. During 1931 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. Five sessions are held weekly in addition to one for tuberculous patients (vide p. 59). 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. 44 . The work of the Dental Clinic during 1931 is summarised as follows:— Sessions held Women. Children. Total. 203 48 251 No. of patients treated 632 172 904 No. of new patients 453 128 581 Total attendances 3,267 656 3,923 Work carried out:— Extractions— Ordinary 3 4 7 With local anaesthetic 133 1 134 „ general anaesthetic 790 184 974 Total 926 189 1,115 No. of teeth extracted 2,936 491 3,427 Scaling and polishing 56 - 56 Fillings 76 22 98 Upper dentures 83 - 83 Lower dentures 80 - 80 Denture visits 625 - 625 Dressings and treatment to gums 91 8 99 Repairs to dentures 28 - 28 Advice 1,387 434 1,821 The estimated cost of dental treatment (Maternity and Child Welfare) in the financial year 1931-32 was £898 19s. 10d. This sum includes £335 5s. 3d. paid for dentures supplied, etc., the cost of which is distributed as under :— £ s. d. Contributed by patients 230 5 0 Payments by Chelsea Health Society 51 9 0 Grants from British Dental Hospital 8 4 6 Grants from Saturday and Sunday Hospital Funds 37 12 6 Grants from other philanthropic agencies 2 15 0 Contribution by the Council 419 3 335 5 3 The net cost of this service during 1931-32 was £568 13s. 10d. 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. 45 The equipment consists of:— 2 carbon arc lamps. 2 mercury vapour lamps. 4 general radiation lamps. 4 couches. During the year 98 sessions for Welfare patients were held, the number of patients on the roll at the end of the year being 35. The total attendances numbered 2,241, the average number per session being 22.9. During the year arrangements were made for massage treatment of children attending the light treatment centre immediately after their treatment by light. Particulars relating to tuberculous patients treated at the Clinic during the year will be found on page 117. 46 Notifiable Infectious Diseases. During 1931 under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 1,819 cases of infectious diseases (excluding tuberculosis) were notified, including Cerebro-spinal fever 3, acute poliomyelitis 3, enteric fever 4, small-pox 3. In 1930 the total was 4,883. 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. 47. Excluding tuberculosis, measles and whooping cough, there were 1,251 cases which occurred in 1,090 houses. Of these cases 992, or 79.3 per cent., were removed to the Isolation Hospitals of the London County Council or to other Institutions and 259, or 20-7 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 122). Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 47 Notifications of Infectious Diseases, 1931, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. Totals. 1 2 3 4 5 6 7 8 9 E N S Small-pox 3 - - - - - - - - 3 - - 3 Diphtheria 51 50 48 30 34 47 6 22 10 152 107 39 298 Erysipelas 10 15 9 7 7 10 3 7 4 37 21 14 72 Scarlet Fever 76 119 57 32 39 49 18 38 20 247 123 78 448 Enteric (Typhoid) Fever - 1 - - 3 — — — — 1 3 — 4 Puerperal Fever 1 — 2 1 — 1 — 1 — 2 3 1 6 Puerperal Pyrexia 6 2 2 4 1 3 2 4 1 11 5 9 25 Ophthalmia Neonatorum 6 4 3 2 3 6 — 10 3 12 11 14 37 Cerebro-Spinal Meningitis 1 1 — — — — 1 — — 2 — 1 3 Polio-myelitis 1 — — — 1 — — 1 — 1 1 1 3 Polio-encephalitis — — — — — — — — — — — — — Encephalitis Lethargica - - - - - - - - - - - - - Malaria 1 — 1 — — — 1 1 — 2 Dysentery - — — — — — 1 — — — — 1 1 Acute Primary Pneumonia 63 28 44 26 37 41 14 18 11 132 105 45 282 Acute Influenzal Pneumonia 18 6 6 3 3 9 5 7 10 29 15 23 67 *Whooping Cough 141 48 62 44 54 90 12 20 22 253 179 61 493 *Measles 5 5 20 9 6 7 3 10 10 34 17 24 75 Tuberculosis (all forms) 46 35 26 19 15 31 25 31 29 111 58 88 257 Totals 428 314 279 178 203 295 90 169 120 1,028 649 399 2,076 * Notifiable in Battersea from 24th April, 1922. 48 Small-Pox. Three cases of small-pox occurred in Battersea during 1931 compared with 7 in 1930. The three patients attacked were of one family-the mother and two sons, aged 4 years and 16 years respectively. The original case was that of the child of four years. This child had not been vaccinated. The rash appeared on November 28th and the patient was removed to hospital on December 2nd. The other members of the family were vaccinated on December 3rd, but in the case of the mother vaccination was not successful, and was performed again 8 days later with a successful result. In spite of this, however, both the mother and the son aged 16 years developed small-pox. Unless vaccination is performed within four days from the time of infection it is unlikely to protect from an attack of small-pox, although the disease may be considerably modified thereby, as happened in these two patients. In each case the attack was of the prevailing mild character known as variola minor. All the cases were removed to the isolation hospital, the average duration of isolation being 11 days. In the case of the patient aged 16 years the duration of isolation in hospital was only 5 days, as the attack was of such a mild nature due to his recent vaccination. During the year there were 1,452 cases of this disease recorded in London, 5 of these cases occurring in the neighbouring borough of Wandsworth and 256 in Lambeth. 101 cases occurred in Stepney, 144 in Bethnal Green, 122 in Shoreditch, 352 in Poplar and 116 in Camberwell. The disease was also prevalent in Greater London, West Ham having 761 cases. It is satisfactory to note that notwithstanding the prevalence of the disease in adjoining boroughs and other London districts, Battersea was comparatively free. 252 "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, 5,665 cases of small-pox were notified during 1931. No vaccinations were performed by the Medical Officer of Health during the year under report. Scarlet Fever. The incidence of Scarlet Fever was lower in 1931, 448 cases being notified as compared with 566 in the previous year. 49 The case-rate per 1,000 of the population was 2.80 and 6 deaths were registered from the disease, giving a death-rate of 0.04 per 1,000 as compared with 2 deaths and a death-rate of 0.012 in 1930, and 4 deaths and a death-rate of 0.025 in 1929. Of the cases notified 440 or 98.2 per cent. were removed to hospital. The infected houses numbered 391. In 54 of the notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at hospital. Diphtheria. The number of cases of Diphtheria notified in Battersea during 1931 was 298 as compared with 489 in 1930, 445 in 1929, 652 in 1928, and 680 in 1927. The number of deaths registered from the disease was 5, giving a death-rate of 0.03 as compared with 15 deaths and a death-rate of 0.09 in 1930, 12 deaths and a death-rate of 0.07 in 1929, 26 deaths and a death-rate of 0.16 in 1928, and 25 deaths and a death-rate of 0.15 in 1927. Of the 298 cases notified 297 or 99.7 per cent. were removed to hospital. The infected houses numbered 267. In 54 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 1.86 as compared with 3.04 in 1930, 2.75 in 1929, 3.97 in 1928, and 4.02 in 1927. The case-mortality was 1.68 per cent. as compared with 3.07 per cent. in 1930, 2.70 per cent. in 1929, 3.99 per cent. in 1928, and 3.68 in 1927. The incidence of the disease was highest in the Park, Latchmere and Winstanley wards. 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 26 phials (approximately 148,000 units) of anti-toxin were supplied, on request, to medical practitioners practising in the Borough. Schick Test Clinic. Summary of Work Carried Out, 1931. The Schick test clinic, established at the close of 1927, is held weekly at the Southlands Maternity and Child Welfare Centre. 50 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 1931 (new 143) 212 Attendances 762 „ (average per session) 14.7 New Patients tested 113 Readings of tests (positive 82, negative 27, result unknown 4) 113 Patients inoculated— Without test 30 After positive test (1931 patients) 81 " " " (old " ) 15 — 126 Inoculations 345 Total immunised (including 1 patient (1929)) 105 Patients still on Register at end of year 65* Discontinued treatment 103 The total number of patients immunised or found by test to be immune is 132, out of a total of 212 patients who have attended during the year (62.3 per cent.). Since the opening of the clinic 755 patients have attended, and of these 525 have been immunised or found immune by test (69.7 per cent.). Acute Polio-Myelitis and Polio-Encephalitis. There were three cases of Acute Polio-Myelitis notified in Battersea during 1931. Three other cases of Polio-Myelitis, not in the acute stage, were notified but subsequently cancelled. No death was recorded from the disease. Of the 30 cases on the register (including three notified in 1931) 22 were under 5 years of age when first brought under observation. When last visited 7 were no longer receiving treatment, 1 was receiving in-patient and 11 out-patient hospital treatment, 4 were in convalescent institutions, while 4 were still wearing instruments. In 1 case no information was obtainable; 1 case removed during the year, and 1 was reported to be cured. No case of Acute Polio-Encephalitis was notified during 1931. Puerperal Fever and Puerperal Pyrexia. Six cases of Puerperal Fever were notified in Battersea in 1931, as compared with 9 in 1930, 4 in 1929, 7 in 1928 and 9 in 1927. In addition there were 4 unnotified cases, in 3 of which the diagnosis was made after post-mortem examination, and in the fourth was *Includes 4 patients (1931) negative after 1st test, who are to attend again for re-test. 51 arrived at in the Isolation Hospital to which the patient had been removed as suffering from Puerperal Pyrexia. Five deaths from the disease were registered, namely, the 4 unnotified cases mentioned above, and 1 notified case. Of these deaths, 3 occurred in St. James's Hospital and 2 in the Isolation Hospitals of. the London County Council. The number of notified cases per 1,000 births was 2.42, as compared with 3.39 in 1930, 1.53 in 1929, 2.55 in 1928, and 3.21 in 1927. The case-mortality was 50 per cent. of all cases, notified or reported, and the death-rate per 1,000 births was 2.02. There were 297 cases of Puerperal Fever notified in London and 2,339 in England and Wales during 1931. The number of cases of Puerperal Pyrexia notified in Battersea during 1931 was 25, and the incidence per 1,000 births was 10.09. There were 829 cases of Puerperal Pyrexia notified in London and 5,742 in England and Wales during the year. 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 1931 four cases of Enteric Fever were notified in Battersea. Two other cases notified were subsequently cancelled, the diagnosis not being confirmed at hospital. There was one death from this disease during the year. The case had been notified and removed to hospital, death occurring 18 days later. Cerebro-Spinal Fever. During 1931 three cases of Cerebro-Spinal Fever were notified in Battersea, and there were two deaths from the disease, both patients dying in hospital. The death in one case was not registered in Battersea, the patients' family having removed from the Borough during his absence in hospital. Encephalitis Lethargica. Two notifications of this disease were received during 1931, but both were subsequently cancelled, in one case the diagnosis not being confirmed on removal of the patient to hospital, and the second case not being notified in the acute stage. 52 A third (unnotified) case occurred in the person of a child who developed the disease while on holiday in Wales and died there. This was the only death recorded from this cause during the year. In London the number of cases notified was 43, and in England and Wales 652. Ophthalmia Neonatorum. There were 37 cases of Ophthalmia Neonatorum notified in Battersea during 1931, as compared with 34 in 1930, 43 in 1929, 39 in 1928, and 48 in 1927. The rate per 1,000 births was 14.9, as compared with 12.8 in 1930, 16.4 in 1929, 14.2 in 1928, and 17.1 in 1927. There were 7 severe cases amongst the 37 notified, all of which were removed to St. Margaret's (L.C.C.) Hospital for treatment, and three cases received in-patient treatment at other hospitals. A few cases were still under treatment at the end of the year, but no case of permanent injury to the eyes resulted. During 1931 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 2,466. All cases were kept under systematic supervision by the Health Visiting Staff, by whom 139 visits were made. The following table shows the distribution of the cases notified:— Sub-Districts. Cases Births. Rate per 1,000 Births. Year. Cases. Births. Rate per 1,000 Births. Ward. E. Battersea 12 1,079 11.1 N.W. Battersea 11 696 15.8 1926 35 2,969 11.8 S.W. Battersea 14 702 19.9 1927 48 2,801 17.1 1. Nine Elms 6 455 13.2 2. Park 4 286 14.0 1928 39 2,743 14.2 3. Latchmere 3 310 9.7 4. Shaftesbury 2 204 9.8 1929 43 2,619 16.4 5. Church 3 231 13.0 6. Winstanley 6 314 19.1 1930 34 2,652 12.8 7. St. John 139 - 8. Bolingbroke 10 284 35.2 Mean 9. Broomwood 3 254 11.8 1926-30 39.8 2,757 14.4 Borough 37 2,477 14.9 1931 37 2,477 14.9 53 Erysipelas. There were 72 cases of Erysipelas notified and 4 deaths were recorded from the disease during 1931 in Battersea. The casemortality was 5.56 per cent. and the death-rate per 1,000 population was 0.025. Measles. The number of cases of Measles notified or otherwise reported in 1931 was 89 and there were 2 deaths recorded from the disease. Of the 89 cases 75 were notified under the Regulations—The Battersea (Measles and Whooping-Cough) Regulations, 1922—and the remaining 14 cases were reported by the public elementary schools or from other sources. No death occurred among the notified cases, but the percentage case-mortality of the total incidence (notified and reported) was 2.25 per cent., as compared with 1.13 per cent in 1930 and 0.88 per cent in 1929. Whooping-Cough. During 1931 there were 493 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 284 additional cases were reported from the public elementary schools and other sources. There were 5 deaths registered from this disease, the deathrate being 0.03 as compared with 7 deaths and a death-rate of 0.04 in 1930, 43 deaths and a death-rate of 0.27 in 1929, 14 deaths and a death-rate of 0.08 in 1928, and 15 deaths and a death-rate of 0.09 in 1927. The total number of cases notified or otherwise reported during 1931 was 747, as compared with 537 in 1930, 1,317 in 1929, 1,228 in 1928, and 749 in 1927, the increase in 1931 compared with 1930 being 39.1 per cent. Vaccination. The Public Vaccinators for the Borough are as follows:— Districts 1, 3 and 6. Dr. C. E. McDade, 114 Clapham Common North Side. (Deputies—District 1: Dr. M. Sayers, 65 Battersea Park Road. District 3: Dr. F. S. McDade, 114 Clapham Common North Side. District 6: Dr. L. Golomb, 347 Queens Road.) Districts 2 and 7. Dr. M. Lurie, 347 Queens Road. (Deputy—Dr. L. Golomb, 347 Queens Road.) District 4. Dr. P. Purcell, 154 High Street (vice Dr. J. J. Oakman, resigned). (Deputy—Dr. M. Sayers, 65 Battersea Park Road.) 54 District 5. Dr. W. Walsham, 61 Clapham Common West Side. (Deputy—Dr. G. R. Laing, 38 Bolingbroke Grove.) St. James's Hospital. Dr. W. L. Maccormac, St. James's Hospital, Ouseley Road. (Deputy—Dr. A. P. Piggot, St. James's Hospital, Ouseley Road.) St. John's Hospital. Dr. E. F. W. Nixey, St. John's Hospital, St. John's Hill. (Deputy—Senior Assistant Medical Officer, St. John's Hospital, St. John's Hill.) Vaccination Officer.—T. C. P. Asbey, Town Hall, Battersea, S.W. 11. TUBERCULOSIS. During the 52 weeks ended 2nd January, 1932, there were 255 cases of Tuberculosis (all forms) notified in Battersea as compared with 286 in 1930, 330 in 1929, 301 in 1928, and 308 in 1927. In addition 40 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making 295 cases in all. The following table (required by the Ministry of Health) shows the age and sex distribution of the 297 cases of Tuberculosis notified or otherwise reported during the year ended 2nd January, 1932 (53 weeks) and the 173 deaths registered as due to the disease. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary Non. Pulmonary. M. F. Total M. F. Total M. F. Total M. F. Total 0 - - - - 1 1 - - - - 1 1 1 1 1 2 7 13 20 - - - 1 8 9 5 1 4 5 10 1 11 - - - 3 - 3 10 3 3 6 2 2 4 - - - 1 2 3 15 16 15 31 3 4 7 11 5 16 3 1 4 20 14 29 43 4 6 10 12 13 25 - 2 2 25 36 26 62 5 3 8 24 12 36 2 2 4 35 26 13 39 1 1 2 16 5 21 1 1 2 45 20 5 25 - - - 25 8 33 - - - 55 14 — 14 1 1 2 9 1 10 1 - 1 65 and upwards 3 2 5 — — — 2 — 2 — 1 1 Totals 134 98 232 33 32 65 99 44 143 12 18 30 Deaths from non-pulmonary forms of tuberculosis formed 17.3 per cent. of the total deaths from the disease. 55 PERIOD 28th DECEMBER, 1930, to 2nd JANUARY, 1932. The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population of the 297 cases notified or otherwise reported, and of the 173 deaths. New Cases. Deaths. SubDistrict. 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 62 35 97 15 15 30 77 50 127 197 40 21 61 7 6 13 47 27 74 115 N.W. 24 29 53 13 4 17 37 33 70 157 30 11 41 4 6 10 34 17 51 114 S.W. 48 34 82 5 13 18 53 47 100 198 29 12 41 1 6 7 30 18 48 95 Ward 1 23 15 38 5 6 11 28 21 49 192 18 8 26 2 3 5 20 11 31 122 2 21 12 33 4 3 7 25 15 40 236 10 5 15 1 1 2 11 6 17 100 3 15 9 24 4 3 7 19 12 31 168 8 4 12 1 3 4 9 7 16 87 4 10 6 16 4 4 8 14 10 24 170 10 6 16 3 2 5 13 8 21 149 5 9 7 16 3 1 4 12 8 20 119 13 4 17 1 1 2 14 5 19 113 6 11 14 25 8 2 10 19 16 35 182 13 6 19 3 2 5 16 8 24 125 7 10 9 19 1 5 6 11 14 25 292 3 2 5 — 1 1 3 3 6 70 8 17 14 31 1 3 4 18 17 35 189 13 6 19 — 1 1 13 7 20 108 9 18 12 30 3 5 8 21 17 38 175 11 3 14 1 4 5 12 7 19 87 Boro' Rate per 100,000 populn. 134 98 232 33 32 65 167 130 297 186 1 99 44 143 12 18 30 111 62 173 108 177 117 145 44 38 41 221 155 186 — 131 52 89 16 21 19 146 74 108 — 56 In the table on pp. 64 to 66 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 297 new cases notified or reported in 1931 is summarised below:— Localisation of Disease. Pulmonary (232) Bones and Joints (19) Glands (14) Lungs 221 Elbow 1 Cervical 12 Lungs, Brain, Glands & Spleen 1 Hip 1 Ileum 1 Knee 2 Unspecified 1 Lungs and Intestines 1 Mastoid 1 Genito-Urinarv (4) Sacro-iliac Joint 2 Bladder 1 Lungs and Kidney 1 Shoulder 1 Kidney 2 Lungs and Knee 1 Spine 8 Testicle 1 Lungs and Larynx 2 Spine and Peritoneum 1 Skin (3) Lungs and Miliary 1 Lupus 2 Lungs and Pharynx 1 Thigh and Groin 1 Unspecified 1 Lungs and Wrist 1 Wrist 1 Pleura 2 Abdominal (8) General (4) Brain (13) Generalised 2 Peritoneum 5 Miliary 1 Peritoneum and Fallopian Tubes 1 Miliary and Meninges 1 Rectal Abscess 1 Total 297 Unspecified 1 Meninges 13 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 5 year 1927-1931. Year. Not notified (dead). Notified after Death. Notified on Form I. & II. (Primary Notification not received). Reported from other sources Total. 1927 12 14 — 26 1928 8 10 2 3 23 1929 13 13 1 7 34 1930 10 12 1 2 25 1931 17 14 2 7 40 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 1931. Deaths from Tuberculosis. The death rate from Tuberculosis was somewhat higher in 1931 than in the previous year, being 108.3 per 100,000 population, as compared with 100.8 in 1930, 127.3 in 1929, 98.1 in 1928 and 103.6 in 1927. The lowest death-rate recorded was that of 1926, when it was 96.6 per 100,000 population. 57 The allocation of the deaths in 1931 according to age and sex, and in the Wards and Sub-Districts is shown on pp. 54 and 45. During 1931 deaths from Tuberculosis registered as belonging to the Borough of Battersea numbered 173, 143 (i.e. 82.7 per cent.) being due to pulmonary tuberculosis, 13 (i.e. 7.5 per cent.) to tubercular meningitis and 17 (i.e. 9.8 per cent.) to other forms of the disease. In 1930 the number of deaths from tubercular diseases was 162 and it will be noted that there was an increase in 1931 in the mortality from Tuberculosis as compared with the previous year. Of the 173 deaths registered from Tuberculosis during the year 14 cases were not notified until one month before death; in 14 cases the notifications were received after death, and in 17 cases no notification was received. Of the 17 cases in respect of which no primary notification was received 13 (5 pulmonary, 8 non-pulmonary) were patients who died in hospitals or infirmaries. The remaining 4 cases (3 pulmonary, 1 non-pulmonary) were under treatment by private medical practitioners, notification in one instance having been made to another local authority. Of the 14 cases notified after death 9 (2 pulmonary, 7 nonpulmonary) were from Public Assistance Institutions; 2 (pulmonary) died in other hospitals, and the remaining 3 cases (pulmonary) were under private medical practitioners. 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 1931 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 1931 89.5 18.8 108.3 While there is an increase in the death-rate from Tuberculosis as compared with the previous year, it will be noted that the rate is also slightly higher than the mean death rate for the previous 5 years. 58 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 1931. The report of the Tuberculosis Medical Officer is set out in the appendix (pp. 112-120). 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. 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. 59 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. 117. 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. 118 to 120. 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 1931 was 50, and 266 attendances were made, the average attendance per session being 5.32. The cost to the Council during the financial year 1931-32 for this service was £141 5s. 0d, less contributions from patients and other sources amounting to £21 10s. 0d. Full details of the work carried out are given in the report on the work of the Dispensary in the Appendix (p. 117). 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 1931 is summarised as follows :— Patients and Attendances. The number of new patients was 585 (407 adults, 178 children), and the number of contacts examined 209 (72 adults, 137 children). There were 18 patients (adults) transferred from other areas during the year who subsequently attended the Dispensary, making a total of 812 new patients and contacts. Of these 603 new patients 187 were found tuberculous, and 1 new case was discovered amongst the 209 contacts examined. The total number of attendances at the Dispensary during the year was 3,917, as compared with 3,621 in 1930. Visits to the homes of dispensary patients were made by the Tuberculosis Officer in 204 instances, and 4,175 visits were made by the Dispensary Nursing Staff. The number of deaths of dispensary patients was 117 as compared with 96 in 1930. Sixteen of the patients were discharged as "recovered" or "diagnosis not confirmed" during the year, and 19 others ceased to attend, in addition to 57 patients removed to other districts. 60 Institutional Treatment. The number of patients who received institutional treatment under the L.C.C. Tuberculosis Scheme was 139, and the average length of stay was 116.4 days. The average period of waiting before admission was 14 days. Definite improvement as a result of institutional treatment was shown in 53 cases. Twenty-five patients discharged themselves while undergoing institutional treatment. The number of Dispensary patients admitted to the L.C.C. Hospitals 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 £683 11s. 6d. Examinations and Reports. Sputum examinations made during the year numbered 1,332, of which 440 were received from medical practitioners, and 278 from St. James's Hospital. The number of positive examinations was 267 or 20 per cent. Reports to public bodies were made to the number of 998. Consultations with medical practitioners at the houses of patients and reports made on patients sent to the Dispensary totalled 823, while reports received in respect of insured persons numbered 99 (Form G.P. 36, 98, form G.P. 17, 1). There were 136 patients referred to hospitals, including 129 sent to St. Thomas's for X-ray examination. Artificial Sunlight Treatment. During the year 7 patients (4 children, 3 adults) received treatment for surgical tuberculosis at the Council's artificial sunlight treatment centre at Southlands (vide page 44). In 2 cases treatment was completed, and the 5 remaining were still under treatment at the end of the year. The average period of treatment in the 2 completed cases was 69 days, and the result of the treatment in these cases is shown on p. 117. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. In the Appendix (pages 129 to 132) will be found Form T. 145, which contains the returns required by the Ministry of Health of the work of the Dispensary during the year 1931, and Form T. 145a, which shows in a summarised form the condition of all patients whose case records were in possession of the Dispensary at the end of 1931, arranged according to the years (from 1921 to 1931) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. 61 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 1931 the number of new cases notified (including 7 notified after death) and not attending the Tuberculosis Dispensary was 98 (women 60, children 38). There were 10 other cases among women and children which came to the knowledge of the Medical Officer of Health, 9 upon registration of the deaths and 1 by information as to the removal of the patient into the Borough. There were 29 deaths (including 8 of tubercular meningitis) recorded amongst these 108 cases. In 18 cases death had occurred prior to the first visit and 11 deaths were subsequently recorded during the year. The following table gives the age and sex distribution of the 108 women and children (non-dispensary cases) notified or otherwise reported to be suffering from Tuberculosis (all forms) during 1931:— 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 - - - - - - - 2 F. - 1 4 2 8 14 21 6 4 — 1 61 Tubercular Meningitis M. - - 3 1 - - - - - - - 4 F. 1 5 — 1 1 - - - - - - 8 Other Forms M. - 7 4 - - - - - - - 11 F. - 9 — 2 2 6 2 1 — — — 22 Total M. - 8 7 2 - - - - - - - 17 f. 1 15 4 5 11 20 23 7 4 - 1 91 Grand Total 1 23 11 7 11 20 23 7 4 — 1 108 The home conditions of 102 of these cases were investigated. In the majority of cases the sanitary state of the home was found to be satisfactory, the average number of persons per room being 1.36. In 7 cases, however, the conditions were found to be unsatisfactory the patient's family occupying only a single room. 62 Of the new cases notified during the year 37 were receiving hospital, sanatorium, or other form of institutional treatment at the time of notification. At the end of 1931 there were 155 women and children nondispensary patients (a decrease of 6 as compared with 1930), including new cases notified during the year, on the register, and 1,173 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, 65 cases were transferred, 54 of these being new cases. Adult Male Patients. There were 140 adult male patients not on the Dispensary roll on the register at the end of 1931. There were 82 new cases notified (including 8 notified after death) and 15 otherwise reported during 1931, and of these 28 died during the year. The following table gives particulars of the 97 non-dispensary new (male) cases coming to the knowledge of the Medical Officer of Heath by notification or otherwise in 1931:— Age Distribution. All ages. 16-20 20-25 25-35 35 45 45-55 55-65 65 up Pulmonary 12 10 24 15 12 8 2 83 Tubercular Meningitis 1 1 — — — — - 2 Other tubercular Diseases 2 3 5 1 — 1 — 12 Total 15 14 29 16 12 9 2 97 The homes of the patients were systematically visited during the year by the District Sanitary Inspectors, and 250 visits, including 90 first visits to new cases were paid. Sixteen of the new cases were found to have died on the first visit. Of the new cases 51 received institutional treatment and 30 were transferred to the Dispensary. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary under the provisions of these Regulations during 1931. 63 Revision of Tuberculosis Register. As mentioned in the Annual Report for 1929, the Tuberculosis 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 1931 the names of 33 additional patients were, after medical examination and consideration of their history, removed from the Register, as compared with 54 in 1930. 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. During 1931 three children were boarded out under the scheme 64 Form T137 1931 Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1932, in the area of the Metropolitan Borough of Battersea (to which this return relates). Age Periods. Formal Notifications. Number of Primary Notifications of New Cases of Tuberculosis. Total Notifications 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males — — 1 3 14 13 33 22 19 12 2 119 176 ,, Females — 1 4 3 15 29 24 12 5 — 2 95 127 Non-Pulmonary Males — 6 8 1 1 1 3 1 — — — 21 25 „ Females — 7 1 2 3 6 2 — — 1 — 22 31 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) NOTES. Part I. (а) Formal notifications are notifications which are made in pursuance of Article 5 of the Public Health (Tuberculosis) Regulations, 1930, or by Naval, Military or Air Force Medical Authorities in pursuance of Section 5 (b) of the Local Government (Emergency Provisions) Act, 1916. (b) Primary notifications for the purpose of columns (2)-(13) relate to patients who have never previously been formally notified in the area to which the Return relates. A patient 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. Only the first of such notifications, however, should be recorded in columns (2)-(13) of the Return for the County concerned, the subsequent notification(s) being included in column (14). (c) Column {14). All formal notifications, whether duplicate or not, should be included in this column. General.—Patients notified as suffering from combined pulmonary and non-pulmonary tuberculosis should be included among the "pulmonary" returns only. If a patient already notified as suffering from one form of tuberculosis is subsequently notified to the Medical Officer of Health of the same Sanitary District as suffering from another form of tuberculosis, the fact should be noted in the Notification Register, but such notification should be recorded as a duplicate notification. 65 Supplemental Return. Part II.—New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — 1 — — 2 1 3 4 1 2 1 15 „ Females — — — — — — 2 1 — — — 3 Non-Pulmonary Males — 1 2 1 2 3 2 — — 1 — 12 „ Females 1 6 — — 1 — 1 1 — — — 10 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 4 2 transferable deaths from Registrar-General 4 7 Posthumous notifications 6 8 "Transfers" from other areas (other than transferable deaths) 2 5 Other sources if any (specify).—Form ii. (discharge notice) 2 — NOTES.—Part II. (a) New cases of tuberculosis first coming to knowledge otherwise than by formal notification may, in some instances, afterwards be formally notified under the Regulations. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the Medical Officer of Health, it should be recorded as a "Primary Notification," and excluded from the Supplemental Return. If the formal notification is received in a subsequent year, such notification should be regarded as duplicate, as the case has already been included in the Supplemental Return for a previous year. (b) A formal notification which is not received until after the death of the patient should be included in the Supplemental Return as a "posthumous notification." (c) No case should be included both in the Summary of Notifications and in the Supplemental Return for the same year. (d) In Counties, the particulars for the purposes of this Return should be obtained by the procedure suggested in paragraph 2 of Part II. of Circular 549. 66 Part III.—Notification Register. Pulmonary. Non-Pulmonary. Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 468 352 820 207 171 378 1,198 Number of cases removed from the Register during the year bv reason inter alia of:— 1. Withdrawal of notification — 1 — — — — 1 2. Recovery from the disease 7 11 18 9 6 15 33 3. Death 106 46 152 14 19 33 185 NOTES.—Part III. In Counties, the information should be compiled from the quarterly statements for the year 1931, which are required to be furnished to the County Medical Officer of Health by the Medical Officer of Health of each District in the County, in pursuance of Article 10 (8) of the above-mentioned Regulations, and should represent the sum of the figures relating to each District in the County. If any of these quarterly statements has not been duly received by the County Medical Officer of Health, the Ministry should be furnished with particulars, including the name of the District concerned. Further, if the County Medical Officer of Health is in any doubt as to the accuracy of the figures included in his Return, he should record the fact, giving reasons. 67 Deaths from Zymotic Diseases. The principal zymotic diseases are small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping-cough, enteric fever and diarrhæa. The deaths from these causes in 1931 numbered 33, as compared with 89 in 1930, a decrease of 62.9 per cent. There was a corresponding decrease in the zymotic death-rate from 0.554 in 1930 to 0.207 in 1931. The mean death-rate from each of the principal zymotic diseases for the ten years 1911-1920, and for the ten years 19211930, are compared with the corresponding rates for 1930 and 1931 in the following table:— Zymotic Diseases Number of Deaths from each of the principal Zymotic Diseases in 1930 and 1931, with corresponding Death Rates for those years and for the 10 years 1911-20 and 1921-1930. No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase( + ) or Decrease(-), 1931 over 1931. 1930. 1931. 1930. 19111920. 19211930. Previous year. 19211930. Small Pox - - - - - .001 - - .001 Measles 2 38 .013 .237 .423 .161 - .224 - .148 Scarlet Fever 6 2 .038 .012 .039 .031 + .026 + .007 Diphtheria 5 15 .031 .093 .138 .171 - .062 - .140 Whooping-cough 5 7 .031 .044 .203 .118 - .013 - .087 Enteric fever ... 1 — .006 — .020 .005 + .006 + .001 Diarrhoea and enteritis 14 27 .088 .168 .595 .190 - .080 - .102 Total 33 89 .207 .554 1.418 .677 - .347 - .470 The death rate from zymotic diseases is the lowest yet recorded in Battersea. 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. 68 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 1931 there were 492 cases of chicken-pox reported, as compared with 469 in 1930, 441 in 1929, 632 in 1928, and 671 in 1927. Diarrhæa. During 1931 the total number of deaths from diarrhæa of children under 2 years of age was 9, equivalent to a fatality-rate of 0.06 per 1,000 of the population. In 1930 there were 21 deaths and a fatality-rate of 0.13. The rate per 1,000 registered births in 1931 was 3.63 as compared with 7.92 in 1930, 8.40 in 1929, and 9.48 in 1928. Influenza. There were 56* deaths registered as being due to Influenza during 1931, as against 14 in 1930, 138 in 1929, 14 in 1928, and 83 in 1927. The mortality-rate was 0.35, as compared with 0.09 in 1930, 0.85 in 1929, 0.08 in 1928, and 0.49 in 1927. Influenzal Pneumonia was more prevalent in 1931 than in the previous year, 67 cases being notified as against 43 cases in 1930, 140 in 1929, and 51 in 1928. The death-rate was 0.42 per 1,000 of the population, as compared with 0.04 in 1930, 0.39 in 1929, and 0.02 in 1928. Ophthalmia. During the year an outbreak of Ophthalmia occurred amongst children attending a group of Public Elementary Schools in the North-Western area of the Borough. From the investigations which were made the outbreak appears to have originated in a School in Church Ward and to have spread rapidly amongst the scholars of Schools in the neighbourhood, about 500 cases being reported. Precautionary measures to limit the spread of infection were taken in conjunction with the School Medical and Nursing Staffs of the London County Council, and the outbreak eventually subsided. The possibility of the Public Baths being the source of infection in this case was considered and a careful investigation, including an analysis of the bath water, was made. The results of these investigations showed clearly that so far as the water was concerned, this was not a factor in the spread of infection. The possibility of * 23 of these deaths were ascribed to Influenzal Pneumonia. 69 infection by the use of towels was not overlooked, but there was no definite evidence pointing to this as a source of infection. Care was taken by the staff of the Public Baths so far as practicable, to prevent the use of towels in common. In co-operation with the London County Council Medical Officer, it was considered advisable that the use of the Public Baths by children attending the Schools affected should be temporarily suspended. Cancer. During 1931 the number of deaths of Battersea residents from Cancer was 283 (males 131, females 152) as compared with 242 in 1930, 243 in 1929, 247 in 1928, and 252 in 1927. The death-rate from the disease per 1,000 of the population was 1.77. The deaths from cancer constitute 14.7 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 1927 1.49 1906-10 0.95 1928 1.51 1911-15 1.11 1929 1.50 1916-20 1.28 1930 1.51 1921-25 1.33 1931 1.77 The following table shews the localisation of the disease in the case of the 283 deaths recorded in 1931. Localisation. No. of deaths. Total. % of Total. Male Female Buccal cavity 8 3 11 3.89 Stomach, liver, peritoneum, intestines and rectum 72 73 145 51.24 Respiratory system 21 7 28 9.89 Female genital organs — 30 30 10.60 Breast — 29 29 10.25 Skin 3 2 5 1.76 Genito-urinary organs (male) 21 — 21 7.42 Other and unspecified organs 6 8 14 4.95 Total 131 152 283 100.00 70 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. 60, 116) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1931 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 1,893 (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 173 1,687 1,860 Enteric fever 1 13 14 Meningococcal Meningitis - 18 18 V.D. — 1 1 Total 174 1,719 1,893 The cost of these examinations is borne by the Council, and in 1931 amounted to £252 11s. 0d., as compared with £338 19s. 9d. in 1930. 71 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1931. Total Sanitary Operations 72,740 Leaky house-roofs and gutters repaired 1,004 Number of house inspections 41,545 House to house inspections 2,909 Houses supplied with water and fittings repaired 95 Bakehouse inspections 248 Bakehouse nuisances abated 30 Houses let in separate tenements on register 62 Urinals-inspections 166 Do. altered, repaired or water laid on 56 No. of inspections of do. 258 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 57 Intimations served under Sec. 3 3,653 Notices served under Sec. 4, &c. 1,231 Notices served under Secs. 62 & 65 1,505 Cisterns covered, cleansed and repaired 150 Complaints received and attended to 3,926 Additional water supplies to upper floors 23 Number of premises disinfected 1,912 Houses supplied with disinfectants 436 Keeping of animals in unfit state discontinued 22 Overcrowding abated 60 Smoke observations 24 Premises improved, cleansed and repaired 2,899 Certificates of disinfection granted 2,546 Drains tested By smoke 586 Houses inspected and certificates granted (Sec. 48) 17 Do. water 2,052 Drains cleansed and repaired 441 Proceedings ordered by Council and Health Committee 3,693 Drains relaid 182 Frontage drains constructed or re-constructed 40 Summonses issued 83 Magisterial Orders obtained and enforced 20 Soil pipes and drains ventilated 121 Sink and rain-water pipes disconnected or repaired 336 Factories, Workshops, &c., inspections 3,834 Water closets cleansed and repaired 713 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 75 Cesspools abolished - Mews and stables drained and paved - Underground sleeping rooms : Yards and forecourts paved and repaired 403 Use discontinued 2 Defects remedied 3 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 4 Gipsy van inspections 57 Drains laid to new houses and tenements 17 Samples taken under the Food and Drugs Adulteration Act 1,200 Dust receptacles provided 952 Miscellaneous 2,295 72 Legal Proceedings. Legal proceedings in connection with nuisances, &c., were taken by the Council in 58 cases during 1931. Particulars with regard to each case are set out below. Public Health (London) Act, 1891. Nature of Offence or Claim. Result of Proceedings. Nuisance at 19 Bridge Road West Work having been completed, case dismissed under the Probation of Offenders Act, 1907, with £2 2s. 0d. costs. Nuisance at 4 Eldred Place The like. Nuisance at 93a Latchmere Grove Order to abate nuisance in 14 days, with £2 2s. 0d. costs. Nuisance at 111 Culvert Road Summons dismissed under the Probation of Offenders Act, 1907, on payment of £1 1s. 0d. costs. Nuisance at 124 Meyrick Road. Order for nuisance to be abated in 7 days, and £2 2s. 0d. costs Failure to comply with Order to abate a nuisance at 24 York Road Defendant fined £5 and £1 1s. 0d. costs. The like. Fined £15 and £5 5s. 0d. costs. The like. Fined £20 and £5 5s. 0d. costs. The like. Fined £33 and £21 costs. Expenses in executing works at No. 33 Stewarts Road (£16 9s. 1d.) Order for amount claimed and £2 2s. 0d. costs. Exposing two pieces of meat for sale in such condition as to be unfit for the food of man. Fined £20. Nuisance at 13 Knox Road Dismissed under the Probation of Offenders Act, 1907, on payment of £2 2s. 0d. costs. Nuisance at 51 Sleaford Street Order to abate the nuisance within 14 days. Nuisance at 10 Strath Terrace Summons withdrawn. (Property changed ownership.) Nuisance at 89 Marney Road Defendant's Solicitor having given an undertaking in Court for the nuisance to be abated, summons adjourned sine die, upon payment of £2 2s. 0d. costs. Nuisance at 7 Creek Street Nuisance having been abated, summons withdrawn on payment of £2 2s. 0d. costs. Nuisance at 27 Belfour Street The like. Nuisance at 38 Woodgate Street The like. 73 Public Health (London) Act, 1891—continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at 39 Woodgate Street Order to abate the nuisance within 14 days and payment of £2 2s. 0d. costs. Nuisance at 29d Chatham Road Order to abate in 14 days, with £2 2s. 0d. costs. Carrying offensive matter other than in a suitable carriage and not having a sufficient covering thereon as to prevent a nuisance arising therefrom on the 20th July, 1931, along Nine Elms lane Fined £1 10s. 0d. with £1 1s. 0d. costs. Carrying offensive matter other than in a suitable container so as to prevent a nuisance arising therefrom on the 22nd and 26th September, 7th November, 1931, and the 6th February, 1932, in Falcon Road and Severus Road respectively Fined 40s. The like during prohibited hours on 22nd and 26th September, 1931 Fined 20s. Nuisance at 13 Orville Road Nuisance having been abated, summons withdrawn on payment of £1 1s. 0d. costs. Nuisances at Nos. 78, 80, 82, 84 Speke Road Nuisances having been abated, summonses withdrawn on payment of £2 2s. 0d. costs. Nuisance at 96 Beaufoy Road Summons not served. Nuisance abated. Nuisance at 51 St. John's Hill Grove. Nuisance having been abated, summons withdrawn on payment of £2 2s. Od. costs. Nuisance at 81 Stainforth Road Nuisance having been abated, summons withdrawn on payment of £1 1s. 0d. costs. Nuisance at 28 Belfour Street Nuisance having been abated, summons withdrawn on payment of £1 1s. 0d. costs. Nuisance at 144 Meyrick Road (Leaky roof, &c.) Nuisance having been abated, summons withdrawn. Order for £2 2s. 0d. costs. Nuisance at 52 Meyrick Road. (Defective roof, &c.) Order to abate nuisance in 7 days, and £2 2s. 0d. costs. Ditto. (Defective flushing cistern) Fined 10s. Nuisance at 66 Grant Road. (Defective roof, &c.) Nuisance having been abated, summons withdrawn on payment of £2 2s. 0d. costs. Nuisance at 29 Darien Road. (Defective guttering of back addition roof) Order to abate nuisance in 7 days. 10s. 6d. costs. Ditto. (Defective flush apparatus of water closet) Cautioned under the Probation of Offenders Act, 1907. £2 2s. 0d. costs. 74 Public Health (London) Act, 1891—continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at 13 Woodgate Street. (Defective W.C. seat, leaky roof, &c.) Summons dismissed for lack of evidence to prove service of Sanitary Notices. Offence against London County Council by-laws respecting the business of a rag and bone dealer Summons not served. The like. Summons not served. In 1930, the Council obtained a nuisance order against the owner of No. 24 York Road to remedy the leaky roof of those premises. The Order was not complied with and summonses were issued against the owner concerned on four different occasions (vide page 72) for failure to comply with the Order of the Court. Fines and costs totalling £105 11s. 0d. were inflicted. Subsequently the work was executed by the Council and the cost charged to the owner. Housing Acts, 1925 and 1930. Nature of Offence or Claim. Result of Proceedings. Expenses incurred in re 150 New Road (£56 17s. 1d.) Order for payment of amount claimed and £1 1s. 0d. costs. *For possession of the premises Nos. 19-29 (odd numbers) Longhedge Street Order made for the possession to be discharged if the repairs as ordered by the Council are certified as completed in 28 days, costs against the Defendant of all parties including the Council, such costs to include qualifying fee for Surveyors to the Plaintiffs. No. 150 New Road.—(1) Declaration that the Council are entitled to a first charge in priority to any mortgage lien or other incumbrance on the premises for £57 18s. 1d. (being expense incurred by them in making the said premises in all respects reasonably fit for human habitation) together with interest thereon at the rate of 5 per cent. per annum from the 26th February, 1931. (2) Order for the Council to sell the premises with conduct of the sale for the purpose of enforcing the said charge. (3) Enquiry as to incumbrances. (4) Receiver to be appointed by the Council to receive the rents and profits pending the sale. (5) Further and other relief. (6) Liberty to apply Judgment for the Council (with costs on the higher scale) in accordance with the reliefs as asked for in the Council's particulars of claim. Failure to furnish particulars re 14-20 Shillington Street, under a Notice as required by Section 42 of the Housing Act, 1930 Particulars having been furnished, Order made for payment of £3 3s. 0d. costs. * Action by freeholders against leaseholder, the Council being joined as defendant. 75 Food and Drugs (Adulteration) Act, 1928. No. of Sample. Article. Nature of Offence, Adulteration, &c. Result of Proceedings. 646 Milk 27% extraneous water... Defendant fined £20, the maximum penalty, and £5 5s. Od. costs. 652 „ 25% 653 „ 33.5% „ 654 „ 22% 751 Milk 2% deficient in fat Summonses adjourned sine die. 752 „ 4% extraneous water 753 „ 1% deficient in fat 756 „ 7% 791 Milk 27% extraneous water Dismissed under the Probation of Offenders Act, 1907, on payment of £3 3s. Od. costs. 185 Milk 23% deficient in fat Fined £4 and £1 Is. Od. costs. 323 Milk 6% extraneous water Dismissed under the Probation of Offenders Act, 1907, upon payment of £1 Is. Od. costs. (No previous conviction.) 386 Milk 6% deficient in fat Dismissed under the Probation of Offenders Act, 1907, upon payment of £2 2s. Od. costs. (No previous conviction.) 549 Milk 6% deficient in fat Cautioned under the Probation of Offenders Act, 1907, and ordered to pay £2 2s. Od. costs. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. Nature of Offence or Claim. Result of Proceedings. Not having name and address conspicuously inscribed on vehicle Dismissed under the Probation of Offenders Act, 1907, on payment of 2s. costs. Name and address not conspicuously inscribed on vehicle Cautioned under Probation of Offenders Act, 1907, on payment of 5s. costs. (No previous conviction.) 76 Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926.—contd.). Nature of Offence or Claim. Result of Proceedings. Carrying on the trade of a dairyman in the Borough without being registered Summonses not served Name and address not conspicuously inscribed on vehicle Delivering milk in bottles not filled and closed on registered premises Dismissed under the Probation of Offenders Act. 1907, upon payment of £1 1s. 0d. costs. (No recent conviction.) Removing the disc from a bottle of milk after it had left registered premises and before delivery to the consumer on the 1st October, 1931 Cautioned under the Probation of Offenders Act, 1907, on payment of 5s. costs. (No previous conviction.) Whilst delivering a bottle of milk unlawfully did remove the disc used for closing such bottle after it had left registered premises and before delivery to the consumer Summons dismissed. £3 3s. 0d. costs against the Council. Carrying on the trade of a dairyman in the Borough on 29th October, 1931, without being registered Fined £3 0s. 0d. and £2 2s. 0d. costs. Carrying on the trade of a dairyman in the Borough on the 12th November, 1931, without being registered Fined £5 (maximum penalty). Carrying on the trade of a dairyman in the Borough on 6th November, 1931, without being registered. Cautioned under the Probation of Offenders Act, 1907, on payment of £1 1s 0d. costs. (No previous conviction.) Name and address not conspicuously inscribed on vehicle The like. Carrying on the trade of a dairyman in the Borough on the 26th September, 1931, without being registered Cautioned under the Probation of Offenders Act, 1907, on payment of 2s. costs. (No previous conviction.) Name and address not conspicuously inscribed on vehicle The like. Whilst delivering a bottle of milk unlawfully did remove the disc used for closing such bottle after it had left the registered premises and before delivery to the consumer Summons dismissed. The like. Summons dismissed. £3 3s. 0d. costs against the Council. 77 Milk and Dairies (Amendment) Act, 1922. Nature of Offence. Result of Proceedings. Selling as milk liquid in the making of which dried milk had been used Dismissed under the Probation of Offenders Act, 1907, upon payment of £2 2s. 0d. costs. (No previous conviction.) Public Health (Meat) Regulations, 1924. Nature of Offence. Result of Proceedings. Failure to comply with the Public Health (Meat) Regulations, 1924 Defendants ordered to pay £10 10s. costs. Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 58 cases during 1931. Acts and Regulations under which Proceedings taken. Cases. Persons prosecuted including employees. Convictions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and by-laws made thereunder 35 28 15 98 0 0 76 2 6 Housing Acts 3 2 2 - 57 5 Food and Drugs (Adulteration) Act, 1928 7 7 2 24 0 0 14 14 0 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 1926 11 11 1 8 0 0 6 1 0 Milk and Dairies (Amendment) Act, 1922 1 1 - - 2 2 0 Public Health (Meat) Regulations, 1924 1 1 — - 10 10 0 Total 58 50 20 130 0 0 167 8 11 Common Lodging Houses. The following table gives a list of the common lodging houses n 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 78. 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 under the Public Health (London) Act relating to waterclosets, &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 88 new buildings, or additions to existing buildings, and the drains of 182 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. During 1931, 7 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 2 cases liability, wholly or in part, was admitted by the Council, and the expenditure incurred by them under this head amounted to £54 15s. lid. In 5 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 1931, as compared with 1930, was as under:— 1930 1931 Re-construction or repair of existing drains 71 83 New buildings or additions to existing buildings 65 92 136 175 In 22 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 by-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 1931, 586 drains were tested by smoke of which 110 were found defective. The water test was applied on 2,052 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 121 instances. 79 Water closets were provided in 57 cases and existing closets repaired in 713 cases. The total number of drains relaid during the year was 182. Those cleansed and repaired numbered 441. 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. Additional by-laws dated 24th February, 1931, were made by the London County Council during the year, the effect of which was to bring into operation in regard to houses already decontrolled, and to others as they become decontrolled, certain provisions in the principal by-laws (e.g., minimum air space in bedrooms, provision of sanitary accommodation, &c.) which were not to come into force until the Rent Restrictions Acts expired. 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 258 inspections of these premises were made in 1931. Sanitary Conveniences attached to Licensed Premises. During 1931 the number of public-house urinals under inspection was 118. In 76 instances the accommodation is accessible to the general public as well as the users of the houses, and in 42 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 14 notices were served to remedy defects discovered, and were duly complied with. During the year the Committee were successful in securing the reconstruction or adaptation of the sanitary accommodation at nine of these premises to meet modern sanitary requirements. In those cases where conveniences are available only to the users of the licensed premises, the Department have endeavoured, whereever an external entrance was available, to arrange for access to be afforded to the general public, and their efforts have been successful in a number of instances. Smoke Nuisances. During the year 24 observations were made and 1 complaint received. Fourteen preliminary and four statutory notices were served by the Council under the provisions of the Public Health (Smoke Abatement) Act, 1926, to abate smoke nuisances. A by-law made by the London County Council under section 2 of the Public Health (Smoke Abatement) Act, 1926, came into force on 19th May, 1931. The by-law provides that the emission of smoke from buildings other than private dwelling houses for a period of 3 minutes (or 2 minutes after 5 years from the date of the confirmation of the by-law) during a period of 30 minutes shall be deemed to be a nuisance liable to be dealt with summarily. 80 Effluvium, &c., Nuisances. No action was found necessary during the year with regard to nuisance from effluvium. Removal of Offensive Matter. The by-laws of the London County Council with regard to the removal of offensive matter are enforced by the Sanitary Inspectorial Staff. During the year proceedings were instituted against two persons for offences against the by-laws. The defendants were convicted and fined £1 10s. 0d. (with one guinea costs) and £2 respectively. Water Supply. During 1931 applications were received for certificates of water supply in respect of 17 houses in accordance with Section 48 of the Public Health (London) Act, 1891. The certificates were granted in each instance. In 23 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 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 1931 was 65. In the following table are set out the situations of the dwellings and number of occupants:— Situation of Vans. No. of Vans. No. Occupants M. F. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 4 Mills' Yard, adjoining 80 Sheepcote Lane 7 7 6 Haines' Yard, Falcon Road 6 8 6 Manley's Yard, Cabul Road 30† 22 28 Mills' Yard, Culvert Road 18* 16 24 Van dwellings are frequently inspected. Five vans were unoccupied. * Including one shed. † Including one cottage. 81 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 1931. 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. The work carried out during 1931 under the Council's Rat Repression Scheme is summarised as follows:Premises visited 1,429 Contracts made or Poison baits used 20,175 renewed ... 14 Dead rats found 1,631 Value of contracts £216 10 0 Cash for poison bait £9 1 0 Total expenditure (financial year 1931-32) £530 3 6 Income (financial year 1931-32) £226 12 0 Drains were tested at 71 premises in connection with this work, and in 63 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" (2nd to 7th 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 local cinemas. The results were good, considerable numbers of rats being found dead, and the education and 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. It was not found necessary during the year to institute proceedings under the by-law made by the Council in 1927 (and renewed in 1929) with regard to the fouling of footways by dogs. In April the Health Committee ordered that enamelled plaques calling attention to the by-law should be affixed to lamp-posts in the Borough, and about 100 such plaques were exhibited. The application of this by-law appears undoubtedly to have effected a diminution of this objectionable form of nuisance on the public footways. 82 Personal Cleansing Station. During the year 1931, there were 3,898 children and 283 adults cleansed and treated at the station. Of the 3,898 children attending, 649 were suffering from scabies or. itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,821 attended from the public elementary schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's sanitary staff. There was an increase in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. Number of Baths, &c. Year. Adults. Children. * Expenditure. Amount Contributed.* Verminous and Scabies. Verminous and Scabies. £ £ 1906 141 2 29 — 1907 504 113 42 — 1908 1,011 656 82 — 1909 1,373 321 91 1910 1,583 341 88 — 1911 1,459 191 93 13 1912 1,351 841 237 65 1913 1,323 1,090 118 69 1914 1,050 1,602 132 78 1915 648 1,273 125 78 1916 475 1,773 143 94 1917 320 2,620 169 140 1918 291 3,179 237 187 1919 366 3,214 287 169 1920 419 4,213 456 331 1921 340 4,607 561 400 1922 274 4,444 584 400 1923 212 4,949 779 487 1924 311 5,394 912 488 1925 261 4,724 879 459 1926 229 4,371 916 425 1927 256 4,360 960 418 1928 221 3,769 863 400 1929 278 4,335 927 400 1930 263 3,901 856 400 1931 283 3,898 875 400 15,242 70,181 £11,441 £5,901 * Financial year ending 31st March. 83 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1931. Total premises disinfected 1,912 Rooms disinfected 2,611 Staircases disinfected 163 Schools disinfected 17 Number of articles laundered 33,975 „ „ destroyed 2,746 „ verminous, etc., persons (including 3,821 school children) 4,171 „ infectious disease contacts 708 „ library books collected 395 Articles. No. Weight. Tons. cwts. qrs. lbs. Bedding, &c., disinfected 62,917 93 2 1 3 (including 13,751 articles from shelters and Cleansing Station) Bedding, &c., lent 1,415 4 4 3 26 Verminous clothing, &c. 7,598 1 16 2 18 Articles from Welfare Centres 3,093 (not weighed) Total 75,023 99 3 3 19 Coroner's Court and Mortuary. In view of the increased number of inquests consequent upon the extended powers given by the Coroners (Amendment) Act, 1926, the County Council approached the Council with a proposal that inquests in the Western Coroners' District (comprising the Boroughs of Battersea, Chelsea, Fulham, Hammersmith and Wandsworth) should be held in future either at the Battersea or the Hammersmith Court. The Council agreed to the extended use of the Court in the manner proposed, subject to the County Council re-imbursing the additional expense occasioned. 84 Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1931 are set out in the following table :— Details of Bodies Received. Usual Place of Residence. Total Battersea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court— Post-mortem at Mortuary 25 51 23 3 102 Post-mortem elsewhere 15 57 24 — 96 No post-mortem 19 43 13 1 76 Body not received — 5 21 2 28 Post-mortem at Mortuary— Inquest elsewhere — — — — — No inquest (Coroner's certificate) 70 51 5 — 126 No inquest (medical certificate) — — — — — Other bodies received— Sanitary reasons 7 2 1 — 10 Other reasons 1 1 1 — 3 Total bodies received 137 205 67 4 413 Total inquests held 59 156 81 6 302 Total post-mortems held 95 102 28 3 228 VERDICTS AT INQUESTS HELD— Natural causes 6 17 2 — 25 Accidental Death— Anaesthesia — 3 4 — 7 Asphyxia 3 6 4 — 13 „ (Epileptic fit) 2 1 — — 3 Blow 1 — 1 — 2 Burns and scalds 7 7 5 — 19 Cellulitis following injury 1 — — — 1 Drowning — 3 3 — 6 Fall 9 18 14 — 41 Injury at birth — 1 — — 1 Poisoning—Coal gas 1 — 1 — 2 „ Drugs, etc. — 1 1 — 2 Post-operative shock — 2 1 — 3 Railway and street 13 43 22 — 78 Sepsis following injury 2 2 — — 4 Open Verdict— Abortion — 2 3 — 5 Asphyxia 2 4 — — 6 Fall 1 — — — 1 Found drowned 1 2 3 1 7 On railway — — 1 1 2 Poisoning—Coal gas 1 — — — 1 ,, Drugs, &c. 1 — — — 1 Still-born — 1 — 2 3 Want of attention at birth — — 1 1 2 Unknown and other causes — 2 — 1 3 Suicide— Cut throat 3 1 1 — 5 Drowning — — 2 — 2 Firearms — 2 1 — 3 Hanging — 4 2 — 6 Jump from high place — — 1 — 1 „ under moving vehicle — 3 2 — 5 Poisoning—Coal gas 2 21 2 — 25 „ Drugs, &c. 3 11 3 — 17 Grand Total 59 157 80 6 302 85 Staff of the Public Health Department. The staff of the Public Health Department at 31st December, 1931, is set out on pages 3 and 4. During the year the following changes in personnel took place:— Dr. H. McKernan resigned her appointment as Resident Medical Officer of the Maternity Hospital in May, and Dr. Ethel R. Emslie, m.b., ch.b., d.p.h., was appointed to fill the vacancy in June. Dr. Emslie resigned the appointment in December and the vacancy was filled by the temporary appointment of Dr. F. A. Mower White. Miss K. Morrison was appointed District Midwife in September vice Miss A. Barker, resigned. In January, Mr. A. E. Tubby was appointed Organising Rat Officer under the Rats and Mice (Destruction) Act, 1919, to fill the vacancy caused by the resignation of Mr. H. Renham in October, 1930. Mr. P. Bracking was appointed Grade A Clerk in the Department on 28th January, 1931, in the place of Mr. W. C. Turner. Messrs. W. E. Anstee and E. Saphier, who had been appointed temporary sanitary inspectors for the purpose of the housing survey (vide p. 104) resigned their appointments in April and January respectively. Mr. B. P. Garrod was appointed for the same purpose in January. 86 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 1931 :— Food. Quantity. Food. Quantity. Fish. Dog Fish 2 boxes. Fruit & Vegetables. Eels 70 lbs. Apples 155 boxes and 1 barrel. Fillet (smoked) 5 boxes. Haddocks 1 trunk. Chestnuts 3 sacks. Herrings 1 stone. Grapes 6 boats. Kippers 1 box. Peaches 100 boats. Plaice ½ stone. Pears 31 cases. Shrimps 1 bag. Potatoes 10 sacks. Skate 2 boxes. Walnuts 9 bags. Whelks 3 bags. Winkles 1 sack. Witches ½ stone. Meat. Pig's head 1 Bread 4 loaves. Pig's pluck 1 Pork 1 piece. Rabbits 33 Proceedings were taken under the above-mentioned Section against proprietors of a butcher's shop at which two pieces of diseased mutton were exposed for sale, and a fine of £20 was inflicted (vide page 72). Cow-houses. There is now no licensed cow-house in the Borough. Slaughter-houses. There are only two slaughterhouses remaining in the Borough. The Council opposed the renewal of the licence of one of these premises on change of ownership, but were unsuccessful. These premises are kept under systematic inspection, and during the year 1931, 124 inspections were made by the Council's inspector. The carcases of 59 animals (calves 2, sheep 17, and pigs 40) 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. 87 Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1931 was 96. Eight new butchers' premises were opened during the year making a total of 104 butchers' premises carrying on business at the end of the year. There are in addition a number of premises where the sale of cooked meats is carried on, in addition to grocers' and provision merchants' premises, where cooked meats are among the articles sold. 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 1,785 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. Legal proceedings were taken during the year under the Public Health (Meat) Regulations, 1924, in respect of premises which were found not to comply with the requirements of the Regulations in regard to cleanliness (vide page 77). Food and Drugs (Adulteration) Act, 1928. The 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. Artificial Cream Act, 1929. (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. 88 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 1931 was 790, of which 28 or 3.5 per cent. were certified by the Public Analyst to be adulterated. In addition to the foregoing, 410 informal samples were procured, none of which were reported by the Public Analyst as being adulterated or containing preservative in contravention of the provisions of the Public Health (Preservatives, &c., in Food) Regulations. The percentage of samples reported by the Public Analyst to be adulterated during the quinquennia 1921—1925 and 1926—1930, and in each year from 1926 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. Formal Informal Year. Samples. Samples. (per cent.) (per cent.) Mean 1921—1925 6.4 7.4 1926 4.3 3.7 1927 4.5 0.8 1928 2.6 1.4 1929 2.6 4.1 1930 2.6 2.2 Mean 1926—1930 3.3 2.4 1931 3.5 Nil The following tables give details of the articles of which samples were obtained for the purpose of analysis:— 89 Main Statement. TABLE I: Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread — 4 4 — 0 0 Butter — 72 78 0 0 0 Cheese — 18 18 — 0 0 Cocoa — 4 4 — 0 0 Coffee — 8 8 — 0 0 Confectionery and Jam — 36 36 — 0 0 Cream — 13 13 — 0 0 Flour, Self-raising — 7 7 — 0 0 Margarine — 58 58 —- 0 0 Milk 777 — 777 28 — 28 „ Separated 3 — 3 0 — 0 „ Condensed (Full Cream) — 9 9 — 0 0 „ „ (Machine Skimmed) — 5 5 — 0 0 Mustard — 7 7 — 0 0 Tea — 24 24 — 0 0 Vinegar 4 — 4 0 — 0 Drugs — 7 7 — 0 0 Other Articles — 138 138 — 0 0 Total 790 410 1200 28 0 28 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Ointment, Zinc — 4 4 — 0 0 Vaseline — 3 3 — 0 0 Total — 7 7 — 0 0 90. TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground 4 4 — 0 0 Arrowroot — 2 2 — 0 0 Baking Powder — 11 11 — 0 0 Cake, Sponge — 3 3 — 0 0 Custard Powder — 7 7 — 0 0 Dripping — 18 18 — 0 0 Fish Paste — 8 8 — 0 0 Fruits, dried — 19 19 — 0 0 Ginger, ground — 8 8 — 0 0 Honey — 4 4 — 0 0 Lard — 17 17 — 0 0 Oatmeal — 3 3 — 0 0 Peel, Candied — 3 3 — 0 0 Pepper — 7 7 — 0 0 Rice — 8 8 — 0 0 Sausages — 7 7 — 0 0 „ Preserved — 1 1 — 0 0 Spice, Mixed — 4 4 — 0 0 Sugar — 4 4 — 0 0 Total — 138 138 — 0 0 Milk. Of the 780 samples of milk (all formal and including 3 samples of separated milk) submitted during the year, 28 or 3.6 per cent., were reported as adulterated, 15 of these samples being deficient in milk fat and 13 containing extraneous water. The deficiency in milk fat varied from 23 per cent. to 1 per cent., and the proportion of extraneous water from 33.5 per cent. to 1.5 per cent. In the 5 years 1926-30, and in 1931 the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1926 738 32 4.3 1927 696 37 5.3 1928 668 21 3.2 1929 603 11 1.8 1930 707 18 2.5 Mean 682 24 3.5 1931 777 28 3.6 91 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 89. The average composition of the 749 samples (all formal) reported as genuine proved to be as under:— Per cent. Total milk solids 12.37 Milk fat 3.56 Non-fatty solids 8.81 The content of fat in these 749 samples ranged as follows:— 4 per cent. and over 49 samples or 6.5 per cent. Between 3.9 and 4.0 per cent. 22 „ ,, 2.9 „ „ 3.8 „ 3.9 „ 45 „ „ 6.0 „ „ 3.7 „ 3.8 86 „ „ 11.5 „ „ 3.6 „ 3.7 „ 128 „ „ 17.1 „ „ 3.5 „ 3.6„ 140 „ „ 18.7 „ „3.4 „ 3.5 „ 108 „ „ 14.4 „ „3.3 „ 3.4 „ 77 „ „ 10.3 „ „ 3.2 „ 3.3 „ 51 „ „ 6.8 „ „ 3.1„ 3.2 „ 30 „ „ 40 „ „3.0 „ 3.1 „ 11 „ „ 1.5 „ Under 3.0 per cent. 2 „ „ 0.3 „ 749 100.0 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 4 Sundays during the year, and 25 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 53 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 185 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. 32 During the year 15 samples of milk were taken for bacteriological examination. Of these 11 were of certified or pasteurised milk, and 4 of ordinary milk. The results of the bacteriological examination showed that all the samples complied with the requirements. Eight 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 Secs. 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 taken of these provisions by 5 milk purveyors in regard to 10 samples of milk. All these samples having been certified to be genuine no action was necessary on the requests. Proceedings with regard to adulteration were taken in 13 instances—fat abstractions, 6; extraneous water, 7, particulars relating to which will be found set out in the tables on page 75. Imported Milk. The attention of the Council was drawn to the importation of milk in large quantities, much of which was being taken to Battersea. In view of the fact that this imported milk had no supervision other than that of the Port Sanitary Authority through whose hands it passed, there being no subsequent control by local Authorities in whose districts it arrives, the Council, on the report of the Health Committee, made representations to the Government Departments concerned on the subject, suggesting that the receptacles containing imported milk should be required to be labelled as in the case of other imported foodstuffs. The Minister of Agriculture replied that he had no power to initiate action in the matter, and the Council addressed a communication to the Metropolitan Boroughs Standing Joint Committee, and the local Members of Parliament were asked to support the action taken. Condensed Milk. During the year, 14 informal samples of condensed milk were submitted to the Public Analyst, of which 9 were described as “full cream" and 5 as “machine separated." All samples were found to be genuine. 93 Cheese. Eighteen samples of cheese were submitted for analysis during the year, all of which were procured informally. The samples proved genuine. Butter. The total number of samples of butter taken during the year was 78. Of these 72 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 78 samples amounted to 13.9 per cent., the maximum amount permitted being 16.0 per cent. Margarine. Fifty-eight samples of margarine were purchased and submitted to the Public Analyst for examination, all 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 13.9 per cent. Sausages, Bacon. Preserved Meats, &c. Eight informal samples of sausages (including 1 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 that labelled “Preserved Sausage" the preservative present was within the limits allowed by the Public Health (Preservatives, etc., in Food) Regulations. Flour. Seven samples of self-raising flour submitted for analysis were all reported as genuine. These samples were all taken informally. Rice. Eight informal samples of rice were procured and submitted to the Public Analyst and all were reported as genuine. Vinegar. Four samples of vinegar were procured formally and submitted to the Public Analyst, and all were reported to be genuine. Pepper. Seven samples (all informal) of pepper were examined and found to be genuine. 94 Dried Fruits. During the year 19 samples (all informal) of dried fruits, were purchased and submitted to the Public Analyst. In no case was a sulphite preservative reported to be present in excess of the quantity permitted by the Public Health (Preservatives, etc., in Food) Regulations. Drugs. The number of samples of drugs submitted to the Public Analyst for analysis during the year was 7 (all of which were informal samples) and comprised 2 varieties. In each case the sample was found to be genuine. Ice Cream. There are 168 premises in the borough in which ice cream is manufactured, stored or sold, 19 of these being occupied by Italian vendors. Twenty new premises were registered during the year and 20 were removed from the register on discontinuance of the business, the number of registered premises therefore remaining the same. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 301 inspections were made and 11 notices were served (8 intimation and 3 statutory) for cleansing of premises. 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 five cases to institute legal proceedings for breaches of the requirements of the Order with regard to the filling of milk bottles. In one case the offence consisted of filling a bottle in the street, and in four cases the opening of bottles already filled and sealed. The results of the proceedings are set out on page 76. 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. 95 During 1931 licences were issued as follows:— Full. Supplemental. Certified milk 9 1 Grade A (Tuberculin tested) milk 56 3 Grade A milk 1 1 Pasteurised milk 17 2 83 7 Two licences to bottle Grade A (T.T.) milk and two to pasteurise milk were granted and are included in the above figures. The bacteriological examination of samples of certified and pasteurised milk is referred to on page 91. Milk Shops. The number of premises registered in Battersea for the sale of milk is 129 (including 6 wholesalers' premises). Three new premises (including one wholesale depot) were registered during the year for the sale of milk, and in 2 cases the sale of milk from registered premises was discontinued. In 13 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 594 inspections were carried out and 42 notices (31 Intimation and 11 Statutory) were served to remedy defects found on inspection. These mainly referred to dirty premises. In addition to the above there are 136 persons registered in respect of premises in which milk in sealed bottles only is sold. Two premises registered for the sale of milk were transferred to the Register for the sale of milk in sealed bottles only. 23 vendors whose registered premises are without the borough are registered as purveyors within Battersea, and 6 premises used for the wholesale distribution of milk are registered by the Council. The improvement which has been noted in recent years 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 1931 no contraventions of the Regulations were reported. 96 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 1931 dealing with the grading and marking of Cider. 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 1931 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 77 (one more than at the end of 1930). All these premises are kept under systematic inspection. Two hundred and eighty-eight inspections were made during 1931 and 37 notices (28 intimation and 9 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 1931 was 122, 12 having been added and 6 removed. During the year 255 inspections were carried out and in 29 cases it was found necessary to serve notices (including 10 statutory notices) to remedy various defects. Street Stalls for Sale of Food. There are 219 street stalls in the borough for the sale of foodstuffs of varied character, namely: vegetables and fruit 139, refreshments (coffee stalls) 9, fish and poultry 25, meats and rabbits 4, sweets 8, and other foods 34. Inspections numbering 234 were made of the premises used by street vendors for the storage of their stocks, and 29 intimation and 6 statutory notices were served to remedy defects found. 97 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) 776 71 - Workshops (including Workshop Laundries) 617 73 _ Workplaces (other than Outworkers' premises included in the Table on page 103) 1,754 174 - Total 3,147 318 - 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 86 86 - - Want of Ventilation 2 2 - - Overcrowding - - - Want of drainage of floors 1 1 - Other nuisances 133 129 - Sanitary accommodation {Insufficient 4 4 - {Unsuitable or defective 70 70 - {Not separate for the sexes 1 1 Nil. - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (Sec. 101) - - - - Other Offences (excluding Offences relating to Outworkers which are included in the Table on page 103) — - - Total 297 293 - - 98 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1931 :— Bakehouses 11 Bootmakers 32 Dressmakers 14 Laundries 3 Milliners 6 Tailors 43 Other Trades 164 Total number of workshops 273 4.—Other Matters. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 12 Notified by H.M. Inspector 1 Underground Bakehouses (Section 101), in use at end of the year 21 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1931:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 50 210 59 30 15 Barge builder 2 12 — — — Bootmaker 37 68 2 — — Builder 4 120 9 — — Butter blender 1 205 16 30 41 Chaff & forage 2 34 — 8 — Chemical works 4 172 10 65 10 Coachbuilder 3 20 — — — Cycle maker 2 5 2 — — Dyer 2 48 5 36 5 Engineer 21 1,015 136 18 35 Firewood cutter 12 43 6 24 — Flour mills 2 120 5 12 — Foundry 2 47 6 — — Lift maker 1 15 3 — — Mason 7 537 24 — — Mineral water 2 28 2 30 — Motor repairer 23 274 18 9 — Printer 20 72 21 21 8 Steam laundry 16 75 17 446 193 Other trades 99 3,729 580 1,180 587 Total 312 6,849 921 1,909 894 99 The duties of sanitary authorities in relation to the sanitation of factories are few, and are limited mainly to the enforcement of suitable and sufficient sanitary accommodation for factory employees. Twenty new factory premises were added to the register during the year, dealing with various trades, and 22 were removed. During the year 53 preliminary and 18 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 1931:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 11 11 17 1 - - Blind maker 2 3 5 — — — Bootmaker 32 33 42 2 — — Carpenter 4 4 7 1 — — Coach builder 5 8 12 2 — — Cycle maker 8 12 16 3 2 — Dressmaker 14 18 — — 39 1 Embroiderer 1 2 — — 13 — Farrier & smith 10 10 18 — — — Firewood cutter 3 3 7 1 1 — Laundry 3 7 2 — 8 — Mason 3 4 5 — — — Milliner 6 6 — — 20 — Motor repairer 21 28 39 11 — — Musical instrument maker 3 6 15 1 2 Photographer 3 7 3 — — — Picture framer 5 8 8 2 — — Rag sorter 19 29 38 — 3 — Saddler 1 1 1 — — — Tailor 43 50 54 8 51 — Upholsterer 17 21 21 2 13 — Other trades 59 91 163 17 25 5 Totals 273 362 473 51 177 6 100 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 1931 the number of inspections amounted to 63. Forty-six intimation and 27 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 4 intimation notices were served by the female inspector. Thirty-two new workshops were added to the register, dealing with the following trades :— Baker 1 Motor repairer 3 Bootmaker 4 Photographer 1 Carpenter 2 Rag sorter 2 Dressmaker 1 Tailor 5 Florist 1 Upholsterer 3 Mason 1 Other trades 8 The following are particulars relating to workshops in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector during 1931:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Carpenter 1 — 1 1 Dressmaker 1 1 — 1 Florist 1 — 1 1 Photographer 1 — 1 1 Poster writer 1 — 1 1 Tailor 3 2 1 3 Rag sorter 1 — 1 1 Outworkers. During 1931, 395 names and addresses of outworkers were received in 90 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 87 names and addresses relating to 51 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:— 101 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaker 19 19 23 Tailor 28 29 59 Other Trades 2 2 4 Totals 49 50 86 Four new male outworkers' premises (not previously registered) were registered during the year, and 21 were removed from the register. There were 87 inspections made of male outworkers' premises during 1931, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 11 cases to remedy sanitary defects found on inspection, viz.:—Defective or dirty w.c. 4 cleansing 5; defective roof 1; defective ashbin 1. Two statutory notices were also served and complied with. No case of infectious disease was notified during 1931 fron 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 3 4 6 Dressmaker 30 34 39 Embroiderer 26 26 29 Fancy boxes 7 7 7 Fancy goods 4 4 4 Fine needlework 4 4 4 Glovemaker 2 2 2 Knitting and crochet 2 2 2 Tailor 24 26 44 Underclothing 4 4 4 Other trades 15 15 15 Total 121 128 156 102 The number of new female outworkers' premises (not previously registered) registered during the year was 18, and there were 35 removed from the register. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 610. In no case was it found necessary to serve notices under the Public Health (London) Act, 1891, to remedy defects. Three cases of infectious disease, viz.: scarlet fever, were notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in these cases. Bakehouses. There were 61 bakehouses on the register at the end of 1931. Of these 50 use power, and are therefore technically factories. Forty of the bakehouses are above ground, and 21 are under ground. Three premises were removed from the register, they being no longer used as bakehouses and one (previously a restaurant) added. Inspections made during the year were 248, and 13 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 1931, there were 50 premises on the register, including railway yards. These premises were systematically inspected during the year, and 73 inspections were made. Thirteen intimation and 7 statutory notices were served to remedy nuisances found on inspection. All these notices were complied with. 103 Home Work, 1931. Outwork in Inpecteo Premises, Secs. 109, 110. Prosecutions (Secs. 109, 110) — — - - - Orders made (S. 110) - - - - — Instances. 3 — - - 3 Outwork in Unwholesome Premises, Sec. 108. Prosecutions. — — - - — Notices served. 11 — - - 11 Instances. 11 — - - 11 OUTWORKERS' LISTS, SECTION 107. Prosecutions. Failing to send lists. - — - - — Failing to keep or permit inspection of lists. - — - - Notices served on Occupiers as to keeping or sending lists. 44 2 4 10 60 Lists received from Employers. Sending once in the year. Outworkers. Workers. 2 — — - 2 Contractors. — — — - — Lists. 1 — — - 1 Sending twice in the year. Outworkers. • Workers. 121 4 2 19 146 Contractors. 15 — — - 15 i Lists. 38 2 2 6 48 NATURE OF WORK Wearing Apparel- (1) Making (2) Cleansing & Washing Furniture and Upholstery Other Trades Total Note.—The 164 names in this table include only 38 workpeople residing in Battersea, the remaining names being either duplicates or those of workers residing outside the Borough. The names of 79 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were, therefore, 117 Battersea home-workers named in the lists. 104 . Housing. The survey of the Borough, in connection with the quinquennial statement of the housing needs of the Borough in accordance with the requirements of section 31 (3) of the Housing Act, 1930, was continued during 1931. The result of this survey was submitted in the form of a report to the Housing Committee in the early part of 1932 and is at present under consideration. Considerable progress was made during the year with the building of the St. John's College Estate, one block, containing 39 tenements, being well in hand at the end of the year and was being pressed vigorously forward. It is anticipated that the second block (50 tenements) will be ready for occupation by the autumn of 1932. Apart from the Plough Road Improvement Extension Scheme (vide p. 107) no new workmen's dwellings were completed during 1931. Eleven houses were erected by private enterprise during the year as under:— Nightingale Lane 3 Thurleigh Avenue 8 11 The lease of Swaffield House, in the Borough of Wandsworth, which was converted into 12 tenements in 1921, expired on the 25th March, 1931. Arrangements were made for the tenants to be re-housed and the premises were given up in October. Overcrowding. As pointed out in previous Annual Reports, and. subsequently confirmed by the results of the 1931 Census, there is no overcrowding in the Borough as a whole. There is, however, serious local overcrowding in certain parts of the Borough, and it is to be regretted that there has been no very material decrease in this unhappy state of affairs, although in some instances it has been possible to mitigate the evil through the County Council. The main difficulty, which has repeatedly been referred to in previous Annual Reports, is that whilst there has been considerable increase in the number of houses built by local authorities very little attempt has been made to provide for that element of the population which is unable to pay the rents demanded for the new houses. The Ministry of Health in a circular addressed to Local Authorities, drew attention to this important matter, and it is to be hoped that some effort will be made to meet what, in my opinion, is a most 105 urgent feature of the housing problem. A considerable number of applications for housing accommodation was received by the Housing Committee during the year, but in only a relatively small number of cases has it been possible to provide the accommodation required. During the year 96 applications for housing accommodation were referred to the London County Council for special consideration on the grounds of hardship or overcrowding. The following table shows the result of such action:— Referred in previous years but not then dealt with. Referred in 1931. Total. Families accommodated 31 44 75 Offer declined by applicant or applicant otherwise suited 64* 11 75 Recommendation not accepted by the London County Council — 19 19 Still under consideration — 22 22 Totals 95 96 191 * The register of cases referred to the London County Council was revised during 1931 when it was found that several families on the register had removed. They have, therefore, been included as "otherwise suited." Repair of Unflt Houses. Since the War, the repair and reconditioning of unfit houses, either under the Housing Acts or the Public Health (London) Act, 1891, has been one of the most successful of the Council's housing activities. During the year this useful work was continued, and the details for the year will be found summarised on page 110. In no 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. Proceedings were taken by the Council against the owner of No. 150, New Road (vide p. 74) to recover the expenses incurred in carrying out repairs in default of compliance by the owner with the notice served under Section 3 of the Housing Act, 1925. An order was made by the Court for the amount claimed, together with costs. 106 Subsequently the Council obtained a declaration at the County Court entitling them to a first charge on the property in priority to any mortgage, &c. The freeholder of six houses in Longhedge Street brought an action for possession under Section 30 of the Housing Act, 1925, against the leaseholder and the Council were joined as defendants in the suit. The order for possession was made, but was to be discharged if the works ordered by the Council were certified to be completed in 28 days. The terms of the Order were complied with. Appeals. It is satisfactory to record that during 1931 the right of appeal by owners against notices served under Section 17 of the Housing Act, 1930, was not exercised. Closing Orders. No Closing Orders were made by the Council during 1931. Demolition Orders. No Demolition Orders were made by the Council during 1931. The Housing Committee, on a report submitted to them, considered as to making a Demolition Order in respect of a house in Usk Road. The Owners, however, gave an undertaking to make the premises in all respects reasonably fit for habitation. As the work was carried out to the satisfaction of the Council's Officers a Demolition Order therefore was not made. The Committee also had under consideration during the year seven other houses reported to them as being unfit for habitation with a view to Demolition Orders being made thereon, but action in regard to these houses was still pending at the end of the year.* In May, 1920, the Council made a Closing Order in respect of No. 7, Darien Road—an empty house—and in due course a Demolition Order in November, 1920. Having regard to the fact that this house is one of a terrace and that its removal gave rise to risk of damage to the adjoining houses the demolition was not proceeded with. * Demolition Orders were made in respect of six of these houses on 24th February, 1932. The owner of the other house gave an undertaking to carry out the necessary works; a Demolition Order was not, therefore, made. 107 In November, 1929, the premises had, however, fallen into such a derelict condition that on the report of the Medical Officer of Health the Housing Committee recommended the Council to make a Demolition Order, which order was subsequently made. In considering the question of demolition, the Housing Committee were of opinion that it would be advantageous for the Council to acquire this site and certain of the adjoining houses. Nos. 3 and 5 were purchased in 1931 and negotiations for the purchase of Nos. 7, 9 and 11 were completed early in 1932. Underground Rooms. No Closing Orders were made by the Council in respect of underground rooms during 1931. Increase of Rent, &c., Acts. During 1931, 12 applications were received from tenants for the certificate, and 7 from owners for the report of the Sanitary Authority under the above-mentioned statutes. The application for the certificate was granted in 8 cases and refused in 4 cases ; that for the report was granted in all cases. Action under Section 5 of the Housing Act, 1925. During 1931 in 20 cases (relating to 26 houses) contraventions of section 5 of the Housing Act, 1925, which requires, under penalty, a rent book to be kept in a prescribed form, were reported to the Housing Committee. In all cases satisfactory explanations having been received and the rent books put in order, no legal proceedings were considered necessary, but the Housing Committee directed cautionary letters to be sent to the offenders. Insanitary Areas. No additional insanitary areas were represented to the Council during 1931. In connection with the Plough Road Improvement Scheme, as stated in the Annual Report for 1928, the Council, by the acquisition by purchase of other properties in the original area represented, were able to extend and improve the scheme and so make provision for three more blocks (eighteen tenements). The third block was completed during the year. During the year the Council took advantage of opportunities that arose to acquire certain properties which were in the areas originally represented in York Road and Plough Road so that the Plough Road Improvement Scheme could be further extended and improved. 108 These properties consisted of Nos. 255 to 261 (odd) York Road; 197 to 201 (odd) York Road; 2 to 6 (even) Plough Road and 231 to 253 (odd) York Road. Certain of the properties were vacant but others were subject to existing leases. No steps have yet been taken to pull down and rebuild on these sites. The Plough Road Improvement Scheme, together with its extension, having been completed, the Council suggested that one of the original streets in the condemned area, viz. Britannia Place, be renamed. The County Council proposed the name of Holgate Avenue, after Robert Holgate, Archbishop of York (1545/54) who was the last archbishop to occupy York House in the immediate vicinity. The Council agreed to this and the formal Renaming Order was then made. Nos. 22 to 26 Plough Road, which formed part of the original area represented by the Medical Officer of Health as the Plough Road Improvement Scheme, were purchased by the Council in December, 1925, with a view to demolition in due course. The tenants having been rehoused, the houses were demolished during the year. 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 17 of the Housing Act, 1930, or under the provisions of section 19 of the Act, during 1931. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 4. District No. 5—con td. Ascalon Street 24 Afghan Road 1 Wickersley Rd. 12 Battersea Pk. Rd. 2 Este Road 3 Wycliffe Road 37 Bramwell Street 17 Falcon Road 1 Montefiore Street 1 Falcon Terrace 2 District No. 6. Ponton Road 1 Grant Road 1 Auckland Road 1 Seldon Street 17 Ingrave Street 8 Belleville Road 1 Sterndale Road 42 Lavender Road 2 Benham Street 28 Mantua Street 4 Brussels Road 1 District No. 2. Meyrick Road 4 Darien Road 1 Alfred Street 3 Musjid Road 1 Harbut Road 1 Anerley Street 2 Newman Street 8 Livingstone Rd. 3 Chesney Street 49 Patience Road 1 Mallinson Road 1 Culvert Road 1 Shillington Street 5 Speke Road 1 Frere Street 4 Speke Road 14 Tritton Street 1 Henley Street 4 Stainforth Road 2 Usk Road 5 Longhedge Street 11 Verona Street 24 Wayland Road 4 Park Grove 2 Wye Street 19 Winstanley Road 3 Sheepcote Lane 1 District No. 5. District No. 7. District No. 3. Beaufoy Road 4 Castle Street 1 Hanbury Road 14 Nil. Church Road 2 Knowsley Road 3 Elcho Street 2 Latchmere Road 1 District No. 8. Goulden Street I Shellwood Road 1 Wiseton Road 1 Randall Street 1 109 Summary. District No. 1 7 streets 104 houses „ „ 2 9 „ 77 „ „ „ 3 5 „ 7 „ „ „ 4 17 „ 100 „ „ „ 5 7 72 >„ „ „ 6 13* „ 51 „ „ „ 7 - „ - „ „ 8 1 1 „ Total 58 streets 412 houses The following is a list of streets in the Borough in which houses were the subject of action during the previous year, either informally or by the service of notice under section 3 of the Housing Act, 1925, or section 17 of the Housing Act, 1930, but to which the necessary works of repair had not been completed during 1930. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 4. District No. 6—con td. Belfour Street 1 Ingrave Street 1 Livingstone Road 4 Foots Row 5 Livingstone Road 7 Sewell Road 1 Mundella Road 4 Mantua Street 1 Speke Road 1 Power Street 1 Meyrick Road 2 Steelworks Road 15 District No. 2. Stainforth Road 1 York Road 1 Wye Street 1 District No. 7. Austin Road 1 Longhedge Street 6 District No. 5. Nil. District No. 3. Nil. Church Road 1 District No. 6. District 'No. 8. Hyde Lane 1 John Street 9 Nil. SUMMARY. District No. 1 4 streets 11 houses „ „ 2 2 „ 7 „ „ „ 3 2 „ 2 „ „ „ 4 6 „ 13 „ „ „ 5 - „ - - „ „ 6 6 ,, 31 „ „ „ 7 - „ — „ „ „ 8 - „ „ „ Total 20 streets 64 houses * Including Speke Road, partly in No. 4 District. 110 Statistics for the Year ended 31st December, 1931. Number of New Houses erected during the year:— (1) By the Local Authority 6 (2) By other Local Authorities Nil (3) By other bodies and persons 11 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing 7,834 (b) Number of inspections made for the purpose 37,042 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 5,058 (b) Number of inspections made for the purpose 33,623 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 4,635 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 304 3. Action under Statutory Powers during the Year:— (a) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling houses in respect of which notices were served requiring repairs 16 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 10 (b) By local authority in default of owners Nil (B) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,636 (3,376 intimation notices) 111 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,505 (3,153 intimation notices complied with) (b) By local authority in default of owners 1 (c) Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (e) Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By local authority in default of owners Nil (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (f) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders were Nil (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (3) Number of dwelling houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 112 APPENDIX. TUBERCULOSIS DISPENSARY. ANNUAL REPORT, 1931. 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, 1931. The personnel of the staff of the Dispensary remained the same as for the previous twelve months. The routine work of the Dispensary has been carried on as in previous years. I have indicated in former reports the great difficulty that is experienced in persuading the "Contacts" of definite cases of Pulmonary Tuberculosis to attend the Dispensary for examination. There has been a considerable increase in the number of attendances of "Contacts" during 1931, but still only a small proportion submit themselves for examination. The examination of "Contacts" has always been one of the chief functions of the Dispensary in an endeavour to search out the early case of Pulmonary Tuberculosis. Most of the "Contacts" examined are children, and although the examination of such children is useful, it is rare to find cases of Pulmonary Tuberculosis amongst them. The greatest difficulty is found with the young adult, who is very unwilling to come to the Dispensary for examination. The incidence of Tuberculosis both Pulmonary and Non-Pulmonary is higher in the age period between 15 and 25 years than in any other period, and it is highly desirable that "Contacts" of this age period especially should be examined at the Dispensary. Every effort is made by the Dispensary Staff to urge these young adults to attend for examination, but this effort has not been very successful. I have little doubt that the fear of Tuberculosis prevents some young "Contacts" from attending the Dispensary, whilst others scoff at the very idea that there can be anything the matter with them. The examination of the sputum of Battersea residents, inpatients at St. James's Hospital, which has previously been undertaken at the Dispensary, was discontinued towards the end of the present year, the London County Council having now made arrangements for this examination to be carried out at one of its own laboratories. Some 400 to 500 specimens of sputum were examined annually at the Dispensary for St. James's Hospital. The treatment of suitable cases of Pulmonary Tuberculosis by Artificial Pneumothorax is now being more generally adopted, and during the year a larger number of Dispensary patients have received this form of treatment. The results in selected cases are good. Artificial Pneumothorax is usually induced in Sanatorium or other institution, and the patients receive "refills" as out-patients 113 on their discharge. The majority of the Dispensary patients get their "refills" at Brompton Hospital. Artificial Pneumothorax treatment is, as a rule, continued over a number of years, "refills" being given at intervals of two or three weeks, and as a consequence the financial cost to the Council for this treatment is an increasing one. As in former years the majority of new patients who attend the Dispensary are sent for an opinion and advice by their own doctors. Routine treatment is only undertaken in those cases who have no doctor and who are unable to afford private medical attention. All insured patients are referred to their own doctors for treatment, attending the Dispensary at intervals for observation. The Tuberculosis Dispensary acts mainly as a centre for diagnosis and as a clearing house. It is also a centre for the examination of "Contacts." It is highly desirable that there should be very close co-operation between the medical practitioners in the area and the medical staff of the Dispensary. The early diagnosis of Pulmonary Tuberculosis, which is often a matter of no little difficulty, is of such supreme importance that every effort is made at the Dispensary to arrive at a correct diagnosis with as little delay as possible. In this connection doubtful cases of Tuberculosis are sent to St. Thomas's Hospital for X-ray examination and for a further opinion. The London County Council, also, on the recommendation of the Tuberculosis Officers, is prepared to admit patients in whom the diagnosis is in doubt to Brompton Hospital or some similar institution with a view to closer observation under its Tuberculosis Scheme. In this direction it is hoped that medical practitioners may find the Dispensary useful and that they will make use of the facilities provided there for early diagnosis. Institutional treatment is provided by the London County Council on the recommendation of the Tuberculosis Officers, and, as in former years, on the patient's return from an institution, a full report of his condition on discharge is sent to his own doctor. 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. Treatment of patients suffering from Non-Pulmonary Tuberculosis by artificial light has been continued during the year. Seven patients have received this form of treatment and the results are set out in the table below. During the year 603 new patients, including 18 transfer cases from other areas, attended the Dispensary being 41 fewer than in the previous year. 114 Of the 603 new patients 157 were found to be suffering from Pulmonary Tuberculosis and 30 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 - 4 3 13 7 7 2 3 1 40 Group T.B. plus {Group i - - - 25 12 8 6 2 - 53 {Group ii - - - 17 17 12 4 1 1 52 {Group iii - - 1 4 3 2 1 1 - 12 Total - 4 4 59 39 29 13 7 2 157 Table II. Non-Pulmonary Tuberculosis. Years. 0-5 5-10 10-15 15-25 25-35 35-45 45-55 55-65 over 65 Total Bones and Joints 4 4 - 6 1 - - - - 15 Abdominal - 1 - 3 - - - -- - 4 Peripheral Glands 4 1 2 - 1 - - - - 8 Skin and Other Organs 2 1 - - - - - - - 3 Total 10 7 2 9 2 - - - - 30 115 Table III. Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 109 69.42 "Influenza" 6 3.82 Pleurisy 9 5.73 Pleurisy with effusion 2 1.28 Haemoptysis 24 15.29 Other modes 7 4.46 Total 157 100.00 Table IV. Occupations in the 157 cases of Pulmonary Tuberculosis. Occupation. No. of Patients. Occupation. No. of Patients Housewives 25 Street Traders 3 School Children 9 Depot Keeper 1 At home 2 Turnstile Operator 1 Domestic Workers 6 Compositor 1 Porters 3 Brewer's Foreman 1 Laundry Workers 4 Metal Polisher 1 Clerks, Typists, &c. 19 Pianoforte Tuner 1 Travellers 2 Stableman 1 Salesmen, Shop Assistants, &c. 12 Surgical Boot-maker 1 Road Sweeper 1 Furriers 2 Coach Trimmer 1 Tailors, Dressmakers, &c. 10 Van Guard 1 Factory Workers 7 Laboratory Assistant 1 Shopkeepers 1 Poster Artist 1 Fitters, Turners, &c. 8 Nurse 1 Motor Drivers 3 Packer 1 Carpenters 2 Architect's Assistant 1 Painters & Decorators 4 Cooper 1 Plumbers 1 Stone Mason 1 Labourers (various) 11 Nil 2 Ex-service men 3 Table V. Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. 62 9 116 116 Of the 187 cases, therefore, a history of Tuberculosis in a near relative was elicited in 33.1 per cent. and in a remote relative in 4.8 per cent. In all 37.9 per cent. gave a family history of Tuberculosis. "Contacts."—209 "contacts" were examined during the year as compared with 153 in 1930. Of the "contacts" examined 72 were adults and 137 children, and one was found to be suffering from Tuberculosis. The total number of attendances at the Dispensary during the year was 3,917 compared with 3,621 in the previous year. The number of visits paid to the homes of patients by the Tuberculosis Officers was 204 and by the Nurses 4,175, as compared with 165 and 4,292 respectively in 1930. The number of sputum examinations carried out at the Tuberculosis Dispensary during 1931 was 1,332—a slight increase over the previous year, despite the fact that no sputum examinations were carried out for St. James's Hospital after the 28th October, 1931. In 267 cases or 20 per cent., Tubercle Bacilli were found to be present. Of the total number of specimens examined 440 were sent by medical practitioners and 278 were examined for St. James's Hospital. The number of reports sent to public bodies during 1931 was 998. Consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 823. 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 98 136 patients were referred to hospitals, 129 of whom were sent to St. Thomas's Hospital for X-ray examination. Definite cases marked off the Dispensary register:— Number of Dispensary patients who died during 1931 117 Number of Dispensary patients who ceased to attend 19 Number of Dispensary patients who removed to other districts (and were transferred to the Medical Officer of Health concerned) 57 Number of patients "recovered" and "diagnosis not confirmed" 16 During the year 139 patients were sent away to various institutions under the London County Council's Tuberculosis Scheme. Of those 87 were discharged during the year and 52 were still away on December 31st. The average length of stay in institution of the 87 patients was 116.44 days and the average waiting period between recommendation and admission to institution was 14 days. 117 53 patients showed definite improvement as a result of institutional treatment ; 25 were discharged at their own request. During the year 44 Dispensary patients were admitted to the London County Council's General Hospitals. Artificial Light Treatment. Tuberculosis Patients. Name Age. Condition. Period of Treatment. Condition on Discharge or at 31/12/31. M. K. 20 Discharging gland of neck 2/1/31—1/5/31 Discharged as cured. m. a. 32 Sinus of neck 8/6/31—26/6/31 Discharged as cured. E. G. 16 Lupus Vulgaris (face) 12/2/30— Improved. N. R. 11 Lupus Vulgaris (face) 3/12/30— Much improved. L. C. 13 Discharging Sinus 17/4/31— Stationary. M. V. 11 Glands of neck 7/9/31— Improved. E. B. 9 Glands of neck 7/9/31— Improved. Springwell House Open-Air School. Accommodation 125 On roll 31/12/31 133 Average attendance 118.9 Admitted during 1931 35 Discharged during 1931 48 Reasons for discharge:— Fit for elementary school 8 Fit for work 20 Transferred to Hospital or Sanatorium 16 Removed from district 1 Transferred to Special School Nil Discharged for other reasons 3 Tuberculosis Dental Treatment. Total attendances 266 Sessions held 50 Average attendance per session 5.32 Extractions, 87; scalings, 9; fillings, 22; dentures supplied—whole sets, 6; partial sets, 7; repairs to dentures, 5; dressings, 15; advice, 61 (average per session, 4.24) Total 212 118 The Tuberculosis Care Committee. The following is a summary of the work carried out by the Committee during 1931:— Battersea Borough Council—extra nourishment, 105; dentures, 6 111 Public Assistance Committee—financial assistance, 6; dentures, 1; clothing, 5 ; nourishment,2 14 Charity Organisation Society—financial assistance, 4; clothing, 4 8 United Services Fund—financial assistance, 9; clothing, 5 ; boarding out of children, 1 15 Other Agencies—financial assistance,11 11 Training and Employment—previous employers, 6; suitable agencies, 6; Ex-Officers' Association, 1; London County Council, 1 14 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 £683 11s. 6d. The following arc some illustrations of the work done by the Care Committee throughout the year:— H.D., aged 36. An ex-service man who was found to be suffering from Tuberculosis. Before coming to the Dispensary he had been out of work for ten weeks and his wife was also unemployed. There were two dependent children and the wife's mother who lived with the family was partly dependent. The man was recommended for sanatorium treatment, and the Committee were able to give him a grant for extra nourishment whilst he was waiting to go away, and they were also able to obtain financial assistance for the patient and his family, and some necessary articles of clothing for the patient. Financial assistance was continued during the time the patient was away, and he was thus able to complete his treatment with a mind at rest about his family. He was discharged as being quite fit for work. W.L., aged 28. This man has been in regular employment but had to give up work on account of illness. He had been off work for four weeks when he was sent to the Dispensary, and found to be suffering from Tuberculosis. He was a married man with two dependent children. He was recommended for Sanatorium treatment but was very worried, as he was afraid he would lose his post. The Care Committee took up the matter with his employers, and were able to assure him that his post would be kept open for him to return to if he was discharged as being fit for work. Whilst waiting to go away he was given a grant for extra nourishment, and the Committee have kept in touch with his wife and family during the time he has been away. A little while ago 119 some articles of his clothing had given out and the Committee were able to arrange through the Charity Organisation Society for him to be supplied with what was necessary. He is still undergoing treatment and making good progress. E.McK., aged 28. This patient, who had suffered from Tuberculosis for some years, moved into this Borough following her discharge after a period of Institutional treatment. Her parents were dead and she had only one brother who was married and not able to help her. Enquiries were made with regard to her insurance benefit, and it was found that she was entitled to arrears of benefit, in addition to the current rate of sick pay. Pending the payment of the arrears a grant for extra nourishment was given by the Committee, and as she was then considered fit for work, enquiries were made with regard to employment. Within a short time domestic work was found for her in a Sanatorium in the country A.H., aged 36. This patient was in domestic service and had been ill for some time, but she was afraid to seek treatment as she felt it would mean her giving up work. Her parents were dead, and she had no home and no savings, and her brothers were not in a position to help her. Her only sister had died of Tuberculosis. Eventually she attended her panel doctor, who sent her to the Dispensary for examination. She was found to be suffering from Tuberculosis in a fairly advanced stage, and after persuasion she agreed to give up her work and enter Hospital. An early vacancy was obtained for her, and the Committee were able to arrange for suitable clothing to be granted to her. As her only income was her National Health Insurance Benefit the Committee recommended that no charge should be made for her maintenance and treatment, and the Council agreed to this. When we last heard from her she was making progress, and her National Health Insurance benefit will accumulate whilst she is in Hospital so that she will have a little sum of money due to her on her discharge. L.W., aged 38. This patient, who had received several periods of Sanatorium treatment between 1916 and 1925, was found to be living in one room on her own, her only income being her National Health Insurance benefit of 7s. 6d. per week. Her parents were dead, and her sister was married and had seven children, and although she gave the patient a little help at times she was not able to do much. The Care Committee gave this patient extra nourishment for a time, and did their best to induce her to apply to the Public Assistance Committee for help. This she refused to do for some time, but the Committee kept in constant touch with the case, and eventually, when the sister's husband became unemployed, they were able to induce the patient to make an application for help which was granted, and she is now able to obtain sufficient for her needs. G.W., aged 41. This man attended the Dispensary for observation, and it was found necessary for him to be admitted to 120 Hospital for special observation. He was a married man with three children, and he was worried as to how his wife would manage whilst he was in Hospital, as his pay ceased when he gave up work, and he had already received two weeks of the insurance and club benefit. His wife was suffering from acute rheumatism and unable to work. The Committee were able to obtain an early vacancy for him and financial assistance for the family during his absence, also the clothing he needed for hospital treatment. He was eventually discharged from Hospital and was able to resume his former work, and is now attending the Dispensary at intervals for observation. (Signed) G. Macdonald, Tuberculosis Officer. 121 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 1931 and Previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. * of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. * Number Rate per 1,000 Nett Births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1931 159,800 2,788 2,477 15.5 2,745 17.2 1,301 487 142 57 1,931 12.1 Area of District in acres (land and inland water), 2,163 acres. Total population at all ages 159,552 (Census, 1931); number of occupied separate dwellings, 27,219; average number of persons in private families per occupied separate dwelling, 5.69 (Census Report 1931). • Rates calculated per 1,000 of estimated population. 122 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 1931. 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 3 ... 1 ... 1 1 ... 3 ... ... 3 ... ... Diphtheria 298 6 93 168 17 14 — 152 107 39 151 107 39 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 72 6 5 4 2 48 7 37 21 14 14 12 4 Scarlet Fever 448 4 125 276 24 19 247 123 78 244 123 73 Enteric Fever 4 ... ... ... 3 1 ... 1 3 ... 1 3 ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 3 3 ... 2 3 1 2 3 1 Puerperal Pyrexia 25 ... ... ... 15 10 ... 11 5 9 6 2 6 Meningococcal Meningitis 3 ... 3 ... ... ... ... 2 ... 1 2 ... 1 Ophthalmia Neonatorum 37 37 ... ... ... ... ... 12 11 14 4 2 4 PoUo-myelitis, &c. 3 ... 1 2 ... ... ... 1 I 1 1 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 2 ... ... ... ... 2 ... 1 1 ... ... ... ... Dysentery 1 ... ... ... ... 1 ... ... ... 1 ... ... ... Acute Influenzal Pneu 67 2 7 8 4 39 7 29 15 23 15 10 6 Acute Primary Pneu. 282 26 58 37 27 116 18 132 105 45 67 59 26 Totals 1,251 81 293 495 96 254 32 630 395 226 510 322 160 Tuberculosis— Pulmonary 214 ... 1 11 72 126 4 92 46 76 ... ... ... Non-Pulmonary 43 ... 13 12 11 7 ... 19 12 12 ... ... ... Totals (Tuberculosis) 257 ... 14 23 83 133 4 111 58 88 ... ... ... Totals 1,508 81 307 518 179 387 36 741 453 314 510 322 160 Whooping-cough* 493 50 311 132 ... ... ... 253 179 61 23 20 7 Measles* 75 11 39 22 ... 3 ... 34 17 24 16 2 1 Grand Totals 2,076 142 657 672 179 390 36 1,028 649 399 549 344 168 123 TABLE III. Causes of, and Ages at, Death during the Year 1931. causes of death. 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. Total Deaths of Residents and NonResidents in Institutions in the District.  1. Typhoid and Paratyphoid Fevers 1 ... ... ... ... ... ... 1 ... ... 2. Measles 2 ... 2 ... ... ... ... ... ... ... 3. Scarlet Fever 6 ... 2 3 ... 1 ... ... ... ... 4. Whooping Cough 5 3 2 ... ... ... ... ... ... 2 5. Diphtheria 5 1 1 3 ... ... ... ... ... 3 6. Influenza 56 3 ... 2 ... 3 5 11 32 22 7. Encephalitis Lethargica 1 ... 1 ... ... ... ... ... ... 1 8. Cerebro-Spinal Fever 1 ... 1 ... ... ... ... ... ... 5 9. Tuberculosis of respira t9ry system 143 ... ... ... ... 41 57 43 2 132 1U. Other Tuberculous Diseases 30 1 4 5 6 6 6 1 1 26 11. Syphilis 7 3 ... ... ... 1 ... 2 1 5 12. General Paralysis of the Insane (Tabes Dorsalis) 8 ... ... ... ... 1 3 3 1 7 13. Cancer, Malignant Disease 283 ... ... ... ... 3 18 124 138 256 14. Diabetes 18 ... ... ... ... 1 2 3 12 24 15. Cerebral Hemorrhage, etc. 50 ... ... ... ... ... ... 19 31 47 16. Heart Disease 527 ... ... ... 2 10 22 121 372 529 17. Aneurysm 4 ... ... ... ... ... ... 2 2 3 18. Other Circulatory Diseases 64 ... ... ... ... ... 2 16 46 16 19. Bronchitis 86 7 ... ... ... ... 6 25 48 46 20. Pneumonia (all forms) 124 29 7 4 4 2 12 38 28 113 21. Other Respiratory Diseases 17 ... ... ... ... 1 ... 7 9 14 22. Peptic Ulcer 13 ... ... ... ... ... ... 10 3 25 23. Diarrhoea, etc. 14 7 2 ... ... ... 2 3 ... 17 24. Appendicitis 8 ... ... 2 2 1 ... 1 2 17 25. Cirrhosis of Liver 3 ... ... ... ... ... ... 1 2 6 26. Other Diseases of Liver, etc. 7 ... ... ... ... ... ... 4 3 11 27. Other Digestive Diseases 25 1 ... 1 ... 1 5 12 5 37 28. Acute and Chronic Nephritis 78 ... ... ... 1 2 5 30 40 114 29. Puerperal Sepsis 5 ... ... ... ... 3 2 ... ... 11 30. Other Puerperal Causes 10 ... ... ... ... 2 8 ... ... 4 31. Congenital Diseases 75 75 ... ... ... ... ... ... ... 77 32. Senility 50 ... ... ... ... ... ... ... 50 50 33. Suicide 14 ... ... ... ... ... 6 7 1 11 34. Other Violence 56 4 1 9 3 9 8 11 11 79 35. Other Defined Diseases 135 8 3 4 7 12 14 44 43 170 36. Causes Ill-defined or Unknown ... ... ... ... ... ... ... ... ... ... All Causes—M 992 84 13 15 15 55 99 323 388 953 F 939 58 13 18 10 45 84 216 495 927 Totals 1931 142 26 33 25 100 183 539 883 1880 124 East Battersea TABLE IV. Infant Mortality, 1931. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year  1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. m. F. m. F. Small-Dox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 i 1 1 ... 1 ... 3 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... 1 ... 1 3 2 4 3 3 2 3 1 13 9 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Syphilis ... ... ... ... 1 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 6 3 2 1 ... ... ... ... 1 ... 9 4 3 1 ... ... ... ... ... 12 5 Congenital Malformation ... ... 4 ... 1 ... ... ... 1 ... 6 ... ... ... ... 1 ... ... ... ... 6 1 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis & Asphyxia Neonatorum 1 4 ... 1 1 ... ... ... ... ... 2 5 ... ... ... ... ... ... ... ... 2 5 Lack of Care ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... ... 1 1 Accident ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 7 8 6 2 3 1 ... 1 3 1 19 13 7 6 6 5 5 2 4 4 41 30 15 8 4 1 !4 32 13 11 7 8 71 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1037 42 1079 65 6 71 125 North-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1931. Nett Deaths from stated causes at various ages under 1 year.  CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year  1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Influenza 1 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 3 ... ... 2 3 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... 4 ... Syphilis ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 2 2 1 1 2 1 ... ... ... 5 5 1 ... ... ... ... ... ... ... 6 5 Congenital Malformation 1 1 2 1 1 ... ... ... ... 3 3 1 ... ... 1 ... ... ... ... 4 4 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis and Asphyxia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... Totals 2 2 3 3 3 3 1 ... ... ... 9 8 5 3 4 1 4 4 1 ... 23 16 4 6 6 1 ... 17 8 5 8 1 39 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 666 30 696 38 1 39 126 South-West Battersea. TABLE IV.—(contd.) Infant Mortality, 1931. Nett Deaths from stated causes at various ages under 1 year.  CAUSES OF DEATH. AGE PERIODS. Under 2| 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... PulmonaryTuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 5 1 3 ... ... ... 1 ... 1 1 10 2 ... 1 ... ... ... ... ... ... 10 3 Congenital Malformation 1 ... ... ... ... 1 1 1 ... ... 2 2 1 ... ... ... 1 ... ... ... 4 2 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Ictcrus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Atelectasis & Asphyxia Neonatorum 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... 3 Totals 7 2 3 1 ... 1 2 1 1 1 13 6 2 2 1 1 4 3 ... ... 20 12 9 4 1 3 2 19 4 2 7 — 32 Nett Births in the year. Nett Deaths in the year(lnfants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 678 24 702 31 1 32 127 iorough of Battersea. TABLE IV.—(contd.) Infant Mortality, 1931. Nett Deaths from stated causes at various ages under 1 year.  CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. To'al under 4 weeks. Months. Total deaths under 1 year. Percentage of Total.  1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. U. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.70 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 1 2.11 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.71 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 2.11 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0.70 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 1 1 ... 1 ... 5 2 4.93 Pneumonia (all forms) ... ... ... 1 ... ... ... ... ... 1 ... 2 3 2 6 3 4 5 3 1 16 13 20.42 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 2 ... ... 2 5 2 4.93 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0.71 Syphilis ... ... ... ... 2 1 ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 211 Premature Birth 12 6 7 2 1 2 2 ... 2 1 24 11 4 2 ... ... ... ... ... ... 28 13 28.87 Congenital Malformation 2 ... 5 2 2 ... 1 1 1 ... 11 5 2 ... ... 2 1 ... ... ... 14 7 14.79 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 2 2.11 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 0.70 Injury at Birth ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0.71 Atelectasis & Asphyxia Neonatorum 2 4 ... 1 1 ... ... ... ... ... 3 5 ... ... ... ... ... ... ... ... 3 5 5.64 Lack of Care ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 0.70 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 1.41 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... ... 1 1 1.41 Accident ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.71 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 2 ... ... 2 3 3.52 Totals 16 12 12 6 6 ... 3 2 4 2 41 27 14 11 11 7 13 9 5 4 84 58 100.00 28 18 11 5 6 68 25 18 22 9 142 — Percentage of Total 19.7 12.7 7.8 3.5 4.2 47.9 17.6 12.7 15.5 6.3 M.59.2 F.40.8 Nctt Births in the year. Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate Total. M. 1.180 53 1,233 81 3 84 F. 1,201 43 1,244 53 5 58 Totals 2,381 96 2,477 134 8 142 128 TUBERCULOSIS SCHEME OF THE BATTERSEA Pulmonary Supplementary Annual Return showing in summary form (a) the Register ; and (6) the reasons for removal of all cases written off the patients were first entered on the Dispensary Register as definite Condition at the time of the last record made during the year to which the Return relates. Previous to 1921. 1921—6. 1927. | 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).  1 (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 5 3 4 — 7 4 1 4 — 5 2 1 1 — 2 F. 1 3 4 9 1 2 — 3 — — — — — Children 24 — — — — 9 1 1 — 2 2 — — — Disease not arrested. Adults—M. 5 12 5 — 17 8 13 24 1 38 3 4 5 2 11 F. 4 4 1 — 5 7 8 11 4 23 3 — 4 2 6 Children 5 2 1 — 3 6 — 1 — 1 1 — 1 — 1 Condition not ascertained during the year 16 2 4 — 7 11 3 7 3 13 1 1 3 — 4 Total on Dispensary Register at 31st December 59 24 18 1 43 54 27 50 8 85 12 6 14 4 24 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. — — All classes – 54 7 3 3 F. — — — — 63 5 — — — — — — — — — Children — — — — 220 6 1 — — 1 — — — — — Lost sight of or otherwise removed from Dispensary Register — — — 575 99 51 104 38 193 21 2 24 2 28 DEAD. Adults—M. — — — — 243 25 22 138 154 314 2 2 23 22 47 F. — — — — 183 14 14 67 111 192 5 — 20 18 38 Children — — — — 42 8 1 6 6 13 1 — 1 1 Total written off Dispensary Register — — — — 1380 164 92 315 309 716 29 4 68 42 114 Grand Totals — — — — 1482 218 119 365 317 801 41 10 82 46 138 129 METROPOLITAN BOROUGH COUNCIL. Form T145a Tuberculosis. condition at the end of 1931 of all Patients remaining on the Dispensary Register. The Table is arranged according to the years in which the cases of pulmonary tuberculosis, and their classification at that time. 1928. 1929. 1930. 1931. 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 – – – – 2 – 1 – 1 – – – – – – – – – — – – – – – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 4 6 16 – 22 14 8 14 2 24 15 11 17 5 33 13 20 24 2 46 6 2 10 1 13 11 7 15 2 24 11 4 10 1 15 14 21 18 3 42 2 – – – – 2 – 1 – 1 4 – – 1 1 8 – – – – 5 3 3 1 7 7 3 3 5 11 11 5 9 1 15 – – – – – 19 11 29 2 42 37 18 34 9 61 41 20 36 8 64 35 41 42 5 88 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 12 6 17 8 31 9 9 15 3 27 5 2 12 4 18 2 3 1 1 5 4 2 18 19 39 1 3 23 25 51 6 – 16 13 29 2 5 4 2 11 6 1 12 27 40 4 3 8 17 28 4 – 7 11 18 2 2 2 4 1 – – – – – – – 1 1 1 – – 1 1 – – – – – 23 9 47 54 110 14 15 46 46 107 16 2 35 29 66 6 10 5 5 20 42 20 76 56 152 51 33 80 55 168 57 22 71 37 130 41 51 47 10 108 130 Non-Pulmonary Supplementary Annual Return showing in summary form (a) the Register ; and (6) the reasons for the removal Condition at the time of the last record made daring the year to which the Return relates. Previous to 1921. 1921—6. 1927. 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.  (a) Remaining on Dispensary Register] on 31st December. Disease arrested. Adults—M. – – – – – 2 , 2 5 3 3 F. – — — 1 — — 1 2 — 1 1 2 Children 3 5 8 8 2 2 23 35 2 1 — 1 4 Disease not arrested. Adults—M. – — – – – 1 1 1 – 3 2 – – 2 4 F. — — 1 1 2 — 1 2 2 5 — — — 1 1 Children 3 3 9 4 2 27 42 – 2 2 5 9 Condition not ascertained during the year – – – 6 6 4 2 – 9 15 1 – 1 – 2 Total on Dispensary Register at 31st December ... 3 1 15 19 25 11 9 62 107 8 3 4 10 25 Transferred to Pulmonary 1 — — — 1 1 1 1 — 3 – – – – – (b) Not now on Dispensary Register and reasons for removal therefrom. | Discharged as Recovered. Adults—M. 1 – 1 1 3 — – 1 3 4 – – – – – F. – – – – – 1 1 – 2 4 – – – 1 1 Children 5 3 2 19 29 5 7 1 36 49 — – 1 – 1 Lost sight of, or otherwise removed from Dispensary Register 20 7 15 47 89 26 6 10 52 94 2 2 2 6 12 DEAD. Adults—M. 1 — — — 1 4 — 1 — 5 1 — — — 1 F. 1 1 — 3 5 1 1 4 2 8 – – – – – Children ... 1 – – 8 9 2 1 1 3 7 1 – – – 1 Total written off Dispensary Register 29 11 18 78 136 39 16 18 98 171 4 2 3 7 16 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 32 11 19 93 155 64 27 27 160 278 12 5 7 17 41 131 Tuberculosis. From T145a condition at the end of 1931 of all Patients remaining on the Dispensary of all cases written off the Register. 1928. 1929. 1930. 1931. 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 C rgans. Peripheral Glands. Total.  2 1 — — 3 1 — — 1 2 — — — — 1 – – – 1 – – – 3 3 1 — — 1 — – — — — 2 – – – 2 1 – 1 – 2 1 — 2 1 4 — – — — — — — 1 – 1 — 2 – 1 3 1 1 — 1 3 2 – — — 2 – – – 1 1 2 – 1 – 3 – 1 1 3 5 5 — — 1 6 2 1 — 3 6 – – – 9 9 3 4 1 5 13 6 1 3 6 16 1 — 1 — 2 1 — — 1 2 4 — — 4 8 — — 8 2 2 4 16 5 2 2 15 24 10 6 4 14 34 13 1 3 7 24 – – – – – – – – – – – – – – – – – – – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 2 2 3 6 13 2 3 5 1 1, – 4 6 1 – – 1 2 – – – – – – – – – – 1 – 1 – 2 – – – – – — - - — - 1 - - - 1 1 - — - 1 — 2 — — 2 – – 1 – 1 – – – – – – – – – – – – – – – 2 2 4 6 14 3 1 — 4 8 3 1 1 4 9 1 2 1 4 10 4 6 10 30 8 3 2 19 32 13 7 5 18 43 14 3 3 8 28 132 Form T 145 TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1931. Return showing the work of the Dispensary (or Dispensaries). Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 71 82 3 5 2 8 9 8 73 ;o 12 13 168 *(6) Diagnosis not completed — — — — — — — — 24 23 16 21 84 (c) Non-tuberculous — – – – – – – – 86 122 57 52 317 B.—Contacts examined during the year:— (a) Definitely tuberculous – – – – – – – – – – 1 — 1 *(b) Diagnosis not completed... – – – – – – – – 1 2 1 1 5 (c) Non-tuberculous — — — — — — — — 22 47 66 68 203 c.—Cases written off the Dispensary Register as— (a) Recovered 2 1 2 — 1 2 2 5 3 3 4 5 15 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) – – – – – – – – 119 177 135 126 557 D.—Number of cases on Dispensary Register on December 31st (a) Definitely tuberculous 346 232 41 45 33 40 109 67 379 272 150 112 913 (b) Diagnosis not completed — — – – – – – – 29 31 17 26 103 I. Number of cases on Dispensary Register on January 1st 971 2. Number of patients transferred from other areas and cases returned after discharge under Head 3 in previous years 32 3. Number of cases transferred to other areas, cases not desiring further assistance under the Scheme, and cases " lost sight of " 76 4. Cases written off during the year as Dead (all causes) 117 5. Number of attendances at the Dispensary (including Contacts) 3,917 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 122 7. Number of consultations with medical practitioners :— (a) Personal (b) Other 24 369 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 204 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,175 10. Number of 769 (a) Specimens of sputum, &c.. examined (563 others) (b) X-ray examinations made in connection with Dispensary work 129 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above... 2 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 407 B.—Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 Provided by Voluntary Bodies — * i.e., remaining undiagnosed on 31st December. [See Memo. 37/T (Revised), p. 10, Sec. II., Note 4.]