C I AC 4386 BAT 31 Metropolitan Borough of Battersea. REPORT ON THE HEALTH OF THE Metropolitan Borough of Battersea, FOR THE YEAR 1932. BY G. QUIN LENNANE, M.C., F.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH. Wightman Of 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 1932. by G. QUIN LENNANE, M.C., F.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH. 1 Health Committee. As constituted 9th November, 1931. 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. As constituted 9th November, 1932. Chairman : Councillor Mrs. K. S. D. Baker His Worship the Mayor. (Councillor E. S. Strange, j.p.). Councillor A. Vincent Clarke, a.m.i.c.e., m.i.m.e., l.c.c. „ Dr. H. B. Dodwell. „ Mrs. J. L. Eaton. „ Mrs. A. M. Gorringe. „ J. Hendrick. Alderman G. Lauriks. Councillor Mrs. F. E. Mills. „ Mrs. A. M. Mossman. „ Mrs. M. J. Robinson. H. W. Walden. Mrs. F. Young. Maternity and Child Welfare Committee. 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. The powers and duties of the Maternity and Child Welfare Committee, were by resolution of the Council, referred to the Health Committee as from 9th November, 1932. Dousing Committee. 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. As constituted 9th November, 1932. Chairman : Councillor J. A. Campbell. His Worship the Mayor. (Councillor E. S. Strange, j.p.). Councillor C. Barrington. „ Miss E. J. E. Butcher. „ H. W. Carpenter, j.p. ,, F. Fryer. „ H. Harling. W. E. Heath. „ Mrs. A. M. Mossman. „ S. B. Sanderson. „ E. Sullivan. Alderman I. O. Thomas. Councillor H. G. White. Committee to issue certificates and reports under the Rent and Mortgage Enterest (Restrictions) Acts. 1920 and 1923, as to the condition of dwelling houes. 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. As constituted 9th November, 1932. Chairman: Councillor J. A. Campbell. His Worship the Mayor. (Councillor E. S. Strange, J.p.). Councillor Miss E. J. E. Butcher. „ F. Fryer. „ H. Harling. Alderman I. O. Thomas. 2 Tuberculosis Committee. The Health Committee, as above. Tuberculosis Care Committee. 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). Lady Almoner, Victoria Hospital (Miss E. W. 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). As constituted 9th November, 1932. Chairman—Councillor Mrs. K. S. D. Baker. Councillor Mrs. J. L. Eaton. „ D. Jenkins. „ Mrs. M. J. Robinson. „ Mrs. F. Young. Other Member: Mrs. E. W. Coles. Representative of the Local Public Assistance Committee: Mrs. F. M. Glanvill. Representative of the London Insurance Committee: Mr. C. F. Botten. 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) Secretary, Invalid Children's Aid Association, Southlands (Miss Denham). 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). Lady Almoner, Victoria Hospital (Miss E. W. 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, 1932). 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. Resident Medical Officer, Borough Maternity Hospital— (Miss) L. G. BACH, 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 Gynæologist, Borough Maternity Hospital— (Miss) ALICE BLOOMFIELD, M.D., F.R.C.S. 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, San. Insp. Board's Cert., Cert. C.M.B. Miss N. Playne, San. Insp. Board's Cert., Cert. C.M.B. Miss M. Carr, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss D. Heap, H.V. Diploma, San. Insp. Board's Cert. Miss F. B. Goodall. H.V. Diploma, Cert. C.M.B., San. Insp. Board's Cert. Miss A. Bannerman, H.V. Cert., Cert. C.M.B. Miss E. M. Hoyles, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss V. Ventris, H.V. Cert., Cert. C.M.B. Sanitary Inspectors— Mr. J. Lawrence, Cert. San. Inst, and Meat Insp. Cert. (Senior Insp.) District Inspectors. 1. Mr. W. E. Selway, Cert. S.I.E.J.B., and Meat Insp. Cert. 2. Mr. J. J. Burgess, San. Insp. Board's Cert 3. Mr. H. H. May, Cert. San. Inst. 4. Mr. F. H. Chuter, San. Insp. Board's Cert. & Meat Insp. Cert. 5. Mr. J. R. Holloway, San. Insp. Board's Cert. 6. Mr. C. Binding, San. Insp Board's Cert. and Meat Insp. Cert. 8. 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. 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. L. Newton. Miss R. Dove. Mr. F. Pedrick. Mr. P. Brocking. Office youths. Miss M. A. Weller (M. &. 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 1932. It is again my privilege to be able to record that the vital and morbid statistics for the year 1932 continue to be satisfactory. It is to be noted, however, that the birth-rate of the Borough (14.8) is the lowest recorded. The general death-rate (12.1) and the infant mortality rate (57.8) are satisfactory and compare favourably with the rates for the County of London. The Maternity and Child Welfare Scheme of the Council, including the organised Voluntary effort linked up with the scheme, has had a successful year, and the results obtained are reflected in the improved statistical returns. The Health Services included in this scheme have been maintained at the high standard of past years. With regard to Housing, rapid progress was made in the erection of working class tenements on the St. John's College Estate, and it is anticipated that this useful contribution to the relief of the housing shortage in Battersea will be completed by the autumn of 1933. In other directions, e.g., slum clearance, the repair and reconditioning, &c., of unfit houses, considerable attention was given during the year by the Housing Committee to the recent Survey of the housing needs of the Borough, and the Committee have had under consideration the five yearly housing programme which it is the duty of Housing Authorities to submit to the Minister of Health. Details relating to the year's work on Housing will be found set out on pp. 103 to 119. It is to be hoped that some substantial progress will be made, under the 1930 Housing Act, with the important subject of Slum Clearance, to which the Housing Committee were giving particular attention at the end of the year. It cannot be too clearly emphasised that one of the most pressing duties of Housing and Health Authorities is the removal of slums. In Battersea a very successful minor effort was made by the Council soon after the war, in the clearance of the Plough Road area. It has, however, taken about 12 years to complete this initial effort. The slow progress made has not been due to any lack of interest on the part of the Council. The new Housing Act (1930) should assist Local Authorities to speed up their programmes in this direction. 6 There are, unfortunately, several areas in the Borough similar to the Plough Road area, urgently requiring attention, and some of these are at present under consideration by the Housing Committee. Unless, however, the present rate of progress in dealing with such areas is accelerated, the hopes engendered by the spate of Housing Legislation since the war will not have been fully realised. In conclusion, I desire to express my thanks to the Mayor, Chairmen of Committees and Members of the Council for the continued support and assistance accorded me. To my colleagues, the Chief Officers of the Council, and the staff of the Public Health Department, my thanks are also due for assistance always willingly given. (Signed) G. QUIN LENNANE, Medical Officer of Health. Electric House, Lavender Hill, S.W. 11. July, 1933. 7 CONTENTS. General. Page Introduction 5-6 Committees 1-2 Staff 3-4, 53, 58, 82 Revision of Sub-Districts 10 Vital Statistics. Summary 9, 18, 19, 20, 130 Census—Population 9-11 Births—General Tables 10-12, 18, 19, 20 „ Notification of Births Act 17-18 „ Still Births 12, 18 Marriages 13 Deaths—General Tables ; Public Institutions ; Senile Mortality 13-15 18, 19, 20, 132 „ Zymotic 19, 67 „ Infant Mortality 15-17, 18, 19, 20, 133-135 Maternity and Child Welfare Scheme 21-43 Centres, Municipal and Voluntary 21-24, 32-34 Health Visiting Staff and Work 3, 23, 24 Day Nursery 21, 25 Ambulances 25 Hospitals 21, 25, 26, 34 Unmarried Mothers (Southwark Diocesan Homes) 21, 26 Invalid Children's Aid Association 21, 28 Home Helps 26 Milk and Dinners for Necessitous Mothers and Children 27 Convalescent Treatment 28 Midwives 28, 40 Nursing 28-29 Test Feeding (St. Thomas's Babies Hostel) 21, 26, 29 Ante-natal Work 30-37 Reports of Work at Centres 30-33 V.D. Clinic 35-6 Maternal Mortality 35-8 Maternity Hospital 38-40, 41 District Midwifery Service 40 Dental Clinic 42 Solarium 43, 60, 121, 126 Infectious Diseases (Notifiable) 44-66, 131 List of Notifiable Diseases 44 Contacts 44, 46 Summary Tables 45, 131 Incidence of the several Notifiable Diseases 45-66 Diphtheria Prophylaxis (Schick Clinic) 48 Vaccinators 53 Tuberculosis 54-66, 120-129, 136-140 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 26, 58-60, 120-129 Bacteriological and X-Ray Examinations 58, 60, 125 Open-air School (Springwell House) 59, 126 Care Committee 2, 59, 122, 127-129 Dental Treatment 59, 126 Institutional and Artificial Sunlight Treatment 59, 60, 121, 126 Artificial pneumo-thorax treatment 60, 121 Non-Dispensary Patients 61 Contacts 59, 120, 140 Tuberculosis Regulations, 1925 and 1930 62-63 Revision of Register 63-66 Summary Tables 64-66, 136-140 Tuberculosis Officer's Report 120-129 Zymotic Diseases 67 8 Page Infectious Diseases (Non-notifiable) 67-69 Bacteriological Examinations 69 Sanitary Circumstances. Summary Table 70 Legal Proceedings 71-75 New Legislation 76 Common Lodging Houses 76 Drains 76 Public Cleansing 78 Houses Let in Tenements 78 Licensed Premises (Sanitary Conveniences) 78 Smoke and Effluvium Nuisance 78, 79 Offensive Matter, Removal of 79 Water Supply 79 Van Dwellings 79 Rag Flock Acts 80 Rats and Mice 80 Dogs—Nuisances by 80 Personal Cleansing Station 81 Disinfecting Department 82 Coroner's Court and Mortuary 82-83 Staff 82 Protection of the Food Supply. Unsound Food 84 Food Poisoning 84 Cow-Houses, Slaughter-Houses, Butchers' Shops 84-85 Public Health (Meat) Regulations, 1924 85 Food and Drugs (Adulteration) Act, 1928 85 Results of Analyses 86-91 Bacteriological Examinations 85, 89 Milk—Analysis; Condensed 87-89 Other Foods and Drugs 90-91 Milk Shops and Milk Orders 92 Ice Cream 91 Preservatives in Foods and Preserved Food premises 93 Export of Food 93 Agricultural Produce and Merchandise Marks Acts 93 94 Artificial Cream Act 94 Food premises, Fish Shops, Restaurants, Food Stalls 94 95 Wrapping of Foodstuffs 95 Factories and Workshops—General Tables 96 Factories and Workshops 97-99 Homework 99-102 Bakehouses, Warehouses and Wharves 101 Housing—Generally 103-119 New Dwellings 103 Survey of Borough 103, 111-119 Housing (Financial Provisions) Bill 104 Overcrowding 104, 113, 117 Unfit Houses 105, 107-108 Appeals : Closing and Demolition Orders 106, 107 Underground Rooms 106 Increase of Rent Acts; Rent Books 106 Rent and Mortgage Interest Amendment Bill 106 Clearance Areas 106, 115 Statistics 107-110, 119 Appendix. Summary Tables 130-140 Tuberculosis Officer's Report 120-129, 136-140 9 Summary of Statistics, 1932. 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 1932) 157,000 Number of private families—Census 1921 42,988 Census 1931 44,618 Structurally separate occupied dwellings (Census, 1921 27,191); Census 1931 27,219 Ditto—on rate books at end of 1932 27,319 Rateable value (average 1932) £1 ,074,758 Sum represented by a penny rate £4,430 2. Extracts from Vital Statistics of the Year. Birlhs— Males, 1,202 ; females, 1,117 2,319 Legitimate births (1,151 males; 1,082 females) 2,233 Illegitimate „ (51 males; 35 females) 86 Birth-rate 14.8 Deaths— Males, 951; females, 944 1,895 Percentage of total Deaths occurring in Public Institutions (Battersea deaths only) 56.6 Death-rate 12 1 Number of women dying in or in consequence of childbirth— From sepsis 2 Other causes 2 Death-rate of infants under 1 year per 1,000 live births. Legitimate 56.9 Illegitimate 81.4 578 Deaths from Measles (all ages) 23 „ Whooping-cough (all ages) 11 ,, Diarrhoea (under 2 years of age) 22 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, gives the population of Battersea at that date as 159,552, compared with 167,739 at the Census of 1921, showing a decrease of 8,187. Under the powers conferred by the Local Government Act, 1929, the Council, with the sanction of the Ministry of Health, altered the Registration sub-districts into which the Borough was hitherto divided. The new Sub-Districts fixed by the Council on 24th February, 1932, are as follows:— (I.) North Battersea—comprising Nine Elms, Park, Latchmere and Church Wards. (This area coincides with the North Battersea Parliamentary Division.) (II.) South Battersea—comprising Shaftesbury, Winstanley, St. John and Bolingbroke Wards, together with the Broomwood Ward, less St. James's Hospital. (This area, with the addition of St. James's Hospital, coincides with the South Battersea Parliamentary Division.) (III.) St. James's Hospital.* The new arrangement came into force on the 1st April, 1932, but for purposes of comparison the statistics are shown as if the arrangement had commenced on the 1st January, 1932. The Registrar-General's estimate of the mid-year population of the Borough (1932) was 157,000. 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:— * Births, deaths, etc., occurring in St. James's Hospital are allocated to the District in which the patient resides. 11 Area. Estimated Mid-Year Population, 1932. Males. Females. Total. Sub-Districts. North Battersea 37,033 39,235 76,268 South Battersea 37,265 43,467 80,732 Total 74,298 82,702 157,000 Wards. No. 1. Nine Elms 12,418 12,636 25,054 No. 2. Park 7,838 8,790 16,628 No. 3. Latchmere 8,627 9,472 18,099 No. 4. Shaftesbury 6,682 7,201 13,883 No. 5. Church 8,150 8,337 16,487 No. 6. Winstanley 9,338 9,542 18,880 No. 7. St. John 3,679 4,743 8,422 No. 8. Bolingbroke 8,243 9,943 18,186 No. 9. Broomwood 9,323 12,038 21,361 Total 74,298 82,702 157,000 BIRTHS. The number of births registered in the Borough during 1932 was 2,649 (1,402 males, 1,247 females), an excess of 155 males. Of this number, 698 were transferred out, the permanent residence of the parents being outside the Borough, and 368, registered outside the Borough, were transferred here, giving on balance a total of 2,319 births (1,202 male, 1,117 female) relating to Battersea residents, and a corrected birth-rate of 14.8 per 1,000 of the population. This is a decrease on that of 1931, and the birth-rate is the lowest so far recorded in Battersea. 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 1932. Area. Estimated Population, 1932. Number of Births. Birthrate. Sub-Districts. North Battersea 76,268 1,217 16.0 South Battersea 80,732 1,102 13.6 Wards. No. 1. Nine Elms 25,054 390 15.6 No. 2. Park 16,628 294 17.7 No. 3. Latchmere 18,099 258 14.3 No. 4. Shaftesbury 13,883 174 12.5 No. 5. Church 16,487 275 16.7 No. 6. Winstanley 18,880 323 17.1 No. 7. St. John 8,422 119 14.1 No. 8. Bolingbroke 18,186 282 15.5 No. 9. Broomwood 21,361 204 9.6 12 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1932, and during the previous decennium 1922-1931:— Birth-rate per 1,000 Population. Year. The Borough. North Battersea. South Battersea. 1922 21.7 23.9 19.5 1923 20.1 23.0 17.3 1924 18.4 20.7 16.0 1925 18.5 21.1 16.0 1926 17.3 20.2 14.4 1927 16.6 18.5 14.6 1928 16.7 19.0 14.5 1929 16.2 18.5 13.9 1930 16.5 17.8 15.2 1931 15.5 16.5 14.5 Average 1922-1931 17.8 19.9 15.6 1932 14.8 16.0 13.6 The birth-rate shows a decline in five Wards of the Borough and an increase in the four remaining Wards. The birth-rate in Battersea is 3 0 per 1,000 lower than the average for the previous decennium 1922-1931. The birth-rate for the County of London was 14.3 per 1,000 of the population, and for England and Wales the rate was 15.3. Illegitimate births numbered 86 or 3 71 per cent. of the total live births. Under the Births and Deaths Registration Act, 1926, the registration of still-births was made compulsory. During 1932, 72 stillbirths were registered as belonging to Battersea. 13 MARRIAGES. The marriages registered in Battersea during 1932 numbered 1,300. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 16.6. Year. Marriages. Marriage-Rate. 1927 1,428 16.9 1928 1,354 16.5 1929 1,376 17.0 1930 1,444 18.0 1931 1,421 17.8 Mean, 1927-31 1,405 17.2 1932 1,300 16.6 DEATHS. The number of deaths registered in the Borough during 1932 was 2,642. Of these, 1,306 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 559 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,895 (males 951, females 944). This gives a recorded death-rate of 12.1 compared with 12.3 for London, and 12 0 for England and Wales. 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. Area. Estimated Population 1932. Number of Deaths. Deathrate. Sub-Districts. North Battersea 76,268 911 11.9 South Battersea 80,732 984 12.2 Wards. No. 1. Nine Elms 25,054 279 11.1 No. 2. Park 16,628 229 13.8 No. 3. Latchmere 18,099 188 10.4 No. 4. Shaftesbury 13,883 161 11.6 No. 5. Church 16,487 215 13.0 No. 6. Winstanley 18,880 217 11.5 No. 7. St. John 8,422 103 12.2 No. 8. Bolingbroke 18,186 229 12.6 No. 9. Broomwood 21,361 274 12.8 14 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1932:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total.[?###] M 73 35 10 10 36 97 274 416 951 F 61 27 10 9 43 92 220 482 944 Ttls. 134 62 20 19 79 189 494 898 1,895 %of Total 7.1 3.3 1.0 1.0 4.1 10.0 26.1 47.4 100.0 The corrected number of deaths of males and females registered in each quarter of the year is set out as follows:— Period. Males. Females. Total. First quarter 294 324 618 Second quarter 223 210 433 Third quarter 201 166 367 Fourth quarter 233 244 477 Total 951 944 1,895 The death-rate, during 1932 was 12.1. It was lowest in the Latchmere Ward (10.4), and highest in Park Ward (13.8). The deaths of persons over 65 years numbered 898 or 47.4 per cent. of the total deaths. The average age at death was 55.7 years, as compared with 55.3 in 1932. Decreased death-rates were recorded in five Wards of the Borough. Death-rate per 1,000 Population. Year. The Borough. North Battersea. South Battersea. 1922 13.2 13.7 12.6 1923 10.8 10.7 10.9 1924 11.8 12.1 11.5 1925 10.5 10.9 10.1 1926 11.4 11.4 11.4 1927 12.2 12.1 12.4 1928 11.9 12.0 11.9 1929 14.2 14.4 14.0 1930 11.5 11.7 11.3 1931 12.1 12.2 11.9 Average 1922-1931 12.0 12.1 11.8 1932 12.1 11-9 12.2 The natural increase of population (that is the excess of births over deaths) was 424 in 1932 as compared with 546 in 1931. 15 Deaths in Public Institutions. During 1932 the deaths of Battersea residents occurring in Public Institutions numbered 1,073. Of this number 563 occurred within and 510 outside the Borough. Of the total Battersea deaths in Institutions 739 occurred in Public Assistance Institutions. Senile Mortality. During 1932 the deaths of 898 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths which constituted 47.4 per cent. of the deaths at all ages is set out in the following table:— Sub-District. 65 and under 75. 75 and under 85. 85 and upwards. Total over 65. Total. M. F. M. F. M. F. M. F. North Battersea 105 79 66 83 13 39 184 201 385 South Battersea 111 98 99 133 22 50 232 281 513 Borough 216 177 165 216 35 89 416 482 898 Infant Mortality. During 1932 the deaths of 134 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,319, giving an infant mortality rate of 57.8 per 1,000 births, as compared with 57.3 in 1931, 54.7 in 1930, 62.6 in 1929, and 64.2 in 1928. The distribution of the 134 infant deaths and the infant mortality-rates for the registration Sub-Districts and the Wards, are shown in the following table: — Area. Births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 births. m. f. total. Sub-District. North Battersea 1,217 36 29 65 53.4 South Battersea 1,102 37 32 69 62.6 The Borough 2,319 73 61 134 57.8 Ward. 1. Nine Elms 390 12 6 18 46.2 2. Park 294 8 9 17 57.8 3. Latchmere 258 7 5 12 46.5 4. Shaftesbury 174 6 4 10 57.5 5. Church 275 9 9 18 65.5 6. Winstanley 323 16 12 28 86.7 7. St. John 119 3 4 7 58.8 8. Bolingbroke 282 8 7 15 53.2 9. Broomwood 204 4 5 9 44.1 16 It will be noted that in the Sub-Districts the rate was lower in North Battersea (53.4) than in South Battersea (62.6). In the Wards, Broomwood showed the lowest rate (44.1) and Winstanley Ward the highest (86.7). The infant mortality rate in the County of London and in England and Wales during 1932 was 66.6 and 64.6 respectively. The number of infant deaths and the infant mortality in each quarter of the year was as follows: — Period Births registered. Infant deaths. Infant Mortality Rate. First quarter 582 39 67.0 Second quarter 636 36 56.6 Third quarter 573 27 47.1 Fourth quarter 528 32 60.6 The infant death-rate was 54.7 during the last 9 months of the year, as compared with 67.0 in the first 3 months. There were 52 deaths of infants during the first four weeks of life (or 38.8 per cent. of the total infant deaths) as compared with 68 deaths (or 47.9 per cent.) in 1931 and a percentage for the quinquennium (1927-1931) of 46.1. Seven infant deaths were recorded as due to Measles during the year. The deaths from developmental diseases were 56 as compared with 75 in 1931. 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 1927 to 1932. 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 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 1931 28 18 22 68 47.9 Total 1927-31 125 132 101 358 46.1 Mean do 250 26.4 20.2 71.6 — 1932 16 20 16 52 38.8 17 Certified Causes of Death. Months 0—3. Months 3—6. Months 6—9. Months 9—12. Total. % of Total. Diphtheria 1 - 1 2 1.49 Measles — — 2 5 7 5.22 Influenza — — 2 — 2 1 .49 Erysipelas 1 — 1 — 2 1.49 Whooping Cough 1 1 2 1 5 3.73 Meningococcal Meningitis - 1 - 1 0.75 Diarrhoea and Enteritis 8 7 6 — 21 15.68 General Tuberculosis — — — — — — Tuberculous Meningitis — — 1 2 3 2.24 Pulmonary Tuberculosis — — — — — — Pneumonia 7 3 5 3 18 13.43 Bronchitis — — — — — — Intussusception — 2 — — 2 1.49 Prematurity 30 — — — 30 22.38 Marasmus 7 — — — 7 5.22 Icterus Neonatorum 1 — — 1 0.75 CongenitalMalformations 11 — 1 — 12 8.96 Injury at Birth 3 — — — 3 2.24 Atelectasis&AsphyxiaN. 3 — — — 3 2.24 Syphilis 4 — — — 4 2.98 Convulsions 1 — — — 1 0.75 Rickets — - - - - - Cancer — 1 1 0.75 Lack of Care 1 — — — 1 0.75 Accident and Homicide 1 — — — 1 0.75 Overlying — — — — — — Miscellaneous 3 2 1 1 7 5.22 Total 83 16 22 13 134 100.0 Percentage of Total 61.9 12.0 16.4 9.7 — 100.0 Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1932 was 81.4 per 1,000 births, as compared with 83.3 in 1931, 161.3 in 1930, 98.9 in 1929, and 73.2 in 1928. The corresponding deathrate of legitimate children in 1932 was 56.9, the ratio of the mortality rate of illegitimate infants to that of legitimate being 1.43 to 1. Notification of Births Act. During 1932 the number of notifications of live births received was 2,200. The corrected number of births registered during the year in Battersea was 2,319. The proportion of notified to registered births was, therefore, 94.9 per cent. There were 267 living and 10 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 1932 there were 93 still-births registered in Battersea, of which 58 were of Battersea parents. Fourteen still-births occurring outside the Borough were registered as belonging to Battersea, making 72 in all, representing a still-birth rate of 30.1 per 1,000 births (live and still) registered. Of the 72 still-births 7 (9.72 per cent.) were registered as illegitimate. Sixty-two still-births were notified, under the provisions of the Notification of Births Acts during the year, the number notified being 86.1 per cent. of the total Battersea still-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 1932:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Mortality per 1,000 live births. 1. Shoreditch 17-5 1. Lewisham 10.2 1. City of London 46.2 2. Poplar 17-2 2. Woolwich 11.1 2. Chelsea 52.2 3. Stepney 16-8 3. Hackney 11.5 3. Hackney 53.9 4. Bermondsey 16-6 4. Wandsworth 11.6 4. Hampstead 54.0 5. Southwark 16-2 5. Hampstead 11.6 5. StokeNewingto 54.1 6. Finsbury 160 6. Greenwich 12.0 6. Lewisham 54.7 7. Islington 160 7. Camberwell 12.0 7. Lambeth 56.3 8. Deptford 15-9 8. Bermondsey 12.1 8. Bermondsey 56.8 9. Bethnal Green 15-4 9. Battersea 12.1 9. Battersea 57.8 10. Stoke Newington 150 10. Poplar 12 .1 10. Fulham 58.0 11. Greenwich 14-8 11 Bethnal Green 12.1 11. Woolwich 59.9 12. Battersea 14-8 12. Deptford 12.3 12. Stepney 60.2 13. Lambeth 14-8 13. Shoreditch 12.3 13. Wandsworth 62.8 f4. Camberwell 14-6 14. Fulham 12.4 14. Poplar 63.5 15. Hackney 14-5 15 Stepney 12.5 15. Deptford 64.7 16. Hammersmith 14-5 16. Westminster 12.5 16. Camberwell 64.7 17. Fulham 14-3 17. Lambeth 12.5 17. Hammersmith 66.5 18. Woolwich 14-0 18. Islington 12.7 18. Westminster 67.2 19. St. Pancras 14-0 19. City of London 12.8 19. Islington 67.6 20. Paddington 13-8 20. Hammersmith 12.8 20. Bethnal Green 69.1 21. Kensington 12-9 21. Stoke Newingtor 112.9 21. St. Pancras 69.3 22. Lewisham 12-7 22. Chelsea 12.9 22. Holborn 71.6 23. Chelsea. 11-9 23. St. Marylebone 13.1 23. Southwark 72.2 24. Wandsworth 11-8 24. Southwark 13.1 24. Shoreditch 80.0 25. St. Marylebone 10-9 25. St. Pancras 13.2 25. Greenwich 81.2 26. Hampstead 10-9 26. Paddington 13.3 26. St. Marylebone 87.2 27. Holborn 9-6 27. Finsbury 13.4 27. Finsbury 87.6 28. Westminster 9-3 28. Kensington 13.6 28. Kensington 98.2 29. City of London 6-5 29. Holborn 14.2 29. Paddington 107.0 County of London 14.3 County of London 12.3 County of London 66.6 These rates are based upon the estimate furnished by the Registrar General of the population of each Borough at the middle of 1932. 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 26·8 468 748 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 18·7 881 2,419 1882 112,661 4,504 39·9 2,214 19·6 353 2,290 1883 116,980 4,711 40·2 2,344 20·0 369 2,367 1884 121,299 5,275 43·4 2,569 21.1 568 2,706 1885 125,618 4,654 37·0 2,566 20·4 432 2,088 1886 129,937 5,140 39·5 2,477 19·0 398 2,663 1887 134,256 5,186 38.6 2,451 18·2 502 2,735 1888 138,565 5,061 36.5 2,187 15·7 363 2,874 1889 142,884 5,161 36·1 2,240 15·6 366 2,921 1890 147,203 5,105 34·6 2,854 19·3 543 2,251 1891 150,880 5,237 34 ·7 2,697 17·9 898 2,540 1892 153,778 4,990 32·4 2,782 18.1 439 2,208 1893 156,719 5,225 33·3 2,974 18·9 614 2,251 1894 159,724 5,024 31·4 2,577 16·1 526 2,447 1895 162,787 5,264 32·3 2,961 18·1 460 2,303 1896 165,309 5,358 32·4 2,994 18·1 642 2,364 1897 166,059 5,266 31·7 2,737 16·4 486 2,529 1898 166,814 5,157 30·9 2,892 17·3 531 2,265 1899 167,570 5,179 30·9 2,905 17·3 418 2,274 1900 168,339 5,161 30·6 2,978 17·6 435 2,183 1901 169,100 5,025 29·7 2,766 16·3 491 2,259 1902 171,401 4,844 28·2 2,581 15·0 367 2,263 1903 173,422 4,973 28·6 2,476 14·2 347 2,497 1904 175,465 4,849 27·5 2,543 14·4 353 2,306 1905 177,532 4,843 27·3 2,561 14·4 342 2,282 1906 179,622 4,654 25·9 2,384 13·2 321 2,270 1907 181,736 4,574 25·1 2,406 13·2 243 2,168 1908 183,873 4,629 25·1 2,272 12·3 228 2,357 1909 186,036 4,450 23·9 2,417 12·9 237 2,033 1910 188,222 4,489 23·7 2,124 11·3 209 2,365 1911 167,765 4,381 26·1 2,404 14·3 331 1,977 1912 167,589 4,255 25·4 2,052 12·2 133 2,203 1913 167,464 4,240 25·3 2,365 14·1 197 1,875 1914 167,338 4,303 25·7 2,217 13·2 142 2,086 1915 161,945 3,820 23·6 2,653 16·4 334 1,167 1916 B*173,432 3,774 21·8 — — — — D*159,402 — — 2,221 13·9 160 1,553 1917 B*167,233 2,960 17·7 — — — — D*150,023 — — 2,285 15·2 185 675 1918 B*168,014 2,700 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 1932 157,000 2,319 14·8 1,895 12·1 75 424 * 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 1932. 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. The Council are required, by a scheme made by the Minister of Health under the Local Government Act, 1929, to make annual payments for a period of three years 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 The Council also made additional contributions in 1932 in connection with their Maternity and Child Welfare Scheme as under:— Invalid Children's Aid Association £40 St. Thomas's Babies' Hostel £100 Victoria Hospital for Children £100 These amounts are equivalent to the grants formerly paid by the Council, and those paid by the Ministry direct to the Associations. In the case of the Battersea School for Mothers the Council, at the request of the School in view of their financial needs, made an additional grant of £100 for the year 1932. 22 MATERNITY AND CHILD WELFARE CENTRES. Name and Situation of Centre. Times of Opening. Monday. Tuesday. Wednesday. Thursday. Friday. Municipal Centres. Southlands, High Street 9.30 a.m. S.L. 2.0 p.m. - — 9.30 a.m. s.L. †2.0 p.m. ‡2.30 p.m. - *1.30 p.m. - 9.30 a.m.S.L. *10.0 a.m. a.n - do. (Dental Clinic) — §10.30 a.m. 2.0 p.m. 10.30 a.m. 2.0 p.m. - - 10.30 a.m. ║2.0 p.m. All Saints' Parish Hall, Prince of Wales Road — - *¶10.0 a.m. A.N. *1.30 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. †2.0 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) — *10.0 a.m. P.N. *2.0 p.m. A.N. *10.0 a.m. A.N. *2.0 p.m. A.N. (Special Clinic) *10.0 a.m.A.N. - — - 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. †2.30 p.m. - *¶112.30 p.m. *¶2.30 p.m. A.N. *2.30 p.m. - †2.30 p.m. - — - 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. Artificial Sunlight treatment clinic. †Mothers only. ‡Protection against diphtheria (Schick clinic). § Children only. ║Tubercular patients only. ¶Session held fortnightly. Dinners for expectant and nursing mothers are provided daily (Monday to Friday) by the Women's League of Service at their Southlands premises. A Fathers' Council is held monthly at the premises of the Battersea School for Mothers, 55, Mundella Road (Tuesday, 7.30 p.m.). 23 At each of the Centres a clinic is held, a woman Medical Officer being in attendance. Each centre is under the supervision of a trained Health Visitor and voluntary helpers assist in the work of the centres. The Voluntary Centres are conducted on similar lines to those of the Municipal Centres. The table on page 24 gives a summary of the work carried out at the Centres in 1932. 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 twelve 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 home visiting carried out during 1932 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 2,855 461 3,316 To Notified Births 7,347 1,454 8,801 To Still-Births 69 11 80 To Children aged 1-5 years 4,953 2,707 7,660 To enquire into Infant Deaths 138 31 169 To cases of Notifiable Infectious Disease 6,334 1,206 7,540 To cases of Non-Notifiable Disease 177 113 290 Re prevention of Diphtheria 87 10 97 „ „ Measles 245 66 311 To Dental Cases 82 30 112 To V.D. Cases 4 — 4 Other Visits 988 536 1,524 Totals 23,279 6,625 29,904 24 Summarised Statistics Relating to Infant Welfare Centres, 1932. 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 100 141 94 97 100 532 93 51 72 216 748 Average attendences per session 47 56 44 59 48 51 43 20 30 33 46 Average ditto weekly 90 153 79 111 92 524 77 20 42 139 663 First attendances 313 466 245 348 223 1,595 308 35 175 518 2,113 Doctor's attendances 52 47 46 48 47 240 93 24 68 185 425 Babies seen by Doctor 1,045 1,584 1,150 1,263 1,028 6,070 2,645 195 1,215 4,055 10,125 Average ditto per attendance 20 34 25 26 22 25 28 8 18 22 24 Weights recorded 4,213 6,259 3,684 5,322 4,268 23,746 3,939 829 2,046 6,814 30,560 Advice only 462 1,686 411 449 509 3,517 55 184 147 386 3,903 Attendances 4,675 7,945 4,095 5,771 4,777 27,263 3,994 1,013 2,193 7,200 34,463 25 Day Nursery. 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 28 children, and a guest house is attached for the reception of residents. The Council make an annual grant of £555 to the Nursery (vide p. 21). No serious outbreak of infectious disease occurred during the year among the children attending the Nursery, although a few isolated cases were notified for which the usual precautionary measures were adopted. During 1932 the attendances at the Nursery totalled 3,899. Ambulance Service. The facilities which are 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., have been made use of by patients attending the Maternity Hospital. The County Council as stated in the last Annual Report, have agreed to extend these facilities to the conveyance of non-urgent cases between the hours of 8 a.m. and 11 p.m. Hospital Provision. In addition to the provision of Midwifery Services, Hospital and District, the Council have provided facilities for the needs of children requiring special hospital treatment by arrangement with the Victoria Children's Hospital, Chelsea, and the St. Thomas's Babies' Hospital (vide page 29). The Council contribute an annual sum to these Hospitals in respect of the facilities afforded (vide page 21). Women and children are referred where necessary from the Ante-Natal and Child Welfare Centres to these or 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 1932:— St. Thomas's Hospital 18 Victoria Hospital, Chelsea 376 St. James's Hospital 17 Bolingbroke Hospital 7 Battersea General Hospital — Borough Tuberculosis Dispensary 3 South London Hospital for Women 14 St. Thomas's Babies' Hostel 420* Invalid Children's Aid Association 15 Chelsea Women's Hospital — Vincent Square Hospital 6 876 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 1932, to the maintenance of which the Council contributed, was 4, the cost to the Council being £164 9s. Od. In the case of other homes, the number of cases during the year was 6, and the additional contribution of the Council amounted to £68 1s. 3d. 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 1932 no application for the services of a home help was received. * Includes cases referred more than once. Vide p. 29. 27 Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, Grade A (Tuberculin Tested) and dried milk have hitherto been provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. In May, however, the Council decided that in future Pasteurised milk should be supplied under their Maternity and Child Welfare scheme in lieu of Grade A (Tuberculin Tested) milk, and the change came into force on 3rd July.* 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 (alter 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 1932 241 (126) 5,184 1,939 (126) 273,103 4,372 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. A proposal to amend the scale of income upon which the grant of milk in necessitous cases is based was under consideration in December, and a revised scale came into operation in January, 1933. Care is taken to see that there is no abuse of the facilities provided, and the fullest investigations are made into the financial circumstances of applicants. Pasteurised milk is supplied in sealed bottles by licensed purveyors in the Borough, and the recipients are given their choice of dairymen from the list of licensed dealers. In addition to the above, dinners to the number of 150 were supplied during 1932 to necessitous expectant and nursing mothers and children at a cost of £3 14s. 2d., by arrangement with the Women's League of Service. * This change has resulted in a saving of approximately £500 during the six months ended 31st December, in the cost of milk supplied to necessitous mothers and children. 28 Mothers were also referred from the Welfare Centres to the kitchen of the Invalid Kitchens' Association in Henley Street, where they were supplied with 120 dinners during 1932 at a cost of £3 10s. 0d. Convalescent Homes. During 1932, accommodation was provided for 16 mothers and 15 children attending the various Maternity and Child Welfare Clinics. Of these, 6 mothers and 6 children were sent to Littlestone-on-Sea Convalescent Home, 6 mothers and 5 babies to the Evelyn Convalescent Home, Upper Wargrave, and 4 mothers and 4 babies to the Salvation Army Home, Tankerton. The cost incurred by the Council amounted to £24 9s. 0d., the families concerned contributing the balance of £8 9s. 0d. Nine 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. In addition to the above 12 mothers and 15 children attending the voluntary centres linked up with the Council's scheme were sent away for the period of convalescence, the cost of which was not borne by the Council (vide pp. 33, 34). Midwives. At the end of the year there were about 21 registered private 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 provided by the Borough Council (vide page 40) the eastern portion of the Borough is served by the district midwifery services of the General Lying-in Hospital, York Road, St. Thomas's Hospital and the Clapham Maternity Hospital. 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 1932 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, 1932. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 116 2,351 - - 116 2,351 Measles 34 423 11 105 45 528 Whooping Cough 8 111 — — 8 111 Diarrhoea & Vomiting 4 16 — — 4 16 Chicken Pox 2 26 — — 2 26 Mumps 1 13 — — 1 13 Pemphigus Neonatorum 2 25 - - 2 25 Puerperal Pyrexia — — — — — — Pneumonia 18 307 59 952 77 1,259 Influenza 1 8 21 215 22 223 Erysipelas - - 1 5 1 5 Totals 186 3,280 92 1,277 278 4,557 The cost of the nursing service in 1932 was £151 18s. 0d. as compared with £143 12s. 0d. in the previous year. St. Thomas's Babies Hostel. The arrangements temporarily made in 1926 with St. Thomas's 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 1932. The results of the year's work have been satisfactory and are summarised below:— A. Test Feeds. Number of cases, 224, comprising: Mothers, 224; babies, 228. Number of attendances, 656. 9 of these cases received in-patient treatment. B. In-Patient Treatment. Battersea cases received— 8 mothers and 8 babies sent by Council. 2 mothers and 9 babies sent from other sources. Period of stay. Cases sent by Council—8 mothers and 8 babies, 408 days; average, 25½ days. Other cases—2 mothers and 9 babies, 430 days ; average, mothers 42½ days, babies 38⅓ 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 Gynaecologist) reports:— Tuesday Afternoon ("Special") Clinic.—In all, 51 sessions of this Clinic were held, with a total attendance of 901, i.e. an average of 17.7 per clinic. New cases numbered 841, and blood for the Wassermann reaction was taken in 832 of these cases, with 6 positive results. Of these 832 cases, 779 attended for blood examination only, while 53 cases attended also for other reasons, and 9 cases are included in the total—841—in which a blood examination was not done. Other reasons for attendance were as follows:— Vaginal discharge—in all 17 cases, in 5 of whom film examinations were made, and many of whom required repeated treatments, over some weeks. For Prolapse. Retroversion of the Gravid Uterus. For the diagnosis of pregnancy, &c. Remarks—The figure, 53, of cases attending this Clinic for other reasons than blood examination is an increase over previous years, showing that the Clinic is gradually but definitely becoming recognised, and used as a consultative Gynaecological Clinic. N.B.—It is also after this Clinic that the various "examinations under anaesthesia" are carried out. (For details see later.) These numbered 14. Wednesday and Thursday Morning Ante-Natal Clinics.—These Clinics numbered 104, with a total attendance of 3,027, and an 31 average attendance per Clinic of 29.1. Total new patients numbered 487, including 3 not pregnant, with 272 primiparae, and 212 multipara. Of the multipara, 79, or 34 per cent., were "return" cases, i.e. patients who had already been confined once or more in the Borough Maternity Home. Booking date with reference to period of pregnancy:— Up to 6 months, 400 cases; 6 to 8 months, 78 cases; over 8 months, 6 cases. Abnormal ante-natal cases included the following:— Albuminurias, 44; cardiac cases, 6; varicose veins (specially severe), 4. Also cases of hyperpiesia, contracted pelvis, epilepsy, herniæ, &c. Cases requiring Institutional treatment during pregnancy, including cases recommended admission to the Maternity Home, 45. These included 25 cases of albuminuria. Cases referred to the Tuberculosis Dispensary, 3; cases referred to the Dental Surgeon, 125; cases referred to private doctor, 1; cases referred to other hospitals for examination, special pathology, &c., 19. Southlands (Friday morning) Clinic.—51 sessions of this Clinic were held, with a total attendance of 1,031, and an average attendance of 20.2 per clinic. New cases numbered 339, one-third of the total attendances, and an average of 6.6 per Clinic, and were made up of 137 multiparae, and 202 primiparae. "Return cases" bered 92, or 67 per cent. of the multiparæ, a very high proportion. Booking date with reference to period of pregnancy:— Up to 6 months, 240; 6 to 8 months, 84 ; over 8 months, 15. Abnormal cases seen at the Clinic included—Albuminurias, 6 cases ; cardiac disease, 1 case. Cases referred to the Tuberculosis Dispensary—2. Cases referred to the Dental Surgeon—177. Cases requiring Institutional treatment during the ante-natal period, including cases referred for admission to the Borough Maternity Home, 6. Borough Maternity Home (In-Patients).—The following is a table of cases supplied from the records of the Borough Maternity Home, which are of interest in relation to the ante-natal work. (It is to be noted in viewing these figures that one case may appear under one or more headings, viz., a case recorded as one of albuminuria may also appear in the table of inductions, &c. Unless this is allowed for, an erroneous idea of numbers may be obtained.) Cases of albuminuria recommended admission—25. Results.—Mothers—good. Babies—still births, 2. Cases of eclampsia—3. Results.—Mothers—good. Babies—good. (Note.—It is of interest to note that no case of eclampsia occurred among the albuminurias. The three cases occurred in patients with no previous sign of albuminuria or toxæmia.) 32 Inductions— Bougie—10. Results.—Mother, good. Baby, good. Drug—50. Results.—Mother, good. Babies, 2 still births (as recorded probably under albuminuria). Forceps deliveries—19. Indications.—Maternal distress, 10. Results.—Mothers, good. Babies, good. Fœtal Distress—9. Results.—Mothers, good. Babies, 1 still birth. Examinations under anæsthesia—14. Indications.—For version—13 (successful, 10; failed, 3). For examination of fit of head—1. Number of cases delivered as breech at term—3. (Diagnosed, 1; undiagnosed, 2). Cæsarean Sections—5. Results.—Mothers and Babies—all good. Remarks.—There has been some increase in the numbers of albuminurias, for which it is impossible to suggest a reason. The number of these cases requiring in-patient treatment has, of course, risen proportionately. No cases of albuminuria are recommended admission unless treatment as out-patients has been tried, without relief, or unless the case when first seen is sufficiently serious to make delay in admission unjustifiable. With the rise in the number of albuminurias admitted, there has come a rise in the inductions. The apparent large rise in this number is, however, accounted for by the fact that this year, in getting out the numbers, it has been found impossible to separate the cases given drugs with the definite intention of inducing premature labour—fairly few in number— from those given one or more doses of castor oil and quinine with the intention of stimulating labour which has already started—a large number. Women's League of Service. Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Ante-natal Work.—24 sessions have been held, with a total attendance of 278. 18 mothers were confined at the Borough Maternity Home. 30 „ „ „ by the Borough Midwife. 15 „ „ „ by private Midwives. 10 „ „ „ at St. James's Hospital. 4 „ „ „ at St. George's Hospital. 1 mother was confined at Charing Cross Hospital. 1 „ ,, „ at St. Thomas's Hospital. 1 „ „ „ at Queen Charlotte's Hospital. 2 mothers were referred to Chelsea Hospital for Women. 1 hysterectomy for fibroid uterus. 1 observation. 33 Infant Welfare Work.—73 sessions held, with a total attendance of 2,226. 17 cases attended Victoria Hospital for Children for bronchitis, operation for tonsils and adenoids, otitis media, conjunctivitis, hernia and skin troubles. 1 case attended St. Thomas's Hospital for V.D. treatment. 4 cases attended St. James's Hospital for bronchitis and worms. 2 cases attended Evelina Hospital for bronchitis and digestive trouble. 12 mothers and 6 children were sent to convalescent homes, 2 children remaining several months. The Borough Dental and Sunlight Clinics have been well attended by mothers and toddlers. The District Nurses have done good work in visiting the children in their own homes for dressings and treatment of minor ailments. Dinners for Toddlers.—The children are coming to the dinners at an earlier age, and the result is most satisfactory. Dinners for Mothers.—These have been especially helpful during this difficult financial year. Battersea School for Mothers. The Ante-natal work at this Centre is transferred to the Ante-Natal Clinic at the Borough Maternity Hospital, all cases being referred to the central clinic there for examination and report. The Mundella Road Centre of the Battersea School for Mothers, which has been in operation since 1918, serves a very large, populous working-class area in the Nine Elms District, which is one of the two important areas served by the Voluntary Associations linked up with the Council's scheme. The financial contribution made by the Council is referred to on page 21. Dr. E. M. Saxton, Medical Officer in charge of the Clinic, reports as follows:— There has been an increase in the work and the attendance this year, partly due to the transfer of an area in the Battersea Park district to the Mundella Road Centre. Ninety-three sessions were attended by the Medical Officer. Total attendances 3,994 First attendances—Under 1 year 226 1-5 years 82 Doctors' interviews 2,645 54 test feeds were given. 34 One interesting departure this year has been the adoption of iron treatment in suitable cases, following the report of the Ministry of Health on Anæmia and Infant Nutrition. Encouraging results have been obtained. 40 new cases were sent to massage. 66 cases were referred to hospital. Several children were sent away for convalescent treatment through the Invalid Children's Aid Association, and holidays were obtained for a number of mothers and children, through the kind help of the Women's Holiday Fund, with much benefit to health. Infant Care Lectures are given on Thursday afternoons, and a sewing class is also held on the same afternoon, and both are well attended. The Fathers' Club meets once a month, and there is a monthly Mothers' Social. An annual Concert is held, at which prizes are given for specimens of handicraft for the fathers and sewing for the mothers. In addition to infant welfare visiting the Health Visitors have paid 142 ante-natal visits; 883 visits to cases of notifiable infectious diseases, and 568 visits in respect of grants of milk in necessitous cases. 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 Gynæcological Departments of several of the larger Hospitals in connection with Battersea patients attending these institutions. The following is a summarised statement showing the Hospitals and the visiting and reporting work carried out for them during 1932. Ante-natal and natal. Other. Total. St. Thomas's Hospital 255 109 364 Charing Cross Hospital 13 9 22 General Lying-in Hospital 295 — 295 King's College Hospital 6 5 11 St. George's Hospital 48 — 48 Westminster Hospital 27 3 30 Victoria Hospital, Chelsea — 24 24 Middlesex Hospital 1 1 2 Battersea General Hospital — 1 1 645 152 797 35 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. H. Corsi, F.R.C.S.). The work carried out during 1932 is summarised in the table on page 36. Mr. Corsi reports as follows:— During 1932 the percentage of expectant mothers shown to be syphilitic by the Wassermann and Kahn tests rose considerably. This is, however, not a matter for surprise, because the figures in the previous two years were remarkably low, and, in fact, even the figure for 1932 may be considered a small percentage for any large city. On the whole patients tend to come for advice earlier in the pregnancy, which is a matter of very great importance as regards congenital syphilis. This is probably due, to some extent, to the greater diffusion of knowledge on the value of all kinds of ante-natal treatment, and partly to acquaintance with the Clinics and confidence in them. Two of the mothers this year were old patients in previous pregnancies, while another had been to a similar Clinic in Lancashire. The average number of ante-natal injections given to each patient was 9. It was not altogether surprising, therefore, that in all 11 instances an apparently healthy infant was obtained. Of these 11,5 so far have been examined by the routine blood tests and proved non-syphilitic. Throughout the year a pleasant atmosphere has been maintained in the Clinic. This is easily upset if there is one "difficult" patient. But there was none such in 1932; on the whole, therefore, a satisfactory year. Maternal Mortality. During 1932 there were 4 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 1.72 per 1,000 births, as compared with 15 deaths and a fatality rate of 6.06 in 1931. Three of these deaths occurred in hospital and one at home. The causes of death were certified as being:— Puerperal Sepsis 2 Uterine Hæmorrhage 1 Pulmonary Embolism following delivery 1 In addition there were three maternal deaths due to causes not directly associated with the puerperium. 36 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1932. 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 1932 832 11 1.3 11 5 6 0 0 * Not syphilitic. 37 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1927. 1928. 1929. 1930. 1931. Mean 1927-31 1932. Deaths from Puerperal Sepsis 1 3 2 4 5 3.0 2 Deaths from other causes connected with child-birth 5 4 3 6 10 5.6 2 Total Maternal Deaths connected with child-birth 6 7 5 10 15 8.6 4 Rate per 1,000 births— Puerperal Sepsis 0.36 1.09 0.76 1. 51 2.02 1.15 0.86 Other Maternal deaths 1.78 1.46 1.15 2.26 4.04 2.14 0.86 Rate per 1,000 births all Maternal deaths in child-birth 2.14 2.55 1.91 3.77 6.06 3.29 1.72 Rate per 1,000 population- Puerperal Sepsis .006 .018 .012 .025 .031 .018 .013 Other Maternal deaths .030 .024 .019 .037 .063 .035 .013 Rate per 1,000 population all Maternal deaths in childbirth .036 .042 .031 .062 .094 .043 .026 There was, it will be noted from an examination of the above Table, a satisfactory decrease in Maternal Mortality in Battersea in 1932. In accordance with the instructions of the Ministry of Health, each of the 4 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 had not been published at the end of the year. The importance of the provision of facilities for the ante-natal examination of expectant mothers cannot be over-estimated. In Battersea in 1932 there were 2,319 births registered in the Borough. Of these 2,319 births during the year, 1,180 of the mothers attended the Ante-Natal Clinics of the Council and in the remainder of the cases made other arrangements with their own doctors or midwives or hospitals. The Maternal Mortality rates amongst the mothers attending ante-natal Clinics are invariably found to be lower than amongst those not attending such clinics. Attention was drawn in the last Annual Report to the failure of midwives practising in the Borough to avail themselves of the facilities provided by the Council for this purpose. The new OutPatient 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 interim Reports already issued by the Departmental Committee set up to investigate the 38 causes responsible for the high maternal mortality prevailing in this country and the final Report of the Committee will therefore be read with increased interest by the public. Reference was made in the last Annual Report to the value of the Maternity Services of the Council as 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. It is satisfactory to note that in 1932 the comparison was equally favourable to 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 also in the Hospital for 12 pupil midwives undergoing training at a time. Many of the patients admitted during the year were cases of extreme gravity or emergency, requiring the calling in of the services of the Consultant Obstetrician. A Post-Natal Clinic has been established at the Hospital where women who have been confined therein may attend for examination six weeks after confinement. During 1932 there were 49 sessions held and 493 attendances were made, 489 being new cases. The average attendance per session was 10.1. 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 12 cases during the year as compared with 11 cases in 1931. 39 During 1932, 552 cases were admitted to the Hospital as compared with 555 cases in 1931, 516 cases in 1930, 605 in 1929, 653 in 1928. and 634 in 1997. Particulars relating to the admissions during 1932 are set out as follows:— Total number of cases admitted 552 Average duration of stay 14 days Number of cases delivered by midwives 517 Number of cases delivered by doctors 25 Number of cases born before arrival 3 Of the above cases, 7 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:— Ante-Natal—44. During Labour—110. Albuminuria 12 Adherent Placenta 1 Ante-partum Haemorrhage 2 Forceps Delivery 19 Induction 26 Prolonged Labour 2 Malpresentation 3 Premature Labour 8 Fainting Attacks 1 Episiotomy 2 Ruptured Perineum 73 Cæsarean section 5 After Labour—12. Pyrexia 2 Inflammation (breast) 1 Pulmonary Embolism 1 Inflammation (finger) 1 Retained membranes 5 Malpresentation (B.B.A.) 1 Post eclamptic fits 1 For Infant—12. White asphyxia 4 Birth injury 1 Congenital defects 3 Ophthalmia Neonatorum 1 General weakness 1 Sticky eyes 2 Number of maternal deaths 1 (Pulmonary embolism) Number of cases notified as Ophthalmia Neonatorum with result of treatment 1 (Sent to St. Margaret's Hospital. Discharged cured.) Number of cases with discharge from eyes however slight 17 Number of infants not entirely breast fed 5 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia 5 Number of infant deaths (8 still-born, 5 within 10 days of birth) and their causes 13 40 Died within 10 days— Prematurity 2 „ breech 1 „ congenital atelectasis 1 Cerebral hæmorrhage 1 5 Still Birth— Feebleness 1 Breech 2 Prematurity 2 Cord round neck 1 Malpresentation 1 Deformity of skull and spine 1 8 The Consultant Obstetrician was called in in 12 cases of grave emergency, particulars of which are set out below:— Cæsarean section 5 Fits (eclamptic) 1 Ante-partum hæmorrhage 1 Torn perineum 1 Deformity 1 Hydramnios 2 Special examination 1 District Midwifery Service. During 1932 there were 190 cases attended in their own homes by the District Midwife as compared with 185 in the previous year, an increase of 5 cases. Particulars relating to this Service during the year are set out helow:— Total number of cases attended in the district 190 Average number of visits to each case 18 Number of cases delivered by:— (a) Midwife 168 (b) Doctors 18 (c) Born before arrival 4 Number of cases where medical assistance was called for, with reasons for requiring assistance:— (a) Ante-Natal—2. (c) After Labour—17. Illness l Ruptured perineum 10 Ante-partum hæmorrhage l Post-partum hæmorrhage 3 2 Rise of temperature 4 17 (b) During Labour—18. Prolonged labour 9 (d) For Infant—18. Retained placenta 2 Dangerous feebleness 4 Complicated breech 2 Discharge from eye 9 ? malpresentation 1 Asphyxia pallida 1 Foetal distress 1 Poor colour at birth 1 Premature labour 1 Septic spots 1 Uterine inertia 1 Hæmorrhage 1 Free loss 1 Chest trouble 1 18 18 Number of cases of— Puerperal sepsis Nil Puerperal pyrexia 2 Maternal deaths Nil Still births 2 Deaths of infants within 10 days (Feebleness). 1 41 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, 1933:— Maternity Hospital, 1932—3. Total beds (excluding cots, labour and isolation beds), 28; total cases admitted and discharged during year, 545; average number of beds occupied during the year, excluding cots, labour and isolation beds, 21.7; number of weeks spent in Institution by such patients, 1,063. Statement* showing expenditure for the year ended 31st March, 1933, in respect of the Maternity Hospital. Item. Total. Per Patient. Week. £ £ s. d. Salaries Medical 336 0 6 4 Nursing 688 0 12 11 Domestic and other 606 0 11 5 Provisions 684 0 12 10 Drugs and other Medical Requisites 159 0 3 0 Heating, Lighting and Water 428 0 8 1 Laundry 375 0 7 1 Repairs and renewals Domestic 130 0 2 5 Structural 249 0 4 8 Miscellaneous items— Telephones, Stationery, etc., and Sundries 118 0 2 3 Totals, excluding rates, insurance and loan charges 3,773 3 11 0 Rates and Insurance 66 0 1 3 Loan Charges 1,148 1 1 7 Gross cost 4,987 4 13 10 Income Pupil Midwives (including training grant) 280 0 5 3 Patients' Payments 2,461 2 6 4 Other 59 0 1 1 Net cost 2,187 2 1 2 * This statement does not take into account the Government Grant. 42 Dental Clinic. During 1932 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. 126). The Dental Clinics are also available for patients recommended by the Medical Officers of the Maternity and Child Welfare Clinics of the Voluntary Associations linked up with the Council's Scheme. The work of the Dental Clinic during 1932 is summarised as follows:— Women. Children Total. Sessions held 202 49 251 No. of patients treated 660 230 890 No. of new patients 440 179 619 Total attendances 3,304 785 4,089 Work carried out:— Extractions- Ordinary 3 2 5 With local anæsthetic 73 9 82 „ general anæsthetic 705 200 905 Totals 781 211 992 No. of teeth extracted 2,855 583 3,438 Scaling and polishing 52 1 53 Fillings 86 26 112 Upper dentures 100 — 100 Lower dentures 95 — 95 Denture visits 696 — 696 Dressings and treatment to gums 70 5 75 Repairs to dentures 21 — 21 Advice 1,492 535 2,027 The gross cost of dental treatment (Maternity and Child Welfare) in the financial year 1932-33 was £920 7s. 3d., which includes the sum of £375 2s. 6d., cost of dentures supplied. The contributions of patients, and those received from other sources during the financial year were as under:— £ s. d. Contributed by patients 238 10 11 Payments by Chelsea Health Society 91 2 0 Grants from British Dental Hospital 18 2 6 Grants from Saturday and Sunday Hospital Funds 29 15 6 Grants from other philanthropic agencies 25 1 0 Contribution by the Council 5 4 6 £407 16 5 The net cost of this service during 1932-33 was £576 6s. l1d. 43 Solarium. The Light Treatment Centre was established at Southlands in 1929. The Centre is housed in a portion of the Southlands building which has been specially adapted and equipped for the purpose. The equipment consists of:— 2 carbon arc lamps. 2 mercury vapour lamps. 4 general radiation lamps. 4 couches. During the year 88 sessions for Welfare patients were held, the number of patients on the roll at the end of the year being 28. The total attendances numbered 2,109, the average number per session being 23.9. 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 pages 60 and 126. 44 Notifiable Infectious Diseases. During 1932 under the Notification Clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 4,641 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 8, enteric fever 3, small-pox 13. In 1931 the total was 1,819. The increase in the number of cases notified during 1932 was chiefly due to the biennial epidemic of measles. 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. 45. Excluding tuberculosis, measles and whooping cough, there were 1,384 cases which occurred in 1,160 houses. Of these cases 1,147, or 82.9 per cent., were removed to the Isolation Hospitals of the London County Council or to other Institutions and 237, or 17.1 per cent., remained under treatment at home. Full particulars of all notifiable infectious diseases will be found in the form required by the Ministry of Health (Table II.), in the Appendix (vide page 131). Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 45 Notifications of Infectious Diseases, 1932, in Wards and Sub-Districts. Notifiable Disease. Wards. 1 Districts. Totals. 1 2 3 4 5 6 7 8 9 N S Small-pox 7 2 - - 1 - 3 - - 10 3 13 Diphtheria 56 45 38 31 43 48 17 18 16 182 130 312 Erysipelas 18 15 11 10 12 11 2 7 6 56 36 92 Scarlet Fever 87 88 60 62 75 57 23 50 43 310 235 545 Enteric (Typhoid) Fever — — — 1 — — — 2 — — 3 3 Puerperal Fever — 1 1 — — 1 — 1 — 2 2 4 Puerperal Pyrexia 3 1 3 1 2 1 — 3 — 9 5 14 Ophthalmia Neonatorum 4 2 4 1 4 7 4 2 2 14 16 30 Cerebro-Spinal Meningitis — — 3 1 — 1 1 2 — 3 5 8 Polio-myelitis — — — — — — — — — - - - Polio-encephalitis — — — — — — — — — — - - Encephalitis Lethargica - - - - - - - - - - - - Malaria - - - - - 3 - - 1 - 4 4 Dysentery — — — — — — — — — — - - Acute Primary Pneumonia 50 37 55 22 39 45 20 16 15 181 118 299 Acute Influenzal Pneumonia 7 9 10 6 2 9 5 6 6 28 32 60 *Whooping Cough 110 73 128 48 127 104 38 96 59 438 345 783 *Measles 510 299 211 244 297 419 129 233 132 1,317 1,157 2,474 Tuberculosis (all forms) 37 25 26 19 35 30 18 22 34 123 123 246 Totals 889 597 550 446 637 736 260 458 314 2,673 2,214 4,887 * Notifiable in Battersea from 24th April, 1922. 46 Small-Pox. Thirteen cases of small-pox were notified in Battersea during 1932 compared with 3 in the previous year, and 7 in 1930. Three persons in one family, and in two other instances two members of the same family, were attacked, so that the disease occurred in 9 different households in the Borough. Of the 13 cases, 10 were unvaccinated, and in the other 3 vaccination had been carried out in infancy. The ages of the patients who had been vaccinated in infancy were 57, 37 and 30 years respectively. In each case the attack was of the prevailing mild character known as Variola Minor and there were no fatal cases. All the patients were removed to the isolation hospital, the average duration of their stay being 18 days. The usual routine disinfection, etc., was carried out immediately after the patients' removal to hospital and all contacts were offered vaccination or re-vaccination. Forty-seven contacts consented to be vaccinated, and two refused. The contacts were visited daily by the Sanitary Inspectorial Staff up to the 19th day after the patient's removal to hospital. During the year there were 1,134 cases of this disease recorded in London, and in England and Wales 2,070 cases. It is satisfactory to note that notwithstanding the prevalence of the disease in the County, Battersea was comparatively free. 224 "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. No vaccinations were performed by the Medical Officer of Health during the year under report. Scarlet Fever. The incidence of Scarlet Fever was somewhat higher in 1932, 545 cases being notified as compared with 448 in the previous year. The case-rate per 1,000 of the population was 3.47 and 4 deaths were registered from the disease, giving a death-rate of 0.03 per 1,000 population, as compared with 6 deaths and a death-rate of 0.04 in 1931, 2 deaths and a death-rate of 0.01 in 1930, and 4 deaths and a death-rate of 0.025 in 1929. Of the cases notified 532 or 97.6 per cent. were removed to hospital. The infected houses numbered 450. In 50 other notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at hospital. 47 Towards the end of the year several cases of Scarlet Fever occurred amongst pupils attending a large boarding and day secondary school in the Borough. The control of an outbreak of infectious disease is rendered more difficult where, as in this case, the pupils include boarders and day boys, there being 110 of the former, and 240 of the latter. There were grounds for suspicion that in this outbreak the infection was introduced from without by the day scholars. Fortunately, owing to the prompt steps taken, the outbreak did not assume serious proportions. Between the 18th October and the 15th December when the boys dispersed for the Christmas holidays, there were 14 cases of Scarlet Fever—13 boys and 1 master. Two of the boys were previously excluded from school and sent home, and were afterwards notified as suffering from Scarlet Fever from districts outside the Borough. A routine daily medical inspection of all the boys was carried out, and the School was closed for the Christmas vacation a week before the usual date, when information was sent to the Medical Officers of Health of the districts to which the boys returned. Diphtheria. The number of cases of Diphtheria notified in Battersea during 1932 was 312 as compared with 298 in 1931, 489 in 1930, 445 in 1929, and 652 in 1928. The number of deaths registered from the disease was 9, giving a death-rate of 0.06 as compared with 5 deaths and a deathrate of 0.03 in 1931, 15 deaths and a death-rate of 0.09 in 1930, 12 deaths and a death-rate of 0.07 in 1929, and 26 deaths and a death-rate of 0.16 in 1928. Of the 312 cases notified 311 or 99.7 per cent. were removed to hospital. The infected houses numbered 273. In 48 other 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 1.99 as compared with 1.86 in 1931, 3.04 in 1930, 2.75 in 1929, and 3.97 in 1928. The case-mortality was 2.88 per cent. as compared with 1.68 per cent. in 1931, 3.07 per cent. in 1930, 2.70 per cent. in 1929, and 3.99 per cent. in 1928. The incidence of the disease was highest in the Park, Church and Winstanley Wards. Diphtheria anti-toxin, in accordance with the recommendation 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 47 phials (approximately 220,000 units) of anti-toxin were supplied, on request, to medical practitioners practising in the Borough. 48 Schick Clinic. The Schick clinic, established at the close of 1927, is held weekly at the Southlands Maternity and Child Welfare Centre. The work is carried on under the supervision of Dr. F. Porter Smith, M.R.C.S., L.R.C.P. The result of the year's work is summarised as follows :— Sessions held 49 Patients attending in 1932 (new 86) 140 Attendances 442 ,, (average per session) 9 New Patients tested (Positive 46, negative 16, no reading 3) 65 Patients inoculated— Without test 17 After positive test (1932 patients) 44 ,, ,, ,, (old ,) 7 — 68 Inoculations 197 Total immunised (including two 1929 patients and one 1928 patient) 67 Patients still on Register at end of year 67* Discontinued treatment 7 The total number of patients immunised or found by test to be immune is 83, out of a total of 140 patients who have attended during the year (59.3 per cent.). Since the opening of the clinic 842 patients have attended, and of these 608 have been immunised or found immune by test (72.2 per cent.). Efforts have been made to secure the co-operation of the School Authority in order to obtain a larger attendance of school children at this Clinic, the value of which is generally recognised. There has„ however, been a difficulty in regard to the recognition of the attendance of a child at the Clinic as a school attendance. It is hoped, however, that this difficulty will shortly be overcome. Acute Polio-Myelitis and Polio-Encephalitis. One case of acute Polio-Myelitis was notified in Battersea during 1932, but the notification was subsequently cancelled. A second case was notified in another district where the patient was. staying. No death was recorded from the disease. *Includes 6 patients (1932) negative after 1st test, who are to attend again for re-test. 49 Of the 32 chronic cases on the register 2 removed during the year. When first notified or reported 24 of the remaining 30 were under 5 years of age, and in 1932, 3 were over 16 years, 23 were of school age, and 4 under 5 years. Of the 23 school children 6 were scholars at elementary or secondary schools, 13 attended special schools for defective children, and 4 were at educational or cripple establishments outside London. Twenty-two of the 30 cases were receiving periodic treatment at out-patient departments of various hospitals, 4 were receiving no treatment, and 4 were in. institutions. No case of acute Polio-Encephalitis was notified during 1932. Puerperal Fever and Puerperal Pyrexia. Four cases of Puerperal Fever were notified in Battersea in 1932, as compared with 6 in 1931, 9 in 1930, 4 in 1929, and 7 in 1928. Two deaths from the disease were registered, of which one occurred in St. James's Hospital* and one in the North Western Hospital of the London County Council, to which cases of puerperal sepsis are removed. Careful investigation was made in these two cases in connection with the Government's enquiry into maternal mortality (vide page 38), and the result forwarded to the Ministry of Health. The number of notified cases per 1,000 births was 1.72, as compared with 2.42 in 1931, 3.39 in 1930, 1.53 in 1929, and 2.55 in 1928. The case-mortality was 40 per cent. of the cases notified and reported, and the death-rate per 1,000 births was 0.86. There were 220 cases of Puerperal Fever notified in London and 2,122 in England and Wales during 1932. The number of cases of Puerperal Pyrexia notified in Battersea during 1932 was 14, and the incidence per 1,000 births was 6.04. There were 748 cases of Puerperal Pyrexia notified in London and 5,445 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 for the treatment of this disease is provided by the London County Council in their North Western Hospital. * This case was notified as one of Puerperal Pyrexia. 50 Enteric Fever. During 1932 three cases of Enteric Fever were notified in Battersea. Two other cases notified were subsequently cancelled, the diagnosis not being confirmed at hospital. No death from this disease occurred in Battersea during the year. Enquiries were made in each of the three cases (one of which was notified 16 days after the patient's admission to a hospital for an internal operation) but the source of infection could not be definitely ascertained. In one case, in which cream had been consumed by the patient, a sample was purchased and submitted to bacteriological examination but with negative result. In each of the three cases the patient was stated to be suffering from "paratyphoid B," a mild form of the typhoid group. Cerebro-Spinal Fever. During 1932 12 cases of Cerebro-Spinal Fever were notified in Battersea, of which 4 were subsequently cancelled, the diagnosis not being confirmed on removal of the patients to hospital. Six deaths occurred from the disease, 2 being among the cases notified, and 4 of un-notified cases in which the diagnosis was arrived at on post-mortem examination. Encephalitis Lethargica. Three notifications of this disease were received during 1932, but all were subsequently cancelled, in one case the diagnosis not being confirmed on removal of the patient to hospital, and the other cases not being notified in the acute stage. One death from this disease was registered during the year, the patient, who had been notified in 1925, dying in a mental hospital. In London the number of cases notified during the year was 52, and in England and Wales 560. Ophthalmia Neonatorum. There were 30 cases of Ophthalmia Neonatorum notified in Battersea during 1932, as compared with 37 in 1931, 34 in 1930, 43 in 1929, and 39 in 1928. The rate per 1,000 births was 12.9. There were 5 severe cases amongst the 30 notified, 4 of which were removed to St. Margaret's (L.C.C.) Hospital for treatment and one received in-patient treatment at another hospital. A few cases were still under treatment at the end of the year, but no case of permanent injury to the eyes resulted. During 1932 the number of visits paid by nurses, under arrangements made by the Council, to cases of Ophthalmia Neonatorum or other inflammatory condition of the eyes of the newly-born was 2,351. All cases were kept under systematic supervision by the Health Visiting Staff, by whom 133 visits were made. 51 The following table shews the distribution of the cases notified :— Sub-Districts. Ward. Cases Births. Rate per 1,000 Births. Year. Cases. Births. Rate per 1,000 Births. 14 1,217 11.5 1927 48 2,801 17.1 S. Battersea 16 1,102 14.5 1928 39 2,743 14.2 1. Nine Elms 4 390 10.3 1929 2. Park 2 294 6.8 43 2,619 16.4 3. Latchmere 4 258 15.5 1930 4. Shaftesbury 1 174 5.7 34 2,652 12.8 5. Church 4 275 14.5 1931 37 2,477 14.9 6. Winstanley 7 323 21.7 7. St. John . 4 119 33.6 Mean 1927 31 40.2 2,658 15.1 8. Bolingbroke 2 282 7.1 9. Broomwood 2 204 9.8 Borough ... 30 2.319 12.9 1932 30 2,319 12.9 Erysipelas. There were 92 cases of Erysipelas notified and 7 deaths were recorded from the disease during 1932 in Battersea. The casemortalitv was 7.61 per cent. and the death-rate per 1,000 population was 0.04. Measles. The number of cases of Measles notified or otherwise reported in 1932 was 2,913 and there were 23 deaths recorded from the disease. Of the 2,913 cases 2,474 were notified under the Regulations—The Battersea (Measles and Whooping-Cough) Regulations, 1922—and the remaining 439 cases were reported by the public elementary schools or from other sources. The death-rate was 0.146 per 1,000 population, as compared with 0.013 in 1931 and 0.236 in 1930. The case-mortality of the total incidence (notified and reported) was 0.79 per cent., as compared with 2.25 per cent. in 1931, 1.13 per cent. in 1930 and 0.88 per cent. in 1929. Incidence and Mortality of Measles in Epidemic Periods, 1921-1932. Period. Cases Notified or Reported. Deaths Death Rate per 1,000 Population Case Rate per 100,000 Population Case Mortality (per centum). Under 10. All ages. 1921-2 3,209 68 1 .13 201 948.3 2..12 1923-4 4,111 75 1.28 .220 1203.5 1.82 1925-6 4,997 47 .87 .137 1452.6 0.94 1927-8 4,197 37 .70 .111 1260.0 0.88 1929-30 3,921 43 .83 .133 1215.8 1.10 1931-32 3,002 25 .51 .079 947.6 0.83 52 While the incidence of the disease has been high in the recent epidemic it is satisfactory to note that the mortality has been lower than in previous epidemics. This is evident from the above table which shows that there has been a decline in Battersea not only in the percentage mortality but also in the severity of the epidemics ; moreover, this decline has been progressive and indicates the value of the measures which, so far as practicable, have been taken in the Borough, namely, notification of cases, visitation of the homes and removal to isolation hospitals of patients where the home conditions are unfavourable, and co-operation with the School Medical Authorities in dealing with cases reported from the Public Elementary Schools. Whooping-Cough. During 1932 there were 783 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 326 additional cases were reported from the public elementary schools and other sources. The total number of cases notified or otherwise reported during 1932 was 1,109, as compared with 747 in 1931, 537 in 1930, 1,317 in 1929, and 1,228 in 1928, the increase in 1932 compared with 1931 being 48.5 per cent. There were 11 deaths registered from this disease, the deathrate being 0.07 as compared with 5 deaths and a death-rate of 0.03 in 1931, 7 deaths and a death-rate of 0.04 in 1930, 43 deaths and a death-rate of 0.27 in 1929, and 14 deaths and a death-rate of 0.08 in 1928. An interesting and instructive investigation into the epidemiology of whooping-cough was carried out by Dr. Percy Stocks, Reader of Medical Statistics in the University of London, to whom I am indebted for a copy of his paper; the statistical records of four metropolitan boroughs, including Battersea, being utilised for this purpose. Some interesting features taken from Dr. Stocks' investigations of this dangerous disease of child life, indicate that the notification records of the four boroughs during the last 10 years show an excess of female over male incidence amounting, after correction for changes in the ratio of sex to age in the population at risk, to 5 per cent. at ages up to 4 years increasing to 20 per cent. in the eighth year, and 50 per cent. in the tenth year. The excess was considerably greater in Greenwich than Battersea. The age distribution of whooping cough incidence is slightly different in the rising phases of epidemics, a somewhat larger proportion of children aged 3 to 6 being attacked. Children aged 4 to 6 are more liable to infect other children in the same house than are children of other ages. A study of the distribution of intervals between the onset of cases in the same house leads to the conclusion that the most frequent interval is one week. The incubation period may, it would appear, be as short as three days, but most likely about a week. Infection after six weeks is probably due to an exacerbation of infection due to a superimposed catarrhal infection. About one case in every 100 is followed by another case in the same house after an interval of between six weeks and six months. 53 The risk of contracting the disease at ages 5 to 6 was increased six or eight-fold by the occurrence of a case in the same house, and at pre-school ages it would be increased to a greater extent. The risk of attack at all ages under 10 years within a month was, in Greenwich, seven times as great if a case occurred in the same house as if one occurred next door. The risk within a month was more than twice as great if there was a case next door than if there was a case in some other house in the street; but was not appreciably greater if there was a case two or three doors away. About 45 per cent. of children under 10, who have not had whoopingcough, may be expected to contract it concurrently with, or within six months, of the onset of a case in the same house. Infection between children living in the same street commonly occurs, and the risk is greatly enhanced for children living next door. School epidemics tend to come to an end more quickly than in the surrounding district, but it seems probable that practically all the susceptible children at school are either attacked or rendered temporarily immune. The value of excluding home contacts from infected schools is questionable. It would probably be better to keep these children at school until the first sign of catarrh or cough, and then send them home to be kept indoors It is worth while, if practicable, to attempt isolation from other children within the home during the most infective period, particularly contacts under 4 years of age, since this may increase the chance of the remaining children acquiring temporary latent immunity, or postponing the attack until an age when the disease is less dangerous. The proportion of children known to their parents to have had whooping-cough before entry to school at ages 3 to 6, is greater in those London boroughs where the population is less dense and better housed. Though this may be partly accounted for by more accurate observation and diagnosis in such areas it is evident that increased crowding of the population does not, in different districts of London, result in increased incidence but rather the reverse, a phenomenon difficult to account for unless latent immunisation occurs. Dr. Stocks' investigation illustrates some of the difficulties associated with the administrative control of whooping cough which, as in the case of measles, is responsible for a considerable toll of early child life. The research work which Dr. Stocks has carried out should prove of considerable value in extending our knowledge of the disease and of measures for the control of epidemics and the lowering of the mortality rate which, notwithstanding the admininstrative methods at present adopted, has remained at a high figure in comparison with other infectious diseases. 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.) 54 District 4. Dr. P. Purcell, 154 High Street. (Deputy—Dr. M. Sayers, 65 Battersea Park Road.) 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.—Mr. T. C. P. Asbey, Town Hall, Battersea, S.W. 11. TUBERCULOSIS. During the 52 weeks ended 31st December, 1932, there were 246 cases of Tuberculosis (all forms) notified in Battersea as compared with 255 in 1931, 286 in 1930, 330 in 1929, and 301 in 1928. In addition 54 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making a total of 300 cases. The following table (required by the Ministry of Health) shows the age and sex distribution of the 300 cases of Tuberculosis notified or otherwise reported during the year ended 31st December, 1932 (52 weeks) and the 164 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 - - - 2 2 4 - - - 2 1 3 1 — — — 6 6 12 — 4 2 6 5 1 2 3 6 1 7 1 1 1 1 10 — 2 2 7 6 13 1 2 3 15 10 23 33 5 1 6 5 7 12 1 1 2 20 17 18 35 5 1 6 10 11 21 1 2 3 25 22 23 45 6 7 13 15 15 30 1 1 35 19 19 38 2 2 4 13 12 25 1 1 45 27 13 40 1 3 4 14 8 22 1 2 3 55 15 4 19 3 2 5 16 4 20 1 1 65 and upwards 2 5 7 2 2 4 2 5 7 1 1 2 Totals 113 109 222 45 33 78 77 64 141 12 11 23 Deaths from non-pulmonary forms of tuberculosis formed 14.0 per cent. of the total deaths from the disease. 55 PERIOD 3RD JANUARY, 1932, TO 31ST DECEMBER, 1932. The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population of the 300 cases notified or otherwise reported, and of the 164 deaths. SubDistrict. New Cases. Deaths. Pulmonary Non-Pulmonary Total Rate per 100,000 populn. Pulmonary Non-Pulmonary Total Rate per 100,000 populn. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. North 52 50 102 22 22 44 74 72 146 191 37 35 72 7 6 13 44 41 85 111 South 61 59 120 23 11 34 84 70 154 191 40 29 69 5 5 10 45 34 79 98 Ward 1 17 13 30 10 3 13 27 16 43 172 12 9 21 5 1 6 17 10 27 108 2 11 13 24 3 3 6 14 16 30 180 7 10 17 ? 1 3 9 11 20 120 3 13 11 24 4 5 9 17 16 33 182 9 8 17 ? 2 9 10 19 105 4 10 6 16 5 2 7 15 8 23 166 7 5 12 1 1 8 5 13 94 .5 11 13 24 5 11 16 16 24 40 243 9 8 17 2 o 9 10 19 115 6 20 9 29 7 — 7 27 9 36 191 7 5 12 2 2 9 5 14 74 7 7 10 17 3 1 4 10 11 21 249 4 3 7 — 4 3 7 83 8 3 15 20 4 5 9 9 20 29 159 6 11 17 1 3 4 7 14 21 115 9 19 19 38 4 3 7 23 22 45 211 16 5 21 1 2 3 17 7 24 112 Boro' Rate per 100,000 populn. 113 109 222 45 33 78 158 142 300 — 77 64 141 12 11 23 89 75 164 — 152 132 141 61 40 50 213 172 — 191 104 77 90 16 13 15 120 91 — 104-5 56 In the tables on pp. 64 to 66 is shown the information required bv the Ministry of Health in reerard to notifications. The localisation of the disease in the 300 new cases notified or reported in 1932 is summarised below :— Localisation of Disease. Pulmonary (222) Skin (2) Chest Wall (1) Lungs 217 Lupus (Face) 2 Abscess 1 Lungs and Bronchial Glands 1 Abdomen (9) Intestines 2 Lungs and Larynx 1 Uro-Genital (8) Kidneys 4 Lungs and Pleura 2 Peritoneum 5 Hilum 1 Post-anal Fistula and Sinus 1 Salpinx 1 Testicle ... 2 Unspecified 1 Testicle and Prostate 1 Brain (14) Meninges... 14 Bones and Joints (22) Ankle 2 Femur 1 General (2) Generalised 1 Glands (20) Hip 3 Cervical ...» 18 Knee 6 Miliary 1 Mesenteric 1 Pre-patella 1 Pre-aortic and Liver ... 1 Spine 7 Total 300 Wrist 2 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 6 years 1927-1932 :— Year. Not notified (dead). Notified after Death. Notified on Form I. & H. (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 1932 18* 21 † 1 15 55 In accordance with the suggestions contained in the circular letter of the Ministry of Health, dated 22nd December, 1924, with reference to the requirement 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 action during 1932 in this connection. Deaths from Tuberculosis. The death-rate from Tuberculosis was lower in 1932 than in the previous year, being 104.5 per 100,000 population, as compared * Includes one case in which the death was not allocated to Battersea. † Includes one case where the death was not ascribed to Tuberculosis. 57 with 108.3 in 1931, 100.8 in 1930, 127.3 in 1929, 98.1 in 1928 and 103.6 in 1927. The lowest death-rates were in 1926, when it was 96.6 and in 1928 when it was 98.1 per 100,000 population. During 1932 deaths from Tuberculosis registered as belonging to the Borough of Battersea numbered 164, 141 (i.e. 86 per cent.) being due to pulmonary tuberculosis, 12 (i.e. 7.3 per cent.) to tubercular meningitis and 11 (i.e. 6.7 per cent.) to other forms of the disease. The allocation of the deaths in 1932 according to age and sex, and in the Wards and Sub-Districts is shown on pp. 54 and 55. In 1931 the number of deaths from tubercular diseases was 173 and it will be noted that there was a decrease in 1932 in the mortality from Tuberculosis as compared with the previous year. Of the 164 deaths registered from Tuberculosis during the year 16 cases were not notified until one month before death; in 19* cases the notifications were received after death, and in 18 cases no notification was received. Of the 18 cases in respect of which no primary notification was received 13 (10 pulmonary, 3 non-pulmonary) were patients who died in hospitals or infirmaries. Of the remaining 5 cases 3 (1 pulmonary, 2 non-pulmonary) were under treatment by private medical practitioners; and 2 (pulmonary) were the subjects of post-mortem examination and enquiry by the Coroner, without inquest. Of the 19* cases notified after death 10 (2 pulmonary, 8 nonpulmonary) were from Public Assistance Institutions; 4 (1 pulmonary, 3 non-pulmonary) died in mental hospitals, of which they were old inmates, and the remaining 5 cases (1 pulmonary, 4 nonpulmonary) died in other hospitals. The death-rates per 100,000 of the population during the 30 years ended 1930 in quinquennial averages and in the individual years 1931 and 1932 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 1931 89.5 18.8 108.3 1932 89.8 14.7 104.5 • Two additional cases notified after death are not included in the 164 cases tabulated on page 54-5. 58 It will be seen from the foregoing table that (except during the war years) there has been a steady decline in mortality rate from Tuberculosis. 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. TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1932. The report of the Tuberculosis Medical Officer is set out in the appendix (pp. 120-129). 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. Caretakers. Specimens of sputum are examined at the Dispensary for Medical Practitioners and reports submitted to them. The Dispensary is affiliated to St. Thomas's and Brompton Hospitals, and cases presenting special difficulties in diagnosis are referred to these Institutions for X-ray examination and for artificial eneumo-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. 126. 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. 127 to 129. Dental facilities for tuberculous 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 1932 was 52, and 246 attendances were made, the average attendance per session being 4.73. The net cost to the Council during the financial year 1932-33 for this service was £109 7s. 4d. Full details of the work carried out are given in the report on the work of the Dispensary in the Appendix (p. 126). Institutional treatment is provided by the London County Council for Battersea patients, this form of treatment being arranged for in the majority of cases through the Tuberculosis Dispensary. The principal work carried out at the Dispensary during 1932 is summarised as follows :— Patients and Attendances. The number of new patients was 547 (392 adults, 155 children), and the number of contacts examined was 212 (100 adults, 112 children), 30 of whom were kept under observation and were entered on the Dispensary roll as new patients. There were 22 patients (adults) transferred from other areas during the year who attended the Dispensary, making a total of 781 new patients and contacts. Of the 599 new patients, 193 were found to be tuberculous, including 3 new cases discovered amongst the 212 contacts examined. The total number of attendances at the Dispensary during the year was 3,741, as compared with 3,917 in 1931. Visits to the homes of dispensary patients were made by the Tuberculosis Officers in 159 instances, and 4,148 visits were made by the Dispensary Nursing Staff. The number of deaths of dispensary patients was 110 as compared with 117 in 1931. Forty-four of the patients were discharged as "recovered" or "diagnosis not confirmed" during the year, and 11 others ceased to attend, in addition to 61 patients who removed to other districts. 60 Institutional Treatment. The number of patients who received institutional treatment under the L.C.C. Tuberculosis Scheme was 104, and the average length of stay was 124 days. The average period of waiting before admission was 14 days. Definite improvement as a result of institutional treatment was shown in 34 cases. Seventeen patients discharged themselves while undergoing institutional treatment. The number of Dispensary patients admitted to the L.C.C. Hospitals during the year (not included in the 104 cases mentioned above) was 27. Thirty-seven patients received Artificial Pneumothorax treatment during the year at various hospitals, the number of refills given being 448, and the cost approximately £235. Contributions of patients undergoing institutional treatment were collected by the Dispensary and remitted to the L.C.C. to the amount of £524 2s. 6d. Examinations and Reports. Sputum examinations made during the year numbered 917, of which 305 were received from medical practitioners. The number of positive results was 209, or 22.8 per cent. Reports to public bodies were made to the number of 1106. Consultations with medical practitioners at the houses of patients and reports made on patients sent to the Dispensary totalled 766, while reports received in respect of insured persons numbered 95 (Form G.P. 36, 95, form G.P. 17, 0). There were 133 patients referred to hospitals, including 112 sent to St. Thomas's for X-ray examination. Artificial Sunlight Treatment. During the year 7 patients received treatment for surgical tuberculosis at the Council's artificial sunlight treatment centre at Southlands (vide page 43). In 5 cases treatment was completed, and 2 cases remained under treatment at the end of the year. The average period of treatment in the 5 completed cases was 342 days, and the result of the treatment in these cases is shown on page 126. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. In the Appendix (pages 136 to 140) will be found Form T. 145, which contains the returns required by the Ministry of Health of the work of the Dispensary during the year 1932, 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 1932, arranged according to the years (from 1921 to 1932) 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 1932 the number of new cases notified (including 15 notified after death) and not attending the Tuberculosis Dispensary was 111 (women 79, children 32). There were 18 other cases among women and children which came to the knowledge of the Medical Officer of Health, 8 upon registration of the deaths and 10 by information as to the removal of the patient into the Borough. There were 35 deaths (including 10 of tubercular meningitis) recorded amongst these 129 cases. In 24 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 129 women and children (non-dispensary cases) notified or otherwise reported to be suffering from Tuberculosis (all forms) during 1932 :— 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 F. — — 2 1 14 14 17 15 9 2 5 79 Tubercular Meningit M. 2 3 - - - - - - - - - 5 F. 2 1 - - 1 - - 1 - - - 5 Other Forms M - 4 4 6 1 - - - - - - 15 F. — 4 1 4 — 1 7 1 2 2 2 24 Total... M 2 7 5 6 1 __ - - - - 21 F. 2 5 3 5 15 15 24 17 11 4 7 108 Grand Total 4 12 8 11 16 15 24 17 11 4 7 129 The home conditions of 125 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 1.14. 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 76 were receiving hospital, sanatorium, or other form of institutional treatment at the time of notification. At the end of 1932 there were 108 women and children nondispensary patients (a decrease of 47 as compared with 1931), including new cases notified during the year, on the register, and 1,193 visits were paid by the female Sanitary Inspector (Miss J. Round) to the homes of patients and contacts. Efforts are made, in as many cases as possible, to induce nondispensary patients to attend the Tuberculosis Dispensary, and during the year, 76 cases were transferred, 56 of these being new cases. Adult Male Patients. There were 97 adult male patients not on the Dispensary roll on the register at the end of 1932. There were 83 new cases notified (including 6 notified after death) and 17 otherwise reported during 1932, and of these 27 died during the year. The following table gives particulars of the 100 non-dispensary new (male) cases coming to the knowledge of the Medical Officer of Heath by notification or otherwise in 1932 :— Age Distribution. All ages. 16-20 20-25 25-35 35-45 45-55 55-65 65 up Pulmonary 5 8 17 13 16 16 2 77 Tubercular Meningitis 1 1 - - - - - 2 Other tubercular Diseases 2 4 7 2 1 3 2 21 Total 8 13 24 15 17 19 4 100 The homes of the patients were systematically visited during the year by the District Sanitary Inspectors, and 327 visits, including 93 first visits to new cases were paid. Eleven of the new cases were found to have died on the first visit. Of the new cases 37 were receiving institutional treatment at the time of notification. Fifty-eight patients (including 42 new cases) were transferred to the Dispensary during the year. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary under the provisions of these Regulations during 1932. 63 Revision of Tuberculosis Register. In accordance with the suggestion of the Ministry of Health the Tuberculosis register is periodically revised, and during 1932 the names of 132 patients were, after medical examination and consideration of their history, removed from the register, as compared with 33 in 1931. 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 1932 two children were boarded out under the scheme. 64 Form T137 1932. Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 3rd January, 1932, to the 31st December, 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- 2014 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males. — — 1 — 9 22 15 17 22 11 1 95 164 „ Females — — 2 2 20 15 22 12 4 4 98 148 Non-Pulmonary Males — 2 5 5 4 3 6 1 1 3 1 31 33 „ Females . — 5 1 6 - 5 2 1 1 1 22 26 (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 (6) of the Local Government (Emergency Provisions) Act, 1916. (б) 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 3 — 4 5 4 1 18 „ Females — — — — 3 3 1 2 1 — 1 11 Non-Pulmonary Males ... 2 4 1 2 1 2 — 1 — — 1 14 „ Females 2 1 — — 1 1 2 — 2 1 1 11 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. No. of Cases. Pulmonary. N on-pulmonary. Death Returns {from local Registrars 5 2 {transferable deaths from Registrar-General 8 2 Posthumous notifications 8 13 " Transfers" from other areas (other than transferable deaths) 7 8 Other sources if any (specify).—Form I. (admission notice) 1 — 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) Particulars of cases coming to knowledge through the Death Returns, as well as of cases notified posthumously, are required by Article 10 (2) of the Regulations to be entered in the Notification Register. It follows that such cases will also be duly included in the number of cases removed from the Register during the year by reason of "death."—(of. Head 3 of the second section of Part III. of the form overleaf.) (d) No case should be included both in the Summary of Notifications and in the Supplemental Return for the same year. (e) 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, 1932, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough... 443 336 779 179 148 327 1,106 Number of cases removed from the Register during the year by reason inter alia of :— 1. Withdrawal of notification 1 — 1 — - 1 2. Recovery from the disease 24 28 52 49 31 80 132 3. Death 82 66 148 13 13 26 174 notes.—part iii. In Counties, the information should be compiled from the quarterly statements for the year 1932, 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 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 diarrhoea. The deaths from these causes in 1932 numbered 75, as compared with 33 in 1931, an increase of 127 per cent. There was a corresponding; increase in the zymotic death-rate from 0.207 in 1931 to 0.478 in 1932. The mean death-rate from each of the principal zymotic diseases for the ten years 1912-1921, and for the ten years 19221931, are compared with the corresponding rates for 1931 and 1932 in the following table :— Zymotic Diseases Number of Deaths from each of the principal Zymotic Diseases in 1931 and 1932, with corresponding Death Hates for those years and for the 10 years 1912.21 and 1922-1931. No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase ( + ) or Decrease (-), 1932 over 1931. 1932. 1931 1932. 19121921. 19221931. Previous year. 19221931. Small Pox .001 - .001 Measles 2 23 .013 .147 .358 .161 +.134 - .014 Scarlet Fever 6 4 .038 .025 .040 .031 -.013 - .006 diphtheria 5 9 .031 .057 .183 .137 +.026 - .080 Whooping-cough 5 11 .031 .070 .220 .103 + .039 - .033 interic fever 1 — .006 — .020 .005 - .006 - .005 Diarrhoea and enteritis 14 28 .088 .179 .483 .157 + .091 + 022 Total 33 75 .207 .478 1.304 .595 + .271 -.117 The death-rate from zymotic diseases was, in 1931, the lowest yet recorded in Battersea, but rose in 1932 to 0.478, the increase being due principally to the measles epidemic and to a slightly increased death-rate from diarrhœa. NON-NOTIFIABLE INFECTIOUS DISEASES. Information as to the occurrence of non-notifiable forms of infectious disease is obtained chiefly from 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 1932 there were 422 cases of chicken-pox reported, as compared with 492 in 1931, 469 in 1930, 441 in 1929, and 632 in 1928. Diarrhoea. During 1932 the total number of deaths from diarrhoea of children under 2 years of age was 22, equivalent to a fatality-rate of 0.14 per 1,000 of the population. In 1931 there were 9 deaths and a fatality-rate of 0.06. The rate per 1,000 registered births in 1932 was 9.49 as compared with 3.63 in 1931, 7.92 in 1930, 8.40 in 1929, and 9.48 in 1928. One-third of these deaths occurred in Winstanley Ward, where proper means of storage and protection of food from contamination are, generally speaking, absent or unsuitable. Influenza. There were 40* deaths registered as being due to Influenza during 1932, as against 56 in 1931, 14 in 1930, 138 in 1929, and 14 in 1928. The mortality-rate was 0.25, as compared with 0.35 in 1931, 0 09 in 1930, 0.85 in 1929, and 0.08 in 1928. Influenzal Pneumonia was not quite so prevalent in 1932 as in the previous year, 60 cases being notified as against 67 in 1931, 43 cases in 1930, 140 in 1929, and 51 in 1928. The death-rate was 0.13 per 1,000 of the population, as compared with 0.14 in 1931, 0.04 in 1930, 0.39 in 1929, and 0.02 in 1928. Cancer. During 1932 the number of deaths of Battersea residents from Cancer was 268 (males 145, females 123) as compared with 283 in 1931, 242 in 1930, 243 in 1929, and 247 in 1928. The death-rate from the disease per 1,000 of the population was 1.71. The deaths from cancer constitute 14.1 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 1927 1.49 1901-5 0.88 1928 1.51 1906-10 0.95 1929 1.50 1911-15 1.11 1930 1.51 1916-20 1.28 1931 1.77 1921-25 1.33 1932 1.71 1926-30 1.51 * 20 of these deaths were ascribed to Influenzal Pneumonia. 69 The following table shews the localisation of the disease in the case of the 268 deaths recorded in 1932. Localisation. No. of deaths. Total. Percentage of Total. Male Female Buccal cavity 9 1 10 3.73 Stomach, liver, peritoneum, intestines and rectum 89 54 143 53.36 Respiratory system 21 5 26 9.70 Female genital organs — 29 29 10.82 Breast 1 27 28 10.45 Skin 1 — 1 0.37 Genito-urinary organs (male) 15 — 15 5.60 Other and unspecified organs 9 7 16 5.97 Total 145 123 268 100.00 Bacteriological Examinations. The bacteriological examination of clinical material (with the exception of specimens of sputum, which are dealt with at the Tuberculosis Dispensary, vide pp. 58, 125) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1932 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 1,848 (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 194 1,648 1,842 Enteric fever 1 5 6 Meningococcal Meningitis — — — Total 195 1,653 1,848 The cost of these examinations is borne by the Council, and in 1932 amounted to £236 16s. 8d., as compared with £252 11s. 0d. in 1931. 70 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1932. Total Sanitary Operations 74,778 Leaky house-roofs and gutters repaired 931 Number of house inspections 40,550 House to house inspections 1.053 Houses supplied with water and fittings repaired 92 Bakehouse inspections 225 Bakehouse nuisances abated 37 Houses let in separate tenements on register 65 Urinals—inspections 225 Do. altered, repaired or water laid on 42 No. of inspections of do. 337 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 17 Intimations served under Sec.3 3,422 Notices served under Sec.4,&c. 1,095 Notices served under Sees. 62 & 65 4,231 Cisterns covered, cleansed and repaired 148 Complaints received and attended to 4,098 Additional water supplies to upper floors 18 Number of premises disinfected 2,417 Houses supplied with disinfectants 423 Keeping of animals in unfit state discontinued 14 Overcrowding abated 39 Smoke observations 21 Premises improved, cleansed and repaired 2,877 Certificates of disinfection granted 5,705 Drains tested By smoke 530 Houses inspected and certificates granted (Sec. 48) 92 Do. „ water 2,031 Drains cleansed and repaired 440 Proceedings ordered by Council and Health Committee 3,440 Drains relaid 135 Frontage drains constructed or re-constructed 42 Summonses issued 53 Magisterial Orders obtained and enforced 21 Soil pipes and drains ventilated 142 Sink and rain-water pipes disconnected or repaired 286 Factories, Workshops, &c., inspections 3,556 Water closets cleansed and repaired 680 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 83 Cesspools abolished 1 Mews and stables drained and paved 1 Underground sleeping rooms: Use discontinued 4 Yards and forecourts paved and repaired 329 Defects remedied 3 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 1 Gipsy van inspections 70 Drains laid to new houses and tenements 92 Samples taken under the Food and Drugs (Adulteration) Act 1,200 Dust receptacles provided 958 Miscellaneous 2,177 71 Legal Proceedings. Legal proceedings in connection with nuisances, &c., were taken by the Council in 40 cases during 1932. Particulars with regard to each case are set out below. Public Health (London) Act, 1891 and By-Laws made thereunder. Nature of Offence or Claim. Result of Proceedings. Nuisance at No. 5 Orville Road (roof leaks, ground floor passage ceiling holed, &c.). Order to abate nuisance in fourteen days. £1 Is. costs. Nuisance at No. 6 Orville Road (passage ceiling and staircase ceiling part down, &c.). The like. Nuisance at No. 7 Orville Road (roof above staircase leaks, w.c. cistern defective, &c.). The like. Nuisance at No. 13 Orville Road (window frame dilapidated, sash cords broken). The like. Nuisance at No. 13 Orville Road (roof leaks, slates loose and dangerous, &c.). The like. Nuisance at No. 15 Orville Road (guttering at front of premises leaky, &c.). The like. Nuisance arising from accumulation of rubbish in yard and sheds at rear of 36 Plough Road. Fined £1. Nuisance at 4 Everett Street, viz., defective treads to stairs and dirty ceilings and walls of two rooms. Nuisance having been abated, summons withdrawn on payment of £2 2s. Od. costs. Nuisance at 9, Orville Road, viz., water service pipe over top floor back addition room leaking, causing dampness. The like. Nuisance arising from accumulation of rubbish in yard and sheds at rear of 36 Plough Road. Order to abate nuisance. Nuisance at 135 Speke Road (leaky roofs, defective and damp walls, defective yard paving, &c.). Nuisance having been abated, Order for £2 2s. Od. costs. Nuisance at 15 Hanbury Road (defec-* tive condition of drains). Consent Order to abate nuisance in 14 days. Order for £2 2s. Od. costs. Nuisance at 50 Palmerston Street (leaky scullery and w.c. roofs, defective and dangerous ceilings, &c.). Nuisance having been abated, summons withdrawn on payment of £2 2s. Od. costs. 72 Public Health (London) Act, 1891, &c.—continued. Nature op Offence or Claim. Result of Proceedings. Nuisance at 79 Plough Road (defective ceilings and flue pipe of kitchen range, &c.). Consent Order to abate nuisance in 14 days. Order for £2 2s. Od. costs. Failing to make good properly the door of the ground floor w.c. at 290 Battersea Park Road. Fined £1. Failing to make good properly the defective paving of yard at the same premises. Fined £1. Nuisances at 290 Battersea Park Road (defective plaster to walls of top back room; defective gutters and waste pipe at rear; defective and leaky roof of back addition; leaky water fittings; accumulation of stagnant water in water tank, &c.). Orders to abate nuisances in 14 days. Costs £4 4s. Od. Nuisance at 507 Battersea Park Road, viz., accumulation of refuse on waste ground at rear. Nuisance having been abated, summons withdrawn. Costs £2 2s. Od. Expenses incurred re 24 York Road (£16 3s. 1 Od.). Order for payment of the amount forthwith and £2 2s. Od. costs. Nuisance at 21 Shillington Street (defective stove in ground floor kitchen). Summons not served. (Nuisance abated.). Nuisance at 103 Grant Road, viz., dilapidated scullery sink of ground floor scullery. Nuisance having been abated, summons withdrawn. Costs £1 Is. Od. Nuisance at 105 Grant Road, viz., dirty walls of ground floor scullery, want of weather board over area of basement back room. The like. Nuisance at 19 Ascalon Street, viz., defective stove to ground floor back room. Nuisance having been abated, summons withdrawn. Costs £2 2s. Od. Nuisance at 170 Stewarts Road, viz., stoppage to sink waste ; defective copper, &c. Nuisance having been abated, summons withdrawn. Costs £2 2s. Od. Nuisance at 25 Belfour Street, viz., defective ceiling in passage-way, leaky scullery roof, &c. Order for nuisance to be abated in 14 days. Costs £2 2s. Od. Neglecting to maintain in proper condition of repair the dust receptacle at 40 Ponton Road. By-law having been complied with, summons withdrawn. Costs £2 2s. Od. 73 Public Health (London) Act, 1891, &c.—continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at 10 Woodgate Street, viz., defective copper. Order for nuisance to be abated in 14 days. Costs £2 2s. Od. Nuisance at 11 Woodgate Street, viz., dirty ceiling and walls to ante-room. Nuisance having been abated, summons withdrawn. Costs £2 2s. Od. Nuisance at 11 Woodgate Street, viz., defective and dilapidated ceiling in passage-way. The like. Nuisance at 34a Orkney Street, viz., defective and leaky condition of factory and w.c's. Order to abate the nuisance within 28 days. Costs £2 2s. Od. Nuisance at 23 Dorothy Road, viz., defective condition of grate in ground floor kitchen. Nuisance having been abated, summons withdrawn. Costs £2 2s. Od. Public Health (London) Act, 1891, and Housing Act, 1925. Nature of Offence or Claim. Result of Proceedings. Failing to provide adequate means of artificial lighting on common staircase at 29 Severus Road. Cautioned under the Probation of Offenders Act, 1907. Costs £3 3s. Od. Metropolis Management Acts and By-Laws made thereunder. Nature of Offence or Claim. Result of Proceedings. Failing to give notice of intended drainage works at 54 Winstanley Road. Cautioned under Probation of Offenders Act, 1907, and ordered to pay 10s. 6d. costs. Altering or reconstructing drainage works at 54 Winstanley Road in such a manner as to offend the By-laws. Defendant gave undertaking to do the work so as to comply with the By-laws. Failing to give notice of intended drainage works at 6 Dickens Street. Fined £1. Failing to keep and maintain in a proper state of repair and in working order all drainage work at 23 Severus Road. Summons adjourned sine die. Costs £2 2s. Od. (A purchaser of the premises had contracted to do the work.). 74 Housing Act, 1930, and Small Tenements Recovery Act, 1838. Nature of Offence or Claim. Result of Proceedings. Possession of No. 23 Speke Road. Demolition Order having been made by the Council on 24th February last, failing to give up possession within 28 days from 18th March, the date upon which the said Order became operative. Warrant for possession issued to operate in 28 days from the 29th June. 23 Speke Road. The like. The like. 25 Speke Road. The like. The like. 25 Speke Road. The like. The like. 27 Speke Road. The like. The like. 102 Ingrave Street. The like. The like. 57 Verona Street. The like. The like. Possession of 32 Orkney Street. Demolition Order having been made by the Council on 25th May last, failing to give up possession within 21 days from 18th June, the date upon which the said Order became operative. Warrant for possession issued to operate in 21 days from 5th October, 1932. Ditto. Application for extension of warrant for possession to the maximum of three months granted under the Small Tenements Recovery Act, 1838. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. Nature of Offence or Claim. Result of Proceedings. *Unlawfully did carry on trade of a dairyman in the Borough without being registered thereat. Cautioned under the Probation of Offenders Act, 1907. Costs £1 1s. 0d. *Unlawfully did sell milk in a highway or place of resort within the Borough from a vehicle without having conspicuously inscribed thereon his name and address. The like. * Proceedings instituted in 1931. Food and Drugs (Adulteration) Act, 1928. Sale of Milk Regulations, 1901. No. of Sample. Article. Nature of Offence. Result of Proceedings. 762 Milk 40% deficient in fat Fined £2 and £1 1s. costs. 75 Merchandise Marks Acts. Merchandise Marks (Imported Goods) No. 4 Order, 1929. Nature of Offence or Claim. Result of Proceedings. Exposing for sale imported raw tomatoes without any indication of origin. Cautioned under the Probation of Offenders Act, 1907. London County Council (General Powers) Act, 1908. By-Laws made thereunder. Nature of Offence or Claim. Result of Proceedings. While carrying on the business of a rag and bone dealer unlawfully did on 4th November, 1932, at Honeywell Road distribute a toy to wit : goldfish, in exchange for left-off clothing. Cautioned under the Probation of Offenders Act, 1907. Costs 5s. (No previous conviction.). Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 40 cases during 1932. 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 22 18 10 3 0 0 48 6 0 Public Health (London) Act and Housing Act, 1925 1 1 — — 3 3 0 Housing Act, 1930, and Small Dwellings Recovery Act, 1838 9 8 9 Metropolis Management Acts 4 3 1 1 0 0 2 12 6 Food and Drugs (Adulteration) Act, 1928 1 1 1 2 0 0 1 1 0 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 1926 1 1 — — 2 2 0 Merchandise Marks Acts 1 1 — — — London County Council (General Powers) Act, 1908 1 1 0 5 0 Total 40 34 21 6 0 0 57 9 6 76 New Legislation, &c. During 1932, the following new Acts and Orders affecting the work of the Public Health Department came into force:— (a) The London County Council (General Powers) Act, 1932, which contained, inter alia, provisions relating to the following matters— Sec. 5. Registration of premises in which ice-cream is manufactured, stored or sold (vide p. 91). Sec. 5. Registration of premises used for the preparation or manufacture of preserved foods (vide p. 93). Sec. 6. The making of By-laws with regard to premises in which food is manufactured, stored, sold or exposed for sale (vide p. 95). Sec. 7. Notification of cases of food poisoning (vide p. 94). Sec. 8. Unsound food (vide p. 94). (b) Public Health (Cleansing of Shellfish) Act, 1932. (c) Orders made under the Agricultural (Grading and Marking) Acts, referred to on p. 93. (d) Order made under the Merchandise Marks Acts relating to imported butter (vide p. 94). Common Lodging Houses. The following table gives a list of the common lodging houses in the Borough:— Premises. Authorised No. of Lodgers. Whether Males or Females. 75 Falcon Road 67 Males 134 High Street 54 Males 67 Winstanley Road 66 Females These are frequently inspected and any sanitary defects noted. 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., are enforced by the Council. During the year new drains were constructed to 178 new buildings, or additions to existing buildings, and the drains of 135 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. 77 During 1932, 11 claims made by the owners that the Council were liable for the reconstruction of the common portion of the drainage systems of their premises were dealt with. In 3 cases liability, wholly or in part, was admitted by the Council, and the expenditure incurred by them under this head amounted to £47 lis. lid. In 7 cases liability was repudiated, and 1 case was still under consideration at the end of the year. The total number of plans of proposed drainage work deposited during 1932, as compared with 1931, was as under:— 1931 1932 Re-construction or repair of existing drains 83 94 New buildings or additions to existing buildings 92 92 175 186 In 4 cases the Committee gave directions for proceedings to be instituted against builders who had failed to submit plans of drainage works executed by them. In 3 of these the required plans were submitted before the summonses were issued, and in the fourth case the defendant died. In 19 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 all instances, satisfactory explanations having been received from the builder responsible, the Committee ordered the offenders to be cautioned. In two other cases, which occurred at the end of 1931, legal proceedings were instituted by order of the Committee, the result of which will be found set out on page 73. During the year 1932, 530 drains were tested by smoke of which 87 were found defective. The water test was applied on 2,031 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 142 instances. Water closets were provided in 17 cases and existing closets repaired in 680 cases. The total number of drains relaid during the year was 135. Those cleansed and repaired numbered 440. 78 Public Cleansing. The collection of house and trade refuse is carried out weekly, except in the case of blocks of dwellings, hospitals, schools, &c., where the collection is carried out more frequently. The refuse is disposed of partly by burning at the Council's destructor, but by far the larger amount is removed by barge to suitable " tips " outside London. The removal is carried out under contract which imposes stringent conditions for the avoidance of nuisance. The total quantity disposed of during the financial year 1932-33 was as follows:- House refuse. Tons. Trade refuse. Tons. Burned at destructor 1,100 1,228 Removed by barge 31,066 2,464 32,166 3,692 The Council is gradually replacing the older type of horse-drawn dust-van by motor vehicles of greater capacity, and when the change is complete, it will be an important advance in sanitary efficiency. There are no earth-closets, privies or cesspools in the Borough. Houses Let in Separate Tenements. By-laws with regard to houses let in separate tenements were made by the London County Council in 1925 and in 1931 under the provisions of the Housing Act, 1925. These by-laws, so far as they are applicable, are being enforced by the Council. There are 65 premises in Battersea registered as houses let in separate tenements and 337 inspections of these premises were made in 1932. Sanitary Conveniences attached to Licensed Premises. During 1932 the number of public-house urinals under inspection was 118. In 73 instances the accommodation is accessible to the general public as well as the users of the houses, and in 45 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 23 notices were served to remedy defects discovered, and were duly complied with. Smoke Nuisances. During the year 21 observations were made and 6 complaints received. Fourteen preliminary and two statutory notices were served by the Council under the provisions of the Public Health (Smoke Abatement) Act, 1926, to abate smoke nuisances. 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. 79 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. Effluvium, &c., Nuisances. No legal 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 two cases of contravention of the by-laws were reported, and the Committee in each case ordered the offender to be cautioned. Water Supply. During 1932 certificates of water supply in respect of 92 houses were issued in accordance with Section 48 of the Public Health (London) Act, 1891. In 18 cases additional water supply was provided to the upper floors of tenement houses, where required by the Borough Council under the provisions of Section 78 of the London County Council (General Powers) Act, 1907, and Section 48 of the Public Health (London) Act, 1891. Van Dwellings. The number of van dwellings in the Borough in 1932 was 71. In the following table are set out the situations of the dwellings and number of occupants:— Situation of Vans. No. of Vans. Occupants M. F. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 4 Mills' Yard, adjoining 80 Sheepcote Lane 7 8 10 Mills' Yard, Culvert Road 19* 20 21 164 Falcon Road (rear of) 10 16 13 Yard, 94 Falcon Road 1 1 1 Manley's Yard, Cabul Road 30† 26 30 Van dwellings are frequently inspected. Two vans were unoccupied. * Including one shed. † Including one cottage. 80 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 1932. 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 1932 under the Council's Rat Repression Scheme is summarised as follows :— Premises visited 1,561 Poison baits used 23,400 Dead rats found 1,129 Contracts made or renewed 17 Value of contracts £209 0 0 Cash for poison bait £7 18 6 Total expenditure (financial year 1932-33) £490 8 1 Income (financial year 1932-33) £217 18 1 Drains were tested at 80 premises in connection with this work, and in 72 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" (7th to 12th 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. The results were good, considerable numbers of rats being found dead. It is difficult to assess the value of such work by the number of rats killed, but I am informed that after Rat Week enormous numbers of dead rats are found at the main sewer outlet. It is also found that considerable interest is taken by the public in the Council's successful efforts for the repression of rats in the Borough and the consequent diminution in the damage (apart from the risk to health) caused by their depredations. 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. Only one contravention was reported, and by order of the Committee a cautionary letter was addressed to the offender. The application of this by-law to the Borough appears undoubtedly to have effected a diminution of this objectionable form of nuisance on the public footways. 81 Personal Cleansing Station. During the year 1932, there were 3,703 children and 248 adults cleansed and treated at the station. Of the 3,703 children attending, 806 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,654 attended from the public elementary schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's sanitary staff. There was a decrease in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. Number of Baths, &c. Year. Adults. Children. * Expenditure. Amount Contributed.* Verminous and Scabies. Verminous and Scabies. £ £ 1906 141 2 29 — 1907 504 113 42 — 1908 1,011 656 82 — 1909 1,373 321 91 — 1910 1,583 341 88 — 1911 1,459 191 93 13 1912 1,351 841 237 65 1913 1,323 1,090 118 69 1914 1,050 1.602 132 78 1915 648 1,273 125 78 1916 475 1,773 143 94 1917 320 2,620 169 140 1918 291 3,179 237 187 1919 366 3,214 287 169 1920 419 4,213 456 331 1921 340 4,607 561 400 1922 274 4.444 584 400 1923 212 4,949 779 487 1924 311 5,394 912 488 1925 261 4,724 879 459 1926 229 4,371 916 425 1927 256 4,360 960 418 1928 221 3,769 863 400 1929 278 4,335 927 400 1930 263 3,901 856 400 1931 283 3,898 875 400 1932 248 3,703 786 400 15,490 73,884 £12,227 £6,301 * Financial year ending 31st March. 82 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1932. Total premises disinfected 2,417 Rooms disinfected 3,424 Staircases disinfected 182 Schools disinfected 42 Number of articles laundered 36,833 „ „ destroyed 3,762 „ verminous, etc., persons (including 3,654 school children) 3,951 „ infectious disease contacts 875 „ library books collected 408 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 only change in personnel which took place was the appointment in June of Dr. Lorna G. Bach, m.r.c.s., l.r.c.p., as Resident Medical Officer of the Borough Maternity Hospital, in place of Dr. H. Mower White, resigned. Coroner's Court and Mortuary. Details of the work carried out at the Coroner's Court and the Public Mortuary are set out in the table on page 83. During the year the Health Committee had under consideration a proposal for the installation of refrigerating equipment at the Mortuary, and it is hoped that it may be found possible in the near future to provide this useful addition to the equipment. 83 Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1932 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 33 62 22 4 121 Post-mortem elsewhere 15 56 18 2 91 No post-mortem 18 43 19 2 82 Body not received — 1 6 6 13 Post-mortem at Mortuary— No inquest (Coroner's certificate) 59 88 10 1 158 No inquest (doctor'scertificate) 1 — — — 1 Other bodies received— Sanitary reasons 5 2 — — 7 Total bodies received 131 251 69 9 460 Total inquests held 66 162 65 14 307 Total post-mortems held 93 150 32 5 280 VERDICTS AT INQUESTS HELD— Natural causes 10 16 3 1 30 Accident and Misadventure— Abortion—Shock — — 1 — 1 Anaesthesia, Operation, etc. 2 5 4 — 11 Asphyxia 2 10 1 — 13 Burns and scalds 3 3 — — 6 Drowning 1 1 3 — 5 Fall 9 21 10 — 40 Injury at birth — 2 — — 2 Injuries (various) 1 4 2 — 7 Poisoning—Coal gas 1 — — — 1 „ Food — 1 — — 1 ,, Lead 1 1 — — 2 Railway and street 18 40 20 — 78 War wounds — — 1 — 1 Open Verdict— Asphyxia — 1 — — 1 Blow — 1 — — 1 Brain Abscess (origin unknown) — 1 — — 1 Burns — — — 1 1 Drowning — 1 1 3 5 Fall 1 2 1 — 4 Inattention at birth — — — 1 1 Pneumonia — — — 1 1 Poisoning—Carbon monoxide — 1 — — 1 „ Drugs, &c. — 1 — — 1 Railway — — 2 — 2 Still-born — 1 — 6 7 Sepsis following Abortion — 1 2 — 3 Unknown cause — — — 1 1 Suicide— Cut throat 2 4 2 — 8 Drowning — — 1 — 1 Firearms — 3 1 — 4 Hanging — 3 — — 3 Jump from high place 1 2 2 — 5 Poisoning—Coal gas 8 25 3 — 36 „ Drugs, &c. 5 11 3 — 19 Railway 1 — 1 — 2 Homicide— Abortion (Sepsis) — — 1 — 1 Grand Total 66 162 65 14 307 84 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 1932:— Food. Quantity. Food. Quantity. Fish. Fruit & Vegetables. Crabs 6 stone. Apples 35 lbs. Fillet 5 boxes. Carrots 1 bag. Kippers 2 boxes. Lemons 2 cases. Roe 2 boxes. Potatoes 1 barrel. Skate Wings 2 stones and Tomatoes 49 boxes. 1 box. Meat & Poultry. Bacon 38½ lbs. Pig's head 1 Pig's head and collar 1 Turkeys 10 By Section 8 of the London County Council (General Powers) Act, 1932, the provisions of the Public Health (London) Act in regard to unsound food were extended so as to include food offered as a prize or reward at any entertainment, or given away for the purpose of advertisement, or exposed or deposited for such purpose. Food Poisoning. Under the provisions of the London County Council (General Powers) Act, 1932, medical practitioners are required to notify to the Medical Officer of Health of the district cases of persons under their care suffering or suspected to be suffering from food poisoning. The requirements came into force on the 12th July, 1932. Nine cases of food poisoning were notified to the Medical Officer of Health between that date and the end of the year (5 of these cases being in one family). Enquiries were made in each case and where a portion of the food suspected was available a bacteriological investigation was made, but with negative result. In each case notified the patient recovered. Cow-houses. There is now no licensed cow-house in the Borough. 85 Slaughter-houses. There are only two slaughterhouses remaining in the Borough These premises are kept under systematic inspection, and during the year 1932, 152 inspections were made by the Council's inspector. The carcases of 222 animals (calves 2, sheep 114, and pigs 106) were examined after slaughter. No contravention of the Public Health (Meat) Regulations or the By-laws in regard to slaughterhouses were reported during the year. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1932 was 104. Three premises were closed during the year leaving 101 butchers' premises where business was carried on 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 1,701 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. It was not found necessary during 1932 to institute legal proceedings for any contravention of the Public Health (Meat) Regulations, 1924. Food and Drugs (Adulteration) Act, 1928. 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, at the laboratory at 325 Kennington Road, S.E. The bacteriological examination of samples (mainly milk) is carried out by the Clinical Research Association, Ltd., at Watergate House, Strand, W.C. The total number of food samples taken under the Act during 1932 was 786, of which 19 or 2.4 per cent, were certified by the Public Analyst to be adulterated. In addition to the foregoing, 414 informal samples were procured, of which, 12 or 2.9 per cent, were reported by the Public Analyst as being adulterated or containing preservatives 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. 86 Year. Formal Samples, (per cent.) Informal Samples, (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 1932 2.4 2.9 It will be seen from this table that the percentage of adulteration of formal samples, in the year under review, is the lowest therein recorded, and consequently the improvement in the food supply of the Borough, referred to in previous reports, is well maintained. The following tables give details of the articles of which samples were obtained for the purpose of analysis. Main Statement. TABLE I. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Bread 4 4 0 0 Butter 11 46 57 0 0 0 Cheese — 14 14 — 0 0 Cocoa — 9 9 — 0 0 Coffee — 12 12 — 0 0 Confectionery — 7 7 — 0 0 Cream — 27 27 — 0 0 Flour — 1 1 — 0 0 Flour, Self-raising — 1 1 — 0 0 Jam — 6 6 — 0 0 Lard — 11 11 — 0 0 Margarine — 39 39 — 0 0 Milk 758 — 758 13 — 13 ,, Separated 2 — 2 0 — 0 ,, Condensed (Full (Cream) 11 11 0 0 „ „ (Machine Skimmed) — 8 8 — 0 0 Mustard — 4 4 — 0 0 Spirits (Whisky) — 1 1 — 0 0 Sugar — 4 4 — 0 0 Tea — 21 21 — 0 0 Vinegar 6 4 10 0 0 0 Drugs — 19 19 — 0 0 Other Articles 9 165 174 6 12 18 Total 786 414 1200 19 12 31 87 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Camphorated Oil 4 4 — 0 0 Cream of Tartar — 4 4 — 0 0 Ointment, Boric 4 4 — 0 0 Zinc 3 3 — 0 0 Paregoric — 1 1 — 0 0 Paregoric Essence (without Opium) — 3 3 — 0 0 Total 19 19 — 0 0 TABLE III. Other Articles. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground 4 4 0 0 Arrowroot — 7 7 — 0 0 Custard Powder — 9 9 — 0 0 Dripping — 12 12 — 0 0 Fish Paste — 8 8 — 0 0 Fruits, dried 4 27 31 1 3 4 Ginger, ground — 4 4 — 0 0 Honey — 4 4 — 0 0 Jelly Crystals — 4 4 — 0 0 Junket Crystals — 2 2 — 0 0 Junket Powder — 1 1 — 0 0 Lemonade Powder — 4 4 — 0 0 Oatmeal — 4 4 — 0 0 Olive Oil — 4 4 — 0 0 Peel, Candied (mixed) — 4 4 — 0 0 Pepper — 8 8 — 0 0 Rennet Powder — 1 1 — 0 0 Rice 17 17 — 0 0 Sauce, Tomato — 4 4 — 0 0 Sausages — 8 8 — 0 0 Soup, Desiccated 5 10 15 5 9 14 Sponge Cakes — 3 3 — 0 0 Spice, Mixed — 4 4 — 0 0 Tapioca — 4 4 — 0 0 Vegetables, tinned — 4 4 — 0 0 Wines, non-alcoholic — 4 4 — 0 0 Total 9 165 174 6 12 18 Milk. Of the 760 samples of milk (all formal and including 2 samples of separated milk) submitted during the year, 13 or 1.7 per cent., 88 were reported as adulterated, 1 of these samples being deficient in milk fat and 12 containing extraneous water. The percentages of extraneous water found in the adulterated samples were small, ranging from 5 per cent, to 1 per cent., whilst the deficiency in milk fat in the one sample so reported against amounted to 40 per cent. In the 5 years 1926-30, and in 1931 and 1932, 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 1932 760 13 1.7 A considerable proportion 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 systematically taken on the arrival of the milk at these two Stations. Such samples are included in the return on page 86. The average composition of the 745 samples of milk (all formal), excluding separated milk, reported as genuine, proved to be as under:— Total milk solids 12.32 per cent. Milk fat 3.54 „ Not-fatty solids 8.78 „ The content of milk fat in these 745 samples ranged as follows: 4 per cent, and over 54 samples or 7.2 per cent. Between 3.9 and 4.0 per cent. 28 „ ,, 3.7 „ „ 38 „ 3.9 „ 48 „ „ 6.5 „ „ 3.7 „ 3.8 „ 79 „ „ 10.6 „ „ 3.6 „ 3.7 85 „ „ 11.4 „ „ 3.5 „ 3.6 103 „ „ 13.8 „ „ 3.4 „ 3.5 149 „ „ 20.0 „ ,, 3.3 ,, 3.4 ,, 87 ,, „ 11.7 ,, „ 3.2 „ 3.3 ,, 72 ,, „ 9.7 ,, „ 3.1 „ 3.2 „ 31 „ „ 4.2 „ „ 3.0 „ 3.1 9 „ „ 1.2 „ 745 100.0 89 All samples were systematically tested for the presence of preservatives and colouring matter but with negative results. Milk sampling was carried out on 5 Sundays during the year, and 28 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 38 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 63 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. During the year 16 samples of milk were taken for bacteriological examination. Of these 12 were of certified or pasteurised milk, and 4 of ungraded milk. The results of the bacteriological examination showed that all the samples complied with the requirements. During the year information was received from the London County Council that two samples of milk which were found to be tuberculous had been purchased from Battersea milk purveyors. From enquiries which were made it was ascertained that the milk was supplied by a wholesale dealer in an adjoining district, and the Medical Officer of Health of the Borough was immediately informed. Subsequently this milk was traced to a farm in Dorset and the infected animal was destroyed. Five samples were taken in course of delivery during the year at the request of the Medical Officers of Health of neighbouring Boroughs under the provisions of Sees. 21 and 29 and the second schedule of the Food and Drugs (Adulteration) Act, 1928, which permits the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. During the year advantage was also taken of these provisions by 9 Battersea milk purveyors in regard to 13 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 one instance of fat abstraction, particulars relating to which will be found set out in the tables on page 74. The Council, in June, at the invitation of the Royal Institute of Public Health, nominated a representative upon a Pure Milk Committee appointed by the Institute with the object of obtaining milk pure and clean at the source. Condensed Milk. During the year 19 informal samples of Condensed Milk were submitted for examination, of which 11 were described as "fullcream" and 8 as "machine-separated." All were found to be 90 genuine and to comply with the requirements of the Public Health (Condensed Milk) Regulations, 1923. Cheese. Fourteen informal samples of Cheese, including 4 samples of "wrapped" cheese, were examined during the year. All were reported as genuine. The "wrapped" cheeses were found to be free from mineral contamination. Butter. Eleven formal and 46 informal samples of Butter were submitted to the Public Analyst in the course of the year and all were reported as genuine. The average water-content of the 57 samples proved to be 14.0 per cent., and the statutory limit of 16 per cent, was not exceeded in any case. Margarine. The 39 samples of Margarine examined during the year were all procured informally. They proved to be genuine and their average water-content amounted to 14.4 per cent. No sample contained moisture in excess of 16 per cent. Sausages, Bacon, Preserved Meats, &c. Eight informal samples of sausages were submitted to the Public Analyst during the year. All the samples were certified to be genuine, and free from preservative. Rice. Seventeen informal samples of rice were procured and submitted to the Public Analyst and all were reported as genuine. Vinegar. Ten samples of vinegar, 4 of which were procured formally were submitted to the Public Analyst, and all were reported to be genuine. Pepper. Eight samples (all informal) of pepper were examined and found to be genuine. Dried Fruits. During the year 31 samples of dried fruits (4 formal and 27 informal) were purchased and submitted to the Public Analyst. Of these, 1 formal sample of dried apricots was found to contain preservative in excess of the amount permitted by the Public Health (Preservatives, &c., in Food) Regulations, and also 3 informal samples (2 of dried apricots and 1 of raisins). The vendor of the formal sample was cautioned on the instructions of the Committee. 91 Desiccated Soups. Five formal and 10 informal samples of desiccated soup were procured for analysis during the year, and of these 14 (5 formal and 9 informal) were certified to contain sulphur dioxide in an amount varying from 56 to 192 parts per million. The attention of the Health Committee was drawn to the presence of sulphur dioxide in these samples, and, on their instructions, the mannfacturer was communicated with. In reply, the manufacturers stated that the sulphur dioxide was Introduced during the drying process owing to the products of combustion passing through the drying trays. The firm stated that they had introduced a new process for drying the soup by hot air, and that their new stock would be found free from sulphur dioxide. The Committee accepted the explanation offered by the manufacturers and decided not to institute legal proceedings in respect of these samples. Drugs. The number of samples of drugs submitted to the Public Analyst for analysis during the year was 19 (all of which were informal samples) and comprised 6 varieties. In each case the sample was found to be genuine. Ice Cream. There are 172 premises in the borough in which ice cream is manufactured, stored or sold, 21 of these being occupied by Italian vendors. Thirty-two new premises were registered during the year and 28 were removed from the register on discontinuance of the business, the number of registered premises therefore being increased by 4. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 299 inspections were made and 8 notices were served (6 intimation and 2 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. The London County Council (General Powers) Act, 1932, which came into force in July, repealed the provisions contained in the Act of 1928 with regard to the registration of ice-cream premises, but re-enacted them in a stricter form. The main effect of the alteration is that Local Authorities have been given power to remove from the Register, or to refuse to register premises which are unsuitable for the purpose, subject to a right of appeal by the applicant. 92 Milk and Dairies Order, 1926. The provisions of the above-named Order continued to be enforced by the Council during the year under report. It was not found necessary to institute legal proceedings during 1932 for breaches of the requirements of the Order. In one case, referred to on page 74, proceedings instituted in 1931 were before the Court during 1932, with the result shown. Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to issue licences to others than producers (i.e., persons producing milk for sale from herds over which they have control). The licences so granted are available for a period up to the end of the year in which they were issued. There is a scale of fees payable to the Licensing Authority by applicants for licences. During 1932 licences were issued as follows :— Full. Supplemental. Certified milk 9 2 Grade A (Tuberculin tested) milk 53 3 Grade A milk 5 1 Pasteurised milk 50 3 117 9 Two licences to bottle Grade A (T.T.) milk, one to bottle Grade A milk, and three 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 89. Milk Shops. The number of premises registered in Battersea for the sale of milk is 129 (including 7 wholesalers' premises). Five new premises (including one wholesale depot) were registered during the year for the sale of milk, and 5 premises were removed from the register on discontinuance of the sale of milk. In 19 cases (relating to 16 premises) 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 systematic inspection and during the year 570 inspections were carried out and 23 notices (21 Intimation and 2 Statutory) were served to remedy defects found on inspection. These mainly referred to dirty premises. Thirty-seven vendors whose registered premises are without the Borough are registered as purveyors within Battersea, and 7 premises used for the wholesale distribution of milk are registered by the Council. In addition to the above there are 151 premises registered in which milk in sealed bottles only is sold. 93 The improvement which has been noted in recent years with regard to the results of the analysis of milk is also found in the condition of premises in the Borough in which milk is sold or stored. These have all been brought up to a satisfactory sanitary standard. Preservatives in Food. The provisions of the Public Health (Preservatives, etc., in Food) Regulations are referred to in the Annual Report for the year 1928. All samples submitted to the Public Analyst are examined for the presence of preservatives and during 1932 contraventions of the Regulations were reported in the case of 4 samples of dried fruits and 14 of desiccated soup, which are referred to on pp. 90, 91. Preserved Food Premises. The London County Council (General Powers) Act, 1932, which came into force on 12th July, provides that premises used for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale shall be registered with the Sanitary Authority, and power is given to the Authority to refuse to register any premises, or to remove from the Register any premises already included, if the Authority are satisfied that such premises are unsuitable for the purpose. The occupier is given the right of appeal. In the case of meat or fish the word "preserved" includes preparation by any process of cooking. The requirement, however, does not apply to premises used as a club, hotel or restaurant. Circular letters were addressed to the occupiers of all premises in the Borough used for the preparation or manufacture of preserved foods, and 156 applications for the registration of such premises were received during the year. Of these, 86 applications were granted and 70 were provisionally granted subject, where required, to the execution of certain requirements of the Sanitary Authority. Export of Food. On the suggestion of the Ministry of Health the Borough Council appointed the Medical Officer of Health to act as Certifying Officer in connection with the exportation of meat food products manufactured in Battersea to the Dominion of Canada. Agricultural Produce (Grading and Marking) Act, 1928. During 1932 five additional Orders were made by the Ministry of Agriculture and Fisheries dealing respectively with the grading and marking of:— Bottled Fruits. Honey. Bottled Vegetables. Plums. Malt Flour and Malt Extract. No legal action was found necessary during the year under review in regard to the various Orders made under the Act. 94 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 1932 and in 1 case proceedings were instituted against a trader for a breach of the Order relating to tomatoes (vide p. 75). An additional Order, the Merchandise Marks (Imported Goods) No. 1 Order, 1932, dealing with imported butter, was made during the year. 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 72 (five less than at the end of 1931). All these premises are kept under systematic inspection. Three hundred and thirty-six inspections were made during 1932 and 38 notices (30 intimation and 8 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 1932 was 124. During the year 297 inspections were carried out and in 29 cases it was found necessary to serve notices (including 6 statutory notices) to remedy various defects. Street Stalls for Sale of Food. There are 239 street stalls in the borough for the sale of foodstuffs of varied character, namely: vegetables and fruit 149, refreshments (coffee stalls) 11, fish and poultry 22, meat and rabbits 7, sweets 12, and other foods 38. These were systematically inspected during the year, but no action was found necessary in regard to the food sold, which is, generally sound and wholesome. No offences against the statutory requirements with regard to the food exposed on these stalls was reported during the year. Inspections numbering 216 were made of the premises used by street vendors for the storage of their stocks, and 32 intimation and 7 statutory notices were served to remedy defects found. 95 Food Premises. Under the provisions of the London County Council (General Powers) Act, 1932, the London County Council were empowered to make By-laws for promoting sanitary and cleanly conditions in the manufacture, storage, transport or exposure for sale of any article intended to be sold for food. The By-laws, however, had not been drafted at the end of the year under report. To extend the usefulness of the proposed By-laws, the Borough Council on the suggestion of the Metropolitan Boroughs Standing Joint Committee, expressed their willingness to collaborate with the Factory Inspectors in administering the By-laws. Wrapping of Foodstuffs. The Council considered a letter from another Borough Council, suggesting the promotion of legislation to provide for the compulsory wrapping of bread, and the prohibition of the use of newspapers or waste paper for the wrapping of foodstuffs, such as fish, meat and sweets. The Council supported the suggestion so far as it related to the use of newspapers, &c., for the wrapping of food. 96 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) 700 59 1 Workshops (including Workshop Laundries) 528 64 - Workplaces (other than Outworkers' premises included in the Table on page 100) 1,780 151 - Total 3,008 274 1 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 113 113 — _ Want of Ventilation _ _ _ _ Overcrowding _ _ _ _ Want of drainage of floors _ _ _ Other nuisances 125 125 1 1 Sanitary accommodation Insufficient 2 1 _ _ Unsuitable or defective 81 81 _ _ Not separate for the sexes 1 1 _ _ 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 102) _ _ _ _ Total 322 321 1 1 97 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1932:— Bakehouses 10 Bootmakers 31 Dressmakers 18 Laundries 3 Milliners 6 Tailors 44 Other Trades 175 Total number of workshops 287 4.—Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 4 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 1932:- Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 49 242 34 50 28 Barge builder 3 18 — — — Bootmaker 44 76 3 — — Builder 4 95 18 — — Butter blender 1 200 16 30 35 Chaff & forage 2 30 — 8 — Chemical works 3 130 15 52 10 Coachbuilder 4 16 — — — Cycle maker 2 4 1 — — Dyer 2 43 3 36 5 Engineer 19 1,023 128 20 30 Firewood cutter 12 34 5 12 — Flour mills 2 120 5 12 — Foundry 2 27 2 — — Lift maker 2 29 5 — — Mason 7 451 38 — — Mineral water 2 18 3 30 — Motor repairer 22 244 14 7 — Printer 21 68 22 20 6 Steam laundry 16 80 9 497 148 Other trades 91 3,589 514 1,422 563 Total 310 6,537 835 2,196 825 98 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. Thirteen new factory premises were added to the register during the year, dealing with various trades, and 15 were removed. During the year 48 preliminary and 11 statutory notices were served under the Public Health (London) Act, 1891, for defects found on factory premises, for the most part relating to defective or insufficient sanitary accommodation, all of which were duly complied with. Workshops. The following is a list of the workshops on the register at the end of 1932:- Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 10 10 16 - - - Blind maker 3 4 9 - - — Bootmaker 31 31 36 - — — Carpenter 5 5 9 1 — — Coach builder 5 8 22 — — — Cycle maker 8 12 18 4 3 — Dressmaker 18 21 — — 43 13 Embroiderer 1 2 13 — Farrier & smith 9 9 15 — — — Firewood cutter 3 3 4 1 — — Laundry 3 7 2 — 8 — Mason 3 4 5 — — — Milliner 6 6 — 14 — Motor repairer 23 26 66 6 - - Musical instrument maker 3 6 11 - 2 - Photographer 4 7 4 — 1 1 Picture framer 3 5 4 1 — — Rag sorter 21 31 36 4 18 — Saddler 1 1 1 — — — Tailor 44 51 58 7 43 7 Upholsterer 14 16 22 1 6 1 Other trades 69 100 148 8 28 22 Totals 287 365 486 33 179 44 99 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 1932 the number of inspections amounted to 83. Fifty-nine intimation and 14 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 8 intimation and 1 statutory notices were served by the female inspector. Seventeen new workshops were added to the register, dealing with the following trades :— Blindmaker 1 Motor repairer 2 Carpenter 1 Photographer 1 Dressmaker 4 Rag sorter 2 Knitting 1 Toy maker 1 Mason 1 Other trades 2 Milliner 1 The following are particulars relating to workshops in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector during 1932:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Dressmaker 4 13 2 15 Knitting 1 3 3 Milliner 1 1 — 1 Motor Repairer 1 - 1 1 Toy Maker 1 1 13 14 Outworkers. During 1932, 299 names and addresses of outworkers were received in 91 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 79 names and addresses relating to 42 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:— 100 Trade. Number on Register. Persons Employed. Premises. Workrooms Bootmaker 18 18 25 Tailor 32 34 76 Other Trades 2 2 4 Totals 52 54 105 Eight new male outworkers' premises (not previously registered) were registered during the year, and 5 were removed from the register. There were 93 inspections made of male outworkers' premises during 1932, and it was found necessary to serve notices under the Public Health (London) Act, 1891, in 9 cases to remedy sanitary defects found on inspection, viz.:—Cleansing, 6; defective roof, 2; defective ashbin, 1. Four statutory notices were also served and complied with. No case of infectious disease was notified during 1932 from premises occupied by male outworkers. Female. The following is a list of the female outworkers registered in the Borough, together with the trades and the number of persons employed:— Trade. Number on Register. Persons Employed. Premises. Workrooms Blousemaker 1 2 4 Dressmaker 33 34 43 Embroiderer 28 28 30 Fancy boxes 6 6 6 Fancy goods 4 4 5 Fine needlework 4 4 4 Glovemaker 2 2 2 Knitting and crochet 3 3 3 Milliner 2 2 2 Tailor 21 22 30 Underclothing 3 3 3 Other trades 12 12 12 Totals 119 122 144 101 The number of new female outworkers' premises (not previously registered) registered during the year was 20, and there were 22 removed from the register. Inspections of female outworkers' premises were made by the woman workshops' inspector (Miss Round) to the number of 455. It was found necessary to serve two notices under the Public Health (London) Act, 1891, to remedy defects. One case of infectious disease, viz.: diphtheria, was notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in this case. Bakehouses. There were 59 bakehouses on the register at the end of 1932. Of these 49 use power, and are therefore technically factories. Thirty-eight 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, which had been removed from the register in a previous year, added. Inspections made during the year numbered 225, and 20 intimation and 3 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 1932, there were 48 premises on the register, including railway yards. These premises were systematically inspected during the year, and 72 inspections were made. Four intimation and 3 statutory notices were served to remedy nuisances found on inspection. All these notices were complied with. 102 Home Work, 1932. NATURE OF WORK OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S-110) Prosecutions (Secs. 109, 110) Seeding twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workers. Contractors. Workers. Wearing Apparel (1) Making 40 13 134 1 — 6 46 — - 10 10 — 1 - — (2) Cleansing & Washing 2 — 4 — — — 2 — — 1 1 — — — — Furniture and Upholstery - - - - - - 2 - - - - - - - - Other Trades - - - - - - 2 - - - - - - - - Total 42 13 138 1 — 6 52 — ----- 11 11 — 1 - — Note.—The 157 names in this table include only 39 workpeople residing in Battersea, the remaining names being either duplicates or those of workers residing outside the Borough. The names of 77 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were, therefore, 116 Battersea home-workers named in the lists. 103 Housing. During the year 1932 considerable attention was given by the Council to the Housing situation in Battersea. In consequence of the coming into force of the 1930 Housing Act, which inter alia required a survey of the housing conditions in the Borough, on the instructions of the Housing Committee a report of this survey carried out in 1931 by the Medical Officer of Health and on the housing needs of the Borough was submitted for consideration by the Committee with regard to the five-yearly programme which is required by the Act to be submitted to the Ministry of Health. This report will be found set out in pages 111 to 119. As a result of the survey, the Committee, so far as the question of Clearance or Improvement Areas was concerned, decided to deal in the first instance with Nine Elms (Island Site) and part of Sheepcote Lane. The first mentioned area was, in part with others, represented by the Medical Officer of Health in 1920 as an insanitary area under the provisions of the 1919 Act, but was not then, mainly owing to the financial stringency, proceeded with. These areas were viewed by the Committee and negotiations were entered into with the Ministry of Health and the London County Council with regard to them, and are still under consideration. It is to be hoped that the Borough Council's efforts to clear up some at least of the worst spots in the Borough will be successful. Where the housing conditions are such as to warrant the use of their powers under the Housing Acts the clearance or improvement of unhealthy dwellings is one of the most pressing reforms of the day. Now that the Government are alive to the vital importance of this aspect of the housing problem, it should not be impracticable to proceed gradually with the clearance of the old worn-out and otherwise unhealthy groups of working-class dwellings which are incapable of being made fit for habitation. New Working-Class Dwellings. Rapid progress was made during the year with the building of the St. John's College Estate. The first and second blocks, containing 39 and 50 tenements respectively, were completed during 1932. The remaining blocks containing 183 tenements, were well in hand at the end of the year, and, it is anticipated, will be complete by the Autumn of 1933. Of the 89 completed tenements there are 6 of 2 rooms, 55 of 3 rooms, 19 of 4 rooms, 7 of 5 rooms, and 2 of 6 rooms. The rental of these flats varies from 13s. 2d. and 14s. per week for two-roomed tenements, to 21s. 6d. per week for those of six rooms, the greater number being three-roomed flats for which the rent was fixed at from 14s. to 17s. per week. In addition to the subsidy payable by the Government in respect of these tenements, the London County Council intimated that they would be prepared to consider the question of granting 104 an additional subsidy per tertement not exceeding £1 17s 6d. In view, however, of the fall in the rate of interest payable, consideration of the matter in relation to the St. John's College buildings was adjourned until the whole of the Estate was completed. Housing (Financial Provisions) Bill, 1932. In this connection it may be noted that in December 1932 a Bill was introduced into the Houses of Parliament with a view to abolishing the Government subsidy in respect of all schemes which had not been approved prior to the 7th December. In the same Bill it was proposed to empower the Minister of Health to reimburse Local Authorities part of the loss sustained by them under guarantees to Building or Public Utility Societies where the proposal to guarantee had been approved by the Minister. This guarantee only applies to houses intended to be let to members of the working classes and it can extend only to the principal and interest on two thirds of the amount advanced in excess of the amount which a Society would normally advance. In the event of default the Government would reimburse one half of the loss. This Bill, however, had not at the end of the year become law. During the year a voluntary organisation, known as the Battersea Housing Association, was inaugurated. This Association has as its object the provision of accommodation for working class families, mainly by reconditioning and the conversion of large houses into separate tenements. Three houses were, by private enterprise, erected during the year in St. James's Road. Overcrowding. While in the Borough as a whole (as pointed out in previous Annual reports) there is no overcrowding, there is still a considerable amount of local overcrowding in certain areas of the Borough, and until adequate provision is made for the accommodation of that element of the population unable to afford the rents demanded for new houses, the problem of overcrowding is still far from being solved. During the year 33 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 1932. Total. Families accommodated 12 6 18 Offer declined or applicant otherwise suited 5 15 20 Recommendation not accepted by the London County Council 8 6 1 14 Still under consideration - 6 6 Totals 25 33 58 # Includes three cases in which the recommendation had been previously not accepted by the London County Council. 105 The London County Council offered to accommodate on a site in Linda Street and Wilson Street, which had been acquired by them for School purposes, a number of urgent cases recommended by the Medical Officer of Health. The Committee accepted this offer and during the year five families previously living in crowded conditions were housed on the site. Repair of Unfit Houses. Since the War, the repair and reconditioning of unfit houses, either under the Housing Acts or the Public Health Act, has been systematically proceeded with, and the work carried out during 1932 will be found summarised on pages 108 to 110. In only 3 cases 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 notices served under the Housing Acts. The expenses incurred, amounting to £95 1s. 10d., were subsequently paid by the respective owners. Appeals. During 1932 the right of appeal by owners against notices served under section 17 or against Demolition Orders made under section 19 of the Housing Act, 1930, was not exercised. Demolition Orders. Demolition Orders were made by the Council during 1932 as under: Premises. Date of Order. 57, Verona Street 24th February, 1932. 102, Ingrave Street 24th February, 1932. 23, 25, 27, 29, Speke Road 24th February, 1932. 32, Orkney Street 25th May, 1932. In each case the premises were duly demolished. The Housing Committee, in 1931, on a report submitted to them by the Medical Officer of Health, considered as to making a Demolition Order in respect of a house in Sheepcote Lane. The owner, however, gave an undertaking to carry out the requirements of the Council to render the premises in all respects reasonably fit for habitation. The work was duly carried out to the satisfaction of the Council's Officers during 1932. A Demolition Order therefore was not made. The Committee also had under consideration during the year 5 other houses reported to them as being unfit for habitation with 106 a view to Demolition Orders being made thereon, but action in regard to these was still pending at the end of the year. Closing Orders. A Closing Order was made by the Council on the 20th July, 1932, in respect of the front basement room on No. 3, Tyneham Road, prohibiting its use for sleeping purposes. Increase of Rent Etc., Acts. During 1932, 10 applications were received from the tenants for the certificate, and 4 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 2 cases; that for the report was granted in all 4 cases. Rent and Mortgage Interest Restrictions (Amendment) Bill. A Government Bill was introduced into Parliament at the end of the year amending the existing legislation relating to the control of dwelling houses. Broadly, the effect of this Bill, so far as London is concerned, is that premises of a rateable value of more than £45 shall be decontrolled, those of rateable value between £20 and £45 are to remain subject to present legislation and those at present controlled having a rateable value of less than £20 are to remain controlled even though under existing legislation the premises would have become decontrolled. The Bill also provides that the Rent and Mortgage Interest (Restrictions) Acts shall continue for a period of five years and no longer. Action under Section 5 of the Housing Act, 1925. During 1932, in 28 cases (relating to 38 houses) contraventions of section 5 of the Housing Act, 1925, which requires, under penalty, the rent book to be kept in a prescribed form, were reported to the Housing Committee. Satisfactory explanations having been received and the rent books having been put in order, no legal proceedings were considered necessary, but the Housing Committee directed cautionary letters to be sent to the offenders. Clearance Areas. No insanitary areas were represented to the Council in 1932. The Housing Committee had under consideration for clearance 2 areas, viz.: the Nine Elms (Island site) area, and the Sheepcote Lane area (vide p. 103) but had not arrived at a definite decision in the matter at the end of 1932. 107 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 1932. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 3. District No. 5. Ascalon Street 1 Church Road . 3 Culvert Road 6 Dashwood Road 14 Green Lane 20 Dorothy Road 1 St. Andrews St. 1 Eversleigh Road 45 Savona House 4 District No. 4. Lavender Hill 1 Sterndale Road 34 Candahar Road 2 Mossbury Road 1 Stewarts Road. 17 Duffield Street 1 Tyneham Road 1 Stockdale Road 2 Falcon Terrace 1 Thessaly Square 22 Gwynne Road 3 Tidemore Street 1 Harroway Road 1 District No. 6. Heaver Road . 1 Grant Road 8 Kambala Road. 1 Wayland Road 11 Kerrison Road 1 Winstanley Road 1 District No. 2. Lavender Road 1 Brougham Street 5 Lubeck Street 1 Culvert Road 79 Meyrick Road 1 District No. 7. Kennard Street 31 Musjid Road 1 Lavender Hill 2 Longhedge Street 1 Nepaul Road 1 Taybridge Road 1 Orkney Street 1‡ Pearson Street 1 Oulton Street ... 11 Shillington Street 10 Raywood Street 9 Stainforth Road 83 District No. 8. Weybridge Street 57 Totteridgc Road 8 Leathwaite Road 1 Summary. District No. 1 9 streets 96 houses „ 2 8 „ 194 „ „ 3 2 „ 23 „ „ 4 17 „ 118 „ „ 5 6* „ 55 „ „ 6 3 „ 20 „ „ 7 2† „ 3 „ „ 8 1 „ 1 Total 46 streets 510 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 17 or 19 of the Housing Act, 1930, but to which the necessary action had not been completed during 1931. * Including Culvert Road partly in No. 2 District, † Including Lavender Hill partly in No. 5 District, ‡ See also page 105 (Demolition Orders). 108 Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. District No. 1. District No. 3. District No. 5—con td. Knowsley Road 2 Ascalon Street 6 Church Road 1 Wickersley Road 7 Belfour Street 1 Goulden Street 1 Montefiore Street 1 District No. 6. Ponton Road 1 District No. 4. Auckland Road 1 Seldon Street 8 Este Road 3 Belleville Road 1 Sterndale Road 28 Ingrave Street 8‡ Brussels Road 1 District No. 2. Shillington Street 4 Harbut Road 1 Speke Road 4‡ Mallinson Road 1 Anerley Street 2 Stainforth Road 1 District No. 7. Chesney Street 49 Verona Street 4‡ Henley Street 4 District No. 5. Nil. Longhedge Street 9 District No. 8. Nil. Sheepcote Lane 1‡ Hanbury Road 10 SUMMARY. District No. 1 6 streets 45 houses „ ,, 2 5 „ 65 „ „ „ 3 2 „ 2 „ „ 4 6 „ 24 „ „ „ 5 3 „ 19 „ „ 6 5 „ 5 „ „ 7 - „ - „ „ 8 - „ - „ Total 27 streets 160 houses Statistics for the Year ended 31st December, 1932. Number of New Houses or Tenements erected during the year:— (1) By the Local Authority 89 (2) By other Local Authorities Nil (3) By other bodies and persons 3 1. Inspection of Dwelling-houses during the year :— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,734 (b) Number of inspections made for the purpose 34,096 ‡ See also page 105 (Demolition Orders). 109 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,178 (b) Number of inspections made for the purpose 31,032 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not in all respects reasonably fit for human habitation 3,030 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 Authorities or their Officers 406 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 44 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 47 (b) By Local Authority in default of owners 3 (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,526 (3,149 intimation notices) (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,642 (3,381 intimation notices complied with) (b) By Local Authority in default of owners Nil (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 7 110 (2) Number of houses in respect of which an undertaking was accepted under sub-section 2 of section 19 1 (3) Number of dwelling houses demolished in pursuance of Demolition Orders 7 (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 1 (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 made 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 (g) Number of representations made to Local Authority with a view to:— (a) Serving of notice requiring the execution of works 174 (relating to 504 houses) (b) The making of Demolition Orders 3 (relating to 6 houses) (c) The making of Closing Orders 1 (relating to 1 house) 111 REPORT of the MEDICAL OFFICER OF HEALTH on the SURVEY OF THE BOROUGH, 1931—2. To the Chairman and Members of the Housing Committee. The expansion of London during the past 100 years has been remarkable. The old parish of Battersea was a semi-rural neighbourhood and even so late as 1857, a period within the lifetime of some of its inhabitants, the population was only 15,000. Its growth to its present position as one of the more considerable and important Metropolitan Boroughs was therefore, rapid. This rapid increase of the population has given rise to a two-fold problem—the provision of new houses for the growing numbers of its families and the replacement of old, worn-out and otherwise unsatisfactory houses, by new ones. In Battersea the latter has been even a more acute problem because there is no further building land available. The situation after the War, in common with other industrial centres, became more and more difficult. New Acts of Parliament were passed into law to enable the Government and Municipal Authorities to devise measures to deal with the situation and hundreds of thousands of houses have been built during the past twelve years to meet the universal shortage of houses. It will not be out of place here to describe the housing situation in Battersea immediately after the War, and to outline the steps which have been adopted to deal with it. If the building trade in London and other industrial centres had expanded in proportion to the growth of population, it should have been possible to meet the gradually increasing demand for houses during the long period which led up to the Great War, and to have made it comparatively easy for arrangements to have been made to deal with the problem of the removal of families from old, worn-out property. Unfortunately, while there were years of great activity in the building of new houses, there were also lean years of output. From 1900 onwards, there was a sudden decline in the housing boom and after 1907 up to the outbreak of War there was a great decline in the annual output of houses. The causes responsible for this were the speculative nature of the business and at the outbreak of War the building of houses in Battersea had practically ceased, at least as far as working class dwellings were concerned. During the War years, the scarcity of housing was not immediately felt, owing to the absence of men in the services. In 1919, rapid demobilisation was bringing thousands of men back to houses in many instances already overcrowded. The marriage and birth rates suddenly increased, with the result that there became a sudden demand for housing accommodation, leading in many cases, to appalling conditions of overcrowding. The Rent & Mortgage Interest (Restrictions) Acts prevented some of the profiteering in rents, but in spite of these Acts exorbitant rents are being paid for housing accommodation in rooms and parts of houses. The problem of insanitary property had become serious in Battersea at the beginning of the century and owing to the limitation of their powers to deal adequately with the worst class of dwelling under the Public Health (London) Act, 1891, the Council in 1907 adopted by resolution the Housing of the Working Classes Act, 1890. This Act (Section 32) was found useful in securing the repair and reconditioning of old, defective and worn-out property in respect to small groups of houses or individual houses. Very useful work was done under these powers before the War, and many insanitary houses were represented to the Council by the Medical Officer of Health for Closing Orders, and 112 the Orders having been made and the premises closed, these were not determined until the premises were made in all respects, fit for habitation. During the War, unfortunately, the activity of the Council in regard to housing was necessarily suspended, with the result that the condition of working class dwellings had steadily deteriorated. Immediately after the War, the Housing Act, 1919, came into force, and although this Act was a considerable advance on previous Housing Acts, simplifying as it did procedure, and otherwise increasing the powers of local authorities, the Council's activities under the parts of the Act dealing with the provision of new houses and slum clearances, especially the latter, had to be curtailed owing to the inability of the Government for economic reasons, to keep its promises in regard to financial assistance towards the Housing Schemes of local authorities. In one direction only, viz., Part 3, dealing with the repair of unfit houses, was any great progress made with these enhanced powers. During the twelve years since the War no less than 6,443 unfit houses were dealt with under the repair sections of this Act, and its successors. By far the greater number were voluntarily reconditioned and repaired by informal negotiation with the owners, who submitted their proposals in writing to the Housing Committee in the form of specifications of the works of repair they were prepared to carry out. In only a small proportion of cases was it necessary for the Council to serve statutory notices under the Housing Acts, a very fortunate circumstance, as the cost of the repairs carried out by the Council in such cases of default by the owners amounted to many thousands of pounds, and in many cases there was a deficit in the amounts recovered from the owners, or by the sale of the properties. Notwithstanding the very useful work done in the repair of unfit houses, very little headway has been made with slum clearance. After the War, a survey of the housing needs of the Borough was carried out and six areas were represented by the Medical Officer of Health, but in only one of these was progress made. In 1922, the Plough Road Area was selected, and the statutory procedure complied with, but the Ministry of Health notified the Council that the scheme could not be approved for financial assistance. In the following year, the Council again approached the Ministry who eventually agreed to approve a modified scheme, subject to the Ministry's annual contribution being limited to 50 per cent, of the annual charge. The formal Order approving the scheme (as modified) was made in 1924. The scheme was put in hand in 1924 and adjoining property was acquired by purchase to make the scheme more effective, and it is now well on its way to completion. In addition to the problems arising out of the shortage of new houses and the bad condition of very old property, a number of problems of a special character required attention. These related to :- (a) Houses let in Lodgings. (b) Hut and Caravan Dwellings. (c) Underground rooms. The first-mentioned has been a troublesome feature of the housing situation for many years. Houses let in Lodgings are houses with rooms let off separately to two or more families, and there are certain groups of these houses which have given rise to considerable difficulties requiring constant supervision by the sanitary inspectors. From time to time, bye-laws have been made by the local authorities under the Public Health Act, but in London, until the passing of the 1919 Housing Act, these bye-laws suffered in effect by lack of uniformity. The bye-laws now in force were made by the London County Council and operate over the County—the Borough Councils being responsible for their administration for their respective districts. These bye-laws have not yet, however, reached their full powers, certain of their most useful clauses being suspended until the repeal of the Rent and Mortgage Interest (Restrictions) Acts. 113 The Housing Situation in 1920. It will be seen therefore, that the Housing problem in Battersea at the end of the War was threefold in character. 1. A decline in building before the War, and the practical cessation of building during the War years, had resulted in grave overcrowding at least in many areas of the Borough, which was intensified by the sudden increase in the marriage and birth rates in 1919 and 1920. As a result of the rapid survey undertaken of the housing needs of the Borough in 1919, it was estimated that about 800 new working class dwellings were required to meet the immediate needs of the population. 2. A considerable amount of old, worn-out property in the Borough was in such a bad condition that only very radical treatment would avail to deal with it. The closing of much of this property was impracticable owing to the difficulty of re-housing the dispossessed occupants, and there were, as already shewn, some thousands of houses which required to be reconditioned. 3. A considerable number of houses registered as houses let in lodgings which it was necessary to deal with under the provisions of the Housing Act. There was little opportunity for the Council, owing to the lack of available building sites, to provide new houses. So far as was practicable the Council secured and built upon every available site and since the War, apart from the Plough Road Area, a number of new working class dwellings have been erected. It was early recognised, however, that it was, in the main, to the County Council that the Borough Council would have to look to provide housing accommodation to meet the shortage in the Borough, and to relieve the severe overcrowding that prevailed in parts of the Borough. Their expectations in this respect to some extent have been fulfilled, and a considerable number of families have been accommodated on the various Estates which the County Council has built in London and the vicinity. Unfortunately, this has only, to a limited extent, relieved the housing situation in Battersea, due partly to the disinclination of many families in urgent need of housing accommodation, to live outside the Borough, and largely to the rents charged for the London County Council houses being beyond the means of many applicants from Battersea. This has led to serious and even dangerous overcrowding, which it has been difficult, and in many cases impracticable, to abate. Overcrowding. In the summer of 1923, a Report on overcrowding was submitted by the Medical Officer of Health to the Council. Although there is evidence pointing to an improvement or amelioration in this direction, owing to the large number of houses built during the interval by the London County Council and to a lesser extent by Municipalities or private enterprise, the conclusions come to in that Report are true in my opinion, as far as old, worn-out, working class property in London is concerned. The failure of the Housing activities in London, and no doubt elsewhere in the Country, is due to the fact that little or no effort has so far been made to provide for the tenant who is unable to pay the rentals charged for the new houses built. There are several different standards of overcrowding in use, none of which can be regarded as completely satisfactory. It is not sufficient to measure overcrowding according to the density of the population only. Individual houses must be taken as units if a satisfactory picture is to be obtained. Three standards are available for measuring overcrowding in individual houses:— 1. The Registrar General's standard, which is used in the Census Reports, and in which overcrowding is indicated if there were 114 more than two persons to a room (excluding sculleries, cellars, pantries, etc.). 2. The so-called "sex separation" standard, which regards a house as overcrowded where separate bedroom accommodation for persons of the opposite sex over the age of 10 years unless they are living together as man and wife, is not available. 3. The "Manchester" standard adopted by the Medical Officer of Health of that City as the official standard for Manchester, which requires that not only should there be separate sleeping accommodation, but that there should be not more than 2½ persons to each bedroom. A child under 10 years of age is counted half an adult. The Registrar General's standard, which is adopted in this Borough, is regarded however, as being too modest in its requirements. Its weakness lies in that it pays no attention to bedroom overcrowding as such, and that it does not take into account the sex of occupiers. A more reliable index therefore, would be the number of rooms to persons. The two other standards would more accurately satisfy the present day conceptions of health and decency. Section 25 of the Housing Act, 1930, imposes on local authorities the duties of reviewing the housing conditions in their areas and of framing and submitting proposals for the provision of new houses for the working classes, distinguishing those houses which the authority purpose to provide for the accommodation of persons displaced by action taken under this Act. In the year 1930 and every fifth year, the Council of every borough or other urban district with a population of more than 20,000 must furnish to the Minister a general statement of the measures they propose to take during the five next succeeding years for dealing with housing conditions in their area, and the provision of further housing accommodation. In accordance with this requirement, a recent survey of the Borough has been undertaken. Housing Situation To-day. The Census of 1931, the complete returns of which are not yet published, shows that the population of the Metropolitan Borough of Battersea has decreased since the preceding census. It may reasonably be supposed, therefore, that the housing requirements of the Borough are very little greater than they were ten years ago. In so far as these requirements are greater, this is due (a) probably to the increased number of families of smaller size, and (b) to the degeneration of property which was not in good condition in 1921. The coming into force of the 1930 Housing Act in August of that year marked another period in the activities of the Legislature in dealing with the difficulties and complexities of the housing problem. The principal objects of the new Act are to simplify procedure and facilitate the clearing of existing slums by clearance areas, and to prevent the creation of new slums by new methods dealing with improvement areas. The Act is intended also to simplify the procedure for dealing with individual houses which are outside these areas but require repair of demolition. A new form of exchequer grant has been devised to provide increased assistance to meet the difficulty of re-housing the poorest inhabitants of slums at rents they can afford. This new grant is available only for re-housing persons displaced from clearance of improvement areas, or from unfit individual houses which are to be demolished. 115 The rent relief which the new grant provides is only to be given to those who need it and for as long as they need it. The new Act is not designed to take the place of the Housing (Financial Provision) Act, 1924. The two Acts are intended to be worked in combination as parts of a single policy. Local authorities are expected to rely upon the Act of 1924 for their ordinary housing needs and to utilise the assistance provided by the new Act for those in special need. The survey recently carried out was restricted to those areas of the Borough where the housing conditions were known to be inadequate and otherwise unsatisfactory. Where it appeared that the conditions of an area or part of an area were such as to suggest consideration as a clearance or improvement area, the houses were inspected individually in detail, and for this purpose 3,480 dwellings were inspected. In addition, 3,602 dwellings were inspected generally, making a total of 7,082 premises inspected. It was not considered necessary to inspect working class dwellings owned by the London County Council and the Borough Council, the standard of such dwellings, generally speaking, being well above the standard of other working class properties in the Borough. In respect of the remaining dwellings, regard was paid to the inspection of such properties prior to the commencement of the survey, and knowledge as to their past histories. A representative number of specimen houses in each street was inspected in order to obtain a reliable estimate of the state of the remaining houses in the street or streets concerned. It is probable, however, that it will be found that since the survey, some of the houses inspected early in the year 1931 will have been found re-conditioned or repaired by the owners. On the other hand, other insanitary houses will have been found to have undergone a further deterioration. Appended will be found a table shewing the number of total inspections carried out under the housing survey and the classification in respect of present state of fitness for habitation and the degree of urgency, etc., of action required to be taken. Clearance or Improvement Areas. The following is a list of areas which are submitted for consideration for clearance of improvement schemes. No. of houses concerned. Approx. No. of families residing on site. No 1 District. * Nine Elms Area 217 415 * Savona Street 29 45 No. 2 District. Austin Road 16 28 Gaines Cottages and Sheepcote Lane 96 149 No. 3 District. * Green Lane and Goslings Yard 8 13 Orville Road 36 141 No. 4 District. Lithgow Street and Thibet Street 33 46 No. 6 District. * Didcot Street and St. Peters Place 39 43 * Lothair Street 9 14 * Plough Road 7 8 No. 7 District. Rush Hill Mews 10 8 Total 500 910 * These areas were represented in whole or in part by the Medical Officer of Health, as unhealthy areas in 1920. 116 Those areas which are regarded as being most urgently in need of consideration for this purpose are:— 1. Nine Elms Area (Island site). 2. Sheepcote Lane Area. Individual Unfit Houses. The following is a list of houses which appear to be incapable of being rendered fit at a reasonable cost:- 34, Savona Place. 15, 48, 50, 52, 54, Brougham Street. 101, Culvert Road. 26, 32, Darien Road. 2-5, (consec.), Yarmouth Cottages. 19, 21, 23, Livingstone Road. *102, Ingrave Street. *23, 25, 27, 29, Speke Road. 143, 169, Meyrick Road. 39, 60, 62, 64a, Winstanley Road. *57, Verona Street. 99, York Road. Houses capable of being rendered fit. The houses inspected under the survey and capable of being rendered fit are classified into four groups; the first, consisting of 1,673 houses, and requiring immediate action either under the Housing Act or the Public Health (London) Act, 1891. The houses in this group are set out below:— No. 1 Sanitary District 534 No. 2 „ 218 No. 3 „ 179 No. 4 „ 278 No. 5 „ 92 No. 6 „ 372 Total 1,673 The second group, consisting of 1,089 houses not so urgently in need of action as the preceding group could be dealt with later as may be necessary. This group is made up as under:— No. 1 Sanitary District 136 No. 2 „ 264 No. 3 „ 273 No. 4 „ 150 No. 5 „ 96 No. 6 „ 170 Total 1,089 The third group consists of 2,374 dwellings and are mainly houses which require the provision of adequate light and ventilation to the staircase but action in regard to which is not so immediately urgent as in the preceding groups. This group is made up as under :— No. 1 Sanitary District 883 No. 2 „ 651 No. 3 ,, 419 No. 4 ,, 239 No. 5 ,, 70 No. 6 „ 112 Total 2,374 *Demolition Orders were made by the Council on 24th February, 1932, in respect of these houses. 117 The fourth group consists of houses which may be regarded as generally in good or fair condition, which can be dealt with in the routine manner by Notices for the abatement of nuisances under the Public Health Act. Conclusions. The results of the recent survey indicate that while the efforts of the Council during the past twelve years have, on the whole, improved the housing situation in Battersea, especially is this so in regard to the improvement which has been effected by the output of new working class dwellings so far as the opportunities at their disposal permitted, and by the repair of unfit houses. The fact that it has been possible for them to build, or have in course of erection, no less than 481 dwellings in the twelve years since the War ended has materially improved the housing situation in Battersea coupled, as it has been, with the assistance of the London County Council in providing outside the Borough on their housing estates accommodation for some of the worst cases of hardship and overcrowding The great improvement in the clearance of what is known as the "Plough Road Area" and the erection of working class dwellings on the site of one of the worst areas in the Borough is also a matter of great satisfaction and when this improvement scheme is completed by the extension rendered possible by the acquisition of adjoining property, the effect will be to improve and even beautify a hitherto depressing and squalid locality. It is to be hoped that similar unhealthy, sordid and demoralising areas in the Borough, some of which have already been represented by the Medical Officer of Health, will be gradually and systematically proceeded with. Notwithstanding the activities of the Council during the past twelve years in housing matters, it will be evident from this report that there is still a lot of leeway to be made up before it can be said that the housing difficulty in Battersea has been solved. It is all to the good that some at least, of the more pressing problems have been dealt with more or less satisfactorily. In only one field of activity, however, have the Council's efforts attained an undoubted success—viz., the repair of unfit houses. This has not been due to any apathy on the part of the Council, but to:— (1) Lack of land in the Borough on which to build working class dwellings. (2) In connection with slum clearance, to the difficulty of re-housing dispossessed tenants and the financial considerations involved. In the main, therefore, it has only been practicable for the Council to concentrate upon the repair of seriously defective and insanitary property, and this policy has been steadily and systematically pursued since the War. It is unfortunate that in regard to much of this class of property the houses are so old, worn out and otherwise defective, that they are hardly, in many instances, worth the outlay expended in putting them into repair. There are many examples of such wasted efforts in the Borough, houses upon which large sums of money were expended in reconditioning them since the War, and which are now as bad or worse even than before. The new Housing Act has made some practical provision to meet this difficulty, of which, no doubt, the Council will be prepared to avail themselves as far as may be required. With regard to overcrowding, the real obstacle to progress is the lack of provision of housing accommodation for families whose incomes do not enable them to pay the rents demanded for the new houses. The importance of this problem has somewhat tardily been recognised by the Ministry of Health, who in January, 1932, addressed a circular letter 118 to local authorities in which the following statement occurs. "The outstanding need at the present time is for the building of houses which can be let at rents within the means of the poorer members of the working classes the Departmental Committee on the Rent Restrictions Acts, whose terms of reference led necessarily to a general review of housing conditions, show clearly in their report that in spite of the immense volume and cost of house building since the War, the needs of the poorer workers are not, in fact, being adequately met. The evidence available in the reports of Medical Officers of Health and of the Minister's Officers lead to the same conclusion." The new housing scheme on the St. John's College site, one block of which is now nearing completion, will be a useful addition toward the housing shortage in Battersea. The scheme, when completed, will provide for the erection of three hundred tenements, or more than half the total number of working class dwellings provided since the War. It is probable, therefore, that so far, the Council will be compelled to confine their activities mainly to dealing with clearance and improvement schemes and to the reconditioning or demolition of unfit houses. The powers and simplified procedure given them under the new Housing Act will no doubt encourage them to proceed gradually and systematically with the first mentioned. A list of the more urgent areas is set out in he results of the survey. It is, however, the more immediately practicable activities—viz., the repair or reconditioning and where necessary the demolition of unfit houses, houses let in lodgings and underground rooms—that, as in recent years, no doubt the Housing Committee will consider the most important of the housing needs of the Borough in the five yearly programme which it is the statutory duty of all local authorities to submit to the Central Authority. (Signed) G. Quin Lennane, Medical Officer of Health. March, 1932. 119 San. Dist. No. of Houses Inspected. No. of Houses in Category Set Out. In detail. Generally. Total. I Improvement or Clearance Area. II Individual unfit houses. Ill Requiring attention in the near future. (a) Urgently. (b) Not so Urgent. (c) When those in preceding columns are dealt with. IV No immediate action required. Total. 1 826 475 1,301 246 1 534 136 883 1,973 3,773 2 491 732 1,223 112 6 218 264 651 3,031 4,282 3 131 731 862 44 4 179 273 419 2,297 3,216 4 634 526 1,160 33 17 278 150 239 2,243 2,960 5 596 110 706 — — 92 96 70 2,658 2,916 6 789 449 1,238 55 1 372 170 112 2,765 3,475 7 11 172 183 10 — — — — 3,277 3,287 8 2 407 409 — — — — — 3,628 3,628 Total 3,480 3,602 7,082 500 29 1,673 1,089 2,374 21,872 27,537 120 APPENDIX. TUBERCULOSIS DISPENSARY. ANNUAL REPORT, 1932. To the Medical Officer of Health. I beg to submit herewith a report on the work carried out at the Tuberculosis Dispensary for the year ending 31st December, 1932. There has been no change in the Dispensary Staff during the twelve months and the routine work of the Dispensary has been carried on as in previous years, the main object in view being that no case of Tuberculosis in the Borough should go uncared for. The number of new patients attending the Dispensary during the year was 599, including 22 cases transferred from other areas— 4 less than in the previous year. The number of new patients attending the Dispensary annually has been a fairly constant figure for the last ten years, in spite of the fact that the incidence of Tuberculosis in the borough as shown by the notifications received by the Medical Officer of Health during that period has fallen by over 25 per cent. How far the present economic conditions may influence the incidence of Tuberculosis and the mortality rate therefrom in future years is a matter of no little concern to tuberculosis workers; but if we may judge from the experience gained during the war years in this and in other countries, there may possibly be a rise in both figures. Tuberculosis is essentially a poverty disease, and whilst the exciting cause of active disease is often obscure there can be little doubt that under-nourishment, anxiety as to employment, worry and poverty—conditions more prevalent to-day than for many years—by lowering the resisting powers are predisposing factors of great importance. Moreover, the same conditions are inimical to recovery. In no previous year has it been so difficult to persuade patients to go away for institutional treatment as in the period under review. The fear of losing his employment and the realisation that, unless his job is kept open for him during his absence, there is little or no prospect of finding work under present conditions on his return, has made the tuberculous patient reluctant to give up his work to undergo the period of residential treatment which is so essential. The number of "Contacts" examined during the year was 212 as compared with 209 in the previous year, and 153 in 1930. Of the "Contacts" examined 112 were children and 100 adults. Difficulty continues to be experienced in persuading "Contacts" to attend the Dispensary for examination, more particularly in the case of the young adult. Active Pulmonary Tuberculosis, at any rate of the adult type, is a very rare disease in children of school age, and the percentage of definite cases of Tuberculosis found as a result of "contact " examination is small. 121 During the year 104 patients were sent away for institutional treatment under the London County Council's Tuberculosis Scheme. Of this number 64 were discharged during the year and 40 were still in institutions on the 31st December. Four patients who were admitted to hospital for observation for diagnosis were discharged as non-tuberculous, and one patient suffering from NonPulmonary Tuberculosis was discharged "much improved" after the completion of treatment. The remaining 59 patients were all suffering from Pulmonary Tuberculosis. The results of treatment are set out in Table VI. The average waiting period between recommendation for and admission to institution was 14 days, as in the previous year, and the average length of stay 124 days; 17 patients took their own discharge—a high percentage. The immediate results of Sanatorium treatment are markedly better in the early stages of Pulmonary Tuberculosis. The object of sanatorium treatment is to secure quiescence of the tuberculous disease, and this cannot reasonably be expected in Group III. cases, whilst in Group II. the tendency to relapse on discharge from Sanatorium is great; this group, in fact, constituting the large number of patients who are so frequently in and out of institutions. From the point of view of treatment, therefore, it is of the utmost importance that Pulmonary Tuberculosis should be diagnosed whilst the disease is limited in extent, and in its early stages, and one of the main functions of the Tuberculosis Dispensary is to assist the General Practitioner in arriving at a diagnosis of a suspicious case at the earliest possible moment. 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. During the year an increasing number of patients received Artificial Pneumothorax treatment. This form of treatment is available for suitable patients under the Tuberculosis schemes of local authorities, and is employed in order to ensure the maximum amount of rest for the diseased lung. The cases are selected, and the most suitable are those in whom one lung only is diseased, although bilateral Pneumothorax is carried out in certain cases. Artificial Pneumothorax is usually induced in Sanatorium or other institution, and the patients receive "refills" as out-patients on their discharge. The majority of the Dispensary patients get their "refills" at Brompton Hospital. Artificial Pneumothorax treatment is, as a rule, continued for a period of two to three years, and in some cases for a longer period, "refills" being given at intervals of two or three weeks. During the year 37 Dispensary patients received this form of treatment, the number of "refills" given being 448 and the cost approximately £235. Treatment of patients suffering from Non-Pulmonary Tuberculosis by Artificial Light has been continued during the year. 122 Seven patients have received this form of treatment and the results are set out in the table below. The Tuberculosis Care Committee has met weekly at Southlands during the year. Owing to the close association of Tuberculosis with unfavourable social conditions, e.g. over-crowding, bad housing conditions, poverty, &c., the value of an adequate Care and After-Care organisation cannot be over-estimated. It should be composed of representatives of all public and charitable bodies in the area in order that every avenue of assistance for the patient and his family may be explored in necessitous cases. Its main functions are to help the patient to take advantage of institutional treatment by seeing that his family are provided for during his absence if he be the breadwinner, to assist the patient upon the completion of his institutional treatment, and to assist in the prevention of the spread of infection by the loan of bed and bedding to enable the patient to sleep alone, or by the boarding out of the children of patients who remain at home. Extra nourishment his 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. A summary of the work carried out by the Care Committee during 1932 is appended with several illustrative cases. During the year 599 new patients, including 22 transfer cases from other areas, attended the Dispensary, being 4 fewer than in the previous year. Of the 599 new patients 151 were found to be suffering from Pulmonary Tuberculosis and 42 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. Tables I and II show the age periods of the new patients for Pulmonary and Non-Pulmonary cases classified according to the above headings. It will be noted that in the Pulmonary group the incidence is highest in the age period 15-25, and that there is only one case of Pulmonary Tuberculosis prior to the age of 15. 123 Table I. Pulmonary Tuberculosis. Years. 0-5 5-10 10-15 15-25 25-35 35-45 45-55 55-65 over 65 Total. Group T.B. minus — — 1 15 13 6 4 2 — 41 Group T.B. plus{ Group I — — — 14 5 6 3 1 — 29 Group II — — — 20 16 8 15 5 — 64 Group III — — — 4 5 4 2 1 1 17 Total — — 1 53 39 24 24 9 1 151 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 1 4 3 5 5 2 — — — 20 Abdominal — 2 1 1 — — — — — 4 Peripheral Glands 1 2 5 — — — 1 — 1 10 Skin and Other Organs — — — 1 3 1 — 3 — 8 Total 2 8 9 7 8 3 1 3 1 42 Table III. shows the mode of onset of Pulmonary Tuberculosis as elicited from the 151 patients who attended the Dispensary during the year. In a comparatively large percentage the first symptom of the onset of Pulmonary Tuberculosis, as noted by the patient, was an attack of haemoptysis, a fact which illustrates the great importance of the fullest investigation being carried out in patients who complain of bringing up blood from the mouth even in the smallest quantities. Unfortunately in many of those patients the significance of this symptom was not realised at the time either, strange as it may appear, through the patient failing to seek medical advice or through the condition being overlooked at the time of examination. Frequently a fairly brisk attack of haemoptysis occurs in a comparatively early stage of the disease and from the point of view of treatment, therefore, it is essential that the fullest investigation should be made in order to determine its cause. Even in these days it is much too common for a patient to volunteer the statement that he thought or was advised that the blood came from a "burst blood vessel in the back of the throat." No patient should be lulled into a false sense of security by any such statement. Pleurisy, either with or without effusion, is also a fairly common mode of onset in Pulmonary Tuberculosis. 124 Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 81 53.64 "Influenza" 8 5.30 Pleurisy 10 6.62 Pleurisy with effusion 2 1.33 Haemoptysis 40 26.49 Other modes 10 6.62 Totals 151 100.00 Table IV. Occupations in the 151 cases of Pulmonary Tuberculosis Occupation. No. of Patients. Occupation. No. of Patients. Housewives 39 Journalists 2 Domestic Workers 13 Compositor 1 Dressmakers, Tailors, &c. 5 Printer 1 School Children 5 Insurance Agent 1 Clerks, Typists, &c. 19 School Teacher 1 Messengers 3 Telephonist 1 Postmen 2 Greengrocer 1 Shop Assistants, Travellers, Gardener 1 &c. 6 Checker 1 Motor Drivers 3 Soldier 1 Engineers 3 Packer 1 Warehousemen 4 Pottery Worker 1 Painters and Decorators 6 Furrier's Assistant 1 Labourers (various) 10 Laundry Worker 1 Bakers 2 French Polisher 1 Factory Workers (various) 7 Carpenter 1 Street Traders 2 Waiter 1 Licensed Victuallers 2 Nil 2 Table V. Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. Pulmonary 48 7 96 Non-Pulmonary 7 3 32 Totals 55 10 128 125 Of the 193 cases, therefore, a history of Tuberculosis in a near relative was elicited in 28-5 per cent., and in a remote relative in 5-2 per cent. In all 33-7 per cent, gave a family history of Tuberculosis. Table VI. Grade Quiescent Much Improved Improved I.S.Q. Worse Died T.C. OR. T.C. O.R. T.C. O.R. T.C. O.R. T.C. O.R. a. 3 - 7 - - - - 1 - - 1 B.i. 3 - 4 2 4 2 1 1 - - - B. ii. - 1 7 2 2 BD - 3 2 2 1 - 2 B. iii. - - - 1 - - 2 - 1 - 4 (T.C. = Treatment completed. OR. = Own request. B.D. = Breach of discipline. I.S.Q. = in statu quo.) The total number of attendances at the Dispensary during the year was 3,741 compared with 3,917 in the previous year, and 3,621 in 1930. The number of visits paid to the homes of patients by the Tuberculosis Officers was 159, and by the Nurses 4,148, as compared with 204 and 4,175 respectively in 1931. The number of sputum examinations carried out at the Tuberculosis Dispensary during 1932 was 917, as compared with 1,332 in the previous year, the smaller number being due to the fact that no sputum examinations were done for St. James's Hospital in 1932. In 209 cases or 22.79 per cent., Tubercle Bacilli were found to be present. Of the total number of specimens examined 305 were sent by medical practitioners, the remainder representing patients on the Dispensary register. The number of reports sent to public bodies during 1932 was 1,106. Consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 766. The number of reports received during the year in respect of insured patients was:— (a) Form G.P. 17 Nil. (b) Form G.P. 36 95 133 patients were referred to hospitals, 112 of whom were sent to St. Thomas's Hospital for X-ray examination. 126 Definite cases marked off the Dispensary register:— Number of Dispensary patients who died during 1932 110 Number of Dispensary patients who ceased to attend 11 Number of Dispensary patients who removed to other districts (and were transferred to the Medical Officer of Health concerned) 61 Number of patients " recovered " 43 Number of patients in whom the diagnosis was not confirmed 1 Artificial Light Treatment. Tuberculosis Patients. Name Age. Condition. Period of Treatment. Condition on Discharge or at 31/12/32. L. C. 13 Ulceration of Hip 17/4/31—27/4/32 Much improved. E. B. 10 Glands of Neck 7/9/31—27/4/32 Quiescent. J B. 5 Glands of Neck 5/10/32—23/12/32 Much improved. N. R. 12 Lupus { 3/12/30—8/6/32 {16/11/32— — Ditto. E. G. 17 Lupus 12/2/30—24/2/32 Improved. M. V. 12 Glands of Neck 7/9/31— 8/6/32 Ditto. W. N. 7 Debility 7/11/32— — Stationary. Springwell House Open-Air School. Accommodation 125 On roll 31/12/32 126 Average attendance 110-8 Admitted during 1932 32 Discharged during 1932 39 Reasons for discharge:— Fit for elementary school 7 Fit for work 15 Transferred to Hospital or Sanatorium 10 Removed from district 7 Transferred to Special School — Discharged for other reasons — Tuberculosis Dental Treatment. Total attendances 246 Sessions held 52 Average attendance per session 4.73 Extractions, 52; scalings, 5; fillings, 10; dentures supplied—whole sets, 11; partial sets, 1; repairs to dentures, —; dressings, 17; advice, 85 (average per session, 3.48) Total 181 127 The Tuberculosis Care Committee. The following is a summary of the work carried out by the Committee during 1932:— Battersea Borough Council—extra nourishment, 123; dentures, 6 129 Public Assistance Committee—financial assistance, 5; nourishment, 2; dentures, 2; clothing, 3; other assistance, 3 15 Charity Organisation Society—financial assistance, 7; clothing, 6; boarding out of children, 1 14 United Services Fund—financial assistance, 11; clothing, 11; boarding out of children, 3 25 Other Agencies—financial assistance, 1; enquiries, 1; dentures, 6 8 Training and Employment—previous employers, 2; C.O.S., 3; other suitable agencies, 3 8 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 £524 2s. 6d. The following are some illustrations of the work done by the Care Committee throughout the year:— E.Y., aged 30. This patient, whose husband had died of tuberculosis, had been working as a cleaner. She was found to have contracted tuberculosis and sanatorium treatment was recommended. It was doubtful at first if she could accept treatment as she had no one to look after her three children, and she was in need of financial assistance as her only income when she ceased work was derived from her war pension, which was inadequate, and she was also in need of several artices of clothing. The Committee on enquiry found that her husband had been in the army for many years, and they were able to arrange with the United Services Fund for the children to be boarded out immediately in one of their Homes. Financial assistance was granted to her, and she was supplied with the necessary articles of clothing and given an early vacancy in a Sanatorium. The patient was thus enabled to go away with her mind at rest about her children, and on completion of her treatment was discharged as fit to resume her former work. H.J., aged 57. Attended the Dispensary following a period of treatment in St. James's Hospital. He was recommended for Sanatorium treatment but in the meantime was finding it difficult to manage. He had been working as a tailor for a firm in Savile Row, but had been stood off work for eight months owing to trade depression. His wife was an invalid and their only income was derived from National Health Disablement Benefit. 128 The Committee were able to arrange for temporary financial assistance to be granted to the man and his wife and for extra nourishment to be granted to the patient. He was also provided with suitable clothing to enable him to go away. L.L., aged 32. This case was referred to the Dispensary from one of the London Hospitals where the woman had been attending as an out-patient. She was suffering from tuberculosis and had been recommended for institutional treatment. The family, consisting of the man and wife and two children, had a very good standard, but were in difficulties owing to the husband having been unemployed for a period of five months. Their only income had been derived from Labour Exchange benefit, and after rent and insurances had been deducted they had an income of 11s. 6d. per week to live on. The patient's clothing was very worn and inadequate, and the children's shoes had entirely given out. The husband had been an officer's steward during the Great War, and he was advised to make an application to the Royal Naval Benevolent Trust. His application was successful, and financial assistance was granted for a time. The Committee were able to give the patient a grant for extra nourishment whilst she was waiting to go away, to provide her with suitable clothing and new shoes for the children, and they kept in constant touch with the family during the patient's absence. F.B., aged 27. A single man, usually living at home, was admitted to St. Luke's Hospital at Lowestoft for treatment for surgical tuberculosis. He had been away for a period of ten months, and his mother had been unable to see him as she could not afford to pay her fare as her husband had been out of work for a considerable time, and she had three dependent children. The patient had been a deposit contributor to National Health Insurance, and having exhausted his benefit had no income whatever. The Committee, after full consideration of the case, agreed to grant the mother's railway fare and incidental expenses to enable her to visit her son. T.C., aged 37. This man, who was suffering from tuberculosis, had been unable to work for some years and his only income was derived from National Health Disablement Benefit. He was informed at the beginning of the year that he would not be eligible for further benefit as he was sixteen stamps short for the contribution year on which his benefit was calculated. His Approved Society agreed to allow him to make up the arrears, but he was unable to meet the cost of the stamps as his wife was only able to obtain part-time work and his daughter had only just started work after leaving school. The Committee arranged to loan the amount to the patient and they obtained the necessary stamps and re-established his claim to benefit. The patient repaid by regular weekly instalments a quarter of the amount involved, and the Committee paid the balance. 129 A.R., aged 26. This patient was a single man living with his mother, who is a widow. He had been working latterly as a free-lance journalist, but had been ill and had to give up work. He attended hospital and was found to be suffering from tuberculosis, and was advised to go away for a period of sanatorium treatment. He was uncertain as to whether he was entitled to insurance benefit, and he had exhausted what savings he had as his income, at best, had been precarious. The Committee were able to arrange for the patient to receive extra nourishment whilst he was waiting for a vacancy. They took up the question of insurance benefit with his Approved Society, and the London County Council, on their recommendation, granted the patient free maintenance and treatment whilst he was away. They also kept in touch with his mother during his absence, and on his return granted him the loan of a shelter and bedstead to enable him to sleep out in his garden. He has now resumed his former work. (Signed) G. Macdonald, Tuberculosis Medical Officer. 130 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 1932 and Previous Years. Year. Population estimated to middle of each Year. 2 Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. Number. 6 Rate.* 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. 1 Number. 4 Rate.* 5 Number 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate.* 13 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 1.1 12.1 1932 157,000 2,649 2,319 14.8 2,642 16.8 1,306 559 134 58 1,895 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. 131 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 1932. Notifiable Disease. Cases Notified in the Borough of Battersea. Total Cases Notified in each SubDistrict. No. of Cases Removed to Hospital from each SubDistrict. 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. n. S. N. S. Small-pox 13 1 4 3 5 ... 10 3 10 3 Diphtheria 312 6 93 184 18 11 ... 182 130 181 130 Membranous Croup ... ... ... ... ... ... ... ... ... ... Erysipelas 92 3 3 7 17 51 ... 56 36 37 15 Scarlet Fever 545 2 144 335 38 26 ... 310 235 307 225 Enteric Fever 3 ... ... ... 2 1 ... 3 3 Continued Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... 2 2 ... 2 2 2 2 Puerperal Pyrexia 14 ... ... ... 2 12 ... 9 5 8 4 Meningococcal Meningitis 8 2 3 3 ... ... ... 3 5 3 4 Ophthalmia Neonatorum 30 30 ... ... ... ... ... 14 16 2 3 Polio-myelitis, &c. .••• ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... Polio-encephalitis ... ... ... ... ... ... ... ... ... ... Malaria 4 ... ... ... ... 4 ... ... 4 1 Dysentery ... ... ... ... ... ... ... ... ... ... Acute Influenzal Pneumonia 60 ... 2 4 8 35 11 28 32 14 16 Acute Primary Pneumonia 299 22 64 46 34 103 30 181 118 104 73 Totals 1,384 65 310 583 124 250 52 795 589 668 479 Tuberculosis— Pulmonary 193 ... ... 5 58 125 5 92 101 ... ... Non-Pulmonary 53 ... 7 17 7 20 2 31 22 ... ... Totals (Tuberculosis) 246 ... 7 22 65 145 7 123 123 .... ... Totals 1,630 65 317 605 189 395 59 918 712 668 479 Whooping-cough* 783 72 469 237 3 1 1 438 345 61 38 Measles* 2,474 111 1,237 1,102 21 3 1,317 1,157 203 144 Grand Totals 4,887 248 2,023 1,944 213 399 60 2,673 2,214 932 661 * Notifiable in Batter sea from 24th April, 1922 132 TABLE III. Causes of, and Ages at, Death during the Year 1932. 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. CAUSES OF DEATH. 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... 2. Measles 23 7 7 7 2 ... ... ... ... 3 3. Scarlet Fever 4 1 3 ... ... ... ... ... ... 4. Whooping Cough 11 5 4 2 ... ... ... ... 5 5. Diphtheria 9 2 1 3 2 ... ... 1 ... 1 6. Influenza 40 2 1 3 4 13 17 39 7. Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... 1 8. Cerebro-Spinal Fever 6 1 1 ... 4 ... ... ... ... 5 9. Tuberculosis of respira tory system 141 ... ... ... 4 33 55 42 7 123 10. Other Tuberculous Diseases 23 3 3 3 1 5 2 4 2 29 11. Syphilis 5 4 ... ... ... ... 1 ... 2 12. General Paralysis of the Insane (Tabes Dorsalis) 9 ... .... ... ... ... 2 5 2 9 13. Cancer, Malignant Disease 268 1 .... 1 ... 2 17 114 133 239 14. Diabetes 17 ... ... ... ... 2 15 19 15. Cerebral Haemorrhage, etc. 72 ... .... ... ... ... 2 25 45 51 16. Heart Disease 545 ... ... 1 3 12 26 101 402 489 17. Aneurysm 9 ... ... ... ... 1 6 2 14 18. Other Circulatory Diseases 63 ... ... ... ... 1 16 45 19 19. Bronchitis 72 ... ... ... ... ... 7 18 47 45 20. Pneumonia (all forms) 103 18 7 6 6 4 12 22 28 93 21. Other Respiratory ... ... ... ... ... Diseases 15 ... ... 3 7 5 13 22. Peptic Ulcer 14 ... 1 2 8 3 26 23. Diarrhœa, etc. 28 21 1 1 ... ... 1 1 3 58 24. Appendicitis 11 ... l ... 3 ... 2 3 2 19 25. Cirrhosis of Liver 8 ... ... ... 1 ... 1 6 ... 9 26. Other Diseases of Liver, etc. 5 ... ... ... ... ... 2 1 2 8 27. Other Digestive Diseases 30 3 ... ... 1 1 5 13 7 34 28. Acute and Chronic Nephritis 54 ... ... ... 1 1 2 24 26 97 29. Puerperal Sepsis 2 ... ... ... ... ... 2 ... ... 4 30. Other Puerperal Causes 2 ... ... ... .... ... 2 ... ... 5 31. Congenital Diseases 57 56 ... ... 1 ... ... ... ... 54 32. Senility 42 ... ... ... ... .... ... ... 42 65 33. Suicide 21 ... ... ... ... 7 10 4 15 34. Other Violence 42 2 1 ... 4 7 5 11 12 82 35. Other Defined Diseases 142 9 ... 8 5 9 26 39 46 165 36. Causes Ill-defined or Unknown 1 ... ... ... ... ... ... ... 1 ... All Causes—M. 951 73 18 17 20 36 97 274 416 943 F. 944 61 9 18 19 43 92 220 482 897 Totals 1895 134 27 35 39 79 189 494 898 1840 133 North Battersea. TABLE IV. Infant Mortality, 1932. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 3 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 Diphtheria & Croup ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 1... 2 3 ... 6 3 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 2. 2. 3 ... ... 5 5 Syphilis ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 1 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 3 2 5 1 ... ... 1 ... ... 1 9 4 1 1 ... ... ... ... ... ... 10 5 Congenital Malformation ... 1 ... ... 2 ... ... ... ... 1 2 2 1 2 ... ... ... ... ... ... 3 4 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 2 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Atelectasis and Asphyxia Neonatorum ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... .... ... 3 1 Totals 3 5 5 1 2 2 ... 1 2 13 8 11 6 3 5 4 7 5 3 36 29 8 6 2 2 3 21 17 8 11 8 65 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1,174 43 1,217 60 5 65 134 South Batteraea. TABLE IV.—(contd.) Infant Mortality, 1932. Nett Deaths from stated causes at various ages under 1 year. causes of death. age periods. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 Small-pox m. f. m. f. m. f. m. f. m. f. m. f. m. f. M. f. m. F. M. f. m. f. Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 .. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 PulmonaryTuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... 1 1 ... ... ... 2 1 1 ... 2 ... ... 3 ... ... 5 4 Diarrhœa & Enteritis ... ... 1 ... ... ... ... ... ... 1 ... 1 1 4 2 2 1 ... ... ... 4 7 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Premature Birth 3 3 2 4 1 ... ... ... ... ... 6 7 ... 2 ... ... ... ... 6 9 Congenital Malformation ... ... 1 ... 1 ... ... ... ... ... 2 ... 1 1 ... ... 1 ... ... ... 4 1 Congenital Debility 1 ... ... ... 1 1 ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 3 1 Icterus Neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Injury at Birth ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Atelectasis & Asphyxia Neonatorum 1 ... 2 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other Causes ... ... ... 1 1 ... ... ... ... ... 1 1 1 ... ... 1 1 ... ... 1 3 3 Totals 5 3 8 6 4 3 1 ... ... 1 18 13 6 8 4 4 5 6 4 1 37 32 8 14 7 1 1 31 14 8 11 5 69 Nett Births in the year. Nett Deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1,059 43 1,102 67 2 69 135 Borough of Battersea. TABLE IV.—(contd.) Infant Mortality, 1932. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF death. AGE PERIODS. Under 24 hours. 1-7 day*. Weeks. Total under 4 weeks. Months. Total deaths under 1 year. Percentage of Total. 1-2 2-3 3-4 1-3 3-6 6-9 9-12 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 1.49 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 2 4 3 5.22 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 1 ... 3 2 3.73 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 2 ... 1.49 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 1.49 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... MeningococcalMe ningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.75 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 1 2.24 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 1 ... ... 1 1 ... ... ... 2 1 4 ... 2 1 ... 5 3 ... 11 7 13.43 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... 1 ... 1 3 4 3 4 3 3 ... ... 9 12 15.67 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0.75 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... 1 ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... 1 3 2.99 Premature Birth 6 5 7 5 1 ... 1 ... ... 1 15 11 1 3 ... ... ... ... ... ... 16 14 22.39 Congenital Malformation ... 1 1 ... 3 ... ... ... ... 1 4 2 2 3 ... ... 1 ... ... ... 7 5 8.95 Congenital Debility... 1 ... ... ... 1 1 ... ... ... ... 2 1 2 2 ... ... ... ... ... ... 4 3 5.22 Icterus Neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.75 Injury at Birth ... ... ... 2 ... ... 1 ... ... ... 1 2 ... ... ... ... ... ... ... ... 1 2 2.24 Atelectasis & Asphyxia Neonatorum 1 ... 2. ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 ... 2.24 Lack of Care ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.75 Convulsions ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 0.74 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accident ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.75 Other Causes ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... 2 2 1 ... ... 1 6 3 6.72 8 8 13 7 6 3 3 ... 1 3 31 21 17 14 7 9 9 13 9 4 73 61 100.00 Totals 16 20 9 3 4 52 31 16 22 13 134 ... Percentage of Total 12.0 14.9 6.7 2.2 3.0 38.8 23.1 12.0 16.4 9.7 M.54.5 F.45.5 Nett Births in the year. Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M. 1,151 51 1,202 71 2 73 F. 1,082 35 1,117 56 5 61 Totals 2,233 86 2,319 127 7 134 136 TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Form T145a. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 of all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the Return relates Previous to 1921 1921—6. 1927 1928 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus 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) 1 (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults— M. 5 1 1 - 2 4 1 5 — 6 1 3 1 — 4 4 — — — — F. 1 1 2 - 3 9 - 1 - 1 - - - - - 1 - - - — Children 14 - - - - 7 - 1 - 1 1 - - - - - - - - - Disease not arrested. Adults— M. 4 11 5 - 16 3 14 19 1 34 4 1 6 1 8 4 7 15 - 22 F. 3 3 2 - 5 6 9 12 2 23 3 - 5 1 6 5 - 8 1 9 Children 5 1 1 - 2 4 1 1 - 2 1 - - - - 2 - - - - Condition not ascertained during the year 18 3 3 1 7 9 3 8 2 13 3 1 2 — 3 2 1 4 1 6 Total on Dispensary Register at 31st December 50 20 14 1 35 42 28 47 5 80 13 5 14 2 21 18 8 27 2 37 (b) Not now on Dispensary Register and reasons for removal therefrom. All classes Discharged as recovered. Adults— M. - - - - 56 7 3 - - - - - -- - - - - - - - F. - - - - 65 7 - - - - - - - - - - - - - - Children - - - - 224 8 2 - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 579 105 51 105 39 195 20 3 24 2 29 13 7 17 8 32 DEAD. Adults— M. 246 26 23 144 154 321 2 2 24 23 49 4 3 19 19 41 F. - - - - 183 14 14 68 112 194 5 20 19 39 6 3 15 27 45 Children - - - — 42 8 1 6 6 13 1 - 2 - 2 1 - — — — Total written off Dispensary Register — — — — 1395 175 94 323 311 728 28 5 70 44 119 24 13 51 54 118 Grand Totals — — — — 1480 217 122 370 316 808 41 10 84 46 140 42 21 78 56 155 137 Condition at the time of the last record made during the year to which the Return relates 1929 1930 1931 1932 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. Hl»s) 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. 4 - 1 - 1 1 - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - - - - - - Children - - - -—- - - - - - - - - - - - - - - -- - Disease not arrested. Adults- -M. 7 8 10 18 10 13 8 21 10 16 14 30 16 13 27 3 43 F. 7 5 8 1 14 9 6 9 2 17 8 7 11 2 20 21 12 18 4 34 Children 2 - - - - 3 - - - - 6 - - - - - -- - - - Condition not ascertained during the year 8 4 2 3 9 8 2 6 — 8 5 8 7 — 15 — — — — — Total on Dispensary Register at 31st December 29 17 21 4 42 31 21 23 2 46 29 31 32 2 65 37 25 45 7 77 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults- M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 12 10 19 3 32 10 2 16 5 23 3 6 5 3 14 2 1 1 ! 3 DEAD Adults- M. 2 4 27 27 58 7 1 24 18 43 4 7 10 4 21 2 3 2 5 F. 5 3 14 20 37 5 - 9 12 21 4 7 4 5 16 1 1 3 3 7 Children 1 - 1 1 2 1 - - 2 2 1 - - - - 1 - - - - Total written off Dispensary Register 20 17 61 51 129 23 3 49 37 89 12 20 19 12 51 6 2 7 6 15 Grand Totals 49 34 82 55 171 54 24 72 39 135 41 51 51 14 116 43 27 52 13 92 138 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 of all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates Previous to 1921 1921—6. 1927 1928 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands. Total Bones and Joints. Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults— M. — — — — — 2 — 1 — 3 2 — — — 2 1 — — — 1 F. - - - - - - - - - - 1 - 1 1 3 1 - - — 1 Children 4 - - 3 7 6 2 16 24 1 1 1 2 5 2 1 - — 3 Disease not arrested. Adults— M. 1 - - - 1 1 1 1 - 3 2 - - 1 3 - - 1 - 1 F. - - 1 1 2 - - 1 1 2 — - - 1 1 - - - - Children - - - 3 3 5 3 2 23 33 — 1 4 5 1 1 — 3 5 Condition not ascertained during the year — — — 5 5 4 3 2 5 14 — — 1 1 2 1 1 1 1 4 Total on Dispensary Register at 31st December 5 — 1 12 18 18 9 7 45 79 6 2 3 10 21 6 3 2 4 15 Transferred to Pulmonary 1 - - - 1 2 1 1 4 - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults— M. 1 1 1 3 2 1 3 6 1 - - - 1 1 - - - 1 F. - - - - - 1 1 - 3 5 - - — 1 1 — - — - - Children 4 3 2 22 31 10 8 2 48 68 1 - 1 — 2 1 — — — 1 Lost sight of or otherwise removed from Dispensary Register 20 7 15 47 89 24 7 10 56 97 2 3 3 6 14 2 1 3 6 12 DEAD. Adults- M. 1 - - - 1 4 - 2 — 6 1 - — - 1 - - - — - F. 1 1 - 3 5 1 1 4 2 8 - - - - - - - - - - Children 1 - - 8 9 3 1 1 3 8 1 — - 1 - - 1 - 1 Total written off Dispensary Register 28 11 18 81 138 45 18 20 115 198 6 3 4 7 20 4 1 4 6 15 Grai *d Totals of (a) and (b) .xcluding those transferred Pulmonary) 33 11 19 93 156 63 27 27 160 277 12 5 7 17 41 10 4 6 10 30 139 Condition at the time of the last record made during the year to which the Return relates 1929 1930 1931 1932 Bones and Joints Abdominal Other Organs Peripheral Glands ' Total Bones and Joints Abdominal Other Organs Peripheral Glands. Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands  (a) Remaining on Dispensary Register on 31st December. Adults— -M. - 1 - 1 2 1 1 - - 2 - - - - - - - - - - Disease arrested. F. 1 - — 2 3 - - 1 1 - — - 1 1 - - — — — Childrer ... 1 - 1 1 3 3 - 2 1 6 - - - - - - - - - Disease not arrested. Adults- -M. - - — 1 1 — - - 1 1 1 - - - 1 8 6 1 15 F. - - 1 - 2 1 - 1 2 4 1 - - - 1 4 1 3 1 9 Childret - - - 7 7 2 4 1 5 12 2 1 1 4 8 8 2 — 10 20 Condition not ascertained during the year 1 — — 2 3 3 1 — 3 7 9 — 1 — 10 — — — — — Total on Dispensary Register at 31st December 4 1 2 14 21 10 6 4 13 33 13 1 2 5 21 20 3 9 12 44 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults- -M. - — - 1 1 - - - - - - - - - - - - - - - F. - - - 1 1 - - - - - - - - - - - - - - - Children - 1 - - 1 - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 3 - - 3 7 1 1 - 5 7 1 - 1 3 5 - - - - DEAD. Adults- -M. — - - - - 1 - 1 - 2 — - - - - - - - - - F. 1 - - 1 1 - - - 1 - 2 - - 2 - - — - - Children - - - - - - - - - - - - - - - - 1 - - 1 Total written off Dispensary Register 4 2 — 5 11 3 1 1 5 10 1 2 1 3 7 — 1 — — 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 8 3 2 19 32 13 7 5 18 43 14 3 3 8 28 20 4 9 12 45 140 Form T 145 TREATMENT OF TUBERCULOSIS. BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1932. (a.) 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 vear (excluding contacts):— (a) Definitely tuberculous 66 61 — 1 14 9 11 6 80 70 11 7 168 - - - - - - - 12 16 10 6 44 (c) Non-tuberculous — — — — — — — — 97 117 61 60 335 b.—Contacts examined during the vear:— (a) Definitely tuberculous — 1 — — — — — 2 — 1 — 2 3 - - - - - - - - 1 - 2 - 3 (c) Non-tuberculous - — - - — — - — 39 59 59 49 206 C.—Cases written off the Dispensary Register as— (a) Recovered 2 4 3 4 4 2 17 7 6 6 20 11 43 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 156 198 135 132 621 D.—Number of cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 340 240 34 38 44 45 97 66 384 286 131 104 904 (b) Diagnosis not completed - - - - - - - - 20 23 12 9 64 1. Number of cases on Dispensary Register on January 1st 1,016 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 39 3. Number of cases transferred to other areas, cases not desiring further assistance under the Scheme, and cases " lost sight of " 72 4. Cases written off during the year as Dead (all causes) 110 5. Number of attendances at the Dispensary (including Contacts) 3,741 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 133 7. Number of consultations with medical practitioners:— (a) Personal † (b) Other 20 344 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) f 159 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,148 10. Number of (a) Specimens of sputum, &c., examined (b) X-ray examinations made in connection with Dispensary work ... 656 (261 others) 112 11. Number of "Recovered cases restored to Dispensary Register, and included in A (a) and A (b) above 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 403 (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.] † All personal consultations, whether held at the homes of patients or elsewhere, should be included in item 7 (a): and all visits by Tuberculosis Officers to homes, whether or not accompanied by a personal consultation already included in item 7 (a), should be entered in item 8. JR2/68