C.J. AC4386 BAT 32 Metropolitan Brough of Battersea. REPORT ON THE HEALTH OF THE Metropolitan Borough of Battersea, FOR THE YEAR 1933. BY G.QUIN LENNANE, M.C., F.R.C.S.,L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH. Wightman & co.Ltd. Printers, Dugdale street, S.E.5, and Regency Street S.W. 1. Metropolitan brough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1933. 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, 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. ,, M. J. Robinson. ,, W. Walden. „ Mrs. F. Young. As constituted 9th November, 1933. Chairman : Councillor Mrs. K. S. D. Baker. His Worship the Mayor (Councillor J. A. Campbell, 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. „ J. Hendrick. Mrs. M. A. Hendrick. ,, F. J. Lamb. Alderman g. Lauriks. Councillor Mrs. F. E. Mills. „ Mrs. A. M. Mossman. „ Mrs. M. J. Robinson. „ Mrs. F. Young. Maternity and Child Welfare Committee 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. Housing Committee. 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. As constituted 9th November, 1933. Chairman: Councillor E. Sullivan. His Worship the Mayor (Councillor J. A. Campbell, j.p.). Councillor C. Barrington. „ Miss E. J. E. Butcher. „ H. W. Carpenter, j.p. „ H. Harling. „ Mrs. A. M. Mossman. „ S. B. Sanderson. „ F. S. Steed. „ J. F. Stevens. „ E. S. Strange, j.p. Alderman I. O. Thomas. Councillor C. H. Young, j.p. Committee to issue certificates and reports under the Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1925, as to the condition of dwelling=houses. The Council on 27th September, 1933, resolved that, until further order, and in pursuance of sec. 10 of the Rent and Mortgage Interest Restrictions (Amendment) Act, 1933, the functions of the Council therein referred to should be exercised by the Housing Committee on behalf of the Council 2 Tuberrculiosis Committee. The Health Committee, as above. Tuberculosis Fare Committee. 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). * Appointed 20th December, 1933. As constituted 9th November, 1933. Chairman—Councillor Mrs. K. S. D. Baker. Alderman G. Lauriks. Councillor Mrs. M. J. Robinson. „ E. Sullivan. „ Mrs. F. Young. Other Member: Mr. J. G. Clancy. Representatives of the Local Public Assistance Committee: Mrs. F. M. Glanvill. *Councillor F. J. Lamb. 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: †Dr. E. J. Boome, Divisional Medical Officer, L.C.C. 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. N. Reeder). Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Spencer). 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). † Appointed 28th February, 1934. 3 Staff of Public Health Department. (At 31st December, 1933) Assistant Deputy M.O.H. in absence of M.O.H., and Tuberculosis Officer Assistant Tuberculosis Officer (part time) Assistant Medical Officer (Maternity and Child Welfare) Resident Medical Officer, Borough Maternity Hospital Medical Officer, Diphtheria Immunisation Clinic Consultant Gynecologist, Borough Maternity Hospital Consultant Obstetrician, Borough Maternity Hospital Consultant Medical Officer, Ante-Natal (V.D.) Clinic Dental Surgeon (by arrangement witli British Dental Hospital) Public Analyst G. MACDONALD, M.A., M.B., Ch.B., D.P.H. (Mrs.) M. J. O'FLYNN, B.A., M B., B.Ch.. B.A.O. (Miss) M. L. HAMILTON, M.B., Ch.B., D.P.H. (Mrs.) K. W. AYLWltt-GIBSON, M.R.C.S., L.R.C.P. F. PORTER SMITH, M.R.C.S., L.R.C.P. (Miss) ALICE BLOOMFIELD, M.D., F.R.C.S. F. W. ROQUES, M.S., F.R.C.S H. CORSI, F.R.C.S., M.A., M.B., B.Ch., L.R.C.P. J. RHYS HERBERT, L.M.S.S.A., L.D.S., R.C.S. C. HACKMAN, F.I.C. Women Sanitary Inspectors and Health Visitors— Miss B. L. Kaye, H.V. Diploma, San. Insp. Board's Cert., Cert. C.M.B. Miss J. Round, H.V. Diploma, San. Insp. Board's Cert. Health Visitors— 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 V. Ventris, H.V. Cert., Cert. C.M.B. Miss H. A. Blackburn, H.V. Cert., Cert. S.I.E.J.B., Cert. C.M.B. Miss B. E. Prager, H.V. Cert., Cert. C.M.B., Tb. Cert. (Brompton). Sanitary Inspectors— Senior Inspector: Mr. J. Lawrence, Cert San. Inst, and Meat Inspec. Cert. District Inspectors. 1. Mr. W. E. Selway, Cert. S.I.E.J.B., and Meat Insp. Cert. 2. Mr. G. Weeks, Cert. S.I.E.J.B., and Meat Insp. Cert. 3. Mr. A. Webb, Cert. S.I.E. J.B., Meat Insp. Cert. 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. Vacant Mr. H. E. Wheeler (Housing), San. Insp. Board's Cert., and Meat Insp.Cert Food Inspector—Mr. J. A. H. Brownlow, Cert. S.I.E.J.B., Meat Insp. Cert. Workshops Inspector—Mr. I. R. Lewis, Cert. S.I.E.J.B., and Meat Insp. Cert. Organising Rat Officer—Mr. A. E. Tubby. 4 Clerical Staff— Chief Clerk—Mr. F. E. Ward. Mr. J. W. Brown (Statistical). Miss R. Dove. Mr. E. Cole. Mr. F. Pedrick. Mr. W. Halstbad. Mr. P. Brocking. Mr. H. C. Godfrey. Office youths. Mr. R. Graham. Miss M. A. Weller (M. & C.W. Miss G. E. L. Newton. 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 (resigned December, 1933). 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. Woodhoube. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer—See page 54. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Batter sea. 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 1933. During the year the vital and morbid statistics of the Borough have been satisfactory. The general death-rate (12.4) and the infant mortality (49 per 1,000 births, the lowest on record) are very satisfactory and compare favourably, as in past years, with the rates for the County of London. The Maternity and Child Welfare Scheme of the Council, including the organised Voluntary effort in ancillary work which is linked up and co-ordinated with that of the Council's Scheme, has maintained a high level of success, and the fact that during the year the infant mortality of Battersea, usually regarded as a sensitive index of the health and sanitary state of a community, reached its lowest figure, points to the efficiency of the Health Services established by the Council under this Scheme. The maternal mortality rate during recent years notwithstanding a slight increase in 1933 compared with 1932, shews a satisfactory decline, and statistics of the Borough in this respect compare favourably with those of London as a whole. Considerable activity took place in housing matters during the year, the new Housing Estate (St. John's College) of the Council being completed during the year, and these good standard workingclass tenements, providing accommodation for 272 families, were fully occupied. Progress was also made in the direction of Slum Clearance, e.g., additional surveys of areas of old, worn-out and otherwise insanitary groups of houses, were carried out on the instructions of the Housing Committee in addition to those already under consideration in the survey report of the Medical Officer of Health, submitted in 1932. The acquisition by purchase of Stewarts Lane, a street of old, worn-out cottages, was decided on by the Council, and will provide a suitable site for the erection of working-class dwellings for rehousing in connection with the Slum Clearance proposals of the Council, and will, it is hoped, help to expedite this important duty of the Council, 6 Additional work has been thrown upon the Department by the transfer from the London County Council to the Borough Council of various powers enumerated in the Transfer of Powers (London) Order, detailed reference to which will be found in various sections of the report. In conclusion I desire to acknowledge the invariable kindness and support I have received from the Mayor and Members of the Council. I desire also to acknowledge my indebtedness to my Colleagues, the Chief Officers of the Council for assistance always willingly rendered. To the Staff of the Public Health Department my thanks are also due for their loyalty and devotion to 'duty which have, in no small measure, conduced to the smooth running and efficiency of the Council's Public Health Department. (Signed) G. QUIN LENNANE, Medical Officer of Health. Electric House, Lavender Hill, S.W. 11. July, 1934. 7 CONTENTS. General. Page Introduction 5-6 Committees 1-2 Staff 3-4, 54, 59, 83 Vital Statistics—Summary 9, 18, 19, 123-128 Census—Population 9-10, 123 Births—General Tables 11-12, 18, 19, 123 „ Notification of Births Act 17, 18 „ Births and Deaths Registration Act 12, 18 „ Still and Illegitimate 12, 18 Marriages 12 Deaths—General Tables ; Public Institutions; Senile 13-15, 18-20, 123-125 „ Zymotic 19, 68 „ Infant Mortality 15-17, 18, 20, 126-128 Maternity and Child Welfare Scheme 21-45 Centres—Municipal and Voluntary 21-24, 30-44 Health Visiting Staff and Work 3, 23-24 Day Nursery 21,25 Ambulance Service 25 Hospital Provision; visits re Hospital Treatment 25, 34 Training of Health Visitors 23 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 27-28 Nursing Facilities and Convalescent Treatment 28-29 Test-feeding (St. Thomas's Babies' Hostel) 21, 26, 29 Midwives and Pupil Midwives 28,38 Ante-natal Work 30-38 Reports of Work at Centres 30-34 V.D. Clinic 35-36 Maternal Mortality 35-37, 136 Maternity Hospital, District Midwifery Service and P.N. clinic 38-42 Dental Clinic: Solarium 42-44, 62, 119-120 Infant Life Protection, Foster-mothers 44-45 Infectious Disease 46-70 List of Diseases Notifiable 46 Summary Tables 47, 124 Contacts 46, 48, 60, 114 Incidence of the Notifiable Diseases 46-67, 136 Diphtheria Prophylaxis (Schick Clinic) 49-50 Vaccination: Districts of Public Vaccinators 54 Tuberculosis 47, 55-67, 114-122 Notifications, Deaths and Death-rates 55-58 New Cases 55, 57, 62 63, 116. 117 Non-notification and Delayed Notification 57-58 Shelters for Patients 59 Dispensary—Staff and Work carried out 4, 59-62, 114-122 Artificial Light Treatment 62, 115, 119 Bacteriological and X-Ray Examinations 59, 61, 119 Institutional Treatment 61, 114-115, 118 Artificial Pneumo-thorax Treatment 61, 62, 115 Open-air School (Springwell House) 59, 120 Care Committee 2, 59, 116, 120-122 Dental Treatment 60, 120 Non-dispensary Cases (Males, Females) 62-63 Contacts 60, 114 Regulations 1925 and 1930 64, 65 Revision of Register 64, 67 Zymotic Deaths 19, 68 Bacteriological Examinations 59, 61, 70, 119 8 Page Sanitary Circumstances—Summary Table 71 Legal Proceedings 72-75 New Legislation 75—76 Common and Seamen's Lodging Houses 76-77 Drains 77-78 Public Cleansing 79 Houses Let in Tenements 79 Licensed Premises (Sanitary Conveniences)79 Smoke and Effluvium Nuisance 79 Offensive Trades ; Offensive Matter 80 Water Supply; Van Dwellings 80 Rag Flock Acts 81 Rats and Mice Destruction Act 81 Dogs : Nuisances by 81 Personal Cleansing Station 81-83 Disinfection 83 Coroner's Court and Mortuary 84-85 Survey of Health Services 84 Staff-Changes 83 Protection of Food Supply. Unsound Food 86 Food Poisoning 86 Slaughter Houses, Cow Houses and Butchers'Shops 86-88 Slaughter of Animals Act, 1933 86 Public Health (Meat) Regulations 88 Food and Drugs (Adulteration) Act, 1928 88-94 Analysis of Various Foods 89-94 Bacteriological Examinations 86, 95 Milk Shops and Milk Orders 94, 95 Milk Samples, Analysis of 90-92 Other Foods and Drugs 93-94 Ice Cream 94 Preservatives in Food and Preserved Food Premises 95-96 Food Export 96 Agricultural Produce and Merchandise Marks Acts 96 Artificial Cream Act 96 Food Premises, Fish Shops, Restaurants and Food Stalls 96-97 Factories and Workshops—General Tables 98 Homework 98, 104 Bakehouses, Warehouses and Wharves 103 Housing—Generally 105-113 New Dwellings, St. John's College Estate 105 Clearance Areas 106-107 Housing (Financial Provisions) Act, 1933 108 Overcrowding: Unfit and Insanitary Houses 108, 110 Appeals, Closing and Demolition Orders 109, 112, 113 Increase of Rent Acts; Rent Books 109 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 109 Statistics 111-113 Appendix. Tuberculosis Officer's Report 114-122, 129-135 Summary Tables 123-136 9 Summary of Statistics, 1933. 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 1933) 154,000 Number of private families—Census 1921 42,988 Census 1931 44,618 Structurally separate occupied dwellings, Census 1931 27,219 Ditto—on rate books at end of 1933 27,527 Rateable value (1933) £1,085,181 Sum represented by a penny rate £4,482 2. Extracts from Vital Statistics of the Year. Births— Males, 1,131; females, 1,132 2,263 Legitimate births (1,082 males; 1,080 females) 2,162 Illegitimate „ (49 males; 52 females) 101 Still-births (33 males ; 32 females) 65 Birth-rate 14-7 Still-birtli rate (per 1,000 births live and still) 27-9 Deaths— Males, 998; females, 926 1,924 Percentage of total Deaths occurring in Public Institutions (Battersea deaths only)57-5 Death-rate 12-49 Number of women dying in or in consequence of childbirth— From sepsis 4 Other causes 1 Death-rate of infants under 1 year per 1,000 live births. Legitimate (105) 48-57 Illegitimate (7) 69-3 49-49 Deaths from Measles (all ages) 1 Whooping-cough (all ages) 12 „ Diarrhoea (under 2 years of age) 22 3. Census— Population. Inhabited dwellings. 1911 167,743 24,321 1921 167,739 27,191 1931 159,552 27,219 10 Vital Statistics. The Registrar-General's estimate of the mid-year population of Battersea (1933) was 154,000 as compared with 157,000 in 1932. The population of Battersea at the Census taken in April, 1931, was 159,552, and the Registrar-General's estimate for 1933 therefore indicates a decrease of 5,552 since the Census and 3,000 during 1932-3. While there would appear to be evidence of a tendency towards a decline in the population of Battersea in recent years, this is probably in the main, due to migration to the outer ring, local sources of information indicating that the decrease is not so great as is estimated by the Registrar-General. The Registrar-General's estimate of the mid-year population of the Borough (154,000) has been adopted for the purpose of the statistics contained in this report. 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:- Area. Estimated Mid-Year Population, 1933. Males. Females. Total. Sub-Districts. North Battersea 36,324 38,486 74,810 South Battersea 36,554 42,636 79,190 Total 72,878 81,122 154,000 Wards. No. 1. Nine Elms 12,180 12,395 24,575 No. 2. Park 7,688 8,622 16,310 No. 3. Latchmere 8,462 9,291 17,753 No. 4. Shaftesbury 6,555 7,063 13,618 No. 5. Church 7,994 8,178 16,172 No. 6. Winstanley 9,160 9,359 18,519 No. 7. St. John 3,609 4,652 8,261 No. 8. Bolingbroke 8,085 9,753 17,838 No. 9. Broomwood 9,145 11,809 20,954 Total 72,878 81,122 154,000 * Births, deaths, etc., occurring in St. James's Hospital sub-district are allocated to the District in which the patient ordinarily resides. 11 BIRTHS. The number of births registered in the Borough during 1933 was 2,682 (1,328 males, 1,354 females), an excess of 26 females. Of this number, 799 were transferred out, the permanent residence of the parents being outside the Borough, and 380, registered outside the Borough, were transferred here, giving on balance a total of 2,263 births (1,131 male, 1,132 female) relating to Battersea residents, and a corrected birth-rate of 14.7 per 1,000 of the population. This is a slight decrease on that of 1932, 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 lor the year 1933. Area. Estimated Population, 1933. Number of Births. Birthrate. Sub-Districts. North Battersea 74,810 1,130 15.1 South Battersea 79,190 1,133 14.3 Wards. No. 1. Nine Elms 24,575 371 15.1 No. 2. Park 16,310 249 15.3 No. 3. Latchmere 17,753 265 14.9 No. 4. Shaftesbury 13,618 194 14.2 No. 5. Church 16,172 245 15.1 No. 6. Winstanley 18,519 295 15.9 No. 7. St. John 8,261 119 14.4 No. 8. Bolingbroke 17,838 278 15.6 No. 9. Broomwood 20,954 247 11.8 The next table shows the birth-rates in the Borough and in the registration sub-districts in 1933, and during the previous decennium 1923-1932:— 12 Birth-rate per 1,000 Population. Year. The Borough. North Battersea. South Battersea. 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 1932 14.8 16.0 13.6 Average 1923-1932 17.1 19.1 15.0 1933 14.7 15.1 14.3 The birth-rate shows a decline in four Wards of the Borough and an increase in the five remaining Wards. The birth-rate in Battersea is 2.4 per 1,000 lower than the average for the previous decennium 1923-1932. The birth-rate for the County of London was 13-2 per 1,000 of the population, and for England and Wales the rate was 14.4. Illegitimate births numbered 101 or 4 46 per cent, of the total live births. Under the Births and Deaths Registration Act, 1926, the registration of still-births was made compulsory. During 1933 65 stillbirths were registered as belonging to Battersea. MARRIAGES. The marriages registered in Battersea during 1933 numbered 1,376. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 17.9. Year. Marriages. Marriage-Rate. 1928 1,354 16.5 1929 1,376 17.0 1930 1,444 18.0 1931 1,421 17.8 1932 1,300 16.6 Mean,1928-32 1,379 17.2 1933 1,376 17.9 13 DEATHS. The number of deaths registered in the Borough during 1933 was 2,839. Of these, 1,485 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 570 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,924 (males 998, females 926). This gives a recorded death-rate of 12.49 compared with 12.5 for London, and 12-3 for Eneland 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 1933. Number of Deaths. Deathrate. Sub-Districts. North Battersea 74,810 918 12.3 South Battersea 79,190 1,006 12.7 Wards. No. 1. Nine Elms 24,575 287 11.7 No. 2. Park 16,310 199 12.2 No. 3. Latchmere 17,753 222 12.5 No. 4. Shaftesbury 13,618 197 14.5 No. 5. Church 16,172 210 13.0 No. 6. Winstanley 18,519 220 11.9 No. 7. St. John 8,261 81 9.8 No. 8. Bolingbroke 17,838 226 12.7 No. 9. Broomwood 20,954 282 13.5 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1933 :— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 60 31 11 8 38 118 307 425 998 F 52 25 13 9 29 82 213 503 926 Ttls. 112 56 24 17 67 200 520 928 1,924 %of Total 5.9 2.9 1.2 0.9 3.5 10.4 27.0 48.2 100.0 14 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 341 311 652 Second quarter 207 207 414 Third quarter 197 168 365 Fourth quarter 253 240 493 Total 998 926 1,924 The death-rate during 1933 was lowest in the St. John Ward (9.8), and highest in Shaftesbury Ward (14.5). The deaths of persons over 65 years numbered 928 or 48.2 per cent. of the total deaths. The average age at death was 56-8 years, as compared with 55.7 in 1932 and 55.3 in 1931. Decreased death-rates were recorded in three Wards'of the Borough. Death-rate per 1,000 Population. Year. The Borough. North Battersea. South Battersea. 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 1932 12.1 11.9 12.2 Average 1923-1932 11.9 11.9 11.8 1933 12.5 12.3 12.7 The natural increase of population (that is the excess of births over deaths) was 339 in 1933 as compared with 424 in 1932. Deaths in Public Institutions. During 1933 the deaths of Battersea residents occurring in Public Institutions numbered 1,107. Of this number 590 occurred within and 517 outside the Borough. Of the total Battersea deaths in Institutions 753 occurred in Public Assistance Institutions. 15 Senile Mortality. During 1933 the deaths of 928 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths, which constituted 48.2 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 98 93 71 105 12 18 181 216 397 South Battersea 116 115 105 129 23 43 244 287 531 Borough 214 208 176 234 35 61 425 503 928 Infant Mortality. During 1933 the deaths of 112 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,263, giving an infant mortality rate of 49.49 per 1,000 births, as compared with 57.8 in 1932, 57.3 in 1931, 54.7 in 1930, and 62.6 in 1929. The infant mortality rate for the year 1933 is the lowest yet recorded in Battersea. The distribution of the 112 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 Mor tality per 1,000 births. M. F. TOTAL. Sub-District. North Battersea 1,130 36 25 61 54.0 South Battersea 1,133 24 27 51 45.0 The Borough 2,263 60 52 112 49.5 Ward. 1. Nine Elms 371 10 7 17 45.8 2. Park 249 10 6 16 64.3 3. Latchmere 265 4 5 9 34.0 4. Shaftesbury 194 6 7 13 67.0 5. Church 245 12 7 19 77.6 6. Winstanley 295 7 6 13 44.1 7. St. John 119 2 3 5 42.0 8. Bolingbroke 278 5 6 11 39.6 9. Broomwood 247 4 5 9 36.4 16 It will be noted that in the Sub-Districts the rate was higher in North Battersea (54.0) than in South Battersea (45.0). In the Wards, Latchmere showed the lowest rate (34.0) and Church Ward the highest (77.6). The infant mortality rates in the County of London and in England and Wales during 1933 were 59.5 and 64.0 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 574 40 69.7 Second quarter 623 26 41.7 Third quarter 565 15 26.5 Fourth quarter 501 31 61.9 The infant death-rate was 42.6 during the last 9 months of the year, as compared with 69.7 in the first 3 months. There were 45 deaths of infants during the first four weeks of life (or 40.2 per cent. of the total infant deaths) as compared with 52 deaths (or 38.8 per cent.) in 1932 and a percentage for the quinquennium (1928-1932) of 43.4. The deaths from developmental diseases were 49 as compared with 56 in 1932. 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 1928 to 1933. 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 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 1932 16 20 16 52 38.8 Total 1928-32 112 123 95 330 43.4 Mean do 22.4 24.6 19.0 66.0 — 1933 21 11 13 45 40.2 17 Certified Cause of Death. Months 0—3. Month; 3—6. Months 6—9. Months 9—12. Total. % of Total. Diphtheria — — 1 — 1 0-89 Measles — — — 1 1 0-89 Influenza — — — 1 1 0.89 Erysipelas 1 1 — 1 3 2.68 Whooping Cough — — 2 2 4 3.57 Enteric Fever — 1 — — 1 0-89 Meningococcal Meningitis — — — — — — Diarrhoea and Enteritis 5 11 5 — 21 18.75 General Tuberculosis — 1 — — 1 0.90 Tuberculous Meningitis — — — 1 1 0.89 Pulmonary Tuberculosis — — 2 — 2 1.79 Pneumonia 3 5 4 4 16 14.29 Bronchitis 1 — — — 10.89 Intussusception - - — — — — Prematurity 26 — — — 26 23.22 Marasmus 3 2 — — 5 4.47 CongenitalMalformations 6 — 1 — 7 6.25 Injury at Birth 4 — — — 4 3.57 Atelectasis&AsphyxiaN. 6 — — — 6 5.36 Umbilical Sepsis 1 — — — 1 0.89 Icterus Neonatorum — — — — — — Epilepsy — 1 — — 1 0.89 Rickets — — — — — — Cancer — — 1 — 1 0.89 Lack of Care — — — — — — Accident and Homicide 2 1 — — 3 2.68 Overlying 1 — — — 1 0.89 Miscellaneous — 2 2 — 4 3.57 Total 59 25 18 10 112 100.0 Percentage of Total 52.7 22.3 16.1 8.9 — 100.0 Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1933 was 69-3 per 1,000 births, as compared with 81-4 in 1932, 83-3 in 1931 161-3 in 1930, and 98-9 in 1929. The corresponding death-rate of legitimate children in 1933 was 48-6, the ratio of the mortality rate of illegitimate infants to that of legitimate being 1 • 43 to 1. Notification of Births Act. During 1933 the number of notifications of live births received belonging to the Borough was 2,143. The corrected number of births registered during the year in Battersea was 2,263. The proportion of notified to registered births was, therefore, 94-7 per cent. There were 296 live births of Battersea children occurring outside the Borough notified from the districts in which these births occurred, these cases being included in the total of 2,143 above. 18 The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926. During 1933 there were 100 still-births registered in Battersea, of which 54 were of Battersea parents. Eleven still-births occurring outside the Borough were registered as belonging to Battersea, making 65 in all, representing a still-birth rate of 27.9 per 1,000 births (live and still) registered. Of the 65 still-births 10 (15.4 per cent.) were registered as illegitimate. Fifty-three still-births were notified under the provisions of the Notification of Births Acts during the year, including 8 cases occurring outside the Borough, the number notified being 81.5 per cent, of the total Battersea still-births registered. The homes from which births are notified 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 1933:— Births per 1,000 Population. Deaths per 1,000 Population. Infant Deaths per 1,000 live births. 1. Shoreditch 16.0 1. Lewisham 10.3 1. Hampstead 38.2 2. Poplar 15.4 2. City of Londqn 11.0 2. Lewisham 39.6 3. Finsbury 15.2 3. Hampstead 11.0 3. StokeNewington 46.4 4. Stepney 15.1 4. Woolwich 11.2 4. Camberwell 49.3 5. Deptford 14.8 5. Hackney 11.5 5. Battersea 49.5 6. Battersea 14.7 6. Wandsworth 11.7 6. Hackney 50.6 7. Islington 14.5 7. Greenwich 11.9 7. Wandsworth 51.5 8. Bethnal Green 14.3 8. Deptford 12.1 8. Finsbury 51.5 9. Southwark 14.1 9. StokeNewingtor 12.3 9. Deptford 54.0 10. Hackney 14.0 10. Camberwell 12.3 10. Poplar 54.5 11. Bermondsey 14.0 11. Bermondsey 12.4 11. St. Marylebone 55.7 12. Hammersmith 13.9 12. Poplar 12.5 12. St. Pancras 58.3 13. Greenwich 13.7 13. City of Westminster 12.5 13. Bermondsey 62.0 14. Lambeth 13.6 14. Woolwich 62.5 15. St. Pancras 13.6 14. Battersea 12.5 15. Southwark 63.1 16. Paddington 13.4 15. Bethnal Green 12.5 16. Lambeth 63.2 17. Camberwell 13.3 16. Islington 12.6 17. Islington 63.2 18. Fulham 13.1 17. Finsbury 12.8 18. Stepney 64.5 19. Woolwich 12.7 18. Hammersmith 12.9 19. Fulham 65.0 20. StokeNewingtor 12. 6 19. Kensington 12.9 20. Hammersmith 65.1 21. Lewisham 12.2 20. Stepney 12.9 21. City of London 65.8 22. Kensington 12.0 21. Shoreditch 13.0 22. Bethnal Green 66.3 23. Wandsworth 11.0 22. Fulham 13.0 23. Greenwich 66.5 24. Chelsea 10.6 23. St. Marylebone 13.0 24. City of Westminster 67.3 25. St. Marylebone 9.7 24. Lambeth 13.1 26. Hampstead 9.6 25. Paddington 13.4 25. Holborn 70.2 27. Holborn 9.5 26. Holborn 13.5 26. Kensington 72.5 28. City of Westminster 8.8 27. Chelsea 13.6 27. Shoreditch 73.6 28. St. Pancras 13.7 28. Chelsea 78.4 29. City of London 7.7 29. Southwark 14.0 29. Paddington 85.5 County of London 13.2 County of London 12.5 County of London 59.5 it will be seen that there were five Boroughs with a higher birth-rate than Battersea; thirteen had a lower death-rate, while only four Boroughs had a lower infant-mortality rate. 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 40 239 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 2,220 404 1,472 26. 8 463 748 1872 60,244 2,349 38.9 1,202 19.9 220 1,147 1873 65,614 2,659 40.5 1,307 19.9 205 1,352 1874 70,984 2,865 40.3 1,387 19 .5 238 1,478 1875 76,354 3,080 40.3 1,724 22.5 307 1,356 1876 81,704 3,455 42.2. 1,745 21.3 340 1,710 1877 87,094 3,481 33.9 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 17.9 398 2,540 1892 153,778 4,990 32.4 2,782 18.1 439 2,208 1893 156,719 5,225 33.3 2,974 18.9 614 2,251 1894 1 59,734 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 19d7 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 3,742 22.1 2,060 12 .2 173 1,682 1922 169,200 3,665 21.7 2,227 13.2 192 1,438 1923 170,600 3,434 20.1 1,839 10 .8 114 1,595 1924 171,000 3,139 18.4 2,018 11.8 122 1,121 1925 172,100 3,184 18.5 1,805 10.5 64 1,379 1926 171,900 2,969 17.3 1,960 11.4 119 1,009 1927 169,000 2,801 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 1933 154,000 2,263 14.7 1,924 12.5 58 839 * 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 Batteksea from 1858 to 1933. 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). The contributions which the Council for many years made to the voluntary bodies linked with their Maternity and Child Welfare Scheme were superseded, on the passing of the Local Government Act, 1929, by grants fixed by the Ministry of Health in a scheme made under the provisions of that Act. The first scheme, which operated from the 1st April, 1930, expired in 1933, and under a new scheme made by the Ministry, which came into force on 1st April, 1933, the new payments to be made by the Council were as follows:— The Battersea School for Mothers £613 The Women's League of Service for Motherhood £546 The Chislehurst Mission £28 The St. Margaret's Day Nursery and Guest House £500 These amounts are approximately equivalent to the grants formerly paid by the Council and those paid by the Ministry direct to the Associations. The Council also made additional contributions in the financial year 1933-34 in connection with their Maternity and Child Welfare Scheme as under:— Invalid Children's Aid Association £40 St. Thomas's Babies' Hostel (vide page 29) £150 Victoria Hospital for Children £100 22 MATERNITY AND CHILD WELFARE CENTRES. Name and Situation of Centre. Times of Opening. Monday. Tuesday. Wednesday. Thursday. Friday. Municipal Southlands, High Street 9.30 a.m. s.l. - 9.30 a.m. s.l. *10.0 a.m. a.n. 2.0 p.m. — — *1.30 p.m. 1.30 p.m. s.L. — — §2.30 p.m. — — do. (Dental Clinic) ‡10.30 a.m. 10.30 a.m. — 10.30 a.m. - 2.0 p.m. 2.0 p.m. — ||2.0 p.m. All Saints' Parish Hall, Prince of Wales Road - *¶10.0 a m. a.n. - 2.0 p.m. — *1.30 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. *10.0 a.m. a.n. *10.0 a.m. a.n. — *2.0 p.m. a.n. *2.0 p.m. a.n. — — Voluntary— (Special Clinic) 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. *¶2.30 p.m. *2.30 p.m. †2.30 p.m. †2.30 p.m. - *¶2.30 p.m. a.n. - - — Chislehurst Mission, St. James's Hall, Ponton Rd. — — — — **2.0 p.m. a.n. Ante-natal clinic. p.m. Post-natal clinic. s.l. Artificial sunlight clinic. * A Medical Officer attends † Mothers only. § Protection against diphtheria (Schick test clinic). ** A Medical Officcr attends alternate weeks. * Children only. ¶Session held fortnightly. II Tubercular patients. 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, S.W. 8. 23 At each of the centres a clinic is held, a woman Medical Officer being in attendance once or twice weekly, as set out in the table on the previous page. 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 1933. 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 eleven 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 1933 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 2,509 499 3,008 To Notified Births 8,301 1,581 9,882 To Still-Births 68 13 81 To Children aged 1-5 years 6,193 3,149 9,342 To enquire into Infant Deaths 112 13 125 To cases of Notifiable Infectious Disease 2,769 225 2,994 To cases of Non-Notifiable Disease 166 146 312 Re prevention of Diphtheria 69 20 89 „ „ Measles 10 — 10 To Dental Cases 102 14 116 To V.D. Cases 15 — 15 To Maternal Deaths 9 — 9 To Foster Mothers and Children 796 — 796 Other Visits 846 593 1,439 Totals 21,965 6,253 28,218 24 Summarised Statistics Relating to Infant Welfare Centres, 1933. 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 100 142 100 96 102 540 94 51 69 214 754 Average attendances per session 39 59 45 65 46 51 44 21 26 33 46 Average ditto weekly 74 161 87 120 91 533 80 21 35 136 669 First attendances 228 402 273 408 265 1,576 208 37 169 414 1,990 Doctor's attendances 52 48 46 51 51 248 94 25 68 187 435 Babies seen by Doctor 1,100 1,654 1,188 1,515 1,162 6,619 2,421 229 1,109 3,759 10,378 Average ditto per attendance 21 34 26 30 23 27 26 9 16 20 24 Weights recorded 3,519 6,183 3,985 5,525 4,197 23,409 4,147 875 1,749 6,771 30,180 Advice only 333 2,211 520 742 521 4,327 3 213 71 287 4,614 Attendances 3,852 8,394 4,505 6,267 4,718 27,736 4,150 1,088 1,820 7,058 34,794 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 24 children, and a guest house is attached for the reception of residents. 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 1933 the attendances at the Nursery totalled 4,665. The annual grant which is made by the Council in accordance with the requirements of the Scheme made by the Ministry of Health (vide page 21), and which, during the period 1930-33, was at the rate of £555 per annum, was reduced under the revised scheme to £500 per annum as from 1st April, 1933. 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 extension of these facilities to the conveyance of non-urgent cases between the hours of 8 a.m. and 11 p.m. (the Council undertaking to pay the charges in such cases) which was referred to in the report for 1931, was not required during 1933. 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 1933:— St. Thomas's Hospital 13 Victoria Hospital, Chelsea 420 St. James's Hospital 6 Bolingbroke Hospital 5 Battersea General Hospital 1 Borough Tuberculosis Dispensary 2 South London Hospital for Women 12 St. Thomas's Babies' Hostel 392* St. George's Hospital 1 Vincent Square Children's Hospital 3 855 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 contributed to the cost of Battersea unmarried mothers who are sent into other approved homes by the Association. These arrangements were reviewed by the Council in July, when, after correspondence with the Association, the Council agreed to make an annual grant of £150 (in lieu of the payments previously made) in respect of all Battersea cases placed by the Association in any Home. The new arrangement came into force as from 1st April. 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 1933 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, pasteurised milk (in lieu of Grade A (Tuberculin tested) milk formerly supplied) and dried milk are provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. The following table gives particulars relating to the number of persons supplied, quantities distributed and cost after deducting payments made by those able in part to contribute : Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons supplied. lbs. supplied. Persons supplied. Pints supplied. £ 1920 1,473 15,588 233 31,894 3,330 1921 2,391 49,020 301 27,254 5,011 1922 2,469 61,511 260 23,879 5,279 1923 2,231 50,110 219 25,633 3,288 1924 1,840 51,837 178 17,654 2,533 1925 1,620 44,805 222 26,079 2 631 1926 609 (469) 26,924 699 (469) 89,435 3,262 1927 111 (53) 2,519 1,381 (53) 206,717 3,438 1928 119(65) 3,286 1,216(65) 149,307 2,667 1929 187 (60) 3,127 1,101 (60) 141,767 2,532 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 1933 184(106) 3.642 1,842(106) 237.636 3.280 [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.] It will be noted that the supply of dried milk, in comparison with pasteurised milk, is comparatively small, dried milk being in general supplied only in those cases where on medical grounds it is considered preferable. The quantity of milk supplied to necessitous mothers and children has declined during the past year. As mentioned in the last annual report, the scale of income upon which the grant of milk in necessitous cases is based was revised 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 154 were supplied during 1933 to necessitous expectant and nursing mothers 28 and children at a cost of £4 5s. 0d., by arrangement with the Women's League of Service. Necessitous mothers were also referred from the Welfare Centres to the kitchen of the Invalid Kitchcns' Association in Henley Street, where they were supplied with 216 dinners during 1933 at a cost of £6 6s. 0d. Convalescent Homes. During 1933, accommodation was provided for 11 mothers and 9 children attending the various Maternity and Child Welfare Clinics. Of these, 4 mothers and 3 children were sent to Littlestone-on -Sea Convalescent Home, 6 mothers and 5 babies to the Evelyn Convalescent Home, Upper Wargrave, and 1 mother with her child to the Salvation Army Home, Tankerton. The cost incurred by the Council amounted to £19 2s. 6d., the families concerned contributing the balance of £4 9s. Od. Thirteen 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, 15 mothers and 8 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). Midwives. So far as can be ascertained there are 15 registered private midwives who reside in Battersea or adjoining districts and practise 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 41) the eastern portion of the Borough is served by the district midwifery services of the St. Thomas's Hospital, Clapham Maternity Hospital and the General Lying-in Hospital, York Road. 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 attendances on cases of infectious disease as set out in the table which follows. No charge is made by the Association for the attendance of their nurses upon mothers and children referred to them under the Council's Maternity and Child Welfare Scheme. During 1933 the total number of attendances made by the nurses of the District Nursing Association in connection with cases of infectious disease was:— 29 Nursing Service, 1933. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia Neon. & other Eye Aff'ns. 104 2,454 - - 104 2,454 Measles 3 40 — — 3 40 Whooping Cough 6 121 1 6 7 127 Diarrhæa & Vomiting 2 7 — — 2 7 Chicken Pox 1 5 1 6 2 11 Mumps — — — — — — Pemphigus Neonatorum — — — — — — Puerperal Pyrexia — — — — — — Pneumonia 7 95 41 814 48 909 Influenza 3 17 71 563 74 580 Erysipelas — — 2 15 2 15 Totals 126 2,739 116 1,404 242 4,143 Many of these cases were referred to the Association by medical practitioners. The total number of visits made by the district nurses to cases sent by the Council, including those for which no charge is made, was 3,252. The cost of the nursing service in 1933 was £138 2s. 0d. as compared with £151 18s. 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 1933. The results of the year's work have again been satisfactory and are summarised below:— A. Test Feeds. Number of cases, 224, comprising: Mothers, 224; babies, 231. Number of attendances, 619. 12 of these cases received in-patient treatment. B. In-Patient Treatment. Battersea cases received— 9 mothers and 18 babies sent by Council. 2 mothers and 4 babies sent from other sources. Period of stay. Cases sent by Council—9 mothers and 18 babies, 1,115 days; average, mothers 30 days, babies 46¾ days. Other cases—2 mothers and 4 babies, 354 days; average, mothers 36½ days, babies 70¼ days. 30 In view of the number of cases sent annually by the Council to this Hostel, and the satisfactory results obtained, the contribution of the Council, formerly £100 per annum, was increased as from 1st April, 1933, to £150 per annum. 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 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 by 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 Gyn£ecologist. 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 A fternoon (" Special ") Clinic.—This clinic is held at the Battersea Borough Maternity Home on Tuesday afternoons at 2 p.m., by me, and is devoted to— (a) The taking of blood specimens for the Wassermann test. (b) To the diagnosis and treatment of gynaecological cases, both ante-natal and post-natal, and (c) To the making of such examinations, under anaesthesia— e.g. for rectifying a breech presentation by external version —as may be necessary. Little more need be said about these cases. They are done as they occur, sometimes one or two on an afternoon, on other occasions, none. During the last year—1933—there have been 882 attendances at this clinic, an average of 15.3 patients per session. In 763 of the cases a specimen of blood has been taken for the Wassermann test. Of these only 4 have given a positive reaction. The taking of the specimens of blood, with the help of a good nurse, is 31 done very rapidly, 15-20 patients passing through in about 30-45 minutes. It is attended with no suffering for the patients, and has come to be looked upon by them as part of the routine ante-natal examination to which all must submit. To estimate the value of this routine testing is difficult, but I have always noted that the positive results which appear are nearly without exception in patients with no suspicious history, e.g. repeated miscarriages, which would have pointed to the necessity of having the test done. As a gynaecological diagnosis and treatment clinic, this is, I think, the only such centre in Battersea, and in my opinion forms an integral and very important part of the ante-natal scheme. During 1933, 128 cases attended this clinic for gynaecological examination, these cases being referred entirely from the Borough antenatal, post-natal and welfare centres. At this clinic, discharges complicating pregnancy are investigated, if necessary by film examination; treatment is given, uterine displacements are corrected, and where necessary, cases are referred to hospital, often to my own out-patient or in-patient beds at the South London Hospital. It is my opinion that, even if it were decided to abandon the routine blood-testing, some provision would always have to be made for a clinic of this sort. Wednesday and Thursday Morning Clinics.—Ante-Natal.— Number of sessions held, 104; total attendances, 3,115; average attendance per clinic, 30; new cases: primiparae 227, multipara 235; not pregnant 1—463. Return cases, 113, i.e. 48 percent. of possible patients. Period of pregnancy when patient first seen:—Months: 1 to 6— 389 (84.2 per cent.); 6 to 8—68 (14.7 percent.); 8andover—5 (1.1 per cent.). Abnormal cases attending the clinics, especially:—Albuminuria, 44; cardiac disease, 4; referred to Tuberculosis Dispensary for opinion re chest condition, 6; small pelvis, 16; other, including high blood pressure, varicose veins, skin conditions, etc., 26. Cases referred for special examination or treatment:—To Tuberculosis Officer, 6; to Dentist, 155; to private Doctor, 6; to other hospitals (excluding cases referred to Mr. Roques for opinion), 3. Cases requiring admission to Battersea Maternity Home during ante-natal period, for examination, treatment, etc., 28. Friday Morning Clinic.—-Number of sessions held, 51; total attendances, 916; average attendance per clinic, 18. New cases: primiparae 103, multiparae 171, not pregnant 1—275. Return cases, 69, i.e. 40 per cent. of possible patients. Period of pregnancy when patient first seen:—Months: 1 to 6 223 (81.4 per cent.); 6 to 8, 43 (15.7 per cent.); 8 and over, 8 (2.9 per cent.). 32 Abnormal cases attending the clinic, especially:—Albuminuria, 10; cardiac disease, 1; referred to Tuberculosis Dispensary for opinion re chest condition, 6; small pelvis, 2; other, 3. Cases referred for special examination or treatment:—To Tuberculosis Officer, 6; to Dentist, 109; to private Doctor, 5; to other hospitals, 1. Cases requiring admission to Battersea Maternity Home during ante-natal period, for examination, treatment, etc., 10. The following information, supplied from the reports of the Resident Medical Officer (of the Borough Maternity Hospital), is also of great interest in relation to the work of the Ante-natal Department. Albuminuria.—Number of cases requiring in-patient treatment, 35. Results.—Mothers—33 good; 2 improved. Babies— 35 good. Cases of eclampsia—3. Results.—Mothers—3 good. Babies— 3 good. Antepartum Hemorrhage.—Accidental hemorrhage, 1 case. Result—(mother—good; baby died 7½ hours). Placenta praevia, 2 cases. Result—(mother—good; baby—good). Inductions.—Medical, 46 cases; by artificial rupture of membranes, etc., 17. Medical.—46 cases. Indications and results:—Hyperpiesis and albuminuria, 15; disproportion, 3; eclampsia, 1; postmaturity, 17; contracted pelvis, 6; large baby, 4. Results.— Mothers—all good. Babies—2 still births (II. and V.). A.R.M., etc.—17 cases. Results.—Albuminuria and hyperpiesis, 16; post-maturity, 1. Results.—Mothers—all good. Babies—all good. Forceps delivery—10 cases. Indications and results—Delay in second stage, 6; occipito-posterior position after manual rotation, 2; threatened uterine inertia, 1; contracted pelvis, 1. Results.— Mothers—all good. Babies—all good. Examinations under anesthesia:—For version, 8 cases (successful, 6; unsuccessful, 2). To confirm diagnosis of presentation, 4 cases. Number of cases delivered as breech at term—3 (diagnosed, 2; undiagnosed, 1). Cesarean Section—10 cases. Indications and results.—Prolapse of cord, 1; primiparae of 41 years, 1; disproportion, 2; contracted pelvis, 3; placenta praevia, 2; accidental haemorrhage, 1. 33 Results.—Mothers—all good. Babies—8 good; 1 died after 7½ hours (congenital heart disease); 1 died after 9 days (hare lip). Trial Labours.—4 cases. Results.—Mothers—all good. Babies —all good. Women's League of Service. Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Ante-natal Work.—21 sessions held, with a total attendance of 238. Average attendance, 11.3 per session. 18 mothers were confined at the Borough Maternity Home. 10 „ „ ,, by the Borough Midwife. 6 „ „ ,, at St. James's Hospital. 1 mother was confined at St. Thomas's Hospital. 2 mothers were confined by private Midwives. 3 cases have been transferred to hospital. 2 prolapsus uteri at Chelsea Hospital for Women. 1 general debility at Battersea General Hospital. Infant Welfare Work.—69 sessions held, with a total attendance of 1,820. Average attendance, 26. Cases referred to Hospital.—2 bronchitis, St. James's Hospital; 2 gastric trouble, Battersea General Hospital; 1 otorrhcea, Victoria Hospital; several for tonsils and adenoids, Victoria Hospital. The average attendances in both the Ante-natal and Infant Welfare work have increased. The toddlers' dinners are a great feature of the work. They are well attended, interesting, and most helpful. Owing to the epidemic of infectious diseases there has been a decrease in the attendance of mothers to dinner—inevitable but unfortunate. The District Nurses have again given valuable help in minor ailments in the homes. The Borough Dental Clinic and Solarium are a very real benefit to our mothers and children, the mothers appreciating the dental and other facilities for themselves and their children. Holidays.—15 mothers and 8 babies have been sent to convalescent and rest homes. Battersea School for Mothers. 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, and 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. 34 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. Dr. E. M. Saxton, Medical Officer in charge of the Infant Welfare Clinic, reports as follows:— Ninety-four sessions were held. Total attendances 4,150 Total doctor's interviews 2,421 First attendances—Under 1 year 173 1-5 years 35 208 Fifty-one cases were referred to hospital. There were 203 attendances in the Massage Department. The health of the children has been good on the wholfe. The infant deaths for the year total 8. Prematurity, 4; pneumonia, 2; atelectasis, 1; delicate baby, 1 (asphyxia through blanket lying accidentally over the face). The Mothers' Social and the Fathers' Club have met each month with good attendances. A sewing class is held each week. In addition to the Ante-Natal work carried out under the Maternity and Child Welfare Scheme of the Council a considerable amount of visiting and reporting of cases is done by the Council's health visiting staff for the obstetric and gynaecological departments of 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, investigating and reporting work carried out for them during 1933. A nte-natal and postnatal. Other. Total. St. Thomas's Hospital 310 91 401 Charing Cross Hospital 18 — 18 General Lying-in Hospital 255 — 255 King's College Hospital 4 — 4 St. George's Hospital 93 5 98 Westminster Hospital 15 1 16 Victoria Hospital, Chelsea — 42 42 University College Hospital 1 — 1 Battersea General Hospital 2 — 2 Royal Free Hospital 1 1 2 Middlesex Hospital 1 — 1 South London Hospital for Women — 5 5 Dr. Barnado's Homes, &c. 2 1 3 702 146 848 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 1933 is summarised in the table on page 33. Mr. Corsi reports as follows:— Of 763 cases examined in the ante-natal clinic 6 were found to be syphilitic. One was a case treated in the clinic some years ago and further treatment was not called for. A second had a very bad history of still-births and infant deaths, but she has always refused treatment and did so again. This leaves four cases treated. Two of the babies have been born at the time of writing and have been found healthy with negative blood Wassermann ; one has been born but has not been completely tested,* and the fourth remains to be born. The clinic has now been in existence twelve years and just over a hundred cases have been treated. Only two definitely syphilitic infants have been born. It is probable that later in life some others may develop interstitial keratitis or other congenital syphilitic trouble, but the number of these will have been greatly diminished by the treatment which the mothers have received. With the exception of the one case who was expected to refuse treatment, no difficulties arose in 1933, and a pleasant atmosphere was maintained throughout the year. Maternal Mortality. During 1933 there were 5 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 2.21 per 1,000 births, as compared with 4 deaths and a fatality rate of 1.72 in 1932. Four of these deaths occurred in hospital and one at home. The causes of death were certified as being:— Puerperal Sepsis 4 Eclampsia 1 In addition there was one maternal death due to causes not directly associated with the puerperium. * At a later date Mr. Corsi writes:—" Since sending in my report a third infant has been tested and blood found negative. The situation regarding babies therefore is now—3 tested Wassermann found negative, 1 not yet born," 36 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1933. 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 1933 763 6 0.8 4 3 1 0 0 * Not syphilitic. 37 Maternal Deaths in Child-birth (Puerperal Sepsis and other Causes). 1928. 1929. 1930. 1931. 1932. Mean 1928-32 1933. Deaths from Puerperal Sepsis 3 2 4 5 2 3.2 4 Deaths from other causes connected with child-birth 4 3 6 10 2 5.0 1 Total Maternal Deaths connected with child-birth 7 5 10 15 4 8.2 5 Rate per 1.000 births— Puerperal Sepsis 1.09 0.76 1.51 2.02 0.86 1.25 1. 77 Other Maternal deaths 1 .46 1.15 2.26 4.04 0.86 1.95 0.44 Rate per 1,000 births all Ma. ternal deaths in child-birth 2.55 1.91 3.77 6.06 1.72 3.20 2.21 Rate per 1.000 population— Puerperal Sepsis .018 .012 .025 .031 .013 .020 .026 Other Maternal deaths .024 .019 .037 .063 .013 .031 .006 Rate per 1,000 population all Maternal deaths in childbirth .042 .031 .062 .094 .026 .051 .032 There was, it will be noted from an examination of the above table, a slight increase in maternal mortality in Battersea in 1933. In accordance with the instructions of the Ministry of Health, each of the 5 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 whose final report has recently been published. The importance of the provision of facilities for the ante-natal examination of expectant mothers cannot be over-estimated. In Battersea in 1933 there were 2,263 live births registered in the Borough, and 1,042 of the mothers attended the ante-natal clinics of the Council, and in the other cases made 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 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 Reports issued by the Departmental Committee referred to above. 38 In recent years there has been a slight increase in maternal mortality in the County of London, and an upward tendency in the incidence of Puerperal Sepsis. In Battersea, however, while the mortality has also slightly increased, it has been consistently lower than in the whole County, and during the past two years, notwithstanding the slight increase in 1933, has shown a marked decline compared with the average for some years previously. The incidence of Puerperal Sepsis has also declined in Battersea, the rate last year per 1,000 births being lower than any rate recorded in recent years. In 1933 only six boroughs in London showed a lower maternal mortality rate than Battersea, while in the previous five years (1928-32) there were eight boroughs with a lower mean rate. On page 136 will be found a table comparing the maternal mortality statistics in Battersea with those of the County of London. Reference has been made in previous Annual Reports 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 1933 the comparison continued to be 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. 39 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 1933 there were 47 sessions held and 491 attendances were made, 487 being new cases. The average attendance per session was 10.4. Arrangements have been made for Mr. F. W. Roques, M.S., F.R.C.S., of the Middlesex Hospital, to act as Consultant Obstetrician and his services are available in cases of grave emergency. It was found necessary to call in the services of the Consultant Obstetrician in 15 cases during the year as compared with 12 cases in 1932. During 1933, 543 cases were admitted to the Hospital as compared with 552 cases in 1932, 555 in 1931, 516 in 1930, 605 in 1929 and 653 in 1928. Particulars relating to the admissions during 1933 are set out as follows :— Total number of cases admitted 543 Average duration of stay 14 days Number of cases delivered by mid wives 524 Number of cases delivered by doctors 14 Number of cases born before arrival 1 Of the above cases, 4 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—113. During Labour—167. Albuminuria 22 Adherent Placenta 4 Ante-partum Haemorrhage 4 Adherent Membranes 9 Induction 51 Artificial Rupture of Membranes 4 Malpresentation. 1 For observation 14 Caesarean Section 7 Version 9 Collapse 2 (?)Fcetal Heart 3 Cord Presentation 1 Varicose Veins 2 Eclamptic Fits 3 Examination under general Episiotomy 16 anaesthetic 3 Forceps 14 Other reasons 4 Precipitate Labour 1 Prolapse of Cord 1 Prolonged Labour 12 Ruptured Perineum 78 Other reasons 15 After Labour—13. Pyrexia 5 Cough, &c. 7 Born before arrival (premature) 1 40 For Infant—47. Eyes watery or sticky 13 Pemphigus Neonatorum 1 (?) Hernia 1 Prematurity 3 Not entirely breast fed 10 Spina Bifida 2 Ophthalmia Neonatorum 1 Other reasons 16 Number of maternal deaths Nil 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 13 Number of infants not entirely breast fed 10 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia 4 Number of infant deaths (9 still-born, 5 within 10 days of birth) and their causes 14 Died within 10 days— Still Birth— Albuminuria (mother) 1 Macerated 7 Prematurity 3 Prematurity 1 Head on perineum on arrival 1 Prolapse of cord 1 5 9 The Consultant Obstetrician was called in in 15 cases of grave emergency, particulars of which are set out below:— Cæsarean section 7 Abnormal presentation 2 Dangerous veins 1 Rise of temperature 2 Eclampsia 3 Cost of Maternity Hospital. I am indebted to the courtesy of the Borough Treasurer for the following statement of the cost of the Home during the financial year ended 31st March, 1934:— Maternity Hospital, 1933—4. Total beds (excluding cots, labour and isolation beds), 30; total cases admitted and discharged during year, 506; average number of beds occupied during the year, excluding cots, labour and isolation beds, 18.7; number of weeks spent in Institution by such patients, 970. 41 Statement* showing expenditure for the year ended 31st March, 1934, in respect of the Maternity Hospital. Item. Total. Per PatientWeek. Medical £ £ s. d. 415 0 8 3 Nursing 688 0 13 8 Salaries Domestic and other 604 0 12 0 Superannuation (Council's contribution) 15 0 0 3 Provisions 677 0 13 5 Drugs and other medical requisites 95 0 1 11 Heating, lighting and water 409 0 8 1 Laundry 351 0 7 0 Repairs and Domestic 119 0 2 4 renewals Structural 299 0 5 11 Miscellaneous items— Telephones, stationery, etc., and sundries 62 0 1 2 Totals, excluding rates, insurance and loan charges 3,734 3 14 0 Rates and insurance 66 0 1 4 Loan charges 1,100 1 1 9 Gross cost 4,900 4 17 1 Income Pupil Midwives (including training grant) 310 0 6 2 Patients' payments 2,324 2 6 0 Other 7 0 0 2 Net cost 2,259 2 4 9 42 Number of cases where medical assistance was called for, with reasons for requiring assistance:— (a) Ante-Natal—2. (c) After Labour—13. Ante-partum haemorrhage 2 Ruptured or lacerated perineum 7 (b) During Labour—21. Inflammation of breasts 1 Premature labour 2 Pain in leg 2 Prolonged labour 6 Rigor and rise of temperature 1 Ante-partum haemorrhage 2 Other reasons 2 Forceps delivery and A.P.H. 1 Post-partum haemorrhage 1 13 Extended breech presentation 1 (d) For Infant—16. Persistent occipito posterior position 1 Watery or sticky eyes 10 Retained membranes 3 Feebleness 1 Bartholin cyst 1 Asphyxia pallida 1 Influenza 1 Prematurity 1 Prolapse of rectum 1 Malpresentation 1 Septic mouth 1 Convulsions 2 21 16 Number of cases of— Puerperal sepsis Nil Puerperal pyrexia Nil Maternal deaths Nil Still births 2 Deaths of infants within 10 days 2 (Prematurity) Dental Clinic. During 1933 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 pp. 60, 120). This service is provided, under contract, by the British Dental Hospital, who supply the dental surgeon, equipment, and other requisites. Advice, extractions, fillings, &c., are supplied free of cost, but a moderate charge is made for artificial dentures which is borne by the patient, assisted in necessitous cases by contributions obtained from various philanthropic bodies, including the Samaritan Fund of the British Dental Hospital, and also by grants from the Council. The Dental Clinic is 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. 43 The work of the Dental Clinic during 1933 is summarised as follows:— Women. Children. Total. Sessions held 203 50 253 No. of patients treated 612 249 861 No. of new patients 389 166 555 Total attendances 3,100 808 3,908 Work carried out:— Extractions— Ordinary 6 — 6 With local anaesthetic 101 10 111 ,, general anaesthetic 625 178 803 Totals 732 188 920 No. of teeth extracted 2,602 602 3,204 Scaling and polishing 71 3 74 Fillings 78 20 98 Upper dentures 93 — 93 Lower dentures 84 — 84 Denture visits 556 — 556 Dressings and treatment to gums 126 18 144 Repairs to dentures 19 — 19 Advice 1,298 553 1,851 The gross cost of dental treatment (Maternity and Child Welfare) in the financial year 1933-34 was £943 8s. 2d. which includes the sum of £388 14s. 2d., 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 231 16 2 Payments by Chelsea Health Society 51 7 6 Grants from British Dental Hospital 22 0 0 Grants from Saturday and Sunday Hospital Funds 36 7 6 Grants from other philanthropic agencies 14 18 4 Contribution by the Council 11 9 0 £367 18 6 The net cost of this service during 1933-34 was £561 15s. 9d. 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. 4 general radiation lamps. 2 mercury vapour lamps. 4 couches. 44 During the year 123 sessions for Welfare patients were held, the number of patients on the roll at the end of the year being 36. The total attendances numbered 3,532, the average number per session being 28.7. The number of children who received treatment during the year (excluding tuberculous children) was 146, whose ages were as follows:— Under 1 year 31 1 to 2 years 83 2 to 3 „ 20 3 to 3½ „ 12 The reasons for their treatment were:— Malnutrition 7 Prevention of Rickets 115 Debility 13 Bronchitis 7 Glands 2 Anaemia 2 Treatment in these cases was by the mercury vapour lamps. Arrangements are 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 62 and 119. Infant Life Protection. By the Order which is referred to on page 76, various powers previously administered by the London County Council were transferred to the Metropolitan Borough Councils, including those conferred by the Children Acts, 1908 and 1932, relating to Infant Life Protection. Under the provisions of these Acts any person undertaking for reward the care and maintenance of a nurse child under the age of 9 years is required to give prior notice to the Local Authority (formerly the London County Council) of the reception or removal, and immediate notice of the death of any nurse child to which the Acts apply, and the Local Authority are given power to regulate the number of nurse children who may be received for payment by any person registered by the Council as a foster mother, and to refuse to register, or to remove from the register, any person whom they consider unsuitable. Penalties are provided for breaches of the requirements of the Acts. The Order gave power to the Council to take into their service the Infant Life Protection Visitors already employed by the London County Council and serving in the Battersea area, but the Council elected to entrust the work to their existing staff of Health Visitors, under the supervision of the Medical Officer of Health, and the duty was, as a preliminary measure, allocated to one of their more experienced Health Visitors (Miss J. Round). 45 All foster mothers on the transferred register who were known to have children in their care were informed by circular letter of the change of authority, and public notice of the alteration was also given by posters distributed throughout the Borough, and by advertisement in the local press. On the 1st April there were 52 Battersea foster mothers on the London County Council register transferred to the Borough Council, having in their care 74 nurse children. At the end of the year there were 64 foster mothers with 89 nurse children, an increase of 12 foster mothers during the year. In addition there were on the register 27 foster mothers who had no children in their charge. The ages of these 89 children were as under:— Under 1 year 16 1 to 5 years 51 Over 5 and under 9 years 22 The whole number of nurse children who were under observation during the period 1st April to 31st December, 1933, was 169. The children were on the whole found to be well, though inclined to be sub-normal. One child was blind, one tuberculous, and one mentally defective. Eleven cases of infectious or contagious disease occurred among nurse children during the period, including four cases of scarlet fever. It is found that the charge of the foster mothers varied between 2s. 6d. to 25s. per week, and at the end of the year was usually between 10s. and 12s. 6d. per week. Of the children under 5 years of age, 15 were, at the date of transfer of powers, attending the Infant Welfare Centres, as compared with 32 at the end of the year. It was not found necessary to take legal proceedings during the period under report in respect of offences against the Children Acts, but in 28 cases foster mothers were cautioned for the undermentioned offences:— Failure to give prescribed notice of— Reception of nurse child 19 Removal of nurse child 5 Reception and removal of nurse child 2 Change of address 1 Caring for nurse child while having cases of Tuberculosis in family 1 28 The Council, on the suggestion of the Metropolitan Boroughs Standing Joint Committee, addressed a communication to the local Court pointing out that the Council, as the Maternity and Child Welfare Authority, is qualified to act as guardian ad litem under the Adoption of Children Act, 1926. 46 Notifiable Infectious Diseases. During 1933 under the notification clauses of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 2,774 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 4, enteric fever 3, small-pox 4. In 1932 the total was 4,641. The decrease in the number of cases notified during 1933 was chiefly due to the quiescence of measles, which compensated for considerable increases in the number of cases of both diphtheria and scarlet fever. The following is a list of the diseases compulsorily notifiable in Battersea:— Small-pox. Acute polio-myelitis. Cholera. Acute polio-encephalitis. Diphtheria. Glanders. Membranous croup. Anthrax. Erysipelas. Hydrophobia. Scarlet fever. Acute influenzal pneumonia. Typhus fever. Acute primary pneumonia. Typhoid or enteric fever. Malaria. Relapsing fever. Dysentery. Continued fever. Plague. Puerperal fever. Acute encephalitis lethargica. Puerperal pyrexia. Measles. Ophthalmia neonatorum. Whooping cough. Cerebro-spinal fever. Tuberculosis. The distribution of the cases notified in the registration subdistricts and the wards is shown in the table on p. 47. Excluding tuberculosis, measles and whooping cough, there were 1,742 cases which occurred in 1,479 houses. Of these cases 1,529, or 87.8 per cent., were removed to the Isolation Hospitals of the London County Council or to other Institutions and 213, or 12.2 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 124). Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 47 Notifications of Infectious Diseases, 1933, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts. † Totals. 1 2 3 4 5 6 7 8 9 N S Small-pox 1 1 2 - - - - - - 4 - 4 Diphtheria 102 62 42 30 41 53 10 26 30 247 149 396 Erysipelas 23 14 18 14 11 17 2 8 8 66 49 115 Scarlet Fever 175 87 90 81 131 115 26 62 59 483 343 826 Enteric (Typhoid) Fever — — — — — — 1 2 — — 3 3 Puerperal Fever — 1 1 — — 1 — — — 2 1 3 Puerperal Pyrexia 2 — 3 1 — — 2 3 3 5 9 14 Ophthalmia Neonatorum 1 3 4 1 2 — 3 1 1 10 6 16 Cerebro-Spinal Meningitis 1 — — — 1 1 — — 1 2 2 4 Polio-myelitis - - - - - - - - - - - - Polio-encephalitis - - - - - - - - - 1 — 1 Encephalitis Lethargica - - - -- - - - - - - - - Malaria - - - - - - - - - - - - Dysentery — — — — — — — — — — — — Acute Primary Pneumonia 47 42 40 15 40 50 11 17 12 169 105 274 Acute Influenzal Pneumonia 14 13 12 9 7 11 5 12 3 46 40 86 *Whooping Cough 92 115 67 87 71 91 29 32 29 345 268 613 *Measles 68 34 21 45 29 21 22 65 114 152 267 419 Tuberculosis (all forms) 36 30 26 20 20 31 8 33 34 112 126 238 Totals 562 402 326 303 354 391 119 261 294 1,644 1,368 3,012 * Notifiable in Battersea from 24th April, 1922. † See footnote, page 10. 48 Small-Pox. Four cases of small-pox were notified in Battersea during 1933 compared with 13 in the previous year, and 3 in 1931. Two persons in one family, and in the two other instances one member of the family was attacked, so that the disease occurred in 3 different households in the Borough. Of the 4 cases, 3 were unvaccinated when attacked, and in the case of the other patient, who was 52 years of age, vaccination had been carried out in infancy. In each case the attack was of the mild type 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 15 days. The usual routine disinfection, etc., was carried out immediately after the patient's removal to hospital and all contacts (34 in number) were offered vaccination or re-vaccination, 20 of whom consented to be vaccinated; four had been vaccinated during recent years, and 10 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 530 cases of this disease recorded in London, and in England and Wales 631 cases. It is satisfactory to note that notwithstanding the prevalence of the disease in the County, Battersea was comparatively free. Sixteen "contacts" with cases of small-pox occurring in other districts were reported to the Medical Officer of Health, and were kept under daily observation for the requisite period. No vaccinations were performed by the Medical Officer of Health during the year under report. Scarlet Fever. The incidence of Scarlet Fever was much higher in 1933, 826 cases being notified as compared with 545 in the previous year. The case-rate per 1,000 of the population was 5.36 and 6 deaths were registered from the disease, giving a death-rate of 0.04 per 1,000 population, as compared with 4 deaths and a death-rate of 0.03 in 1932, 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 813 or 98.4 per cent. were removed to hospital. The infected houses numbered 726. In 59 other notified cases (not included in the above total), the diagnosis of Scarlet Fever was not confirmed at hospital. The question of "return cases" (i.e. cases of infectious disease which occur within a short period after the return to the patient's residence of another patient after treatment in a hospital for infectious diseases) has not been greatly in evidence during recent years in Battersea. It may be noted, however, that 31 of the cases of Scarlet Fever notified in 1933 were of this description. 49 Diphtheria. The number of cases of Diphtheria notified in Battersea during 1933 was 396 as compared with 312 in 1932, 298 in 1931, 489 in 1930, and 445 in 1929. The number of deaths registered from the disease was 12, giving a death-rate of 0.08, as compared with 9 deaths and a deathrate of 0.06 in 1932, 5 deaths and a death-rate of 0.03 in 1931, 15 deaths and a death-rate of 0.09 in 1930, and 12 deaths and a death-rate of 0.07 in 1929. Of the 396 cases notified 395 or 99.7 per cent. were removed to hospital. The infected houses numbered 344. In 54 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 2.57 as compared with 1.99 in 1932, 1.86 in 1931, 3.04 in 1930, and 2.75 in 1929. The case-mortality was 3.03 per cent. as compared with 2.88 per cent. in 1932, 1.68 per cent. in 1931, 3.07 per cent. in 1930, and 2.70 per cent. in 1929. The incidence of the disease was highest in the Nine Elms, Church and Winstanley Wards, the districts of the Borough in which the housing conditions are least satisfactory. 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 9 phials (approximately 66,000 units) of anti-toxin were supplied, on request, to medical practitioners practising in the Borough. 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 51 Patients attending in 1933 (new 151) 193 Attendances 571 „ (average per session) 11 Patients tested— New 126 Old (including 2 second tests) 4 130 (Positive 92, negative 35, no reading 1) Patients inoculated— Without test 25 After positive test (1933 patients) 86 „ „ „ (old „ ) 9 120 50 Inoculations— New patients 278 Old „ 10 288 Total immunised (including one 1930 patient and four 1931 patients) 46 Patients still on register at end of year 125* Discontinued treatment 29 The total number of patients immunised or found by test to be immune is 81, out of a total of 193 patients who have attended during the year (42 per cent.). Since the opening of the clinic 993 patients have attended, and of these 689 have been immunised or found immune by test (69.5 per cent.). Dr. F. Porter Smith, Medical Officer in charge of the Clinic, reports as follows:— "The Battersea Diphtheria Prevention Clinic has shown a definite increase of attendance of new cases during 1933-34, although one is forced to admit that this represents only a trifling proportion of the population of the Borough. The clinic has been in existence long enough to prove that there is absolutely no danger, or inconvenience, attached to the treatment. The injections give little or no pain, and mothers have no difficulty in bringing their children for subsequent injections. As we are all aware, Diphtheria is a fatal and crippling disease, and the old saying "Prevention is better than cure" was never more true than in the case of this dread disease. There is no other method of preventing Diphtheria, and also there is the definite recommendation of the Ministry of Health, plus fifteen years of experience, that this treatment is both safe and efficacious. The clinic at "Southlands" (2 to 5 p.m., Wednesday) is equipped with the latest scientific appliances, and the Medical Officer attending is always willing to interview and advise parents." In view of the remarkable results which have been recorded in New York and other large cities of U.S.A. and in most great centres of population by this invaluable method of preventive inoculation against Diphtheria, by which the incidence and death-rate from this deadly menace to child life has been greatly reduced, it is regrettable that more use is not made by the inhabitants of the Borough of the facilities provided, free of cost, by the Council to safeguard their children from the risk of infection. Acute Polio-Myelitis and Polio-Encephalitis. No case of acute Polio-Myelitis was notified in Battersea during 1933. One death was recorded from chronic polio-myelitis, the patient being temporarily resident at the time in Cornwall. Efforts to trace the earlier history of this case were fruitless. * Includes 3 patients (1932) and 16 (1933) negative alter first test, who are to attend again for re-test. 51 At the beginning of the year there were 30 chronic cases on the register, of whom 2 removed during the year. Two other cases, not in the acute stage, were found by the Health Visiting staff in the course of their duties, and there thus were 30 cases on the register at the end of the year. When first notified or reported 22 of these cases were under 5 years of age, and in 1933, 3 were over 16 years, 23 were of school age, and 4 under 5 years. Of the 23 school children 8 were scholars at elementary or secondary schools, 12 attended special schools for defective children, 2 were at educational or cripple establishments outside London, and 1 was not fit for school. Seventeen of the 30 cases were receiving periodic treatment at out-patient departments of various hospitals, 6 were receiving no treatment, and 7 received in-patient treatment during the year. One case of acute Polio-Encephalitis was notified during 1933, which proved fatal. Puerperal Fever and Puerperal Pyrexia. Three cases of Puerperal Fever were notified in Battersea in 1933, as compared with 4 in 1932, 6 in 1931, 9 in 1930 and 4 in 1929. No death occurred among the notified cases. Four deaths were registered as due to this disease, of which two occurred in Public Assistance Hospitals, one* in a general hospital, and one at home. Two of these deaths were due to septicaemia following abortion. Careful investigation was made in these four cases in connection with the Government's enquiry into maternal mortality (vide page 37), and the result forwarded to the Ministry of Health. No notification of Puerperal Fever had been received in any of these cases. The number of notified cases per 1,000 births was 1.33, as compared with 1.72 in 1932,2.42 in 1931, 3.39 in 1930, and 1.53 in 1929. The case-mortality was 57 per cent. of the cases notified and reported, and the death-rate per 1,000 births was 1.77. There were 256 cases of Puerperal Fever notified in London and 2,090 in England and Wales during 1933. A comparison of the incidence of Puerperal Fever in London and Battersea will be found on page 136. The number of cases of Puerperal Pyrexia notified in Battersea during 1933 was 14, and the incidence per 1,000 births was 6.19. There were 842 cases of Puerperal Pyrexia notified in London and 5,808 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 bacteriological examination of discharges, &c., 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. 52 Enteric Fever. During 1933 three cases of Enteric Fever were notified in Battersea. Another case notified was subsequently cancelled, the diagnosis not being confirmed at hospital. Two deaths of Battersea residents were registered during the year as being due to this disease, one being notified from Bolingbroke Hospital, and dying there, and one (an un-notified case) dying in a mental hospital outside London. In two of the three notified cases the patient was stated to be suffering from "para-typhoid B," a milder type of the typhoid group, and one of these proved fatal. B. Typhosus was reported to have been found in the mental case. Two cases of "Continued Fever" were also notified during the year, but both were cancelled, the patients on removal to hospital being certified to be suffering from Erysipelas and Scarlet Fever respectively. Cerebro-Spinal Fever. During 1933, 4 cases of Cerebro-Spinal Fever were notified in Battersea, the diagnosis of these sporadic cases, which occurred in different Wards of the Borough, being confirmed on removal of the patients to hospital in each case. All four cases proved fatal. Encephalitis Lethargica. Two notifications of this disease were received during 1933, but both were subsequently cancelled, the diagnosis not being confirmed on removal of the patients to hospital. One death was registered as being due to this disease during the year, the patient who had been notified in 1925, dying in St. John's hospital. In London the number of cases notified during the year was 23, and in England and Wales 440. Ophthalmia Neonatorum. There were 16 cases of Ophthalmia Neonatorum notified in Battersea during 1933, as compared with 30 in 1932, 37 in 1931, 34 in 1930, and 43 in 1929. The rate per 1,000 births was 7.1. There were 4 severe cases amongst the 16 notified, which were removed to St. Margaret's (L.C.C.) Hospital for treatment, and one un-notified case also received treatment in that hospital. No case of permanent injury to the eyes was recorded during the year. During 1933 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 2,454. All cases were kept under systematic supervision by the Health Visitng Staff, and 49 visits were made to the homes of these children. 53 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. N. Battersea 10 1,130 8.8 1928 39 2,743 14.2 S. Battersea 6 1,133 5.3 1929 43 2,619 16.4 1. Nine Elms 1 371 2.7 2. Park 3 249 12.0 1930 34 2,652 12.8 3. Latchmere 4 265 15.1 4. Shaftesbury 1 194 5.2 1931 37 2,477 14.9 5. Church 2 245 8.2 6. Winstanley — 295 — 1932 30 2,319 12.9 7. St. John. 3 119 25.2 8. Bolingbroke 1 278 3.6 Mean 9. Broomwood 1 247 4.0 1928 32 36.6 2,562 14.3 Borough 16 2,263 7.1 1933 16 2,263 7.1 Erysipelas. There were 115 cases of Erysipelas notified and 5 deaths were recorded from the disease during 1933 in Battersea, 3 of which were of un-notified cases. The case-mortality was 4.24 per cent. of the total recorded incidence and the death-rate per 1,000 population was 0.03. Measles. Measles was not so prevalent in Battersea during 1933 as in the previous year, the number of cases notified and reported totalling 500 as against 2,913 in 1932. One death from the disease was recorded. Of the 500 cases 419 were notified under the Regulations—The Battersea (Measles and Whooping Cough) Regulations, 1922—and the remaining 81 cases were reported by the public elementary schools or from other sources. The death-rate was 0.006 per 1,000 population, as compared with 0.146 in 1932, 0.013 in 1931 and 0.236 in 1930. The case-mortality of the total incidence (notified and reported) was 0.20 per cent., as compared with 0.79 per cent. in 1932, 2.25 percent. in 1931, 1.13 per cent. in 1930 and 0.88 percent. in 1929. Incidence and Mortality of Measles in Epidemic Periods, 1921-1932, and in 1933. 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 1933 500 1 .04 .006 324.7 0.20 54 Whooping-Cough. During 1933 there were 613 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 363 additional cases were reported from the public elementary schools and other sources. The total number of cases notified or otherwise reported during 1933 was 976, as compared with 1,109 in 1932, 747 in 1931, 537 in 1930, and 1,317 in 1929, the decrease in 1933 compared with 1932 being 12 per cent. There were 12 deaths registered from this disease, the death rate being 0.08, as compared with 11 deaths and a death-rate of 0.07 in 1932, 5 deaths and a death-rate of 0.03 in 1931, 7 deaths and a death-rate of 0.04 in 1930, and 43 deaths and a death-rate of 0.27 in 1929. Vaccination. On 31st March, Dr. Lurie, Public Vaccinator for No. 4 District, resigned his appointment. In May the Council revised the districts into which the Borough is divided for vaccination purposes, reducing the number from 9 to 7, but leaving the number of vaccinators unaltered. In September the Public Vaccinator for the new Nos. 1 and 2 Districts (Dr. C. E. McDade) resigned his appointment, and in October the Council made separate appointments for those districts. The areas comprised in the new districts and the staff of public vaccinators at the end of the year are shewn in the following statement:— District No. 1 (Nine Elms Ward). Dr. M. Sayers, 273 Lavender Hill, S.W. 11 ; 65 Battersea Park Road, S.W. 8. (Deputy—Dr. P. Purcell, 154 High Street, S.W. 11.) District No. 2 (Park Ward). Dr. E. W. G. Young, 331 Queens Road, S.W. 8. (Deputy—Dr. M. Sayers, 273 Lavender Hill, S.W. 11 and 65 Battersea Park Road, S.W.8.) District No. 3 (Latchmere and Church Wards). Dr. P. Purcell, 154 High Street, S.W. 11. (Deputy—Dr. M. Sayers, 273 Lavender Hill, S.W.11, and 65 Battersea Park Road, S.W. 8.) District No. 4 (Shaftesbury, Winstanley and St. John Wards). Dr. L. Golomb, 347 Queens Road, S.W. 8. (Deputy—Dr. H. Shaw, 112 Queens Road, S.W. 8.) District No. 5 (Bolingbroke and Broomwood Wards). Dr. W. Walsham, 61 Clapham Common West Side, S.W. 4. (Deputy—Dr. G. R. Laing, 38 Bolingbroke Grove, S.W. 11.) 55 District No. 6 (St. James's Hospital). Dr. W. L. Maccormac, St. James's Hospital, Ouseley Road, S.W. 12. (Deputy—Dr. A. P. Piggot, St. James's Hospital, Ouseley Road, S.W. 12.) District No. 7 (St. John's Hospital). Dr. E. F. W. Nixey, St. John's Hospital, St. John's Hill, S.W. 11. (Deputy—Dr. F. W. Brunker, St. John's Hospital, St. John's Hill, S.W. 11.) Vaccination Officer—T. C. P. Asbey, Town Hall, Battersea, S.W. 11. TUBERCULOSIS. During the 52 weeks ended 30th December, 1933, there were 238 cases of Tuberculosis (all forms) notified in Battersea as compared with 246 cases in 1932, 255 in 1931, 286 in 1930, and 330 in 1929. In addition 37 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making a total of 275 cases. The following table (required by the Ministry of Health) shows the age and sex distribution of the 275 cases of Tuberculosis notified or otherwise reported during the year ended 30th December, 1933, and the 146 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 1 3 1 - 1 2 - 2 1 1 2 1 — 2 2 1 6 7 — — 2 4 6 5 2 2 4 3 5 8 - 1 1 1 1 10 — 2 2 1 3 4 1 1 15 10 7 17 4 5 9 2 3 5 2 2 4 20 18 21 39 2 1 3 12 8 20 3 3 25 30 27 57 4 8 12 17 17 34 1 -. 1 35 28 11 39 2 6 8 13 10 23 - - - 45 18 5 23 1 — 1 12 3 15 - — - 55 20 5 25 2 - 2 14 5 19 2 - 2 65 and upwards 3 5 8 1 — 1 3 3 6 — 1 1 Totals 131 88 219 22 34 56 75 50 125 11 10 21 Deaths from non-pulmonary forms of tuberculosis formed 14.4 per cent. of the total deaths from the disease. 56 PERIOD 1ST JANUARY, 1933, TO 30TH DECEMBER, 1933. The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population of the 275 cases notified or otherwise reported, and of the 146 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 62 39 101 14 17 31 76 56 132 176 42 28 70 5 5 10 47 33 80 107 South 69 49 118 8 17 25 77 66 143 181 33 22 55 6 5 11 39 27 66 83 Ward 1 25 8 33 4 7 11 29 15 44 179 19 8 27 1 1 2 20 9 29 118 2 12 12 24 7 4 11 19 16 35 215 9 4 13 3 - 3 12 4 16 98 3 18 9 27 1 3 4 19 12 31 175 10 8 18 - 2 2 10 10 20 113 4 9 10 19 2 4 6 11 14 25 184 7 3 10 2 1 3 9 4 13 95 5 7 10 17 2 3 5 9 13 22 136 4 8 12 1 2 3 5 10 15 93 6 18 11 29 1 3 4 19 14 33 178 11 7 18 2 - 2 13 7 20 108 7 4 3 7 — 2 2 4 5 9 109 2 1 3 - 1 1 2 2 4 48 8 13 14 27 2 7 9 15 21 36 202 4 5 9 1 3 4 5 8 13 73 9 25 11 36 3 1 4 28 12 40 191 9 6 15 1 - 1 10 6 16 76 Boro' 131 88 219 22 34 56 153 122 275 — 75 50 125 11 10 21 86 60 146 — Rate per 100,000 populn. 180 108 142 30 42 36 210 150 — 179 103 62 81 15 12 14 118 74 — 94.8 57 In the tables on pp. 65 to 67 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 275 new cases notified or reported in 1933 is summarised below:— Localisation of Disease. Pulmonary (219) Glands (12) Shoulder 1 Lungs 213 Cervical 9 Spine 1 Lungs and Glands 2 Mesenteric 1 Trochanter 1 Lungs and Larynx 1 Facial 1 Wrist 2 Lungs and Meninges 1 Unspecified 1 Chest Wall (1) Lungs and Hip 1 Skin (1) Abscess 1 Mediastinal Glands 1 Back 1 Uro-Genital (7) Brain (9). Abdomen (7) Genitals 2 Intestines 2 Kidneys 2 Peritoneum 5 Suprarenals 1 Meninges 9 Bones and Joint (15) Testicle 1 Urinary tract 1 Eyes (2) Arm 1 General (2) Hip 4 Knee 2 Miliary 2 Eyes 1 Leg 2 Iris 1 Rib 1 Total 275 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 7 years 1927-1933:— Year. Not notified (dead). Notified after Death. Notified on Form i. & ii. (Primary Notification not received). Reported from other sources Total. 1927 12 14 - - 26 1928 8 10 2 3 23 1929 13 13 1 7 34 1930 10 12 1 2 25 1931 17 14 2 7 40 1932 18 21 1 15 55 1933 14 15 2 6 37 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 1933 in this connection. Deaths from Tuberculosis. The death-rate from Tuberculosis was considerably lower in 1933 than in the previous year, being 94.8 per 100,000 population, 58 as compared with 1045 in 1932, 108.3 in 1931, 100.8 in 1930, 127.3 in 1929, and 98.1 in 1928. This is the lowest rate yet recorded in Battersea, the previous lowest being in 1926, when it was 96.6 and in 1928 when it was 98.1 per 100,000 population. During 1933 deaths from Tuberculosis registered as belonging to the Borough of Battersea numbered 146, 125 (i.e. 85.6 per cent.) being due to pulmonary tuberculosis, 9 (i.e. 6.2 per cent.) to tubercular meningitis and 12 (i.e. 8.2 per cent.) to other forms of the disease. The allocation of the deaths in 1933 according to age and sex, and in the Wards and Sub-Districts is shown on pp. 55 and 56. In 1932 the number of deaths from tubercular diseases was 164 and it will be noted that there was a considerable decrease in 1933 in the mortality from Tuberculosis as compared with the previous year. Of the fatal cases 12 were not notified until one month before death; in 15 cases the notifications were received after death, and in 14 cases no notification was received. Of the 14 cases in respect of which no primary notification was received 12 (3 pulmonary, 9 non-pulmonary) were patients who died in hospitals or infirmaries. One of the remaining 2 cases was under treatment by a private medical practitioner; and 1 was the subject of post-mortem examination and enquiry by the Coroner, without inquest. Of the 15 cases notified after death 7 (5 pulmonary, 2 nonpulmonary) were from Public Assistance Institutions; 6 cases (4 pulmonary, 2 non-pulmonary) died in other hospitals, and the remaining 2 cases (pulmonary) died at home. The death-rates per 100,000 of the population during the 30 years ended 1930 in quinquennial averages and in the individual years 1931 to 1933 are given in the following table :— Years. Pulmonary. NonPulmonary. Total. 1901-1905 134.8 49.2 184.0 1906-1910 116. 41.8 158. 1911-1915 124. 33. 158.0 1916-1920 134. 30. 164.8 1921-1925 92. 23. 115. 1926-1930 91. 14. 105. Average (30 years) 115. 32. 147. 1931 89. 18. 108. 1932 89. 14. 104.5 1933 81. 13. 94. It will be seen from the foregoing table that (except during the war years) there has been a steady decline in the mortality rate from Tuberculosis. 59 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 1933. The report of the Tuberculosis Medical Officer is set out in the appendix (pp. 114-122). Staff Engaged on Tuberculosis Work. The staff engaged on 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 pneumo-thorax refills, &c. The Dispensary treatment of school children is carried on in close co-operation with the School Medical Service, and the Springwell House Open Air School on Clapham Common North Side, has, in this connection, carried on useful work during the year, particulars of which will be found in the report of the Tuberculosis Medical Officer on p. 120. 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. 120 to 122. 60 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 1933 was 50, and 257 attendances were made, the average attendance per session being 5.14. The net cost to the Council during the financial year 1933-34 for this service was £104 6s. 6d. Full details of the work carried out are given in the report on the work of the Dispensary in the Appendix (p. 126). The annual contribution made by the London County Council towards the cost of the dispensary treatment of tuberculosis, was superseded in April by a new scheme formulated by the County Council, which provided for a fixed amount to be paid annually for a period of three years (and thereafter revised), subject to certain conditions and to an undertaking to be given by the Council. The amount to be paid annually by the County Council under this revised scheme for the three financialy ears 1933-6 was fixed at £1,037, as compared with a grant made during the year 1932-3 of approximately £953. 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. (See pages 114, 118.) At the request of the London County Council, the Council, in March, agreed to co-operate more closely with that body in the administration of a scheme designed to remove difficulties as to (i.) supply of extra nourishment, (ii.) admission of patients to the County Council's hospitals, and (iii.) reference of cases to the Tuberculosis Dispensary. Subsequently the Council agreed, on the invitation of the London County Council, to permit the Tuberculosis Officer to act as honorary consultant for tuberculosis in one of the general hospitals of the County Council. The principal work carried out at the Dispensary during 1933 is summarised as follows:— Patients and Attendances. The number of new patients was 508 (367 adults, 141 children), and the number of contacts examined was 189 (88 adults, 101 children), 19 of whom were kept under observation and were entered on the Dispensary roll as new patients. There were 21 patients (20 adults, 1 child) transferred from other areas during the year who attended the Dispensary, making a total of 718 new patients and contacts. Of the 548 new patients, 197 were found to be tuberculous, including 2 new cases discovered amongst the 189 contacts examined. 61 The total number of attendances at the Dispensary during the year was 3,545, as compared with 3,741 in 1932. Visits to the homes of dispensary patients were made by the Tuberculosis Officers in 215 instances, and 4,080 visits were made by the Dispensary nursing staff. The number of deaths of dispensary patients was 106 as compared with 110 in 1932. Thirty-five of the patients were discharged as "recovered" or "diagnosis not confirmed" during the year, and 23 others ceased to attend, in addition to 69 patients who removed to other districts. Institutional Treatment. The scheme of the London County Council for the provision of institutional treatment for tuberculous patients was modified bv them as from 1st April, 1933, when the distinction previously made between "municipal" and "tuberculosis scheme" patients ceased to operate. The number of patients who received institutional treatment under the scheme was 152, and the average length of stay was 110 days. The average period of waiting before admission was 11 days. Of these patients, 96 were discharged during the year, leaving 56 under treatment at the end of the year. Definite improvement as a result of institutional treatment was shown in 55 cases. Thirty patients discharged themselves while undergoing institutional treatment. Contributions of patients undergoing institutional treatment were collected by the Dispensary and remitted to the L.C.C. to the amount of £638 17s. 6d. Artificial Pneumo-thorax Treatment. The number of dispensary patients who received artificial pneumo-thorax treatment during the year was 52, as compared with 37 in 1932, and the refills given numbered 829, the cost to the Council amounting to £435 4s. 6d. Examinations and Reports. Sputum examinations made during the year numbered 888, of which 326 were received from medical practitioners. The number of positive results was 193, or 21.7 per cent. Reports to public bodies were made to the number of 1056. Consultations with medical practitioners at the homes of patients and reports made on patients sent to the Dispensary totalled 698, while reports received in respect of insured persons numbered 77 (Form G.P. 36, 77, form G.P. 17, 0). There were 161 patients referred to hospitals, including 138 sent to St. Thomas's for X-ray examination. 62 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 4 cases treatment was completed, and 3 cases remained under treatment at the end of the year. The average period of treatment in the completed cases was 71 days, and the result of the treatment in these cases is shown on page 119. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. Statistics. In the Appendix (pages 129 to 135) 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 1933, 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 1933, arranged according to the years (from 1921 to 1933) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. NON-DISPENSARY CASES. The following particulars relate to notified cases of Tuberculosis not on the roll of patients attending the Tuberculosis Dispensary, some of whom were subsequently transferred to the Dispensary. These cases are systematically visited by the male and female Sanitary Inspectors. Women and Children. During 1933 the number of new cases notified (including 9 notified after death) and not attending the Tuberculosis Dispensary was 83 (women 63, children 20). There were 13 other cases among women and children which came to the knowledge of the Medical Officer of Health, 6 upon registration of the deaths and 7 by information as to the removal of the patient into the Borough. There were 30 deaths (including 10 of tubercular meningitis) recorded amongst these 96 cases. In 17 cases death had occurred prior to the first visit and 13 deaths were subsequently recorded during the year. The following table gives the age and sex distribution of the 96 women and children (non-dispensary cases) notified or otherwise reported to be suffering from Tuberculosis (all forms) during 1933 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. 2 - 2 - - - - - - - - 4 F. 1 1 1 1 3 15 17 7 4 4 4 58 Tubercular Meningitis m. 1 1 1 - - - - - - - 3 F. — 4 1 - - - - - - - - 5 Other Forms m. - - 3 1 - - - - - - - 4 F. — 2 3 2 5 — 5 5 — — — 22 Total M. 3 1 5 2 — — — — — — 11 F. 1 7 5 3 8 15 22 12 4 4 4 85 Grand Total 4 8 10 5 8 15 22 12 4 4 4 96 63 The home conditions of 93 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 1.16. In 4 cases, however, the conditions were found to be unsatisfactory, the patient's family occupying only a single room. Of the new cases notified during the year 52 were receiving hospital, sanatorium, or other form of institutional treatment at the time of notification. At the end of 1933 there were 101 women and children nondispensary patients (a decrease of 7 as compared with 1932), including new cases notified during the year, on the register, and 562 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, 62 cases were transferred, 52 of these being new cases. Adult Male Patients. There were 101 adult male patients not on the Dispensary roll on the register at the end of 1933. There were 94 new cases notified (including 2 notified after death) and 11 otherwise reported during 1933, and of these 14 died during the year. The following table gives particulars of the 105 non-dispensary new (male) cases coming to the knowledge of the Medical Officer of Health by notification or otherwise in 1933:— Age Distribution. All ages. 16-20 20-25 25-35 35-45 45-55 55-65 65 up Pulmonary 4 14 23 13 17 17 3 91 Tubercular Meningitis - - - - - - - - Other tubercular Diseases 3 1 4 2 1 2 1 14 Total 7 15 27 15 18 19 4 105 The homes of the patients were systematically visited during the year by the District Sanitary Inspectors, and 215 visits, including 103 first visits to new cases were paid. Seventeen of the new cases were found to have died on the first visit. Of the new cases 51 were receiving institutional treatment at the time of notification. Fifty-four patients (including 43 new cases) were transferred to the Dispensary during the year. 64 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary under the provisions of these Regulations during 1933. Revision of Tuberculosis Register. In accordance with the suggestion of the Ministry of Health the Tuberculosis register is periodically revised, and during 1933 the names of 42 patients were, after medical examination and consideration of their history, removed from the register, as compared with 132 in 1932. 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 1933 four children were boarded out under the scheme. 65 Form T137 1933. Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933, in the area of the Metropolitan Borough of Battersea (to which this return relates). Age Periods. Formal Notifications. Number of Primary Notifications of New Cases of Tuberculosis. Total Notifications 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males — — 2 — 10 16 27 27 17 16 1 116 164 „ Females — 2 2 2 7 19 25 9 5 5 4 80 117 Non-Pulmonary Males 1 — 2 1 2 1 4 2 1 — 1 15 17 „ Females - 1 4 3 4 1 8 6 — — — 27 28 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) NOTES—Part 1. (a) Formal notifications are notifications which are made in pursuance of Article 5 of the Public Health (Tuberculosis) Regulations, 1930, or by Naval, Military or Air Force Medical Authorities in pursuance of Section 5 (b) of the Local Government (Emergency Provisions) Act, 1916. (b) Primary notifications for the purpose of columns (2)—(13) relate to patients who have never previously been formally notified in the area to which the Return relates. A patient who changes his residence from one Sanitary District to another in the same County may properly be the subject of Primary Notification in each such District. Only the first of such notifications, however, should be recorded in columns (2)-(13) of the Return for the County concerned, the subsequent notification(s) being included in column (14). (c) Column (14). All formal notifications, whether duplicate or not, should be included in this column. General.—Patients notified as suffering from combined pulmonary and non-pulmonary tuberculosis should be included among the "pulmonary" returns only. If a patient already notified as suffering from one form of tuberculosis is subsequently notified to the Medical Officer of Health of the same Sanitary District as suffering from another form of tuberculosis, the fact should be noted in the Notification Register, but such notification should be recorded as a duplicate notification. 66 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 2 — — — - 2 3 1 1 4 2 15 „ Females 1 — — — — 9 2 2 — — 1 8 Non-Pulmonary Males — 1 1 — 2 1 — — — 2 — 7 „ Females — 5 1 — 1 - — — — — - 7 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death Returns from local Registrars 2 5 transferable deaths from Registrar-General 3 4 Posthumous notifications 11 4 " Transfers " from other areas (other than transferable deaths) 5 1 Other sources if any (specify).—Form II. (discharge notices) 2 — NOTES.—Part II. (a) New cases of tuberculosis first coming to knowledge otherwise than by formal notification may, in some instances, afterwards be formally notified under the Regulations. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the Medical Officer of Health, it should be recorded as a "Primary Notification," and excluded from the Supplemental Return. If the formal notification is received in a subsequent year, such notification should be regarded as duplicate, as the case has already been included in the Supplemental Return for a previous year. (b) A formal notification which is not received until after the death of the patient should be included in the Supplemental Return as a "posthumous notification." (c) 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."—(cf. Head 3 of the second section of Part III. of the form overleaf.) (d) No case should be includ 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. 67 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, 1933, on the Register of Notifications kept, by the Medical Officer of Health of the Metropolitan Borough 436 339 775 161 150 311 1,086 Number of cases removed from the Register during the year by reason inter alia of :— 1. Withdrawal of notification 3 2 5 1 2 3 8 2. Recovery from the disease 8 6 14 12 9 21 35 3. Death 79 53 132 15 10 25 157 NOTES.—Part III. In Counties, the information should be compiled from the quarterly statements for the year 1933, 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. 68 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 1933 numbered 58, as compared with 75 in 1932, a decrease of 23 per cent. There was a corresponding decrease in the zymotic death-rate from 0.478 in 1932 to 0.376 in 1933. The mean death-rate from each of the principal zymotic diseases for the ten years 1913-1922, and for the ten years 19231932, are compared with the corresponding rates for 1932 and 1933 in the following table:— Zymotic Diseases Number of Deaths from each of the principal Zymotic Diseases in 1932 and 1933, with corresponding Death Rates for those years and for the 10 years 1913-22 and 1923-1932. No. of Deaths. Death-rate " per 1,000 population. Mean Death-rate per 1,000 population. Increase ( + ) or Decrease (-), 1933 over 1932. 1933. 1932. 1933. 19131922. 19231932. Previous year. 19231932. Small Pox - - - - - .001 - - .001 Measles 23 1 .147 .006 .364 .137 - .141 - .131 Scarlet Fever 4 6 .025 .039 .044 .026 + .014 + .013 Diphtheria 9 12 .057 .078 .187 .108 + .021 - .030 Whooping-cough 11 12 .070 .078 .194 .097 + .008 - .019 Enteric fever — 2 — .013 .018 •005 + .013 + .008 Diarrhoea and enteritis 28 25 .179 .162 .467 .156 - .017 + .006 Total 75 58 .478 .376 1.274 .533 - .102 - .154 The death-rate from zymotic diseases was 0.207 in 1931, the lowest yet recorded in Battersea, but rose in 1932 to 0.478, and declined to 0.376 in 1933. 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. 69 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 1933 there were 790 cases of chicken-pox reported, as compared with 422 in 1932, 492 in 1931, 469 in 1930 and 441 in 1929. Diarrhoea. During 1933 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 1932 there were also 22 deaths and a fatality-rate of 0.14. The rate per 1,000 registered births in 1933 was 9.72 as compared with 9.49 in 1932, 3.63 in 1931, 7.92 in 1930, and 8.40 in 1929. Seven of these deaths occurred in the Nine Elms, and 5 in the Winstanley Wards, where proper means of storage and protection of food from contamination are, generally speaking, absent or unsuitable. Influenza. There were 71* deaths registered as being due to Influenza during 1933, as against 40 in 1932, 56 in 1931, 14 in 1930, and 138 in 1929. The mortality-rate was 0.46, as compared with 0.25 in 1932, 0.35 in 1931, 0.09 in 1930, and 0.85 in 1929. Influenzal Pneumonia was rather more prevalent in 1933 than in the previous year, 86 cases being notified as against 60 in 1932, 67 in 1931, 43 in 1930, and 140 in 1929. The death-rate was 0.22 per 1,000 of the population, as compared with 0.13 in 1932, Cancer. During 1933 the number of deaths of Battersea residents from Cancer was 289 (males 138, females 151) as compared with 268 in 1932, 283 in 1931, 242 in 1930, and 243 in 1929. The death-rate from the disease per 1,000 of the population was 1.88. The deaths from cancer constitute 15.0 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 1933 1.88 * 34 of these deaths were ascribed to Influenzal Pneumonia. 70 The following table shews the localisation of the disease in the case of the 289 deaths recorded in 1933. Localisation. No. of deaths. Total. Percentage of Total. Male Female Buccal cavity 11 1 12 4.15 Stomach, liver, peritoneum, intestines and rectum 68 63 131 45.33 Respiratory system 19 3 22 7.61 Female genital organs — 37 37 12.80 Breast — 35 35 12.11 Skin - 2 2 0.69 Genito-urinary organs (male) 33 — 33 11. 42 Other and unspecified organs 7 10 17 5.89 Total 138 151 289 100.00 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. 59, 119) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1933 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 1,960 (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 221 1,725 1,943 Enteric fever — 12 12 Tuberculosis — 1 1 Gonorrhoea - 1 1 Total 221 1,739 1,960 The cost of these examinations is borne by the Council, and in 1933 amounted to £252 12s. 11d., as compared with £236 16s. 8d. in 1932. 71 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1933. Total Sanitary Operations 65,355 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 6 Number of house inspections 33,862 House to house inspections 589 Bakehouse inspections 200 Bakehouse nuisances abated 70 Dust receptacles provided 736 Urinals—inspections 84 Leaky house-roofs and gutters repaired 697 Do. altered, repaired or water laid on 30 Houses supplied with water and fittings repaired 86 Intimation notices (Sec. 3) 3,239 Notices served under Sec.4, Ac. 1,188 Houses let in separate tenements on register 66 Notices served under Secs. 62 & 65 2,413 No. of inspections of do. 591 Complaints received and attended to 3,865 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 27 Premises disinfected 2,471 Houses supplied with disinfectants 445 Cisterns covered, cleansed and repaired 150 Certificates of disinfection granted 5,011 Additional water supplies to upper floors 14 Overcrowding abated 30 Premises improved, cleansed and repaired 2,281 Keeping of animals in unfit state discontinued 9 Drains tested By smoke 651 Smoke observations 13 Do. water 1,696 Proceedings ordered by Council and Health Committee 3,250 Drains cleansed and repaired 404 Drains relaid 136 Summonses issued 29 Drains laid to new houses and tenements 188 Magisterial Orders obtained and enforced 14 Houses inspected and certificates granted (Sec. 48) 188 Factories, Workshops, &c., inspections 3,989 Frontage drains constructed or re-constructed 34 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 52 Soil pipes and drains ventilated 177 Sink and rain-water pipes disconnected or repaired 220 Underground sleeping rooms: Use discontinued 1 Water closets cleansed and repaired 629 Defects remedied 1 Cesspools abolished 2 Gipsy van inspections 41 Mews and stables drained and paved 4 Samples taken under the Food and Drugs (Adulteration) Act 1,200 Yards and forecourts paved and repaired 341 Miscellaneous 2,021 72 Legal Proceedings. Legal proceedings in connection with nuisances, &c., were taken by the Council in 28 cases during 1933. Particulars with regard to each case are set out below. Public Health (London) Act, 1891 and By-Laws made thereunder. Nature of Offence or Claih Result of Proceedings. Nuisance at No. 44 Gonsalva Road, viz. :—dampness to wall of ground floor front room. Nuisance at No. 7 Gladstone Terrace, viz. :—want of proper water supply to premises. Nuisance at No. 17 Tyneham Road, viz. :—dampness in walls and defective condition of flooring in basement back room. Nuisance at No. 143 High Street, viz.:—defective condition of drains Caused to be carried by road offensive matter otherwise than in a suitable carriage or vessel on. 20th June, 1933, at Green Lane. Nuisance at No. 125 Lavender Sweep, viz.:—dirty condition of walls and ceiling of ground floor scullery, &c. Nuisance at No. 38 Wadhurst Road, viz. :—stoppage to rain-water pipe, leaky roofs, &c. Did on 5th July, 1933, expose for sale in Brougham Street certain fruit to wit : gooseberries, grapes and pineapples, in such a condition as to be liable to be seized and be condemned as unfit for the food of man. Nuisance at No. 51 Sleaford Street, viz. accumulation of rubbish in house and in yard, dirty condition of premises throughout, and animals, to wit, a number of rabbits, kept in such a manner as to be a nuisance. Nuisance at No. 7 Orville Road, viz. :—defective plaster and paper of walls, defective condition of passage floor, defective and leaky roof. Summons withdrawn, nuisance having been abated. Costs £2 2s. Order to abate nuisance in 14 days. Costs £1 Is. Summons withdrawn, nuisance having been abated. Costs £2 2s. Adjourned sine die. Discharged under Probation of Offenders Act, 1907. Summons adjourned sine die. Nuisance having been abated, summons withdrawn. £2 2s. costs allowed to the Council. Vendor fined 20s. Summons against alleged proprietor of fruit withdrawn. Order to abate nuisance in seven days. £2 2s. costs allowed to the Council. Order to abate nuisance in 14 days. £1 1s. costs to be paid by Defendant. 73 Public Health (London) Act, 1891, &c.—continued. Nature of Offence or Claim. Result of Proceedings. Nuisance at No. 9 Orville Road, viz. :—defective condition of ceiling and hearth to fireplace, defective and leaky roof, &c. Nuisance at No. 11 Orville Road, viz. :—defective condition of sashes to windows and plaster of walls, &c. Nuisance at No. 11 Orville Road, viz. :—defective floor of ground floor passage, &c. Nuisance at No. 13 Orville Road, viz. :—recurring burst water pipe in top floor kitchen, causing dampness. Nuisance at No. 15 Orville Road, viz. :—Defective condition of fire grate to first floor back addition room. Nuisance at No. 17 Orville Road, viz. :—dirty walls and ceiling of top floor back addition room, defective and leaky roof, &c. Nuisance at No. 6 Orville Road, viz. :—defective plaster and paper of walls, &c. Caused to be carried by road offensive or noxious matter during prohibited hours on 14th October, 1933, at St. Johns Hill. Nuisance at No. 8 Howie Street, viz. :—defective ceiling, verminous walls and broken sash cords in first floor front rooms, &c. Nuisance at No. 34 Gideon Road, viz. :—dilapidated dirty condition of walls and ceilings of passage and staircase. Failure to abate nuisance, i.e. defective condition of drains at Nos. 53 and 55 Sheepcote Lane, after notice served under the Act. Failure to abate nuisance at No. 29 Webbs Road, i.e. defective condition of range in ground floor kitchen, defective condition of flushing apparatus to w.c. on first floor, after service of notice under the Act. Order to abate nuisance in 14 days. £1 Is. costs to be paid by defendant The like. The like. Summons withdrawn. Fined 40s. Order to abate nuisance in 14 days. The like. Nuisance having been abated, summons withdrawn. £2 2s. costs to be paid by Defendant. Fined £1. Dismissed, as no proper service of summons proved. (Nuisance since abated.) Order to abate nuisance in seven days. Costs £2 2s. allowed to the Council. By consent adjourned sine die. Nuisance having been abated since service of summons and fl Is. costs paid before hearing, summons withdrawn. 74 Metropolis Management Acts, 1855 and 1899. Drainage By-laws made by the L.C.C. thereunder. Nature of Offence or Claim. Failing to deposit with the Council plans in duplicate of re-construction of drainage system at No. 299 Lavender Hill. Failing to deposit with the Council plans in duplicate of the re-construction of the drainage system at No. 2 Garfield Road. The like at No. 32 Currie Stieet. Result of Proceedings. Fined £1, defendant undertaking to deposit the plans within 7 days. Summons dismissed under Probation of Offenders Act, 1907. Summons dismissed. Milk and Dairies Order, 1926. Milk and Dairies (Consolidation) Act, 1915. Nature of Offence or Claim. Jnlawfully did on 9th October, 1933, carry on the trade of a Dairyman in the Borough without being registered. Result of Proceedings. Cautioned under the Probation of Offenders Act, 1907. Food and Drugs (Adulteration) Act, 1928. Sale of Milk Regulations, 1901. Nature of Offence or Claim. Selling milk deficient in fat to the extent of 13 per cent. Selling milk to the prejudice of the purchaser which upon analysis was found to be 13 per cent, deficient in fat. Result of Proceedings. Fined £1. Fined £5 and £5 5s. costs. Merchandise Marks Acts, 1887 to 1926. Merchandise Marks (Imported Goods) No. 4 Order, 1929. Nature of Offence or Claim. Exposing for sale imported raw tomatoes and apples without any indication of origin. Result of Proceedings. Fined 10s. 75 Summary of Legal Proceedings. Legal Proceedings were taken by the Council in connection with the work of the Health Department in 28 cases during 1933. Acts and Regulations under which Proceedings taken. Cases. Persons prosecuted including employees. Convictions. Fines. Costs. Public Health (London) Act, 1891, and by-laws made thereunder 21 16 10 £ s. d. £ s. d. 6 0 0 13 18 0 Metropolis Management Acts 3 3 1 1 0 0 - Food and Drugs (Adulteration) Act, 1928 2 2 2 6 0 0 5 5 0 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 1926 1 1 - - - Merchandise Marks Acts 1 1 1 0 10 0 — Total 28 23 14 13 10 0 24 3 0 New Legislation, &c. During 1933, the following new Acts and Orders affecting the work of the Public Health Department came into force :— (a) Acts of Parliament— (1) Housing (Financial Provisions)Act, 1933. (2) Pharmacy and Poisons Act, 1933. (3) Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. (4) Slaughter of Animals Act, 1933. (b) Orders— (1) The Transfer of Powers (London) Order, 1933. (2) Various Orders made under the Agricultural Produce (Grading and Marking) Acts and relating to— Apples. Asparagus. Black currants. Bottled fruits. Brussels sprouts. Bunched carrots. Cabbage lettuce. Canned fruits. Canned vegetables. Celery. Cheshire cheese. Gooseberries. Green peas. Honey. Jam. Loganberries. Malt extract and malt flour. Pears. Plums. Raspberries. Red currants. Wheat flour. 76 The Transfer of Powers (London) Order, 1933. By virtue of powers contained in the Local Government Act, 1929, the Minister of Health issued the Transfer of Powers (London) Order, 1933, which came into force on 1st April, and which transferred to the Metropolitan Borough Councils certain functions previously exercisable by the London County Council, relating to the following matters :— Common Lodging Houses.—Licensing inspection and regula tion (vide p. 76). Seamen's Lodging Houses.—Licensing, inspection and supervision (vide p. 77). Cowhouses.—Licensing of dairymen to use premises as a cowhouse (vide p. 87). Slaughter-houses and Knackers' Yards.—Licensing and inspection (vide p. 87). Offensive Trades.—Consideration of and decision upon applications for sanction to the establishment anew or enlargement of certain offensive businesses (vide p. 80). Infant Life Protection.—Reception of notices by persons who undertake for reward the nursing of infants; inspection of dwellings where nurse children are maintained; fixing number of children who may be kept in any such dwellings, and application to a Court of Justice for an order directing the removal of an infant to a place of safety (vide p. 44); and certain other matters not coming within the purview of the Public Health Department. Upon the Order coming into force the Council delegated the new duties imposed upon them, as far as legally permissible, to the Health Committee, and the Medical Officer of Health was appointed as the person to undertake certain statutory duties. The Council also adopted rules relating to the licensing of the various persons and premises dealt with by the Order. These matters are referred to in greater detail under the headings relating to the various subjects. Common Lodging Houses. The Transfer of Powers (London) Order, 1933, which is referred to above, placed upon the Council, as from the 1st April, 1933, functions previously exercised by the London County Council, including the registration, licensing, inspection and regulation of common lodging houses and the enforcement of the by-laws made by the London County Council relating thereto, but not the power of making such by-laws. 77 The Health Committee were empowered by the Council to exercise on their behalf the powers transferred and the Medical Officer of Health was appointed to inspect and approve houses in respect of which application for registration was received, and the Sanitary Officers of the Council were authorised to enter common lodging houses. The common lodging houses in Battersea are three in number, and details relating thereto are set out in the following table :— Premises ledgers authorised. Inspections. Notices. Prosecutions. Served. Complied with. Males— 75 Falcon Road 67 23 - - - 134 High Street 54 24 — — — Females. 67 Winstanley Rd. 66 9 — — — Total 187 56 - — — Systematic inspection has been carried out of these houses for some years by the Council's inspectors, and, generally speaking, they have been found to be in a sanitary condition and conducted in accordance with the requirements of the by-laws. Applications for the renewal for one year of the existing licences were granted by the Committee in June. The Council in September adopted rules relating to the procedure to be adopted in dealing with applications for licences. Seamen's Lodging Houses. By the Transfer of Powers (London) Order referred to on page 76 the Council were empowered to enforce the by-laws made by the London County Council as to seamen's lodging houses, to licence and inspect such premises, and to supervise their sanitary condition, in accordance with the by-laws for the time being in force. There are, however, no seamen's lodging houses in the Borough 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. 78 During the year new drains were constructed to 266 new buildings, or additions to existing buildings, and the drains of 136 old buildings were partially or entirely reconstructed, under the supsrvision of the Officers of the Department. During 1933, 17 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 £126 8s. 9d. In 11 cases liability was repudiated, and 3 cases were still under consideration at the end of the year. The total number of plans of proposed drainage work deposited during 1933, as compared with 1932, was as under :— Re-construction or repair of existing 1933 1932 drains 96 94 New buildings or additions to existing buildings 79 92 175 186 In 2 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 one case the required plans were submitted before the summons was issued, and in the other the defendant was fined £1 (vide p. 74). In 20 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 require2 ments of the drainage by-laws. These cases were reported to the Health Committee, and except in 2 instances, satisfactory explanations having been received from the builder responsible, the Committee ordered the offenders to be cautioned. In two cases legal proceedings were instituted by order of the Committee, the result of which will be found set out on page 74. During the year 1933, 651 drains were tested by smoke of which 85 were found defective. The water test was applied on 1,696 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and ventilating pipes were reconstructed or repaired in 177 instances. Water closets were provided in 17 cases and existing closets repaired in 629 cases. The total number of drains relaid during the year was 136. Those cleansed and repaired numbered 404. 79 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 1933-34 was as follows :— House refuse. Tons. Trade refuse. Tons. Burned at destructor 1,160 1,100 Removed by barge 28,622 2,084 29,782 3,184 The Council is continuing its policy of 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 66 premises in Battersea registered as houses let in separate tenements and 591 inspections of these premises were made in 1933. Sanitary Conveniences attached to Licensed Premises. During 1933 the number of public-house urinals under inspection was 119. In 76 instances the accommodation is accessible to the general public as well as the users of the houses, and in 43 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 8 notices were served to remedy defects discovered, and were duly complied with. Smoke Nuisances. During the year 13 observations were made and 6 complaints received. Eleven preliminary notices were served by the Council under the provisions of the Public Health (Smoke Abatement) Act, 1926, to abate smoke nuisances. Effluvium, &c., Nuisances. No legal action was found necessary during the year with regard to nuisance from effluvium. 80 Offensive Trades. By the Transfer of Powers (London) Order, 1933, the Council were entrusted with the duty, hitherto carried out by the London County Council, of considering and deciding upon any application made to them for sanction to the establishment anew or enlargement of certain offensive businesses, or the imposition, modification or removal of conditions relating to the conduct of such businesses. There are three scheduled offensive trades carried on in Battersea, viz. : fat melters 2, soap boilers 1, all of which have been established for many years and are generally well-conducted. The Council in September adopted rules relating to the procedure to be followed in dealing with any application for the establishment anew or enlargement of such scheduled trades. During the year six inspections were made of the registered premises in the Borough. Removal of Offensive Matter. The by-laws of the Lohdon County Council with regard to the removal of offensive matter are enforced by the Borough Council. During the year three cases of contravention of the by-laws were reported, and the Committee in one case ordered the offender to be cautioned. In the other two cases, by direction of the Committee, legal proceedings were instituted against the offenders, the result of which is set out on pp. 72-3. Water Supply. During 1933 certificates of water supply in respect of 188 houses or tenements were issued in accordance with Section 48 of the Public Health (London) Act, 1891. In 14 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 1933 was 68. 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* 9 7 Mills' Yard, Culvert Road 19* 19 21 164 Falcon Road (rear of) 8 16 6 Manley's Yard, Cabul Road 29 26 31 82 Usk Road (rear of) 1 1 1 Van dwellings are frequently inspected. Two vans were unoccupied. * Including Sheds. 81 Rag Flock Acts, 1911 and 1928. These Acts were passed to prevent the use of material known as rag flock, unless such material complies with the standard of cleanliness laid down in the Act. No proceedings were taken under these Acts in Battersea during 1933. 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 1933 under the Council's Rat Repression Scheme is summarised as follows :— Premises visited 1,687 Contracts made or renewed 12 Poison baits used 20,600 Dead rats found 1,050 Value of contracts £180 7 0 Cash for poison bait £7 6 6 Total expenditure (financial year 1933-34) ... £499 4 9 Income (financial year 1933-34) £151 16 6 Drains were tested at 120 premises in connection with this work, and in 106 cases defects of more or less serious character were found. 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" (6th to 11th 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. The results were good, considerable numbers of rats being found dead. 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. 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. Personal Cleansing Station. During the year 1933, there were 3,385 children and 223 adults cleansed and treated at the station. Of the 3,385 children attending, 635 were suffering from scabies or itch, a contagious parasitic 82 skin affection. The remainder were verminous. Of these children 3,324 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. The Committee, at the request of the Lambeth Borough Council, agreed to provide facilities for the cleansing of inmates of common lodging-houses in Lambeth referred for the purpose. 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 1933 223 3,385 821 400 15,713 77,269 £13,048 £6,701 * Financial year ending 31st March. 83 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1933. Total premises disinfected 2,471 Rooms disinfected 3,381 Staircases disinfected 180 Schools disinfected 20 Number of articles laundered 38,486 „ „ destroyed 3,943 ,, verminous, etc., persons (including 3,324 school children) 3,608 „ infectious disease contacts 1,200 „ library books collected 494 Articles. No. Weight. Tons. cwts. qrs. lbs. Bedding, &c., disinfected 63,808 122 16 0 1 Ditto (articles from shelters and Cleansing Station) 18,226 (not weighed) Bedding, &c., lent 1,556 4 15 2 0 Verminous clothing, &c. 8,476 1 18 2 14 Articles from Welfare Centres 2,126 (not weighed) Total 94,192 129 10 0 15 Staff. Dr. Bach, the Resident Medical Officer of the Borough Maternity Hospital, left the Council's service in June, and in the same month Dr. K. Aylwin-Gibson was appointed to the post. During the year the department has also sustained the loss, by superannuation, of three of their older officers, viz.: Miss A. Moss, health visitor and sanitary inspector, who retired in June after 26 years' service; and Messrs. J. J. Burgess and H. H. May, sanitary inspectors, who were superannuated in April after 26 and 39 years respectively. Miss E. M. Hoyles, Health Visitor, resigned her appointment in January, and Miss K. Morrison, District Midwife, in December. Miss H. A. Blackburn and Miss B. E. Prager were appointed in April to fill the two vacancies on the Health Visiting staff, and in October Miss B. L. Kaye, Health Visitor, was appointed Sanitary Inspector also. 84 Mr. I. R. Lewis was appointed Workshops Inspector in April, the other vacancy on the Inspectorial staff being still vacant at the end of the year. Pending consideration of the question of filling this vacancy a revision of the districts to which the Sanitary Inspectors are assigned was made, the result being shewn on page 3. Survey of Health Services. The Ministry of Health, in pursuance of powers conferred by the Local Government Act, 1929, gave notice in November of the appointment of two of their medical officers to conduct a survey of the Public Health and Maternity services of the Council. The survey was commenced on the 4th December, and was in progress at the end of the year. Coroner's Court and Mortuary. During the year the Public Mortuary was still further improved by the installation of refrigerating plant for the preservation of bodies awaiting burial or identification, &c. Further improvements which were contemplated in the shape of increased ventilation and the installation of electro-motor fans were postponed until the financial year 1933-34. In view of the fact that Battersea has been made by the London County Council one of the principal Centres in London for the holding of inquests, the increased number of bodies received at the Mortuary rendered these improvements essential if the usefulness and efficiency of the Mortuary were to be maintained. An interesting and illustrated account of these additions was published in the Lancet of the 18th November, 1933, which appears to have stimulated interest amongst other Sanitary Authorities, several of them having sent representatives to inspect these improvements, which will no doubt result in greater attention to the sanitary and more seemly conduct of public mortuaries. The refrigerating plant consists of two compartments, the larger holding twelve bodies in four tiers, being maintained at a temperature of 34° F., and the smaller accommodating six bodies at a temperature of 20° F., the temperature in each compartment being adjustable. The compartments are separately controlled and are fitted with sliding body racks in lacquered metal, the whole construction being designed to secure the maximum cleanliness. 85 Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1933 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 46 75 34 5 160 Post-mortem elsewhere 13 41 20 3 77 No post-mortem 18 40 14 1 73 Body not received 2 5 6 1 14 Post-mortem at Mortuary— No inquest (Coroner's certificate) 68 109 20 2 199 No inquest (doctor'scertificate) — — — — — Other bodies received— Sanitary reasons 5 4 2 — 11 Total bodies received 150 269 90 11 520 Total inquests held 79 161 74 10 324 Total post-mortems held at Mortuary 114 184 54 7 359 VERDICTS AT INQUESTS HELD— Natural causes 18 21 11 2 52 Accident and Misadventure— Abortion—Shock Anaesthesia, Operation, etc. — 2 4 6 Asphyxia 3 4 2 - 9 Burns and scalds 4 7 11 Drowning — 2 2 - 4 Fall 10 31 5 46 Overlying 1 — — - 1 Injuries (various) 2 10 1 - 13 Poisoning—Coal gas — 1 — - 1 „ Food ,, Lead — Railway and street 24 36 28 1 89 Open Verdict— Asphyxia — — — - — Blow Burns Drowning 1 — 5 1 7 Fall 1 I — - 2 Inattention at birth Pneumonia Poisoning—Carbon monoxide 1 3 — - 4 „ Drugs, &c. — 3 1 1 5 Railway — — 1 - 1 Still-born 5 5 Sepsis following Abortion 1 — — — 1 Unknown cause — — '— — Suicide— Cut throat 4 2 6 Drowning 1 1 4 — 6 Electrocution 1 — 1 Firearms 2 2 Hanging 2 2 1 — 5 Jump from high place 1 1 — — 2 Poisoning—Coal gas 4 23 1 — 28 „ Drugs, &c. 5 5 5 — 15 Railway — — — — — Homicide— Abortion (Sepsis) — 1 1 — 2 Grand Total 79 161 74 10 324 86 Protection of Food Supply. INSPECTION AND SUPERVISION OF FOOD. Unsound Food. The following is a tabulated return of unsound foods which, under the provisions of Section 47(8) of the Public Health (London) Act, 1891, were brought to the notice of the Sanitary Inspectors and voluntarily surrendered during 1933:— Food. Quantity. Food. Quantity. Fish. Fruit & Vegetables. Crabs 1 barrel. Apples 5 boxes. Dogfish 10 ¾ stones. Celery 31½ bundles. Melts 1 box. Pears 13 cases and Roe 3 boxes. 6 boxes. Wings 5 stones. Tomatoes 120 boxes. Miscellaneous. Meat & Poultry. Sweets... 185 lbs. Cooked Meat 3 pieces. Corned Beef 1 tin. Ham 1 tin. Pig 1 Pigs' heads 14 Pig's head and collar 1 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. Eight cases of suspected food poisoning were notified to the Medical Officer of Health during the year, 2 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. Slaughter of Animals Act, 1933. This Act, which came into force on the 28th July, 1933, and is enforceable in London by the Metropolitan Borough Councils, contains provisions requiring that animals shall be instantaneously slaughtered or stunned before slaughter by a mechanically 87 operated instrument. This requirement is only to be applied to sheep by resolution of the local authority; and they are given power to exclude goats from the operation of the requirement. Local authorities are also given power to license slaughtermen' their licences to be available throughout England and Wales. The right of inspection of slaughterhouses and knackers' yards is given to the Medical Officers of Health and Sanitary Inspectors. The Council, on 22nd November, resolved that the section with regard to humane slaughtering should apply from 1st January, 1934, to sheep, ewes, wethers, rams and lambs, the Health Committee having previously, by request, received a deputation from the London Retail Meat Traders' Association upon the subject. The Council also decided not to exclude goats and kids from the Act. During the year four applications for licences by slaughtermen employed in the Borough were granted. Cow-houses. The duty of licensing dairymen to use premises as a cow-house or place for keeping cows was one of the functions of the London County Council which were transferred to the Metropolitan Borough Councils by the Transfer of Powers (London) Order, 1933. There are, however, now no cow-houses in the Borough. Slaughterhouses and Knackers' Yards. As from 1st April, 1933, the duty of licensing knackers and slaughterers of cattle and horses, and the premises used by them, was transferred to the Metropolitan Borough Councils by the Transfer of Powers (London) Order, 1933, referred to above. The Council adopted rules regulating the procedure to be adopted in dealing with applications for such licences, and the licences relating to the two existing slaughterhouses in the Borough, which expired in October, 1933, were extended to 30th June, 1934. These two slaughterhouses have for many years been kept under systematic inspection by the sanitary inspectorial staff, and during the year 1933, 136 inspections were made by the Council's inspector. The carcases of 168 animals (calves 1, sheep 78, and pigs 89) were examined after slaughter. 88 No contravention of the Public Health (Meat) Regulations or the By-laws in regard to slaughterhouses was reported during the year. There are no knackers' yards in the Borough. Butchers' Shops. The number of butchers' shops in the Borough at the beginning of the year 1933 was 101. Five new premises were opened during the year making 106 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 1,550 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. It was not found necessary during 1933 to institute legal proceedings for any contravention of the Public Health (Meat) Regulations, 1924, but a cautionary letter was, by order of the Committee, addressed to a street vendor whose stall failed to comply with the requirements of the Regulations. 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 1933 was 785, of which 8 or 1 per cent, were certified by the Public Analyst to be adulterated. In addition to the foregoing, 415 informal samples were procured, of which 2 or 0-5 per cent, were reported by the Public Analyst as 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. 89 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 1933 10 0.5 It will be seen from this table that the percentage of adulteration of all samples, formal and informal, 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 1. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Butter 8 41 49 0 0 0 Cheese — 4 4 — 0 0 Cocoa — 16 16 — 0 0 Coffee — 7 7 — 0 0 Confectionery — 12 12 — 0 0 Cream — 29 29 — 0 0 Flour — 3 3 — 0 0 Flour, Self-raising — 12 12 — 0 0 Jam and Marmalade — 14 14 — 0 0 Lard — 5 5 — 0 0 Margarine — 43 43 — 0 0 Milk 767 — 767 6 — 6 „ Separated 1 — 1 0 — 0 „ Condensed (Full Cream) - 9 9 - 0 0 „ „ (Machine Skimmed) - 2 2 - 0 0 Sugar — 4 4 — 0 0 Tea — 15 15 — 0 0 Vinegar 6 - 6 0 — 0 Drugs — 7 7 — 0 0 Other Articles 3 192 195 2 2 4 Total 785 415 1200 8 2 10 90 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Cream of Tartar 3 3 0 0 Ointment, Boric — 4 4 — 0 0 Total — 7 7 — 0 0 TABLE III. Other Articles. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Arrowroot 4 4 0 0 Custard Powder — 12 12 — 0 0 Dripping — 11 11 — 0 0 Fish Paste — 6 6 — 0 0 „ Tinned — 7 7 — 0 0 Flavouring essence — 2 2 — 0 0 Fruits, dried 2 26 28 1 1 2 „ tinned —• 4 4 — 0 0 Ginger, ground — 3 3 — 0 0 Jelly, table — 8 8 — 0 0 Junket Crystals — 3 3 — 0 0 Lemonade Powder — 8 8 — 0 0 Meat, minced — 4 4 — 0 0 Oatmeal — 4 4 — 0 0 Oats, crushed — 1 1 — 0 0 Olive Oil — 7 7 — 0 0 Peel, Candied — 8 8 — 0 0 Pepper — 7 7 — 0 0 Rice — 15 15 — 0 0 Sago — 1 1 — 0 0 Sardines & Tomatoes — 4 4 — 0 0 Sauce, Tomato — 3 3 — 0 0 Sausages 1 10 11 1 1 2 ,, preserved — 3 3 — 0 0 Soup, Desiccated — 4 4 — 0 0 Sponge Cakes — 12 12 — 0 0 Spice, Mixed — 7 7 — 0 0 Tapioca — 1 1 — 0 0 Vegetables, tinned — 3 3 — 0 0 Wines non-alcoholic — 4 4 — 0 0 Total 3 192 195 2 2 4 Milk. Of the 768 samples of milk (all formal and including 1 sample of separated milk) submitted during the year, 6 or 0.8 per cent., were reported as adulterated, 4 of these samples being deficient in 91 milk fat and 2 containing extraneous water. The percentages of extraneous water found in the 2 adulterated samples were 1 £ per cent, and 4i per cent, respectively, whilst the deficiency in milk fat in the four samples so reported against ranged from 2 to 13 per cent. In the 5 years 1928-32, and in 1933, the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1928 668 21 3.2 1929 603 11 1.8 1930 707 18 2.5 1931 777 28 3.6 1932 760 13 1.7 Mean 703 18.2 2.6 1933 768 6 0.8 A considerable proportion of the milk supply of London is received at Clapham Junction and the South Lambeth 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 89. The average composition of the 761 samples of milk (all formal), excluding separated milk, reported as genuine, proved to be as under:— Total milk solids 12.38 per cent. Milk fat 3.61 „ Not-fatty solids. 8.77 „ The content of milk fat in these 761 samples ranged as follows: 4 per cent, and over 67 samples or 8.8 per cent. Between 3.9 and 4.0 per cent. 38 „ „ 5.0 „ „ 3.8 „ 3.9 „ 57 „ „ 7.5 „ „ 3.7 „ 3.8 „ 87 „ „ 11.4 „ „ 3.6 „ 3.7 „ 119 „ „ 15.6 „ „ 3.5 „ 3.6 „ 129 „ „ 170 „ „ 3.4 „ 3.5 „ 125 „ „ 16.4 „ „ 3.3 ,, 3.4 „ 87 „ „ 11.4 „ „ 3.2 „ 3.3 „ 34 „ „ 4.5 „ „ 3.1 „ 3.2 „ 12 „ „ 1.6 „ 3.0 „ 3.1 „ 6 ,, „ 0.8 „ 761 100.0 92 All samples were systematically tested for the presence of preservatives and colouring matter but with negative results. Milk sampling was carried out on 6 Sundays during the year, and 33 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 51 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 104 were taken in course of delivery to hospitals and elementary schools in the Borough, one of which was certified to be deficient in milk fat to the extent of 13 per cent. The result of the proceedings in this case are set out on p. 74. 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 18 samples of milk were taken for bacteriological examination. Of these 15 were of certified or pasteurised milk, and 3 of ungraded milk. The results of the bacteriological examination showed that 15 of the samples complied with the requirements. In three cases the samples were reported against as under:— Certified milk—Containing bacteria in excess of the permitted number, and containing bacillus coli. Grade A (Tuberculin tested) milk—Containing excess bacteria. Pasteurised milk—Containing excess bacteria. Appropriate action was taken in regard to these samples. Six 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 5 Battersea milk purveyors in regard to 11 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 two instances of fat abstraction, particulars relating to which will be found set out in the tables on page 74. Condensed Milk. During the year 11 informal samples of Condensed Milk were submitted for examination, of which 9 were described as "fullcream" and 2 as "machine-separated." All were found to be genuine and to comply with the requirements of the Public Health (Condensed Milk) Regulations, 1923. 93 Cheese. Four informal samples of Cheese were examined during the year. All were reported as genuine. Butter. Eight formal and 41 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 49 samples proved to be 14.5 per cent., and the statutory limit of 16 per cent, was not exceeded in any case. Margarine. The 43 samples of Margarine examined during the year were all procured informally. They proved to be genuine and their average water-content amounted to 14.1 per cent. No sample contained moisture in excess of 16 per cent. Rice. Fifteen informal samples of rice were procured and submitted to the Public Analyst and all were reported as genuine. Vinegar. Six formal samples of vinegar were submitted to the Public Analyst, and all were reported to be genuine. Pepper. Seven samples (all informal) of pepper were examined and found to be genuine. Dried Fruits. During the year 28 samples of dried fruits (2 formal and 26 informal) were purchased and submitted to the Public Analyst. Of these, 1 formal and 1 informal sample of raisins were found to contain preservative in excess of the amount permitted by the Public Health (Preservatives, &c., in Food) Regulations. Proceedings were ordered by the Committee against the vendor of the formal sample but were subsequently withdrawn on legal advice, by order of the Health Committee. Sausages and Minced Meat. Eleven samples of sausages (10 of which were procured informally) were examined by the Public Analyst, and two samples (one formal, one informal) were found to contain a sulphite preservative, and should therefore have been described as "preserved." The vendor of the formal sample was, by direction of the Health Committee, cautioned. Samples of sausage labelled "preserved" were also procured informally and submitted to the Public Analyst. Four samples of minced meats were certified on analysis to be genuine. 94 Desiccated Soups. Four informal samples of desiccated soup were procured for analysis during the year, all of which were reported to be genuine. Drugs. The number of samples of drugs submitted to the Public Analyst for analysis during the year was 7 (all of which were informal samples) and comprised 2 varieties. In each case the sample was found to be genuine. Ice Cream. There are 204 premises in the borough in which ice cream is manufactured, stored or sold, 26 of these being occupied by Italian vendors. Thirty-eight new premises were registered during the year and 6 were removed from the register on discontinuance of the business, the number of registered premises therefore being increased by 32. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 350 inspections were made and 20 notices were served (14 intimation and 6 statutory) for cleansing of premises. The improved conditions under which this commodity is now prepared and sold in Battersea, referred to in previous annual reports, are on the whole being maintained. Milk and Dairies Order, 1926. The provisions of the above-named Order continued to be enforced by the Council during the year under report. Legal proceedings were instituted against a milk vendor who was found to be trading in Battersea without having been registered (vide p. 74); and in four cases cautionary letters were addressed to vendors in respect of offences, viz.: trading in Borough without being registered therein (1 case), and failure to have the vendor's vehicle conspicuously inscribed with his name and address (3 cases). Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to issue licences to others than producers (i.e., persons producing milk for sale from herds over which they have control). The licences so granted are available for a period up to the end of the year in which they were issued. There is a scale of fees payable to the Licensing Authority by applicants for licences. 95 The number of licences in force during 1933 was as follows:— Full. Supplemental. Certified milk 11 2 Grade A (Tuberculin tested) milk 53 3 Grade A milk 5 1 Pasteurised milk 69 3 138 9 Two licences to bottle Grade A (T.T.) milk, one to bottle Grade A milk, and four 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 92. Milk Shops. The number of premises registered in Battersea for the sale of milk is 126 (including 7 wholesalers' premises). Three premises were removed from the register on discontinuance of the sale of milk. In 16 cases registration was transferred on account of change of proprietorship. There are also 8 premises registered for the sale of cream only. All milk shops are kept under systematic inspection and during the year 688 inspections were carried out and 20 notices (15 Intimation and 5 Statutory) were served to remedy defects found on inspection. These mainly referred to dirty premises. Forty-two 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 175 premises registered in which milk in sealed receptacles only is sold. 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 1933 contraventions of the Regulations were reported in the case of 4 samples, 2 of dried fruits and 2 of sausages, which are referred to on page 93. 96 Preserved Food Premises. The duty of registering premises in which preserved foods are prepared or manufactured was imposed upon Metropolitan Borough Councils by the London County Council (General Powers) Act, 1932. In addition to the 156 premises registered in 1932 (70 of which were provisionally registered only), 31 new premises were placed upon the register during 1933, and 1 removed. Ten of the provisional registrations referred to were not confirmed and the number of registered premises at the end of the year was therefore 176. Export of Food. During 1933 the Medical Officer of Health, acting as certifying officer, issued one certificate for the export of meat food products manufactured in Battersea to Uruguay. Agricultural Produce (Grading and Marking) Act, 1928. During 1933 additional orders relating to the grading and marking of 22 varieties of foodstuffs were made by the Ministry of Agriculture and Fisheries (vide page 75). No legal action was found necessary during the year under review in regard to the various Orders made under the Act. Food Premises. The by-laws which the London County Council were empowered to make under the provisions of the London County Council (General Powers) Act, 1932, for promoting sanitary and cleanly conditions in the manufacture, storage, transport or exposure for sale of any article intended to be sold for food, and which are referred to in the Annual Report for 1932, had not been drafted at the end of the year under report. 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. Eleven offences were reported during 1933 and in 1 case proceedings were instituted against a trader for a breach of the Orders relating to tomatoes and apples. Cautionary letters were, by order of the Committee, addressed to the offenders in the 10 other cases. 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. 97 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 80 (eight more than at the end of 1932). All these premises are kept under systematic inspection. Three hundred and twenty inspections were made during 1933 and 21 notices (14 intimation and 7 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 1933 was 126. During the year 411 inspections were carried out and in 51 cases it was found necessary to serve notices (including 11 statutory notices) to remedy various defects. Street Stalls for Sale of Food. There are 207 street stalls in the borough for the sale of foodstuffs of varied character, namely: vegetables and fruit 141, refreshments (coffee stalls) 10, fish and poultry 16, meat and rabbits 5, sweets 8, and other foods 27. 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. In one case, also referred to on page 88, the proprietor of a street stall was cautioned in respect of an offence against the Public Health (Meat) Regulations, 1924; otherwise no offences against the statutory requirements with regard to the food exposed on these stalls were reported during the year. Inspections numbering 194 were made of the premises used by street vendors for the storage of their stocks, and 15 intimation and 10 statutory notices were served to remedy defects found. 98 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) 819 82 - Workshops (including Workshop Laundries) 659 63 _ Workplaces (other than Outworkers' premises included in the Table on page 102) 2,134 162 - Total 3,612 307 _ 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 144 137 - - Want of Ventilation 1 1 - - Overcrowding 3 3 - - Want of drainage of floors - - - - Other nuisances 127 121 - - Sanitary accommodation Insufficient 1 - - - Unsuitable or defective 54 52 - - Not separate for the sexes - - - - 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) 1 1 - - Total 331 315 - -- 99 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1933:— Bakehouses 9 Bootmakers 33 Dressmakers 17 Laundries 3 Milliners 6 Tailors 42 Other Trades 184 Total number of workshops 294 4.—Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 10 Notified by H.M. Inspector Nil Underground Bakehouses (Section 101), in use at end of the year 20 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1933:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 52 250 33 42 36 Barge builder 3 22 — — - Bootmaker 45 76 5 — — Builder 4 70 4 — — Butter blender 1 208 20 38 35 Chaff & forage 2 33 — 10 - Chemical works 3 183 5 94 17 Coachbuilder 4 13 — — — Cycle maker 2 4 — — — Dyer 2 47 4 39 4 Engineer 21 1,060 137 21 37 Firewood cutter 12 41 5 18 — Flour mills 2 127 6 12 — Foundry 2 28 2 — — Lift maker 2 33 3 — — Mason 7 384 44 — — Mineral water 2 18 3 30 — Motor repairer 22 229 12 9 — Printer 21 81 21 23 8 Steam laundry 16 82 6 483 143 Other trades 92 3,930 554 1,494 494 Total 317 6,919 864 2,313 774 100 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. Nine new factory premises were added to the register during the year, dealing with various trades, and 2 were removed. During the year 63 preliminary and 19 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 1933:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 9 9 12 2 - - Blind maker 4 5 11 — — — Bootmaker 33 33 38 - — — Carpenter 4 4 8 1 - — Coach builder 6 9 25 — — — Cycle maker 8 12 17 3 — 3 Dressmaker 17 21 — — 43 9 Embroiderer 1 2 — — 11 — Farrier & smith 9 9 17 — — — Firewood cutter 3 3 4 1 — — Laundry 3 8 2 — 5 — Mason 3 3 5 — — — Milliner 6 6 — — 14 — Motor repairer 24 27 67 5 — — Musical instrument maker 3 4 9 - - 2 Photographer 4 7 4 — 2 1 Picture framer 3 5 3 — — — Rag sorter 23 39 49 4 22 — Saddler 1 1 1 — — — Tailor 42 50 60 7 47 3 Upholsterer 13 13 25 — 8 — Other trades 75 98 172 13 50 9 Totals 294 368 529 36 202 27 101 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 1933 the number of inspections amounted to 138. Forty-four intimation and 19 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 5 intimation notices were served by the female inspector. Fourteen new workshops were added to the register, dealing with the following trades:— Blindmaker 1 Motor repairer 1 Bootmaker 2 Rag sorter 2 Dressmaker 2 Toy maker 1 Coach builder 1 Upholsterer 2 Florist 2 The following are particulars relating to workshops in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector during 1933:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Dressmaker 2 5 2 7 Milliner 1 2 — 2 Florist 2 5 2 7 Outworkers. During 1933, 396 names and addresses of outworkers were received in 101 lists sent in by employers and by the Medical Officers of Health of Metropolitan Boroughs and District Councils. 77 names and addresses relating to 41 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:— 102 Number on Register. Persons Trade. Employed. Premises. Workrooms Bootmaker 15 16 24 Tailor 32 35 70 Other trades 1 1 1 Total 48 52 95 There were no new male outworkers' premises registered during the year, but 4 were removed from the register. There were 54 inspections made of male outworkers' premises during 1933, and it was found necessary to serve one notice under the Public Health (London) Act, 1891, to remedy sanitary defects found on inspection and one statutory notice was also served and complied with. No case of infectious disease was notified during 1933 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 1 1 Dressmaker 31 32 40 Embroiderer 29 29 31 Fancy boxes 6 6 6 Fancy goods 3 3 3 Fine needlework 5 5 5 Glovemaker 1 1 1 Knitting and crochet 2 2 2 Milliner 3 3 3 Tailor 18 20 34 Underclothing 3 3 3 Other trades 15 15 15 Total 117 120 144 103 The number of new female outworkers' premises (not previously registered) registered during the year was 24, and there were 26 removed from the register. Inspections of female outworkers' premises were made, by the woman workshops' inspector (Miss Round) to the number of 323. It was found necessary to serve two notices under the Public Health (London) Act, 1891, to remedy defects. Two cases of infectious disease, viz.: scarlet fever and erysipelas were notified from female outworkers' premises. Such precautionary measures as were necessary were taken to prevent spread of infection in these cases. Bakehouses. There were 61 bakehouses on the register at the end of 1933. Of these 52 use power, and are therefore technically factories. Forty-one of the bakehouses are above ground, and 20 are under ground. One bakehouse was removed from the register, being no longer so used, and 3 were added, all these being above ground. Inspections made during the year numbered 200, of which 182 were to factory bakehouses, and 42 intimation and 12 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 1933, there were 57 premises on the register, including railway yards. These premises were systematically inspected during the year, and 87 inspections were made. Three intimation and 1 statutory notice were served to remedy nuisances found on inspection. All these notices were complied with. 104 Home Work, 1933. nature of work outworkers' lists, section 107. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Secs. 109, 110) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workers. Contractors. Workers. Wearing Apparel- (1) Making 38 25 105 4 — 5 45 — — 3 2 — 2 — — (2) Cleansing & Washing 4 — 4 — — — 4 — — — — — — — — Furniture and Upholstery 4 2 7 — — — 4 — — — — — — — — Other Trades 2 — 12 1 — 1 4 — — — — — — — — Total 48 27 128 5 — 6 57 — — 3 2 — 2 — — Note.—The 161 names in this table include only 45 workpeople residing in Battersea, the remaining names being either duplicates or those of workers residing outside the Borough. The names of 105 additional Battersea outworkers were included in the lists furnished by Medical Officers of Health of other Boroughs. There were, therefore. 150 Battersea home-workers named in the lists. 105 Housing. During the year 1933 progress was made with the housing situation in Battersea, especially in the direction of the provision of new working-class dwellings on the St. John's College Estate, the Hope Street and Darien Road sites. Special attention was also given to slum clearance areas in connection with the survey report on the housing needs of the district required by the Housing Act, 1930, which was submitted by the Medical Officer of Health to the Council in 1932. The Health Department of the Council also had under consideration the question of the survey of additional insanitary areas, with a view to securing, as far as practicable, that such areas should be dealt with in order of urgency. Several areas not included in the report of the Medical Officer of Health above referred to were under consideration during the latter part of 1933 and the early part of 1934. With a view to meeting their obligation to re-house displaced tenants the Council decided to acquire the Stewarts Lane site, consisting of 36 mainly worn-out, old-fashioned single-storey cottages, occupied by 45 families, by a compulsory purchase Order, which, after a local inquiry, was approved by the Minister of Health. Arrangements are being made for the demolition, as soon as practicable, of the houses on this site, and for the erection thereon of approximately 101 working-class tenements, which, when completed, will materially assist in the provision of alternative accommodation for decanting purposes. During the year interviews were had with the Ministry and the London County Council, and the Chairman and Officers of the Housing Committee of the London County Council visited, in conjunction with theHousing Committee, several of the areas under consideration, notably Nine Elms. In the case of one of the areas, viz., Didcot Street, originally represented in 1920, the London County Council have intimated their intention of themselves dealing with this area in view of the proximity of the site to their East Hill Estate. It is anticipated, therefore, that early in 1934 some, at least, of these areas will be proceeded with and that the clearance, so long overdue, of many of these old, worn-out and insanitary properties in the Borough will be gradually accomplished under the extended powers contained in the 1930 Housing Act. New Working-Class Dwellings. St. John's College Estate. It is satisfactory to report that the St. John's College Estate, which has been briefly described in previous annual reports, was completed during the year, and that all the tenements thereon are now fully occupied. 106 This estate is set out in five blocks, and comprises 272 tenements—8 of two rooms, 115 of three rooms, 114 of four rooms, 32 of five rooms, and 3 of six rooms, and provides accommodation for 272 families of approximately 1,391 persons. The estate, which is situate in an open part of the Borough at the corner of Vicarage Road and Green Lane, and close to the river Thames, is a notable contribution to the housing needs of the Borough, and will relieve to some extent the serious overcrowding which, since the war, has been such a difficult problem to deal with. Houses Erected by Private Enterprise. During the year 5 houses (2 in St. James's Road and 3 in Thurleigh Road) were erected by private enterprise. Clearance Areas. Plough Road Improvement (Extension) Scheme. The site of the Hope public house, the adjoining three shops and the land at the rear of them, which formed part of the Plough Road insanitary area originally represented by the Medical Officer of Health in 1920, but which at the time was not agreed to by the Minister of Health, was subsequently acquired by the Council. It was decided to erect 17 flats (9 of three rooms and 8 of four rooms) in two blocks on the cleared site, and the erection of these tenements was rapidly proceeded with during the year, and it is anticipated that they will be completed by the early part of 1934. This block provides a useful extension of the Plough Road Improvement Scheme. The Housing (Financial Provisions) Act, which received Roya' assent in May, abolished the Government subsidy in respect of all schemes not approved prior to the 7th December, 1932, unless the Minister was satisfied that the scheme was substantially ready for submission by that date. As the erection of these tenements was considered prior to 7th December, 1932, application was made for a subsidy and the Minister approved the scheme for this purpose, provided the tenements were completed by 31st March, 1934.* The amenities of this area have been further improved by the acquisition of the buildings at the corner of Plough Road and York Road, thus enabling the road to be widened and rendered safer for pedestrians and traffic in this very congested industrial district of the Borough. Darien Road Site. As mentioned in my previous annual report, a demolition Order was made by the Council in respect of No. 7 Darien Road, but in view of the risk to the adjoining property this house could not, at the time, be demolished. The Council, however, decided to acquire the site occupied by Nos. 1 to 11 (odd) Darien Road, with a *In view of unforeseen difficulties the buildings could not be completed by this date, and the Minister agreed to an extension of the date of completion until 30th June, 1934. 107 view to erecting new tenements on the site. The purchase of the property was completed during the year, and in November plans were approved for the erection of 12 working-class tenements, each containing four rooms. It was anticipated that these tenements would be completed early in 1934. Stewarts Lane Site. This site, to which reference has been made in previous annual reports, consists mainly of old fashioned one-storey cottages, with long gardens at the rear, and was considered by the Council to be suitable for the erection of working class dwellings, especially with a view to the re-housing obligation in connection with scheduled clearance areas under consideration by this Council. A compulsory purchase Order was made by the Council in July, and after a local inquiry held in November by the Ministry of Health the Order was confirmed. The negotiations for the acquisition of the property were in hand at the end of the year. Other Sites. The following areas, represented with others, in the survey report of the Medical Officer of Health, were under consideration by the Housing Committee during the year. Area. Approximate number of houses involved. Approximate number of families. Approximate number of persons. Nine Elms 155 305 1,301 Sheepcote Lane 84 137 419 Lothair Street 9 14 52 Didcot Street 39 43 241 The Committee have also had under consideration the following additional areas:— Area. Approximate number of houses involved. Approximate number of families. Approximate number of persons. Linford Street 125 186 807 Mendip Road 37 45 169 Ashton's Buildings 20 20 87 Saltdean Place 15 15 53 Bournes Place 14 15 53 Foots Row 20 21 70 Union Terrace 20 27 109 108 The Committee visited these areas, but with the exception of Didcot Street area, referred to on page 105, no definite decision had been arrived at by the end of the year. Housing (Financial Provisions) Act, 1933. The Housing (Financial Provisions) Bill referred to in the Annual Report for 1932, received the Royal Assent on the 18th May. Overcrowding. Some improvement has taken place in the abatement of overcrowding due, in part, to the activities of the Borough Council and to the assistance provided by the County Council. There is, however, considerable room for improvement in certain areas in the Borough, and it is hoped that the action of the Council in providing a certain number of tenements to be let at rents within the means of the tenants requiring them will in time further abate a nuisance which, since the War, has been one of the greatest difficulties with which sanitary authorities have to contend. During the year 38 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 1933. Total. Families accommodated 3* 16 19 Offer declined or applicant otherwise suited 2 9 11 Recommendation not accepted by the London County Council — 6 6 Still under consideration 2 7 9 Totals 7 38 45 * Includes one case in which the recommendation had been previously not accepted by the London County Council. 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 1933 will be found summarised on pages 111 to 113. † Early in 1934, as a result of communications, the London Connty Council intimated that they were willing, on behalf of the Borough Council to make the necessary clearance or compulsory purchase orders in respect of the Sheepcote Lane site. 109 In no case was it found necessary for the Council's Works Department to enter and carry out, in default of the owner, the necessary repairs in compliance with notices served under the Housing Acts. Appeals. During 1933 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. It was not found necessary for the Council to make any Demolition Orders during 1933. The Housing Committee, however, had under consideration the question of making Demolition Orders in respect of 5 houses in Brougham Street, 1 in Sheepcote Lane, and 1 in Berkeley Street. The last mentioned case was under consideration at the end of the year, but in respect of the other cases the Committee agreed to accept the owners' undertakings to render the premises in all respects fit for habitation. Closing Orders. No Closing Orders were made by the Council during 1933. Increase of Rent, Etc., Acts. During 1933 11 applications were received from tenants for the certificate, and 3 from owners for the report of the Sanitary Authority under the above mentioned statutes. The application for a certificate was granted in 8 cases and refused in 3 cases; that for a report was granted in 2 cases. Rent and Mortgage Interest Restrictions (Amendment) Act. The Rent and Mortage Interest Restrictions (Amendment) Bill referred to in the Annual Report of the Medical Officer of Health for 1932 came into law in July, 1933. Action under Section 5 of the Housing Act, 1925. During 1933, in 10 cases (relating to 14 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. 110 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 1933. Street. Houses dealt with Street. Houses dealt with. Street. Houses dealt with. No. 1 District. No. 3 District. No. 4 District—(contd). Dashwood Road 31 Castle Street 3 Mantua Street 2 Church Road ... 3 Meyrick Road... 2 Goulden Street... 1 Newman Street 1 Henning Street 1 Shillington Street 2 Inworth Street... 1 No. 2 District. Octavia Street 2 No. 5 District. Anerley Street 2 Orbel Street 3 Eversleigh Road 1 Austin Road 11 Randall Street 13 Latchmere Road 23 Berkeley Street 1‡ Somerset Street 2 Chatham Street 4 Stanmer Street 27 No. 6 District. Doddington Grove 2 Abyssinia Road 4 Gladstone Terrace 6 No. 4 District. Darien Road 3 Latchmere Street 1 Este Road 3 Hibbert Street 1 Longhedge Street 5 Gwynne Road 1 Hope Street 15 Orkney Street 1 Heaver Road 1 Knox Road 4 Pagden Street 3 Kambala Road 1 Raywood Street 1 Lavender Road 2 Rollo Street 1 Lavender Terrace 1 No. 7 District. Sheepcote Lane 4‡ Lubeck Street 1 Eccles Road 1 Summary. District No. 1 1 street 31 houses ,, „ 2 13 streets 42 „ „ ,, 3 10 „ 56 „ ,, ,, 4 11 „ 17 „ ,, „ 5 2 „ 24 „ ,, „ 6 5 „ 27 „ ,, ,, 7 1 street 1 house ,, „ 8 — — Total 43 streets 198 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 1932. ‡See also page 109 (Demolition Orders). SUMMARY. District No. 1 5 streets 64 houses ,, ,, 2 6 „ 65 ,, „ „ 3 1 street 13 ,, ,, ,, 4 7 streets 23 ,, ,, ,, 5 2 ,, ‡ 25 „ ,, ,, 6 2 „ 13 „ ,, „ 7 1 street 2 ,, ,, ,, 8 1 1 house Total 24 streets 206 houses Statistics for the Year ended 31st December, 1933. Number of New Houses or Tenements erected during the year:— (1) By the Local Authority 183 (2) By other Local Authorities Nil (3) By other bodies and persons 5 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) 6,490 (b) Number of inspections made for the purpose 28,631 ‡ See also page 109 (Demolition Orders). ‡ Including Lavender Hill, partly in No. 7 District. 111 Street. Houses dealt with. Street. Houses dealt with. Street. houses dealt with. No. 1 District. No. 3 District. No. 5 District. Ascalon Street 6 Green Lane 13 Eversleigh Road 24 Dashwood Road 13 Lavender Hill 1 Sterndale Road... 27 Stewarts Road... 17 No. 6 District. Thessaly Square 1 Grant Road 2 No. 4 District. Wayland Road 11 In grave Street 1 No. 2 District. Kerrison Road 1 Brougham Street 5‡ Lavender Road 1 No. 1 District. Culvert Road 1 Nepaul Road 1 Lavender Hill 2 Kennard Street 15 Shillington Street 9 Oulton Street 11 Stainforth Road 6 Raywood Street 9 Totteridge Road 4 No. 8 District. Weybridge Street 24 Leathwaite Road 1 112 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,745 (b)Number of inspections made for the purpose 24,335 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 2,563 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 302 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 13 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 12 (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,367 (2,932 intimation notices) (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,499 (3,053 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 Nil 113 (2) Number of houses in respect of which an undertaking was accepted under sub-section 2 of section 19 6 (3) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) N umber of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (e) Number of representations made to Local Authority with a view to:— (a) Serving of notice requiring the execution of works 105 (relating to 196 houses) (b) The making of Demolition Orders 2 (relating to 2 houses) (c) The making of Closing Orders Nil 114 APPENDIX. TUBERCULOSIS DISPENSARY. ANNUAL REPORT, 1933. To the Medical Officer of Health. I beg to submit herewith a report on the work carried out at the Tuberculosis Dispensary during the year ended 31st December, 1933. There is no change to record in the Dispensary staff during the twelve months under review, and the routine work of the Dispensary has been carried on as in previous years. The number of new patients attending the Dispensary during the year was 548, including 21 patients transferred from other areas. Thus 51 fewer patients attended the Dispensary than in the previous year. This is the lowest number of new patients recorded for many vears, and coincides with the fewest number of notifications received by the Medical Officer of Health since notification was made compulsory and the lowest death rate from Tuberculosis ever recorded in the Borough. The number of "contacts" examined during the year was also lower at 189 compared with 212 in the previous year, 209 in 1931, and 153 in 1930. The fall in the number of "contacts" examined corresponds with the smaller number of new patients examined, but considerable difficulty is still experienced in persuading "contacts" to attend for examination in spite of special efforts made by the staff to invite them. They may attend for examination at any session held at the Dispensary, and a special session has been set aside for them weekly. Of the "contacts" examined 88 were adults and 101 children. Two were found to be suffering from Tuberculosis, and in one other case the diagnosis was not completed at the end of the year. During the year 1933, 152 patients were sent away for institutional treatment under the London County Council's Tuberculosis Scheme. Of this number 96 were discharged during the year, and 56 were still in institutions on the 31st December. Two patients were admitted to hospital for observation with a view to arriving at a definite diagnosis. One was discharged as nontuberculous, and in the other case the diagnosis was not completed at the end of the year. Of the remaining 94 patients three were suffering from Non-Pulmonary Tuberculosis, and 91 from Pulmonary Tuberculosis, and the results of treatment on discharge are set out in Table VI. The average waiting period between recommendation for and admission to institution was 11 days, three days less than in the previous year, and the average length of stay 110 days. Thirty patients were discharged at their own request, a considerably higher number than in the previous year. Of the 115 30 patients who took their own discharge from institutions, 16 were in the B. ii. group—patients suffering from chronic pulmonary Tuberculosis, with Tubercle Bacilli present in the sputum and moderately advanced disease. The method of handling patients in this group constitutes one of the most difficult problems of the Tuberculosis worker, and many of them are in and out of institutions over a period of years. As in previous years doubtful cases of Tuberculosis are sent to St. Thomas's Hospital for X-ray examination and for a further opinion, and if the diagnosis is still not established, observation beds are provided by the London County Council in Brompton Hospital, or some similar institution. Treatment of patients suffering from non-pulmonary Tuberculosis by Artificial Light has been continued during the year. Seven patients have received this form of treatment, and the results are set out in the table below. In my experience the results are disappointing, and compare unfavourably with those obtained under routine sanatorium treatment. I have little doubt that as an adjuvant to Sanatorium treatment in those cases, Artificial Light treatment has a definite value, but I am satisfied that in the majority of cases, in addition to the local treatment, Sanatorium conditions are desirable. The number of patients receiving Artificial Pneumo-thorax treatment increased during the year from 37 during 1932 to 52, and the cost to the Council was £435 4s. 6d. as compared with £235. The number of "refills" given was 829. The list of hospitals with the number of refills given at each during the year is as under. Hospital. Number of Refills. Cost. £ s. d. Brompton 513 269 6 6 St. Thomas's 253 132 16 6 Colindale 18 9 9 0 Margaret Street 9 4 14 6 City of London 3 1 11 6 Miller General 5 2 12 6 Grove Park 28 14 14 0 829 £435 4 6 During the year, at the request of the London County Council, the Tuberculosis Officers of the various Metropolitan Borough Councils have been appointed Consultant Medical Officers for Tuberculosis at the County Council's general hospitals. Following upon this, the Tuberculosis Officer has visited St. James's Hospital, 116 Balham, each week. Many Battersea patients who are unfit for Sanatorium treatment proper are admitted to this hospital, and the contact thus established by the visit of the Tuberculosis Officer has, in my opinion, been of definite value in two ways. Patients are more readily persuaded to enter hospital and, once admitted, are not so likely to take their discharge against medical advice. The Tuberculosis Care Committee has met once a fortnight at Southlands during the year. A summary of the work carried out is appended with several illustrative cases. During the year 548 new patients, including 21 transfer cases from other areas, attended the Dispensary, being 51 less than in the previous year. Of the 548 new patients 166 were found to be suffering from Pulmonary Tuberculosis and 31 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 period of the new patients for Pulmonary and Non-Pulmonary cases classified according to the above headings. As in previous years, it will be noted that in the Pulmonary Group the incidence is highest in the age period 16-25, being 36.7 per cent. of the total cases. Table I. Pulmonary Tuberculosis. Years. 0-5 6-10 11-15 16-25 26-35 36-45 46-55 56-65 over 65 Total. Group t.b. minus 1 1 1 20 10 3 3 4 1 44 Group t.b plus Group I — — — 7 8 4 4 — — 23 Group II — — — 31 18 14 10 9 1 83 Group III — — — 3 2 4 2 5 — 16 Total 1 1 1 61 38 25 19 18 2 166 117 Table II. Non-Pulmonary Tuberculosis. Years. 0-5 6-10 11-15 16-25 26-35 36-45 46-55 56-65 over 65 Total Bones and Joints — 3 1 3 5 1 — — 1 14 Abdominal — — — 1 1 2 — — — 4 Peripheral Glands 1 3 1 2 1 — — — — 8 Skin and Other Organs — — — 2 3 — — — — 5 Total 1 6 2 8 10 3 — — 1 31 Table III. shows the mode of onset of Pulmonary Tuberculosis as elicited from 166 new patients who attended the Dispensary during the year. As in 1932, so during the past year, in a surprisingly large percentage the first symptom of the onset of Pulmonary Tuberculosis, as noted by the patient, was an attack of haemoptysis. The importance of the symptom of blood-spitting, even in small quantities, has already been stressed in these reports, and it is highly desirable that due significance should be given to it both by doctor and patient in order that a thorough investigation of the cause should be made. In more than half the cases, as is to be expected, cough was the symptom of which the patient first complained, and in 14 per cent. the patients dated the onset of the disease to an attack of "Influenza." Table III. Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 91 54.82 "Influenza " 23 13.85 Pleurisy 11 6.63 Pleurisy with effusion 1 0.60 Haemoptysis 32 19.28 Other modes 8 4.82 Totals 166 100.00 118 Table IV. Occupations in the 166 cases of Pulmonary Tuberculosis. Occupation. No. of Patients. Occupation. No. of Patients. Housewives 22 Clerks (various) 19 School Children 2 Travellers 2 Infant 1 Lift Attendant 1 Domestic Workers 6 Milkman 1 Barmen, &c. 3 Store Boy 1 Laundry Workers 2 Telephone Operator 1 Shop Assistants 13 Anaesthetic Maker 1 Needleworkers 3 Instrument Maker 1 Pastry Cooks 2 Window Cleaner 1 Soldiers 4 Cutler 1 Post Office Workers 3 Bill Poster 1 Drivers, Carmen, &c. 4 Grave Digger 1 Engineers (various) 11 Undertaker's Assistant 1 Wireless Workers 5 Warehouse Porter 1 Railway Workers 5 Warehouse Checkcr 1 Painters and Decorators 5 Professional Pianist 1 Plumber 1 Waiter 1 Iron Moulder 1 Sign Writer 1 Stone Mason 1 Night Watchman 1 Carpenter 1 Boot Repairer 1 Labourers (various) 8 Street Musician 1 Factory Workers (various) 12 Auctioneer 1 Caretakers 2 Printer's Apprentice 1 Nurses 3 Unemployed 1 Teachers 2 No occupation 1 Table V. Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. Pulmonary 53 3 110 N on-Pulmonary 8 1 22 Totals 61 4 132 Of the 197 cases, therefore, a history of Tuberculosis in a near relative was elicited in 31 per cent. and in a remote relative in 2 per cent. In all 33 per cent. gave a family history of Tuberculosis. Table VI. Results of Institutional Treatment. Grade. Quiescent. Much Improved. Improved. In statu quo. No material i improvement. Worse. Died. T.C. O.R. T.C. O.R. T.C. O.r. T.C. O.R. T.C. O.R. T.C. o.R. A 5 - 3 - 6 3 - - - 2 - - - B. i 2 - 1 2 8 3 - - 1 - - 1 2 B ii 1 - 9 2 10 5 2 4 1 2 - 3 6 B. iii - - 1 - - 1 - 1 - 1 - - 3 Non-Pulmonary 2 - - " 1 - - " " - - - - T.C. =treatment complete. O.R. = own request. 119 The total number of attendances at the Dispensary during the year was 3,545 compared with 3,741 in the previous year. The number of visits paid by the Tuberculosis Officers was 215 compared with 159 in 1932, and by the Nursing Staff 4,080 as against 4,148. The number of sputum examinations carried out at the Tuberculosis Dispensary during the year was 888, 29 fewer than.in 1932. In 193 cases or 21.7 per cent. Tubercle Bacilli were found to be present. Of the total number of specimens examined 326 were sent by medical practitioners, the remainder representing patients on the Dispensary register. The "number of reports sent to public bodies was 1,056, and consultations with medical practitioners at the homes of their patients and reports on patients sent to the Dispensary numbered 698. 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 77 161 patients were referred to hospitals, 138 of whom were sent to St. Thomas's Hospital for X-ray examination. Definite cases marked off the Dispensary register:— Number of Dispensary patients who died during 1933 106 Number of Dispensary patients who ceased to attend 23 Number of Dispensary patients who removed to other areas (and were transferred to the Medical Officer of Health concerned) 69 Number of patients recovered 33 Number of patients in whom the diagnosis was not confirmed 2 Total removals from Dispensary register 233 Artificial Light Treatment. Tuberculosis Patients. Name. Age. Condition. Period of Treatment. Condition on Discharge or at 31/12/33. N. R. 11 Lupus of Face 27/1/33— 6/3/33 Improved. E. B. 13 Lupus of Face 2/1/33—17/5/33 Improved. M. V. 11 Glands of Neck 10/5/33—29/5/33 Stationary. B. W. 5 Glands of Neck 15/2/33—19/5/33 Improved. S. C. 25 Sinus of Chest and neck 9/10/33— — Stationary. R. S. 7 Glands of Neck 6/11/33— — Stationary. I. C. 8 Glands of Neck 6/12/33 — — Improved. 120 Springwell House Open-Air School. Accommodation 125 On roll 31/12/33 143 Average attendance 119.4 Admitted during 1933 58 Discharged during 1933 41 Reasons for discharge:— Fit for elementary school 2 Fit for work 22 Transferred to Hospital or Sanatorium 7 Removed from district 10 Transferred to Special School — Discharged for other reasons — Tuberculosis Dental Treatment. Total attendances 257 Sessions held 50 Average attendance per session 5.14 Extractions, 57; scalings, 2; fillings, 12; dentures supplied—whole sets, 11; partial sets, 4; repairs to dentures, 8; dressings, 13; advice, 86 (average per session, 3-86). Total 193 The Tuberculosis Care Committee. The following is a summary of the work carried out by the Committee during 1933:— Battersea Borough Council—extra nourishment, 135; dentures, 8 143 Public Assistance Committee—financial assistance, 9; nourishment, 5; clothing, 7; other assistance, 1 22 Charity Organisation Society—financial assistance, 6; clothing, 6; boarding out of children, 1 13 United Services Fund—financial assistance, 7; clothing, 4 11 Other Agencies—financial assistance, 3; enquiries, 4; dentures, 8; clothing, 3; dinners, 1 19 Training and Employment—previous employers, 1; other suitable agencies, 2 3 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 £638 17s. 6d. The following are some illustrations of the work done by the Care Committee throughout the year:— E.S., aged 39. This man had been out of work for six months and living on his National Health Insurance and Sick Club benefits. He attended the Dispensary and was found to be suffering from 121 Tuberculosis, and was advised to accept Sanatorium treatment. He was, however, averse to this as his sick club benefit had then expired and his National Health Insurance benefit was his sole source of income, and this was being reduced to disablement rate within two weeks. His wife was unable to work and he had one child at school, and his youngest child was suffering from Tuberculosis. He was an ex-service man and the Committee took up the matter with the United Services Fund, who granted immediate financial assistance, and also provided the patient with some necessary articles of clothing. An allowance for extra nourishment was given to him by the Borough. Council whilst he was waiting to go away, and an early vacancy was obtained for him. Financial assistance has been granted during the whole of the time the patient has been away, so that he has been enabled to complete his treatment without undue anxiety. J.P., aged 39. Had received sanatorium treatment previously, and had been able to resume work, but his health broke down again and he was urged to accept institutional treatment. His only income when he gave up work was 7s. 6d. National Health Insurance benefit. His wife was at work, but she was only able to earn 23s. per week. There was one dependent child. The total income was above the scale under which the Public Assistance Committee could grant relief, but it was impossible for the wife to carry on, and keep the rent and insurances, &c., paid. She had also to pay for the care of her child during the time she was at work. The patient was in need of suitable clothing, also his wife was unable to give him sufficient nourishment. The Council granted extra nourishment whilst he was awaiting a vacancy. The Care Committee obtained suitable clothing for him, arranged for the child to receive dinners at school, and also gave a grant towards the care of the child during the father's absence. The man was thus enabled to complete the treatment recommended and he resumed work on his discharge. D.M., aged 25. This woman, who was suffering from Tuberculosis, began to lose ground after her return home from Sanatorium treatment. She had friends in Somerset who were willing to have her to stay with them for a period of three to four months, but she had been unable to accept their invitation as she could not afford the railway fare. The Committee, after enquiry into the family circumstances, agreed to grant half the railway fare and to advance the balance, leaving the parents to repay the loan by small weekly instalments. The patient remained away for fifteen weeks, and her case was transferred to the local authority for continuance of treatment, and she returned having derived great benefit from the change. M.B., aged 42. This patient had been in an institution for a considerable time, suffering from Tuberculosis, and it was eventually found impossible to retain her, and she was discharged to her home. Her parents were old age pensioners, and the only son at home was their main support. The patient's only income was derived from 122 National Health Disablement benefit. The Committee arranged for this patient to be granted extra nourishment, and this is renewed when the grant expires. It was also found that owing to her long confinement to bed she needed a special kind of air ring. She had borrowed money and purchased one, but it was unsatisfactory. The Committee, therefore, arranged with a firm of surgical appliance makers for her to be provided with one made specially for her, from which she derived great comfort—the outstanding debt on the previous one being cleared by the Committee, much to the relief of the patient M.C., aged 50. Patient had been ill and unable to work for four years. During that time she had a period of Sanatorium treatment. She was a single woman living with two sisters. Her parents were dead. The patient had only her National Health Disablement benefit, and the eldest sister had no income at all. She was unable to work but assisted in keeping house. The other sister, who was the breadwinner, was badly in need of a holiday, but she would not consent to go away without her sisters. By dint of careful saving, and by working late she had managed from her small earnings to put aside sufficient to cover the cost of board and lodging for two weeks, but she was finding it difficult to get the fares together. The Committee paid the patient's return fare to the seaside, and gave a grant in addition sufficient to give her pocket money during her stay there. With this help the sister was able to complete her arrangements and a very enjoyable holiday was obtained for them all. 123 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 1933 and Previous Years. Year. 1 Population estimated to middle of each Year. 2 Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. Number. 6 Rate. * 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. Number. 4 Rate.* 5 Number 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate.* 13 1923 170,600 3,415 3,434 20.1 2,368 14.0 874 345 170 49 1,839 10.8 1924 171,000 3,180 3,139 18.4 2,506 14.7 858 370 196 62 2,018 11.8 1925 172,100 3,264 3,184 18.5 2,397 13.9 920 328 186 58 1,805 10.5 1926 171,900 3,198 2,969 17.3 2,547 14.8 948 361 183 62 1,960 11.4 1927 169,000 3,099 2,801 16.6 2,773 16.4 1,102 394 150 53 2,065 12.2 1928 164,100 3,054 2,743 16.7 2,674 16.3 1,091 371 176 64 1,954 11.9 1929 161,800 2,877 2,619 16.2 3,314 20.5 1,400 380 164 63 2,294 14.2 1930 160,700 2,880 2,652 16.5 2,716 16.9 1,227 357 145 55 1,846 11.5 1931 159,800 2,788 2,477 15.5 2,745 17.2 1,301 487 142 57 1,931 12.1 1932 157,000 2,649 2,319 14.8 2,642 16.8 1,306 559 134 58 1,895 12.1 1933 154,000 2,682 2,263 14.7 2,839 18.4 1,485 570 112 49 1,924 12.5 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. 124 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 1933. 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 4 ... ... 2 1 1 ... 4 ... 4 ... Diphtheria 396 5 105 230 27 29 ... 247 149 247 148 Membranous Croup ... ... ... ... ... ... ... ... ... ... ... Erysipelas 115 3 2 7 18 66 19 66 49 36 25 Scarlet Fever 826 3 219 497 47 60 ... 483 343 482 331 Enteric Fever 3 1 ... ... ... 2 ... ... 3 ... 3 Continued Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... 2 1 ... 2 1 2 1 Puerperal Pyrexia 14 ... ... ... 6 8 ... 5 9 3 6 Meningococcal Meningitis 4 ... 2 1 ... 1 ... 2 2 2 2 Ophthalmia Neonatorum 16 16 ... ... ... ... ... 10 6 3 1 Polio-myelitis, &c. ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... Polio-encephalitis 1 ... ... 1 ... ... ... 1 ... i ... Malaria ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... Acute Influenzal Pneumonia 86 ... 1 3 12 59 11 46 40 29 22 Acute Primary Pneumonia 274 12 44 38 32 130 18 169 105 110 70 Totals 1.742 40 373 779 145 357 48 1,035 707 919 609 T uberculosis— Pulmonary 196 ... 2 8 52 129 5 89 107 ... ... Non-Pulmonary 42 1 1 10 8 21 1 23 19 ... ... Totals (Tuberculosis) 238 1 3 18 60 150 6 112 126 ... ... Totals 1,980 41 376 797 205 507 54 1,147 833 919 609 Whooping-cough* 613 70 391 151 1 ... ... 345 268 43 34 Measles* 419 24 170 214 9 2 ... 152 267 19 28 Grand Totals 3,012 135 937 1,162 215 509 54 1,644 1,368 981 671 * Notifiable in Battersea from 24th April, 1922 125 TABLE III. Causes of, and Ages at, Death during the Year 1933. CAUSES OF DEATH. All Ages. 0-1 year. 1-2 years. 2-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. 65 years upward. Total Deaths of Residents and NonResidents in Institutions in the District. 1. Typhoid and Paratyphoid Fevers 2 1 ... ... ... ... ... 1 ... 2 2. Measles 1 1 ... ... ... ... ... ... ... 1 3. Scarlet Fever 6 ... ... 2 3 1 ... ... ... ... 4. Whooping Cough 12 4 4 3 1 ... ... ... ... 3 5. Diphtheria 12 1 1 2 7 ... 1 ... ... 1 6. Influenza 71 1 1 1 ... 3 11 21 33 73 7. Encephalitis Lethargica 1 ... ... ... ... 1 ... ... ... 2 8. Cerebro spinal Fever 4 ... ... 2 1 ... 1 ... ... 1 9. Tuberculosis of respiratory system 125 2 ... ... 1 25 57 34 6 142 10. Other Tuberculous Diseases 21 2 3 3 2 7 1 2 1 34 11. Syphilis 3 ... ... ... ... ... ... 1 2 4 12. General Paralysis of the Insane (Tabes Dorsalis) 8 ... ... ... ... 1 1 4 2 6 13. Cancer, Malignant Disease 289 1 ... 1 ... 1 25 122 138 268 14. Diabetes 22 ... ... ... 1 ... 1 3 17 18 15. Cerebral Haemorrhage, etc. 54 ... ... ... ... 1 1 14 38 27 16. Heart Disease 510 ... ... 1 2 ... 14 108 381 528 17. Aneurysm 14 ... ... ... ... 1 2 7 4 6 18. Other Circulatory Diseases 75 ... ... ... ... ... 3 12 60 36 19. Bronchitis 80 1 1 2 1 1 4 24 46 54 20. Pneumonia (all forms) 100 16 8 6 2 1 13 33 * 21 110 21. Other Respiratory Diseases 14 1 ... ... ... 1 ... 7 5 14 22. Peptic Ulcer 18 ... ... ... ... ... 3 9 6 35 23. Diarrhoea, etc 25 21 1 ... ... 1 2 ... ... 37 24. Appendicitis 7 ... ... ... 1 2 ... 2 2 17 25. Cirrhosis of Liver 5 ... ... ... ... 1 1 3 ... 4 26. Other Diseases of Liver, etc. 8 ... ... ... ... ... 2 3 3 12 27. Other Digestive Diseases 25 1 1 1 l 1 2 6 12 52 28. Acute and Chronic Nephritis 72 ... ... ... l 1 9 26 35 125 29. Puerperal Sepsis 4 ... ... ... ... ... 2 ... ... 7 30. Other Puerperal Causes 1 ... ... ... ... ... 1 ... ... 6 31. Congenital Diseases 51 49 ... ... ... ... ... ... ... 60 32. Senility 34 ... ... ... ... ... ... ... 34 36 33. Suicide 21 ... ... ... ... ... 8 13 ... 14 34. Other Violence 67 4 2 ... 8 6 17 13 17 103 35. Other Defined Diseases 161 6 4 6 8 3 18 52 64 211 36. Causes Ill-defined or Unknown 1 ... ... ... ... ... ... ... 1 ... All Causes— M 998 60 15 16 19 38 118 307 425 1093 F 926 52 11 14 22 29 82 213 503 956 Totals 1924 112 26 30 41 67 200 520 928 2049 126 North Battersea. TABLE IV. Infant Mortality, 1933. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 m. f. m. f. m. f. m. f m. f. m. f. m. f. m. f. m. f. m. f. m. f. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... 3 ... 2 ... 10 ... Diarrhoea & Enteritis ... ... ... ... ... 1 ... ... ... ... ... 2 2 1 2 5 1 2 ... ... 5 10 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 4 2 1 3 ... ... ... ... ... 9 5 ... ... ... ... ... ... ... ... 9 5 Congenital Malformation ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 1 ... ... 1 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Atelectasis and Asphyxia Neonatorum 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbilical Sepsis ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Epilepsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... 1 2 Collapse of Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Totals 7 5 2 1 5 1 1 1 ... 1 15 9 5 4 7 7 6 3 3 2 36 25 12 3 6 2 1 24 9 14 9 5 61 Nett Births in the year. Legitimate. Illegitimate. Total. 1,074 56 1,130 Nett Deaths in the year (Infants under 1 year Legitimate. Illegitimate. Total. 56 5 61 127 South Battersea. TABLE IV.—(contd.) Infant Mortality, 1933. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. If. F. M. F. M. F. l«. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... 1 ... 1 2 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 1 1 ... 2 ... 4 2 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 1 ... ... 2 4 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Premature Birth 1 5 4 2 ... ... ... ... ... ... 5 7 ... ... ... ... ... ... ... ... 5 7 Congenital Malformation ... 1 1 ... 1 ... ... ... ... ... 2 1 ... ... ... ... 1 ... ... ... 3 2 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Atelectasis & Asphyxia Neonatorum 1 ... 1 ... 1 ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... 3 1 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbilical Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Collapse of Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Totals 2 7 6 2 3 ... ... ... ... 1 11 10 1 4 2 9 6 3 4 1 24 27 9 1 8 3 ... 1 21 5 11 9 5 51 Nett Births in the year. Legitimate. Illegitimate. Total. 1,088 45 1,133 Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. 49 2 51 128 Borough of Battersea. TABLE IV.—(contd.) Infant Mortality, 1933. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year. Percentage of Total. 1-2 2-3 3-1 1-3 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... 1 ... 1 2 2.68 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.89 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.89 Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 3 3.57 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0.89 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0.89 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 1.79 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.89 Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.90 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 0.89 Pneumonia (all forms) ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 4 1 4 ... 4 ... 14 2 14.29 Diarrhoea & Enteritis ... ... ... ... ... 1 ... 1 ... ... ... 2 2 1 3 8 2 3 ... ... 7 14 18.75 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.89 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.89 Premature Birth 5 9 6 3 3 ... ... ... ... ... 14 12 ... ... ... ... ... ... ... ... 14 12 23.22 Congenital Malformation ... 1 1 ... 1 ... 1 ... ... ... 3 1 1 1 ... ... 1 ... ... ... 5 2 6.25 Congenital Debility ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 2 ... ... ... ... 1 4 4.47 Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 1 ... ... 1 ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 3 1 3.57 Atelectasis & Asphyxia Neonatorum 3 1 1 ... 1 ... ... ... ... ... 5 1 ... ... ... ... ... ... ... ... 5 1 5.36 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbilical Sepsis ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.89 Epilepsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.89 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 0.89 Asphyxia, accidental ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... 1 2 2.68 Collapse of lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.89 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 1.79 Totals 9 12 8 3 8 1 1 1 ... 2 26 19 6 8 9 16 12 6 7 3 60 52 100.00 21 11 9 2 2 45 14 25 18 10 112 ... Percentage of Total 18.8 9.8 8.0 1.8 1.8 40.2 12.5 22.3 16.1 8.9 M.53.6 F.46.4 Nett Births in the year. Legitimate. Illegitimate. Total. M. 1,082 49 1,131 F. 1,080 52 1,132 Totals 2,162 101 2,263 Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. 57 3 60 48 4 52 105 7 112 129 Form T 145 TREATMENT OF TUBERCULOSIS. BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1933. (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 year (excluding contacts):— (a) Definitely tuberculous 84 62 1 2 8 10 3 4 92 72 4 6 174 *(b) Diagnosis not completed - - - - - - - - 8 26 13 18 65 (c) Non-tuberculous — — — — — — — — 83 86 49 61 269 B.—Contacts examined during the year:- (a) Definitely tuberculous 1 - - - - - - 1 1 - - 1 2 *(b) Diagnosis not completed - - - - - - - - - - - 1 1 1c) Non-tuberculous — — - — — — — — 28 59 56 43 186 C.—Cases written off the Dispensary Register as- (a) Recovered 9 2 1 2 5 2 6 6 14 4 7 8 33 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 125 159 117 100 501 D.—Number of cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 337 244 30 38 38 50 87 59 375 294 117 97 883 (b) Diagnosis not completed - - - - - - - - 12 35 14 21 82 1. Number of cases on Dispensary Register on January 1st 968 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 32 3. Number of cases transferred to other areas, cases not desiring further assistance under the Scheme, and cases "lost sight of" 92 4. Cases written off during the year as Dead (all causes) 106 5. Number of attendances at the Dispensary (including Contacts) 3,545 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 162 7. Number of consultations with medical practitioners:— (a) Personal † (b) Other 29 332 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) † 2 5 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,080 10. Number of (а) Specimens of sputum, &c., examined (б) X-ray examinations made in connection with Dispensary work 606 ( + 282 others) 138 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. 130 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 1933 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 rccord made during the year to which the Return relates Previous to 1921 1921—6 1927 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 6 1 - - 1 3 3 4 — 7 1 2 — — 2 F. - 1 2 - 3 5 - 3 - 3 - - - — - Children 9 - - - - 4 1 1 - 2 2 - - — - Disease not arrested. Adults—M. 3 9 4 - 13 2 7 17 2 26 3 1 2 - 3 F. 1 3 1 - 4 4 7 9 3 19 3 - 3 - 3 Children. 2 2 1 - 3 5 1 1 - 2 - - - - - Condition not ascertained during the year 23 5 4 1 10 14 3 4 1 8 — 1 5 6 Total on Dispensary Register at 31st December 44 21 12 1 34 37 22 39 6 67 9 4 10 - 14 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. All classes Adults—M. — — — — 59 7 3 2 — 5 — 1 — — 1 F. - - - - 65 9 - - - - - - - - - Children - - - - 227 8 2 - - 2 - - - — — Lost sight of or otherwise removed from Dispensary Register - 579 108 54 109 39 202 23 3 27 4 34 DEAD. Adults—M. - - - - 246 26 25 145 154 324 2 2 26 23 51 F. - - - - 184 14 15 71 112 198 5 - 20 19 39 Children - - - - 42 8 1 6 6 13 1 - 2 — 2 Total written off Dispensary Register — — — — 1402 180 100 333 311 744 31 6 75 46 127 Grand Totals — — — — 1480 217 122 372 317 811 40 10 85 46 141 131 PULMONARY TUBERCULOSIS—(Contd.). Form T145a—(Contd.). Condition at the time of the last record made during the year to which the Return relates 1928 1929 1930 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus 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) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 3 — 2 — 2 5 1 1 — 2 2 — - — — F. 1 — - - - 2 1 - - 1 — - - — Children - - - - - - - - - - - - - - - Disease not arrested. Adults—M. — 7 10 - 17 6 6 7 - 13 6 11 5 - 16 F. 4 - 5 - 5 8 4 9 2 15 8 5 6 2 13 Children 1 — - - - 2 - - - - 2 - - - - Condition not ascertained during the year 4 6 1 7 3 3 1 — 4 10 3 3 — 6 Total on Dispensary Register at 31st December 13 7 23 1 31 26 15 18 2 35 28 19 14 2 35 (6) Not now on Dispensary Register andl reasons for removal therefrom. Discharged as recovered. Adults—M. 2 — — — — 1 — — — — — — - — - F. - - - - - - - - - - - - - - - Children — — - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 13 8 17 8 33 10 13 22 4 39 12 2 20 5 27 DEAD Adults—M. 6 3 22 19 44 3 4 31 28 63 8 2 26 18 46 F. 6 3 17 28 48 6 3 14 22 39 5 1 13 12 26 Children 1 - - - - 1 - 1 1 2 1 - - 2 2 Total written off Dispensary Register 28 14 56 55 125 21 20 68 55 143 26 5 59 37 101 Grand Totals 41 21 79 56 156 47 35 86 57 178 54 24 73 39 136 132 PULMONARY TUBERCULOSIS—(Conid.). Form T145a-(Contf.) Condition at the time of the last record made during the year to which the Return relates 1931 1932 1933 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 Group 2 Group 3 Total (Class T.B. plus) Group Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. — — — — — — — — — — — — — — — F. - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - Disease not arrested. Adults—M. 8 11 10 - 21 10 11 17 2 30 19 10 32 2 44 F. 7 9 9 1 19 11 9 14 1 24 17 8 22 1 31 Children 5 - - - - - - - - - 3 1 - - 1 Condition not ascertained during the year 5 7 4 — 11 4 1 5 — 6 — — — — — Total on Dispensary Register at 31st December 25 27 23 1 51 25 21 36 3 60 39 19 54 3 76 (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 5 6 9 3 18 13 4 5 1 10 3 1 4 5 DEAD. Adults—M. 4 9 15 4 28 3 1 8 3 12 1 3 8 7 18 F. 4 9 7 6 22 1 2 7 6 15 2 — 6 3 9 Children 2 - - - - 1 - - - - - - - - - Total written off Dispensary Register 15 24 31 13 68 18 7 20 10 37 6 4 18 10 32 Grand Totals 40 51 54 14 119 43 28 56 13 97 45 23 72 13 108 133 NON-PULMONARY TUBERCULOSIS. Form T145a(Contd. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands. Total Bones and Joints. Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. — — — — — — — 2 - 2 1 — - 1 2 F. - - - - - - - - - - - - - 1 1 Children 1 - - 4 5 5 2 - 15 22 1 - 1 2 4 Disease not arrested. Adults—M. 1 - - - 1 1 1 1 - 3 - - - 1 2 F. - - 1 - 1 2 - 1 1 4 - - - 1 1 Children - - - 1 1 2 2 2 11 17 - 1 - 2 3 Condition not ascertained during the year 2 — — 5 7 4 1 1 9 15 1 1 — 1 3 Total on Dispensary Register at 31st December 4 - 1 10 15 14 6 - 36 63 4 2 1 9 16 Transferred to Pulmonary 1 - 1 - 1 1 - 4 - - - - - (6) Not now on Dispensary Register and reasons for removal therefrom.| Discharged as Recovered. Adults—M. 1 — 1 1 3 2 1 1 3 7 2 - - - 2 F. - - - - - 1 1 - 3 5 - - 1 1 2 Children 4 3 2 24 33 12 10 2 54 78 1 - 1 - 2 Lost sight of or otherwise removed from Dispensary Register 21 7 15 47 90 26 7 10 59 102 2 3 4 7 16 DEAD. Adults—M. 1 - - - 1 4 - 2 - 6 2 - - - 2 F. 1 1 - 3 5 1 1 4 2 8 - - - - - Children 1 - - 8 9 4 1 1 3 9 1 - - - 1 Total written off Dispensary Register 29 11 18 83 141 50 21 20 124 215 8 3 6 8 25 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 33 11 19 93 156 64 27 27 160 278 12 5 7 17 41 134 NON-PULMONARY TUBERCULOSIS—(Contd.). Form T145a (Contd.). Condition at the time of the last record made during the year to which the Return relates 1928 1929 1930 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands / (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 1 — — — 1 — 1 - — 1 - 1 — 1 2 F. 1 - - - 1 2 - - 1 3 1 - - - 1 Children 2 - - 1 3 1 - - - 1 3 - 2 2 7 Disease not arrested. Adults—M. - - - - - - - - - - - - - - - F. - - - 1 1 - - 1 - 1 - - 1 2 3 Children 1 1 - 2 4 - - - 8 8 1 4 - 2 7 Condition not ascertained - - 2 - 2 1 - 1 2 4 3 - 1 3 7 Total on Dispensary Register at 31st December 5 1 2 4 12 4 1 2 11 18 8 5 4 10 27 Transferred to Pulmonary _ — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults—M. 1 1 — — 2 — — — 3 3 — — — — — F. - 1 - - 1 - - - 1 1 - - - - - Children 1 - - - 1 - 1 - - 1 - - - - - Lost sight of, or otherwise removed from Dispensary Register 3 1 3 6 13 3 1 4 8 2 2 - 8 12 DEAD. Adults—M. - - - - - - - - - - 1 - 1 - 2 F. - - - - - 1 - - - 1 1 - - - 1 Children - - 1 - 1 - - - - - 1 - - - 1 Total written off Dispensary Register 5 3 4 6 18 4 2 — 8 14 5 2 1 8 16 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 10 4 6 10 30 8 3 2 19 32 13 7 5 18 43 135 NON-PULMONARY TUBERCULOSIS—(Contd.). Form T145a—(Contd.). Condition at the time of the last record made during the year to which the Return relates 1931 1932 1933 Bones and Joints Abdominal Other Organs Peripheral G lands 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. 1 — — — 1 — — — — — — — — - — F. - - - 1 1 - - - - - - - - - - Children 1 - - 1 2 - - - 1 1 - - - - - Disease not arrested. Adults—M. - - - - - 4 - 4 1 9 5 - 1 1 7 F. 3 - - - 3 1 1 4 1 7 3 2 1 3 9 Children - 1 2 3 6 2 2 - 8 12 3 - - 5 8 Condition not ascertained during the year 5 — 1 — 6 9 — 1 1 11 — — — — — Total on Dispensary Register at 31st December 10 1 3 5 19 16 3 9 12 40 11 2 2 9 24 Transferred to Pulmonary - (6) 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 4 - - 3 7 2 - 2 1 1 2 DEAD. Adults—M. - - - - - 2 - 2 - 4 - - 1 - 1 F. 1 2 - - 3 - - - - - - - - - - Children 1 - - - 1 - 1 - - 1 - - - - - Total written off Dispensary Register 6 2 — 3 11 4 1 2 — 7 — 1 2 — 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 16 3 3 8 30 20 4 11 12 47 11 3 4 9 27 136 Maternal Mortality in the County of London and in Battersea, 1921-1933. Year. London. (Per 1,000 live births.) Battersea. (Per 1,000 live births.) Puerperal Sepsis. Other Causes. Total. Puerperal Sepsis. Other Causes. Total. 1921 1.42 1.56 2.98 1.07 2.67 3.74 1922 1.36 1.48 2.84 0.82 1.64 2.46 1923 1.37 1.52 2.89 — 2.91 2.91 1924 1.24 1.84 3.08 1.27 1.59 2.86 1925 1.42 1.77 3.19 0.94 0.94 1.88 Mean (1921-1925) 1.36 1.63 2.99 0.82 1.95 2.77 1926 1.61 1.74 3.35 1.01 2.36 3.37 1927 1.31 1.60 2.91 0.36 1.78 2.14 1928 1.59 2.00 3.59 1.09 1.46 2.55 1929 1.88 1.73 3.61 0.76 1.15 1.91 1930 1.93 1.40 3.33 1.51 2.26 3.77 Mean (1926-1930) 1.66 1.69 3.35 0.95 1.80 2.75 1931 2.01 1.80 3.81 2.02 4.04 6.06 1932 1.33 1.66 2.99 0.86 0.86 1.72 1933 1.69 1.97 3.67 1.77 0.44 2.21 Mean (1931-1933) (3 years) 1.68 1.81 3.49 1.55 1.78 3.33 Puerperal Fever Notifications in the County of London and in Battersea, 1921-1933. Year. London. (Rate per 1,000 births.) Battersea. (Rate per 1,000 births.) 1921 3.55 4.00 1922 3.28 3.55 1923 3.84 2.04 1924 3.43 4.78 1925 3.83 1.88 Mean (1921-1925) 3.59 3.25 1926 4.24 4.04 1927 3.57 3.21 1928 4.09 2.55 1929 4.46 1.53 1930 4.15 3.39 Mean (1926-1930) 4.10 2.94 1931 4.44 2.42 1932 3.51 1.72 1933 4.51 1.33 Mean (1931-1933) (3 years) 4.15 1.82