AC4386 m BAT 33 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1934. by G. MACDONALD, M.A., M.B., D.P.H., MEDICAL OFFICER OF HEALTH. Wightman & Co., Ltd., Printers, Dugdale Street, S.E. 5, and Regency Street, S.W. 1 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1934. by G. MACDONALD, M.A., M.B., D.P.H., MEDICAL OFFICER OF HEALTH. 1 Health Committee. (acting also as the Maternity and Child Welfare Committee.) 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. As constituted 9th November, 1934. Chairman: Councillor Mrs. M. J. Robinson. His Worship the Mayor (Councillor A. Bailey, j.p.). Councillor Mrs. K. S. D. Baker. Alderman Mrs. H. Bowler. Councillor Mrs. A. A. Burton. ,, E. W. Coles. Mrs. E. A. Cooper. ,, Dr. H. L. Gulati. T. J. Hines. ,, F. Humphrey. F. J. Lamb. Alderman G. Lauriks. Councillor R. Moore. Housing Committee. 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. As constituted 9th November, 1934. Chairman: Councillor I. O. Thomas. His Worship the Mayor (Councillor A. Bailey, j.p.). Alderman J. A. Campbell. „ H. Harling. Councillor A. W. Inman. „ J. F. Lane, jun. ,, G. F. Meecham. ,, D. A. G. Prichard. ,, F. S. Steed. „ E. J. Sullivan. „ H. T. Vincent. „ W. J. Wye. Alderman 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 Tuberculosis Care Committee. 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 20th December, 1933. †Appointed 28th February, 1934. As constituted 9th November, 1934. Chairman—Councillor Mrs. M. J. Robinson. Alderman Mrs. H. Bowler. Councillor Mrs. E. A. Cooper. „ Dr. H. L. Gulati. „ F. J. Lamb. Other Member: Mrs. F. Young. Representatives of the Local Public Assistance Committee: Councillor A. Bailey, j.p. (Mayor). Councillor Mrs. F. E. Mullings. 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) L.C.C. Divisional Medical Officer (Dr. E. J. Boome). Secretary, Invalid Children's Aid Association, Southlands (Miss Denham). Representative of the War Pensions Committee Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss 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). 3 Staff of public Health Department. (At 31st December, 1934) Assistant M.O.H. and Tuberculosis Officer Appointment Vacant. Assistant Tuberculosis Officer (part time) (Mrs.) M. J. O'FLYNN, B. A., M B., B.Ch., B.A.O. Assistant Medical Officer (Maternity and Child (Miss) M. L. HAMILTON, M.B., Welfare) Ch.B., D.P.H Resident Medical Officer, Borough Maternity (Miss) D. J. HEALEY, M.B., B.S. Hospital Medical Officer, Diphtheria Immunisation F. PORTER SMITH, M.R.C.S., Clinic L.R.C.P. Consultant Gynecologist, Borough Maternity (Miss) ALICE BLOOMFIELD, Hospital M.D., F.R.C.S. Consultant Obstetrician, Borough Maternity F. W. ROQUES, M.S., F.R.C.S Hospital Consultant Medical Officer, Ante-Natal (V.D.) H. CORSI, F.R.C.S., M.A., M B Clinic B.Ch., L.R.C.P. Dental Surgeon (by arrangement with British J. RHYS HERBERT, L.M.S.S.A Dental Hospital) L.D.S., R.C.S. Public Analyst 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 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). Miss I. M. J. Sweeney (temporary), H.V. Cert., Cert.C.M.B., S.R.N. Sanitary Inspectors— Senior Inspector: Mr. J. Lawrence, Cert San. Inst, and Meat lnspec. 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., Meat Insp. Cert. 6. Mr. C. Binding, San. Insp Board's Cert, and Meat Insp. Cert. 8. Vacant Mr. R. J. McCarthy (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). Mr. P. Brocking. Mr. E. Cole. One Vacancy. Mr. W. Halstead. Miss M. A. Weller (M. & C.W. Mr. H. C. Godfrey. Records). Mr. R. Graham. Two temporary Clerks. Mr. F. Pedrick. Two Office youths. Maternity Home— Matron—Miss M. Fevyer, Cert. C.M.B. Sister—Miss D. Anthony—4 Staff Nurses. Borough Midwife (District Service)—Miss M. L. Thompson. Tuberculosis Dispensary— Tuberculosis Nurses—Miss M. Schotborgh, Miss B. O'Connor, Miss C. Thompson. Secretary and Clerk—Miss L. Wadham. Dispenser—Miss E. F. Davies. Clerks—Miss C. Turner. Miss M. E. Brown. Disinfecting Station—Superintendent—C. Woodhouse. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer—See page 53. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Batlersea. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report on the Health and Sanitary condition of the Borough for the year 1934. In the course of the year Dr. G. Quin Lennane, who has been Mcdical Officer of Health for the Borough for 28 years, retired, and I succeeded him in that office on the 1st October. During the year a survey of the public health services was carried out by the Medical Officers of the Ministry of Health, who reported to the Minister that a reasonable standard of efficiency and progress was being maintained by the Council in the discharge of their functions relating to Public Health. Suggestions which were made by the Ministry on certain points connected with particular services have received the careful attention of the Council. I wish to express my appreciation of the help and consideration I have received on taking over my new post, from the Mayor and Councillors, the Chief Officers of the Council, and the staff of the Public Health Department. I have the honour to be, Mr. Mayor, ladies and gentlemen, Your obedient servant, (Signed) G. MACDONALD, Medical Officer of Health. Electric House, Lavender Hill, S.W. 11. May, 1935. 6 CONTENTS. page General 1-6 Vital Statistics 7-17 Maternity and Child Welfare 18-44 Infectious and Other Diseases 45-67 General Sanitary Administration 68-81 Food Supply 82-92 Factories and Workshops 93-98 Housing 99-106 Appendices 107-124 (See Index at end.) 7 Summary of Statistics, 1934. 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 1934) 150,870 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 1934 27,586 Rateable value (1934) £1,119,562 Sum represented by a penny rate £4,555 2. Extracts from Vital Statistics of the Year. Births— Males, 1,102; females, 1,052 2,154 Legitimate births (1,055 males ; 1,010 females) 2,065 Illegitimate „ (47 males; 42 females) 89 Still-births (40 males; 25 females) 65 Birth-rate 14.3 Still-birth rate (per 1,000 births live and still) 29.3 Deaths— Males, 959; females, 923 1,882 Percentage of total Deaths occurring in Public Institutions (Battersea deaths only) 58.0 Death-rate 12.47 Number of women dying in or in consequence of childbirth— From sepsis 3 Other causes 4 Death-rate of infants under 1 year per 1,000 live births. Legitimate (120) 58.11 Illegitimate (12) 134.83 61.28 Deaths from Measles (all ages) 32 „ Whooping-cough (all ages) 7 „ Diarrhœa (under 2 years of age) 27 3. Census— Population. Inhabited dwellings. 1911 167,743 24,321 1921 167,739 27,191 1931 159,552 27,219 8 Vital Statistics. The Registrar-General's estimate of the mid-year population of Battersea (1934) was 150,870 as compared with 154,000 in 1933. The population of Battersea at the Census taken in April, 1931, was 159,552, and the Registrar-General's estimate for 1934 therefore indicates a decrease of 8,682 since the Census, and 3,130 during 1933-4. The Registrar-General's estimate of the mid-year population of the Borough (150,870) 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. Acres. Estimated Mid-Year Population, 1934. Males. Females. Total. Density per acre. Wards. 1. Nine Elms 407 11,932 12,144 24.076 59·2 2. Park 316 7,532 8,447 15,979 50·6 3. Latchmere 182 8,290 9,102 17,392 95·6 5. Church 171 7,832 8,011 15,843 92·6 North Battersea 1,076 35,586 37,704 73,290 68·1 4. Shaftesbury 140 6,422 6,919 13,341 95·3 6. Winstanley 126 8,974 9,169 18,143 144·0 7. St. John 117 3,536 4,557 8,093 69·2 8. Bolingbroke 205 7,921 9,554 17,475 85·2 9. Broomwood 499 8,958 11,570 20,528 41·1 South Battersea 1,087 35,811 41,769 77,580 71· 4 Borough 2,163 71,397 79,473 150,870 69·8 * Births, deaths, etc., occurring in St. James's Hospital Sub-district (situate within Broomwood Ward) are allocated to the District in which the patient ordinarily resides. BIRTHS. The number of births registered in the Borough during 1934 was 2,765 (1,404 males, 1,361 females), an excess of 43 males. Of this number, 947 were transferred out, the permanent residence of the parents being outside the Borough, and 336, registered outside the Borough, were transferred here, giving on balance a total of 2,154 births (1,102 male, 1,052 female) relating to Battersea residents, and a corrected birth-rate of 14•3 per 1,000 of the population. This is a decrease of 0.4 on that of 1933, and the birth-rate is the lowest so far recorded in Battersea. The table on the next page gives the distribution of the births and the birth-rate per 1,000 of the population in the Sub-districts and in the Wards for the year 1934, also in the registration subdistricts during the previous decennium 1924-33:— 9 BIRTHS AND DEATHS, 1934. In Sub-Districts and Wards. Rates for 10 Years (per 1,000 Population). Area. Estimated Population 1934 Births Deaths No. Rate. No. Rate. Year. North Battersea. South Battersea. The Borough. Birth Rate. Death Rate. Birth Rate. Death Rate. Birth Rate. Death Rate. Sub-Districts. 1924 20.7 12.1 16.0 11.5 18.4 11.8 North Battersea 73,290 1,157 15.8 876 12.0 1925 21.1 10.9 16.0 l0.1 18.5 10.5 South Battersea 77,580 997 12.9 1,006 13.0 1926 20.2 11.4 14.4 ll.4 17.3 11.4 Wards. 1927 18.5 12.1 14.6 12.4 16.6 12.2 No. 1, Nine Elms 24,076 365 15.2 259 10.8 1928 19.0 12.0 14.5 11.9 16.7 11.9 No. 2, Park 15,979 263 16.5 186 11.6 1929 18.5 14.4 13.9 14.0 16.2 14.2 No. 3, Latchmere 17,392 241 13.9 217 12.5 1930 17.8 11.7 15.2 11.3 16.5 11.5 No. 4, Shaftesbury 13,341 161 12.1 163 12.2 1931 16.5 12.2 14.5 11.9 15.5 12.1 No. 5, Church 15,843 288 18.2 214 13.5 1932 16.0 11.9 13.6 12.2 14.8 12.1 No. 6, Winstanley 18,143 290 16.0 253 13.9 1933 15.1 12.3 14.3 12.7 14.7 12.5 No. 7, St. John 8,093 108 13.3 83 10.3 Mean 19241933 18.3 12.1 14.7 11.9 16.5 12.0 No. 8, Bolingbroke 17,475 226 12.9 225 12.9 No. 9, Broomwood 20,528 212 10.3 282 13.7 Borough 150,870 2,154 14.3 1,882 12.5 1934 15.8 12.0 12.9 13.0 14.3 12.5 10 The birth-rate shows a decline in five Wards of the Borough and an increase in the four remaining Wards. The birth-rate in Battersea is 2.2 per 1,000 lower than the average for the previous decennium 1924-1933. The birth-rate for the County of London was 13.4 per 1,000 of the population, and for England and Wales the rate was 14.8. Illegitimate births numbered 89 or 4.13 per cent. of the total live births. Under the Births and Deaths Registration Act, 1926, the registration of still-births was made compulsory. During 1934, 65 stillbirths were registered as belonging to Battersea. MARRIAGES. The marriages registered in Battersea during 1934 numbered 1,432. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 19.0. Year. Marriages. Marriage-Rate. 1929 1,376 17.0 1930 1,444 18.0 1931 1,421 17.8 1932 1,300 16.6 1933 1,376 17.9 Mean, 1929-33 1,383 17.5 1934 1,432 19.0 DEATHS. The number of deaths registered in the Borough during 1934 was 2,789. Of these, 1,414 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 507 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,882 (males 959, females 923). This gives a recorded death-rate of 12.47 compared with 12.2 for London, and 11.8 for England and Wales. The Registrar-General has supplied a factor for the purpose of rendering the death-rate of the Borough comparable with that of a district the population of which is of standard age and sex distribution. For the year 1934 this factor is 0.99, and the adjusted death-rate for the purpose of such comparison is therefore 12.3. 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 table on page 9. 11 The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1934:— Under 1 year. 1-5 5-10 10-15 15-25 25-45 45-65 65 + Total. M 73 33 13 14 40 76 301 409 959 F 59 34 10 6 35 76 202 501 923 Ttls. 132 67 23 20 75 152 503 910 1,882 % of Total 7.0 3.6 1.2 1.1 4.0 8.1 26.7 48.3 100.0 The corrected number of deaths of males and females registered in each quarter of the year is set out as follows:— Period. Males. Females. Total. First quarter 327 302 629 Second quarter 226 237 463 Third quarter 203 177 380 Fourth quarter 203 207 410 Total 959 923 1,882 The death-rate during 1934 was lowest in the St. John Ward (10.3), and highest in Winstanley Ward (13.9). The deaths of persons over 65 years numbered 910 or 48.3 per cent. of the total deaths. The average age at death was 55.7 years, as compared with 56.8 in 1933, 55.7 in 1932 and 55.3 in 1931. Decreased death-rates were recorded in four Wards of the Borough. The natural increase of population (that is the excess of births over deaths) was 272 in 1934 as compared with 339 in 1933. The causes of the 1882 deaths occurring in 1934, classified in various age groups, are shewn in the Appendix, pages 110-111. Deaths in Public Institutions. During 1934 the deaths of Battersea residents occurring in Public Institutions numbered 1,091. Of this number 639 occurred within and 452 outside the Borough. Of the total Battersea deaths in Institutions 756 occurred in Public Assistance Institutions. 12 Senile Mortality. During 1934 the deaths of 910 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths, which constituted 48.35 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 108 76 64 90 13 28 185 194 379 South Battersea 122 134 84 137 18 36 224 307 531 Borough 230 210 148 227 31 64 409 501 910 Infant Mortality. During 1934 the deaths of 132 infants were registered as belonging to Battersea. The total number of births registered during the year was 2,154, giving an infant mortality rate of 61.28 per 1,000 births, as compared with 49.49 in 1933, 57.8 in 1932, 57.3 in 1931, and 54.7 in 1930. The infant mortality rate for the year 1933 was the lowest vet recorded in Battersea. The distribution of the 132 infant deaths and the infant mortality-rates for the registration Sub-Districts and the Wards, are shown in the following table:— Area. Live births. Deaths of Infants under 1 year of age. Infant Mortality per 1,000 live births. m. f. total. Sub-District. North Battersea 1,157 38 40 78 67.4 South Battersea 997 35 19 54 54.2 The Borough 2,154 73 59 132 61.3 Ward. 1. Nine Elms 365 14 15 29 79.5 2. Park 263 7 13 20 76.0 3. Latchmere 241 6 2 8 33.2 4. Shaftesbury 161 7 5 12 74.5 5. Church 288 11 10 21 72.9 6. Winstanley 290 9 6 15 51.7 7. St. John 108 3 2 5 46.3 8. Bolingbroke 226 11 3 14 61.9 9. Broomwood 212 5 3 8 37.7 13 It will be noted that in the Sub-Districts the rate was higher in North Battersea (67.4) than in South Battersea (54.2). In the Wards, Latchmere showed the lowest rate (33.2) and Nine Elms Ward the highest (79.5). The infant mortality rates in the County of London and in England and Wales during 1934 were 67.4 and 59.0 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 504 42 83.3 Second quarter 574 36 62.7 Third quarter 581 28 48.2 Fourth quarter 495 26 52.5 The infant death-rate was 54.5 during the last 9 months of the year, as compared with 83.3 in the first 3 months. There were 53 deaths of infants during the first four weeks of life (or 40.2 per cent. of the total infant deaths) as compared with 45 deaths (or 40.2 per cent.) in 1933 and a percentage for the quinquennium (1929-1933) of 43.5. The deaths from developmental diseases were 57 as compared with 49 in 1933. Table showing Deaths of Infants under 1 day, under 1 week and under 4 weeks from 1929 to 1934. 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 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 1933 21 11 13 45 40.2 Total 1929-33 110 107 87 304 43.6 Mean do 22.0 21.4 17.4 60.8 — 1934 25 15 13 53 40.2 The causes of the 132 infant deaths are shewn in detail in the appendix, pages 112-114. 14 Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1934 was 134.8 per 1,000 births, as compared with 69.3 in 1933, 81.4 in 1932, 83.3 in 1931, and 161.3 in 1930. The corresponding death-rate of legitimate children in 1934 was 58.1, the ratio of the mortality rate of illegitimate infants to that of legitimate being 2.3 to 1. Still-births. The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926. During 1934 there were 98 still-births registered in Battersea, of which 52 were of Battersea parents. Thirteen still-births occurring outside the Borough were registered as belonging to Battersea, making 65 in all, representing a still-birth rate of 29.3 per 1,000 births (live and still) registered. Of the 65 still-births 4 (6.2 per cent.) were registered as illegitimate. The number of Battersea still-births registered, and the stillbirth rates, from 1928 to 1934, were as under :— No. Rate. No. Rate. 1928 90 31.8 1932 72 30.1 1929 71 26.4 1933 65 27.9 1930 103 37.4 1934 65 29.3 1931 66 26.0 Notification of Births Act. During 1934 the number of notifications of live births received belonging to the Borough was 2,043. The corrected number of births registered during the year in Battersea was 2,154. The proportion of notified to registered births was, therefore, 94.8 per cent. There were 257 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 2,043 above. Sixty-three still-births were notified under the provisions of the Notification of Births Acts during the year, including 14 cases occurring outside the Borough, the number notified being 96.9 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. 15 COMPARATIVE STATISTICS OF BIRTHS. MORTALITY, &c Year. Mean population for year. Births. Deaths. Natural Increase. Birth Rate. Death Rate. Infant Mortality Rate. 1861 19,582 750 505 245 38.3 25.7 194.7 1871 54,847 2,220 1,472 748 40.4 26.8 194.1 1881 108,342 4,452 2,033 2,419 41.8 18.7 146.2 1882 112,661 4,504 2,214 2,290 39.9 19.6 154.8 1883 116,980 4,711 2,344 2,367 40.2 20.0 168.5 1884 121,299 5,275 2,569 2,706 43.4 21.1 164.7 1885 125,618 4,654 2,566 2,088 37.0 20.4 179.0 1886 129,937 5,140 2,477 2,663 39.5 19.0 162.1 1887 134,256 5,186 2,451 2,735 38.6 18.2 156.6 1888 138,565 5,061 2,187 2,874 36.5 15.7 146.2 1889 142,884 5,161 2,240 2,921 36.1 15.6 138.2 1890 147,203 5,105 2,854 2,251 34.6 19.3 174.1 1891 150,880 5,237 2,697 2,540 34.7 17.9 146.8 1892 153,778 4,990 2,782 2,208 32.4 18.1 164.3 1893 156,719 5,225 2,974 2,251 33.3 18.9 171.3 1894 159,724 5,024 2,577 2,447 31.4 16.1 147.5 1895 162,787 5,264 2,961 2,303 32.3 18.1 177.1 1896 165,309 5,358 2,994 2,364 32.4 18.1 178.8 1897 166,059 5,266 2,737 2,529 31.7 16.4 162.2 1898 166,814 5,157 2,892 2,265 30.9 17.3 166.0 1899 167,570 5,179 2,905 2,274 30.9 17.3 161.2 1900 168,339 5,161 2,978 2,183 30.6 17.6 160.0 1901 ‡169,007 5,025 2,766 2,259 29.7 16.4 163.4 1902 ‡169,332 4,844 2,581 2,263 28.6 15.2 135.6 1903 ‡169,543 4,973 2,476 2,497 29.3 14.6 134.9 1904 ‡169,642 4,849 2,543 2,306 28.6 15.0 147.5 1905 ‡169,635 4,843 2,561 2,282 28.6 15.1 131.3 1906 ‡169,526 4,654 2,384 2,270 27.5 14.1 126.3 1907 ‡169,318 4,574 2,406 2,168 27.0 14.2 114.1 1908 ‡169,018 4,629 2,272 2,357 21.4 13.4 106.7 1909 ‡168,628 4,450 2,417 2,033 26.4 14.3 107.4 1910 ‡168,152 4,489 2,124 2,365 26.7 12.6 96.7 1911 167,765 4,381 2,404 1,977 26.1 14.3 124.6 1912 167,589 4,255 2,052 2,203 25.4 12.2 83.0 1913 167,464 4,240 2,365 1,875 25.3 14.1 111.3 1914 167,338 4,303 2,217 2,086 25.7 13.2 92.3 1915 161,945 3,820 2,653 1,167 23.6 16.4 112.0 1916 B* 173,432 3,774 — — 21.8 — 84.3 D* 159,402 — 2,221 1,553 — 13.9 1917 B* 167,233 2,960 — — 17.7 — 101.0 D* 150,023 — 2,285 675 — 15.2 1918 B* 168,014 2,700 — — 16.1 — 98.9 D* 149,951 — 2,809 -109† — 18.7 1919 B* 165,960 3,075 — — 18.5 — 74.1 D* 159,316 — 2,061 1,014 — 12.9 1920 B* 166,093 4,669 — — 28.1 — 82.7 D* 165,664 — 2,079 2,590 — 12.5 1921 169,200 3,742 2,060 1,682 22.1 12.2 73.8 1922 169,200 3,665 2,227 1,438 21.7 13.2 69.3 1923 170,600 3,434 1,839 1,595 20.1 10.8 49.5 1924 171,000 3,139 2,018 1,121 18.4 11.8 62.4 1925 172,100 3,184 1,805 1,379 18.5 10.5 58.4 1926 171,900 2,969 1,960 1,009 17.3 11.4 61.6 1927 169,000 2,801 2,065 736 16.6 12.2 53.5 1928 164,100 2,743 1,954 789 16.7 11.9 64.2 1929 161,800 2,619 2,294 325 16.2 14.2 62.6 1930 160,700 2,652 1,846 806 16.5 11.5 54.7 1931 159,800 2,477 1,931 546 15.5 12.1 57.3 1932 157,000 2,319 1,895 424 14.8 12.1 57.8 1933 154,000 2,263 1,924 339 14.7 12.5 49.5 1934 150,870 2,154 1,882 272 14.3 12.5 61.3 *Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. †Decrease. Census years in heavy type. ‡These are revised figures (approved by the Registrar General) abstracted from London Statistics, Vol. 22., p.49 .The birth- and death-rates have been modified accordingly. 16 Chart Showing Birth, Death and Infant Mortality Rates in Battersea from 1858 to 1934. 17 Comparative Statistics, Metropolitan Boroughs. Table showing the birth-rates, death-rates and infant mortalityrates in the 29 Metropolitan Cities and Boroughs for the year 1934:— Births per 1,000 Population. *Deaths per 1,000 Population. Infant Deaths per 1,000 live births. 1. Shoreditch 16.1 Lewisham 10.1 Lewisham 43 2. Deptford 15.8 Wandsworth 10.4 Finsbury 51 3. Poplar 15.5 Hampstead 10.6 Hampstead 53 4. Stepney 15.3 Stoke Newington 11.0 Hackney 56 5. Finsbury 15.1 Chelsea 11.4 Wandsworth 57 6. Southwark 14.9 City of London 11.6 Fulham 59 7. Bermondsey 14.8 Islington 11.9 Stoke Newington 61 8. Islington 14.7 Woolwich 12.0 St. Marylebone 61 9. Bethnal Green 14.3 City of Westminster 12.1 Battersea 61 10. Battersea 14.3 Hackney 12.2 Poplar 62 11. Hackney 14.2 Camberwell 12.3 Islington 62 12. Lambeth 14.2 Paddington 12.3 Lambeth 63 13. Hammersmith 13.8 Battersea 12.3 Woolwich 63 14. Woolwich 13.8 Greenwich 12.5 Bermondsey 64 15. Fulham 13.7 Kensington 12.5 Chelsea 65 16. Greenwich 13.7 St. Marylebone 12.6 St. Pancras 65 17. Stoke Newington 13.7 Lambeth 12.6 City of Westminster 66 18. Paddington 13.7 Fulham 12.7 Camberwell 67 19. Camberwell 13.2 St. Pancras 13.2 Deptford 68 20. St. Pancras 13.1 Hammersmith 13.3 Holborn 71 21. Kensington 12.3 Bethnal Green 13.4 Bethnal Green 73 22. Lewisham 12.2 Deptford 13.6 Hammersmith 77 23. Wandsworth 11.0 Poplar 13.7 Southwark 77 24. Chelsea 10.8 Holborn 13.8 Shoreditch 84 25. Hampstead 10.4 Bermondsey 14.1 Greenwich 87 26. City of Westminster 9.4 Stepney 14.3 Stepney 87 27. St. Marylebone 9.0 Shoreditch 14.4 Kensington 93 28. Holborn 8.6 Southwark 14.5 Paddington 96 29. City of London 6.8 Finsbury 14.6 City of London 121 County of London 13.4 County of London 12.5 County of London 67.4 *The rates in this column have been adjusted by the "comparability factor" referred to on page 10. 18 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 19. Ancillary services included in the scheme are:— (1) St. Mary's Hostel, Macaulay Road, Clapham Common (vide page 23). (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road (vide page 22). 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 scheme, which was revised in 1933, provided for payments to be made by the Council 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 together with those paid by the Ministry direct to the Associations. The Council also made additional contributions in the financial year 1934-35 in connection with their Maternity and Child Welfare scheme as under:— Invalid Children's Aid Association £40 St. Thomas's Babies' Hostel (vide page 28) £150 Victoria Hospital for Children £100 Southwark Diocesan Association for Preventive and Rescue Work £150 19 MATERNITY AND CHILD WELFARE CENTRES (at 31st December, 1934.) Name and Situation of Centre. Times of Opening. Monday. Tuesday. Wednesday. Thursday. Friday. Municipal— Southlands, High Street (Central Clinic) 9.30 a.m. s.l. - 9.30 a.m. s.l. - *10.0 a.m. a.n. 2.0 p.m. — §2.30 p.m. *1.30 p.m. 1.30 p.m. s.l. do. (Dental Clinic) - ‡10.30 a.m. 10.30 a.m. - 10.30 a.m. 2.0 p.m. 2.0 p.m. — All Saints' Parish Hall. Prince of Wales Road - *10.0 a.m. a.n. - - - — *1.30 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. — — *1.30 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. (Special Clinic) — — Voluntary— Battersea School for Mothers, 55 Mundella Road *2.0 p.m. *2.0 p.m. — †2.15 p.m. m.c. — †3.30 p.m. h.t. Women's League of Service, Southlands, High St. †2.30 p.m. m.c. *¶2.30 p.m. *2.30 p.m. †2.30 p.m. m.c. †2.30 p.m. m.c. — *¶12.30 p.m. a n. — — — Chislehurst Mission, St. James's Hall, Ponton Rd. — — — — **2.0 p.m. a.n. Ante-natal clinic. p.n. Post-natal clinic. s.l. Artificial sunlight clinic. h.t. Health talk. m.c. Mothercraft class. * A Medical Officer attends. † Mothers only. § Protection against diphtheria (Schick test clinic). ** A Medical Officer attends alternate weeks. ‡ Children only. ¶ Session held fortnightly. Dinners for expectant and nursing mothers are provided daily (Monday to Friday) by the Women's League of Service at their Southlands premises. A Fathers' Council is held monthly at the premises of the Battersea School for Mothers, 55, Mundella Road, S.W. 8. 20 At each of the centres a clinic is held once or twice weekly with a woman Medical Officer in attendance, 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 Health Committee at their December meeting gave instructions that the mothercraft classes formerly held at the Southlands and Chatham Hall Centres, which had been discontinued since 1933 should be resumed. The necessary arrangements had not been completed at the end of the year, but the classes were re-started early in 1935. The table on the next page gives a summary of the work carried out at the centres in 1934. 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 eight 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 1934 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. Council. Vol. Total. To expectant mothers 2,459 512 2,971 To notified births 8,506 1,497 10,003 To still-births 68 10 78 To children aged 1-5 years 5,899 2,467 8,366 To enquire into infant deaths 136 33 169 To cases of notifiable infectious disease 5,622 924 6,546 To cases of non-notifiable disease 165 76 241 Re prevention of Diphtheria 166 36 202 „ „ Measles 394 169 563 To dental cases 71 27 98 To V.D. Cases 1 — 1 To maternal deaths 5 4 9 To foster mothers and children 1,584 — 1,584 Other visits 1,040 609 1,649 Totals 26,116 6,364 32,480 21 Summarised Statistics Relating to Infant Welfare Centres, 1934. Municipal. Voluntary. Grand Total. Southlands Plough Road East Battersea Chatham Road Gideon Road Total. Battersea School for Mothers. Chislehurst (St James's) Mission. Women's League of Service. Total. Municipal and Voluntary. Sessions held 99 136 99 100 100 534 92 51 68 211 745 Weights recorded 2,692 5,008 4,061 5,232 3,221 20,214 3,118 650 1,829 5,597 25,811 Advice only given 407 1,603 918 507 507 3,942 17 205 86 308 4,250 Total attendances 3,099 6,611 4,979 5,739 3,728 24,156 3,135 855 1,915 5,905 30,061 Average per session 31 49 50 57 37 45 34 17 28 28 40 ,, ,, week 60 127 96 110 72 465 60 16 37 113 578 First attendances 183 375 301 367 216 1,442 207 22 191 420 1,862 Doctor's attendances 49 49 47 50 49 244 92 23 69 184 428 ,, interviews 931 1,562 1,161 1,489 1,040 6,183 1,906 223 1,196 3,325 9,508 ,, average per attendance 19 32 25 30 21 25 21 10 17 18 22 (Summary of the work carried out at other centres will be found as under:— Ante-natal clinics, page 32; Dental Clinic, pages 39, 62; Light Treatment Centre, pages 40, 63; Anti-diphtheria Clinic, page 48; Massage Centre, page 24.) 22 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. It continues, however, to be administered by a local committee upon which the Borough Council is represented. There is accommodation for 27 children, and for 24 in a guest house which is attached for the reception of residents. No serious outbreak of infectious disease occurred during the year among the children attending the Nursery or Guest house, although a few cases were notified, including 17 cases of Measles during the epidemic of that disease, for which the usual precautionary measures were adopted. During 1934 the attendances at the Nursery totalled 4,192. An annual grant of £500 is made by the Council in accordance with the requirements of the Scheme made by the Ministry of Health(vide page 18). 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 1934. At their meeting on 20th November, the London County Council decided to make arrangements for this service to be available at all hours throughout London without charge, but this extension was not yet in operation at the end of the year. 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 Hospital for Children, Chelsea, and the St. Thomas's Babies' Hostel(vide page 28). The Council contribute an annual sum to these Hospitals in respect of the facilities afforded(vide page 18). Women and children are referred where necessary from the ante-natal and Child Welfare centres to appropriate institutions, children being usually sent to one of the above named hospitals. 23 The Council also undertake, on behalf of various hospitals, to visit and report on the home conditions of Battersea patients receiving treatment in the obstetric, gynaecological and other departments of the hospitals. The following table presents a summary of the number of cases referred to various hospitals and other institutions from the various clinics, and also the number of visits paid by the Council's Health Visitors on the request of the hospitals:— Hospital or Institution. Cases referred from Clinics. Visits paid for Hospital. Ante- and post-natal Visits. Other. Total. Battersea General 2 2 Bolingbroke 4 — — — Charing Cross — 19 — 19 Elizabeth Garrett Anderson — 1 — 1 General Lying-in — 211 — 211 Kings College — 11 — 11 Metropolitan — 1 — 1 Middlesex 18 — — — National, for Diseases of the Heart 1 — — — National Orthopaedic 1 — — — Royal Free — 1 — 1 St. Bartholomew's — 1 — 1 St. George's — 103 3 106 St. James's 5 — — — St. Thomas's 11 331 100 431 St. Thomas's Babies 329 — — — South London, for Women 17 — — — University College — — — — Victoria, Chelsea 252 — 90 90 Vincent Square — — — — Westminster — 38 2 40 Battersea Tuberculosis Dispensary 2 — — — Dr. Barnardo's Homes — — 5 5 Totals 640 717 202 919 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 and their children resident in the district, by the Southwark Diocesan Association for Preventive and Rescue 24 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. The Council have since April, 1933, made a contribution of £150 per annum, in lieu of per capita payments formerly made. The number of Battersea mothers received in the Association's homes with their babies during 1934 was five. 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. This service has not been used to the extent anticipated, and during the past three years no application for the services of a home help has been received. Massage Treatment. For many years the Council have provided facilities in suitable cases for massage treatment for children attending their various centres. A competent masseuse gives treatment four times weekly either at the Southlands centre or at her home. A charge of one shilling per treatment is made, but this is borne in whole or in part by the Council in necessitous cases. During 1934, 198 massage sessions were held, at which the attendances numbered 2,499, an average per session of 12.6. The cost to the Council in 1934 was £67 7s. 9d. This service includes the provision of massage treatment where necessary for those patients who attend the Council's artificial light treatment centre (vide page 40). Milk for Necessitous Persons. Under the provisions of the Maternity and Child Welfare Act, 1918, milk both fresh and dried is provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. In November the Council decided to revert to their former practice of supplying Grade A (Tuberculin tested) in lieu of pasteurised milk which had been ordered since 3rd July, 1932. 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:— 25 Year. Dried Milk. Fresh Milk. Cost (after deducting payments made). Persons supplied. lbs. supplied. Persons supplied. Pints supplied. £ 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 44,372 1933 184(106) 3,642 1,842(106) 237,636 3,280 1934 140(51) 2,449 1,361(51) 145,298 2,045 [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 fresh milk, is comparatively small, dried milk being in general supplied only in those cases where on medical grounds it is considered preferable. During 1934 the quantity of milk supplied to necessitous mothers and children has again declined. Care is taken to see that there is no abuse of the facilities provided, and investigations are made into the financial circumstances of applicants. Pasteurised and Grade A(Tuberculin tested) milk is supplied in sealed bottles by licensed purveyors in the Borough, and the recipients are given their choice of dairymen from the list of licensed dealers. In April the Council decided to co-operate with the London County Council in a scheme framed by that body by which the County Council undertook to provide through their Public Assistance organisation milk or special nourishment for expectant or nursing mothers or delicate children where the family is already in receipt of public assistance. The Council were informed that the grant of milk or extra nourishment in such cases would be in addition to the relief which would otherwise be given, and that arrangements had been made to avoid the occurrence of any delay in the supply of the nourishment ordered. The scheme came into operation on 7th May and from that date until 31st December, 115 persons in 88 families who came within its terms were supplied with milk through the Public Assistance Authority. The quantity of milk supplied to these families was about 8,608 pints of pasteurised or Grade A(Tuberculin tested) milk, and 34 lbs. of dried milk, at a cost of £146 approximately, which was borne by the London County Council. 26 In September the Council also agreed to a further proposal made by the London County Council under which the Council undertook to supply milk to those expectant mothers(not in receipt of Public Assistance grants) who attend the ante-natal clinics attached to the County Council's general hospitals and who are certified by the medical officers of the County Council to be in need of additional nourishment. The grant of milk in these cases however is limited to those mothers whose income comes within the Council's scale. This extension of the Council's scheme was not used in the year under report. In addition to the provision of milk, dinners to the number of 38 were supplied during 1934 to necessitous expectant and nursing mothers and children at a cost of £1 2s. 2d., by arrangement with the Women's League of Service. Necessitous mothers were also referred from the Welfare Centres to the kitchen of the Invalid Kitchens' Association in Henley Street, where they were supplied with 246 dinners during 1934 at a cost of £6 5s. 6d. Convalescent Homes. During 1934, accommodation was provided for 9 mothers and 8 children attending the various Maternity and Child Welfare clinics. Of these 2 mothers and 2 children were sent to Littlestoneon-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 £14 19s. 0d., the families concerned contributing the balance of £2 15s. 0d. Eleven 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, 14 mothers and 7 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 p. 43). Midwives. So far as can be ascertained there are 14 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 38) the eastern portion of the Borough is served by the district midwifery services of St. Thomas's Hospital, Clapham Maternity Hospital and the General Lying-in Hospital, York Road. The question of securing a greater degree of co-operation between the private midwives practising in the Borough and the ante-natal services organised by the Council has been before the Health Committee on various occasions, and in December the Committee decided to recommend the Council— 27 (a) In those cases where a private midwife's patient attends an ante-natal clinic on her advice, and is subsequently admitted to a hospital or other similar institution for confinement on the recommendation of the Medical Officer of the clinic—to pay a fee of 10s. to the midwife as compensation. (b) In those cases where a midwife loses her fee when her patient is removed to hospital at the time of confinement on the advice of a doctor called in because of some difficulty arising—to pay a fee of 15s. to the midwife as compensation. The Committee's recommendation was adopted by the Council on 2nd January, 1935. 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 1934 the total number of attendances made by the nurses of the District Nursing Association in connection with cases of infectious disease was:— Nursing Service, 1934. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia neon. & other eye aff'ns. 99 1,796 - - 99 1,796 Measles 86 744 25 209 111 953 Whooping cough 6 77 1 15 7 92 Diarrhoea & vomiting 2 5 - - 2 5 Chicken pox 1 7 3 21 4 28 Mumps - - - - - - Pemphigus neonatorum 2 28 - - 2 28 Puerperal pyrexia - - 1 25 1 25 Pneumonia 35 542 50 909 85 1,451 Influenza - - 12 128 12 128 Erysipelas - - 3 113 3 113 Totals 231 3,199 95 1,420 326 4,619 28 Many of these cases were referred to the Association by medical practitioners. In addition to the cases mentioned above 2,804 visits were made by the district nurses to cases sent by the Council, for which no charge was made. The cost of the nursing service in 1934 was £153 19s. 4d. as compared with £138 2s. Od. in the previous year. St. Thomas's Babies' Hostel. Since 1926 cases have been sent from the Borough Maternity and Child Welfare Clinics to this Hostel for test feeding and the encouragement of breast feeding. The result of this work during 1934 is as follows:— A. Test Feeds. Number of cases, 177, comprising: Mothers, 177; babies, 184. Number of attendances, 585. 14 of these cases received in-patient treatment. B. In-Patient Treatment. Battersea cases received— 12 mothers and 20 babies sent by Council. 2 mothers and 6 babies sent from other sources. Period, of stay. Cases sent by Council—12 mothers and 20 babies, 1,515 days; average, mothers 27.7 days, babies 59.1 days. Other cases—2 mothers and 6 babies, 324 days; average, mothers 27.5 days, babies 44.8 days. A contribution of £150 is made by the Council annually in respect of the work carried out by the Hospital for Battersea mothers. 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, Wednesdays and Thursdays, and for the convenience of patients living at a distance from the Hospital a session is held at the Southlands centre on Fridays. Clinics are also 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 the Council's scheme, also holds an ante-natal clinic at their Southlands premises. The clinic at All Saints' Parish Hall(East Battersea Centre) formerly held at fortnightly intervals was made a weekly clinic during the year. 29 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 gynaecologist. Doctors and private midwives practising in Battersea are also encouraged to send their maternity patients to the central ante-natal clinic at the Borough Maternity Hospital for examination and report by the consultant gynaecologist. Miss Bloomfield(Consultant Gynecologist) reports:— Wednesday and Thursday morning Ante-natal Clinics. During the year 1934, 103 Sessions were held, with an average attendance of 29.4 patients per clinic. 430 new patients were seen, and the total attendances at the clinics numbered 3,027. Classification of new cases. Of the new cases attending the Clinics, 234—or more than 50 per cent. were primiparæ, 194 were multipart, of which no fewer than 85 or approximately 45 per cent. were "return cases" —i.e., had previously been confined in the Battersea Borough Maternity Home, or by the Borough Midwife—and 2 were not pregnant. Period of pregnancy when patient first attended. 1—6 months. 6—8 months. 8 months and over. 336 cases. 70 cases. 7 cases. Provision made for confinement. B.M.H. Midwife. Other. 336 cases. 91 cases. 1 case. Abnormal cases. Among others, the following abnormal cases were seen:— Albuminuria 47 Small pelvis or disproportion 15 High blood pressure 27 Cardiac disease 3 Suspected Tuberculosis 1 Other complications(e.g., varicose veins, prolapse, &c.) 17 Cases referred to hospital for opinion, special examination, &c. Middlesex Hospital 18 South London Hospital 7 Bolingbroke Hospital 1 Tuberculosis Dispensary 1 30 Cases recommended for admission to the B.M.H. during the ante-natal period 28 Cases recommended for dental treatment 139 Friday morning Ante-natal Clinic—Southlands institute. During the year 1934, 51 sessions were held, with an average attendance of 17.7 per clinic. 286 new cases were seen, and the total attendances at the clinic numbered 901. Classification of new cases. Of the new cases attending the Clinic, 96 or 33.6 per cent. were primiparæ, 189 were multiparæ, of which 85 or almost 45 per cent. were " return " cases, and one was not pregnant. Period of pregnancy when patient first attended. 1—6 months. 6—8 months. 8 months and over 208 cases. 68 cases. 9 cases. Provision made for confinement. B.M.H. Borough Midwife. Private Midwife. Other. 164 cases. 113 cases. 3 cases. 5 cases. Abnormal cases. Among others the following abnormal cases were seen:— Albuminuria 1 Small pelvis 2 Cardiac disease 5 Suspected Tuberculosis 2 Pyelitis 1 High blood pressure 5 Anæmia 4 Other complications 3 (Note.—The apparently small number of cases of albuminuria occurring in patients attending this clinic may be accounted for by the fact that a very large proportion of these patients are referred to the B.M.H. or are attending another clinic during the last month or six weeks of their pregnancy—i.e., at the time when albuminuria most frequently occurs.) Cases referred to hospital for opinion, special examination, &c. South London Hospital 10 cases. anæmia—4 cases. cardiac disease—4 cases. high blood pressure—1 case. for X-ray examination? twins—1 case. 31 St. James's Hospital 5 cases. for admission? induction—2 cases. high blood pressure—2 cases. pyelitis—1 case(did not go). Tuberculosis Dispensary 2 ,, B.M.H.(for admission) 3 „ To private doctor 2 „ Cases recommended for dental treatment 142 ,, Tuesday afternoon (special) clinic. During the year 1934, 51 sessions were held with an average attendance of 17 per clinic. 740 new cases were seen and the total attendances numbered 866. Wassermann reactions. Blood was taken for the Wassermann reaction in 727 cases, of which 5, or under 1 per cent., gave a positive reaction. Gynecological cases. In addition to the above a large number of gynaecological cases were seen, in some cases, the lesion complicating pregnancy, in others occurring in post-natal cases, while several cases were referred simply for diagnosis or an opinion—e.g. sterility, diagnosis of pregnancy, &c. The cases seen and treated included the following: Vaginal discharge(complicating pregnancy or occurring in postnatal cases) 62 cases. (N.B.—This number refers to total examinations made, and includes in many cases repeated treatments, film examinations, &c.) Retroversion of the gravid uterus(cases seen on several occasions) 4 cases. For diagnosis of pregnancy 21 ,, For prolapse, changing of rings 14 „ Other cases seen at this clinic included cases for catheter specimens, special albuminuria cases, cases for blood pressure examinations(these however are usually carried out as a routine in the ante-natal clinics.) Versions under anæsthesia. It is after this clinic on Tuesdays that examinations under anaesthesia, e.g., for version—are carried out. During 1934, 22 examinations under anaesthesia were carried out:— for diagnosis of presentation 3 cases. for external version 19 ,, (successfully-—11 cases, unsuccessfully—8 cases.) 32 In relation to the ante-natal work, the following figures, obtained from the record of the Borough Maternity Home, are of interest. Cases of albuminuria requiring admission, 20. Results— Mother—good; baby—good. Cases of eclampsia—nil. Cardiac cases.—2. Results—Mothers—1 died; babies—both good. Antepartum hemorrhage.—5 cases. Accidental—2 cases. Results—Mother—2 good; baby—2 good. Placenta prævia—3 cases. Results—Mother—all good; baby—all good. Inductions.—36 cases. Methods used and results—Drugs, 29 (mother—all good; baby—all good). Rupture of membranes, 6 (mother and baby—all good). Tube, 1(mother—good; baby— good). Indications for—albuminuria, 6 cases; disproportion, 8; post maturity, 4; high blood pressure, 5; cardiac disease, 2; antepartum hæmorrhage, 4. Forceps deliveries.—20 cases. Indications—Cardiac disease, 2; persistent occipito posterior presentation, 8; long second stage, 5; fætal distress(2 with prolapsed cord), 5. Results—Mothers—19 good; 1 died. Babies—17 good; 3 died. Examinations under anæsthesia carried out—22 cases. For diagnosis of presentation, 3; for external version, 19 (successful 11. unsuccessful 8). Cesarean Section.—9 cases. Results—Mother, Baby—all good The subjoined table shows in summary the number of attendances, &c., at the municipal ante-natal clinics(excluding the special clinic referred to on page 33) during 1934. Clinics held at Maternity Hospital. Southlands. Plough Road. All Saints' Hall. Total. Sessions 103 51 52 41 247 Attendances 3,027 901 634 503 5,065 „ average 29 18 12 12 21 New cases 428 285 14 20 747 Cases seen by doctor 3,027 875 592 454 4,948 Average per session per doctor 15 17 11 11 15 The work of visiting and reporting upon Battersea cases, which is done by the Council's health visiting staff for the obstetric and gynµcological departments of several of the larger hospitals is summarised on page 23. 33 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 1934 is summarised in the table on page 34. Mr. Corsi reports as follows:— During 1934 the blood of 727 prospective mothers was examined and of this number 5 were found to give a positive Wassermann reaction. This represents a percentage incidence of 0.7, a figure which may be considered a very low one. Of the five patients found positive one was transferred to the Surrey County Council, one ceased to attend, and a third had had courses of treatment in 1929 and 1932 of sufficient intensity that it was considered unnecessary to give further injections; she did, in fact, give birth to a healthy baby with negative Wassermann. A fourth patient with strongly positive Wassermann had always failed to reach full term during previous pregnancies. In her instance treatment was given before, as well as during pregnancy. As a result she went to full term and had a perfectly healthy baby. Her case was one of the most gratifying the clinic has had. For various reasons, of which some are indicated above, the amount of work in the clinic was considerably reduced during 1934, and it would seem that the time is not far distant when it will be most exceptional to find a positive Wassermann in any of the women coming to the ante-natal clinic. Maternal Mortality. During 1934, there were 7 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 3.15 per 1,000 births(live and still), as compared with 5 deaths and a fatality rate of 2.15 in 1933. Six of these deaths occurred in hospital and one at home. The causes of death were certified as being:— Puerperal sepsis 3 Eclampsia 1 Post-partum hæmorrhage and shock 1 Inversion of the uterus and shock 1 Cæsarean section 1 In addition there was one maternal death due to causes not directly associated with the puerperium. 34 BATTERSEA ANTE-NATAL(V.D.) CLINIC. Results 1922—1934. 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 1934 727 5 0.7 3 3 0 0 * Not syphilitic. 35 Maternal Deaths in Child-birth and Maternal Mortality Rate per 1,000 Births(Live and Still). Year. Puerperal Sepsis. Other Causes. Total. No. Rate. No. Rate. No. Rate. 1929 2 0.74 3 1.10 5 1.84 1930 4 1.45 6 2.18 10 3.63 1931 5 1.97 10 3.93 15 5-90 1932 2 0.83 2 0.84 4 1.67 1933 4 1.72 1 0.43 5 2.15 Mean, 1929-33 3.4 1.34 4.4 1.70 7.8 3.04 1934 3 1.35 4 1.80 7 3.15 From the above table it will be noted that there was a slight increase in maternal mortality in the borough as compared with the previous year. Following the usual procedure, and in accordance with the instructions of the Ministry of Health, each of the 7 deaths of Battersea mothers was fully investigated, and reports submitted to the Ministry. The Council has made free provision under its Maternity and Child Welfare scheme for the ante-natal examination of expectant mothers. Doctors and practising midwives are invited to refer expectant mothers for examination and report by the Consultant Specialist who attends the ante-natal clinics on three days weekly, but up to the present they have failed to avail themselves of the facilities provided by the Council for this purpose to any extent. In this connection the Council decided to compensate any practising midwife who suffers loss of fees owing to her patient(having been referred by her to the Council's ante-natal clinic) entering hospital for her confinement on the advice of the medical officer of the clinic. This subject is more fully referred to on page 26. Arrangements have also been 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 36 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 the special treatment clinic 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. 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 1934 there were 51 sessions held and 464 attendances were made, 378 being new cases. The average attendance per session was 9.1. Arrangements have been made for Mr. F. W. Roques, M.S., F.R.C.S., of the Middlesex Hospital, to act as Consultant Obstetrician and his services are available in cases of grave emergency. It was found necessary to call in the services of the Consultant Obstetrician in 22 cases during the year(as compared with 12 cases in 1933) for the following reasons:— Caesarean Section 9 Ante-partum haemorrhage 2 Post-partum hæmorrhage 1 Difficult delivery 3 Retained membranes 2 Induction 1 Extensive rupture of Perineum 1 Uterine inertia 1 Other reasons 2 During 1934, 493 cases were admitted to the Hospital as compared with 543 in 1933, 552 cases in 1932, 555 in 1931, 516 in 1930, and 605 in 1929. Particulars relating to the admissions during 1934 are set out as follows:— N umber of cases admitted— For confinement 488 „ ante-natal treatment 5 493 Number of confinements— 1933 patients 2 1934 „ 483 485 (5 patients not yet confined at 31st December.) 37 Number of deliveries— By midwives 457 ,. doctors 28 485 Number born before arrival - Total births(including 14 twins) 492 Number of maternal deaths Nil (One death, not ascribed to puerperal causes, occurred at the Hospital in November.) Number of cases notified as Ophthalmia Neonatorum with result of treatment.(Both cured) 2 Number of cases with discharge from eyes however slight 12 Number of infants not entirely breast fed 12 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia 10 Number of infant deaths (8 still-born, 12 within 10 days of birth) and their causes 20 Died within 10 days— Prematurity 7 Atelectasis, &c. 3 Congenital heart disease 2 12 Still Birth— Macerated 1 Prematurity 1 Prolapse of cord 1 No foetal heart on admission 1 Breech presentation 1 Hand and cord presentation 1 White asphyxia 1 Long first stage of labour 1 8 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, 1935:— Maternity Hospital, 1934—5. Total beds(excluding cots, labour and isolation beds), 30; total cases admitted and discharged during year, 477; average number of beds occupied during the year, excluding cots, labour and isolation beds, 17.8; number of weeks spent in Institution by such patients, 969.4. A statement* showing expenditure for the year ended 31st March, 1935, in respect of the Maternity Hospital is given on the next page. •*This statement does not take into account the Government Grant. 38 Item. Total. atientWeek. £ £ s. d. Salaries Medical 454 0 9 1 Nursing 715 0 14 3 Domestic and other 641 0 12 10 Superannuation(Council's contribution) 66 0 1 4 Provisions 713 0 14 3 Drugs and other medical requisites 244 0 4 10 Fuel, lighting and water 387 0 7 9 Laundry 314 0 6 3 Repairs and renewals Domestic 172 0 3 5 Structural 354 0 7 1 Miscellaneous items— Telephones, stationery, etc., and sundries 183 0 3 8 Totals, excluding rates, insurance and loan charges 4,243 4 4 9 Rates and insurance 61 0 1 3 Loan charges 1,074 1 1 5 Gross cost 5,378 5 7 5 Income Pupil Midwives(including training grant) . 295 0 5 11 Patients' payments 2,205 2 4 0 Other 37 0 0 9 Net cost 2,841 2 16 9 District Midwifery Service. During 1934 there were 190 cases attended in their own homes by the District Midwife as compared with 185 in the previous year, an increase of 5 cases. Particulars relating to this service during the year are set out below:— Total number of bookings 234 Number of bookings cancelled or transferred 32 Total number of cases attended in the district 190 Average number of visits to each case 19 Number of cases:— (a) Delivered by Midwife 172 (b) „ Doctors 3 (c) Born before arrival 15 (d) Referred to hospital before or after confinement 13 39 Number of cases where medical assistance was called for, with reasons for requiring assistance:— (a) Ante-Natal—-6. Abortion 1 Abscess 1 Hæmorrhage 1 (?) Placenta prævia 1 Pain in side 1 Twin pregnancy 1 6 (c) After Labour—2. Retained placenta 1 Retained chorion 1 2 (6) During Labour—28. Prolonged labour 9 Forceps delivery 3 Post-partum hæmorrhage 3 Ruptured perineum 3 Uterine inertia 6 Other reasons 4 28 (d) For Infant—13. Watery or sticky eyes 5 Anencephalus 1 Umbilical stump 1 Jaundiced condition 2 Hare-lip and cleft palate 1 Other reasons o Convulsions 1 • 13 Number of cases of— Puerperal sepsis Nil Puerperal pyrexia Nil Maternal deaths Nil Still births 1 Deaths of infants within 10 days 9 Dental Clinic. This 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 expeciant and nursing mothers and children under 5 years of age. Five sessions are held weekly in addition to one for tuberculous patients(vide page 62). 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. The work of the Dental Clinic during 1934 is summarised as follows:— Women. Children. Total. Sessions held 202 48 250 No. of patients treated 621 256 877 No. of new patients 418 163 581 Total attendances 2,947 875 3,822 40 Work carried out:— Extractions— Ordinary 2 1 3 With local anaesthetic 48 5 53 „ general anæsthetic 653 244 897 Totals 703 250 953 No. of teeth extracted 2,364 603 2,967 Scaling and polishing 49 — 49 Fillings 62 12 74 Upper dentures 116 — 116 Lower dentures 95 — 95 Denture visits 639 — 639 Dressings and treatment to gums 105 4 109 Repairs to dentures 24 — 24 Advice 1,291 607 1,898 The Council have, since 1927, undertaken the dental treatment at scale charges of Chelsea patients referred by the Chelsea Health Society for the purpose. The gross cost of dental treatment(Maternity and Child Welfare) in the financial year 1934-35 was £932 7s. 6d. which includes the sum of £359 17s. 6d., cost of dentures supplied. The contributions of patients, and those received from other sources during the financial year, were as under:— £ s. d. Contributed by patients 132 14 11 Payments by Chelsea Health Society 116 2 6 Grants from British Dental Hospital 40 15 0 Grants from Saturday and Sunday Hospital Funds 62 11 6 Grants from other philanthropic agencies 27 10 10 Contribution by the Council 10 13 0 £390 7 9 The net cost of this service during 1934-35 was £566 ls. 0d. Solarium. The Light Treatment Centre was established at Southlands in 1929. The Centre is housed in a portion of the Southlands building which has been specially adapted and equipped for the purpose. The equipment consists of:— 2 carbon arc lamps. 2 mercury vapour lamps. 4 general radiation lamps. 4 couches. 41 During the year 123 sessions for Welfare patients were held, the number of patients on the roll at the end of the year being 12. The total attendances numbered 2,228, the average number per session being 18.1. A medical officer attended six of the sessions and saw 42 of the patients. The number of persons who received treatment during the year(excluding tuberculous children) was 72, whose ages were as follows:— Under 1 year 12 1 to 2 years 44 2 to 3 „ 14 Other(adult) 2 The reasons for their treatment were:— Prevention of Rickets 65 Debility 2 Bronchitis 1 Septic condition 1 Anaemia 2 Fracture 1 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 page 63. Infant Life Protection. The provisions of the Children and Young Persons Acts, 1908 and 1932, relating to Infant Life Protection have since the 1st April, 1933, been administered by the Council. Foster mothers and the children in their care were visited throughout the year by the Health Visiting staff, who have been appointed by the Council as Infant Life Protection visitors. The number of visits paid by them in 1934 to foster mothers and children was 1584. At the end of 1933 there were 64 Battersea foster mothers on the register, having in their care 89 nurse children. At the end of 1934 there were 70 foster mothers with 102 nurse children, an increase of 6 foster mothers during the year. In addition there were on the register 44 foster mothers who had no children in their charge. Forty notices of intention to receive nurse children were received during the year from foster mothers not previously registered, and 18 names were removed from the register. There was thus an increase of 22 mothers on the register, but of these a number had no children in their care at 31st December. 42 The ages of the 102 children were as under:— Under 1 year 20 1 to 5 years 49 Over 5 and under 9 years 33 The whole number of nurse children who were under observation during 1934 was 200. Of the children under 5 years of age 20 were attending the Infant Welfare Centres at the end of the year. In four cases the Committee exercised their power of fixing the maximum number of nurse children permitted to be kept by certain registered foster mothers. Thirteen cases of measles and 10 of other infectious diseases occurred among nurse children during 1934, and also one death, due to pneumonia. It was found necessary in one case to take legal proceedings during the period under report in respect of an offence, viz., failure to give the notice prescribed by the Children Acts of the reception of a nurse child. The defendant, who did not appear, was subsequently arrested on warrant and fined £2 with £1 ls. 0d. costs. In 27 cases foster mothers were cautioned for the undermentioned offences:— Failure to give prescribed notice of— Reception of nurse child 14 Removal of nurse child 8 Reception and removal of nurse child 3 Death of nurse child 1 Exhibiting anonymous advertisement 1 Women's League of Service. The Battersea centre of this League(formerly situated at 111 Bridge Road West) was established in 1911, and was transferred to Southlands, Castle Street, in 1928. The district served by the League is a populous one adjoining the Thames, and situate between Battersea Bridge Road and High Street. An important feature of the work of the League is the provision of cheap dinners for nursing and expectant mothers and children. This centre is carried on as an integral part of the Council's Maternity and Child Welfare Scheme, and the Council make an annual grant of £546 towards the expenses. Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Ante-natal Work.—25 sessions have been held, with a total attendance of 290. 43 30 mothers were confined at the Borough Maternity Home. 18 ,, „ ,, by the Borough Midwife. 4 ,, ,, ,, at St. James's Hospital. 1 mother was confined at Clapham Maternity Home. 4 mothers were confined by private midwives. Infant Welfare Work.—68 sessions held, with a total attendance of 1,915. Cases referred to Hospital.—1 case sent to Belgrave Hospital for Children for acute diarrhæa; 1 case sent to Golden Square Throat and Ear Hospital for otitis media; 2 cases sent to Battersea General Hospital for bronchitis; several cases sent to Victoria Hospital for Children for tonsils, adenoids, circumcisions, &c. Fourteen mothers and 7 babies were sent to Convalescent Homes. The District Nurses have done good work in visiting the children in their own homes for special dressings and discharging ears. Dinners for Mothers.—We are having excellent attendances, and many mothers are being sent to us from the Borough. Dinners for Toddlers.—These dinners are becoming increasingly popular and proving most helpful. The Borough Dental Clinic has been a very great help to our mothers and children. 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 18. 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:— Infant Welfare sessions 92 Total attendances 3,135 Doctor's interviews 1,906 New cases—under 1 year 177 1 to 5 years 30 Total first attendances during year 616 44 The Health Visitors paid 4,262 home visits, including 405 first visits to measles cases. The prevalence of measles and other infectious illness in the earlier part of the year inevitably affected the attendances at the centre. Twenty-four children were referred for massage; 46 sessions were held and the attendances numbered 170. We are again indebted to the Invalid Children's Aid Association and the Women's Holiday Fund for their help in arranging convalescence and holidays for a number of mothers and children, with very great benefit to health. Test feeds are given on Wednesdays, and in cases of difficulty with breast-feeding mothers are asked to bring their babies for two feeds, if possible, on that day, and they are also given advice as to the methods of increasing the breast milk. Infant care lectures and sewing Classes are given. Infant care lectures 37 Attendances 529 Sewing classes 37 Attendances 529 First attendances 24 A Pound Day and Sale was organised by the mothers and staff in aid of the Centre, which realised over £6. A Mothers' Social is held each month, and in November a concert and prizegiving was held, at which prizes won by mothers and fathers in needlework and handicraft were given by Lady Maclagan. The Father's Council, which is in its fifth year, meets one evening a month. The annual conference was held in the Small Town Hall, on March 14th, 1934, the Lady Cynthia Colville in the chair. Speakers: Sir Bruce Bruce-Porter, K.B.E., C.M.G., M.D., and Dr. D. H. Geffen, Medical Officer of Health for Enfield. The meeting was well attended, and a resolution was sent to the Ministry of Health:— "That the Conference of Fathers' Councils is of the opinion that the formation of Fathers' Councils should be included as an important element of the organised Maternity and Child Welfare Schemes of Health Authorities, and that the Ministry of Health be urged to sanction the reasonable expenditure incurred under this heading." Chislehurst (St. James's) Mission. The centre established by this Society has been held for many years at a Church Hall in Ponton Road. The sessions held weekly are in charge of one of the Council's Health Visitors, who also carries out the necessary visiting work in the area served. Details of the work carried out will be found in the table on page 21. The Council make an annual grant of £28 towards the expenses. 45 Notifiable Infectious Diseases. During 1934 under the notification clauses of the Public Health(London) Act, 1891, and the Orders and Regulations made thereunder, 5,146 cases of infectious diseases(excluding tuberculosis) were notified, including cerebro-spinal fever 2, enteric fever 1, small-pox 1. In 1933 the total was 2,774. The increase in the number of cases notified during 1934 was chiefly due to the prevalence of measles. The following is a list of the diseases compulsorily notifiable in Battersea:— Small-pox. Acute polio-myelitis. Cholera. Acute polio-encephalitis. Diphtheria. Glanders. Membranous croup. Anthrax. Erysipelas. Hydrophobia. Scarlet fever. Acute influenzal pneumonia. Typhus fever. Acute primary pneumonia. Typhoid or enteric fever. Malaria. Relapsing fever. Dysentery. Continued fever. Plague. Puerperal fever. Acute encephalitis lethargica. Puerperal pyrexia. Measles. Ophthalmia neonatorum. Whooping cough. Cerebro-spinal fever. Tuberculosis. Excluding tuberculosis, measles and whooping cough, there were 1,647 cases which occurred in 1,407 houses. Of these cases 1,400, or 85.0 per cent., were removed to the isolation hospitals of the London County Council or to other institutions and 247, or 15.0 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 in the Appendix (vide page 109), and the distribution of the cases notified in the registration sub-districts and the wards is shown in the table on the next page. Infectious Disease Contacts. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 46 Notifications of Infectious Diseases, 1934, in Wards and Sub-Districts(see also table on page 109). Notifiable Disease. Wards. Districts.† Totals. 1 2 3 4 5 6 7 8 9 N S Small-pox — — — — 1 — — — — 1 — 1 Diphtheria 101 71 87 44 72 99 30 26 27 331 226 557 Erysipelas 11 14 6 5 9 11 5 9 5 40 35 75 Scarlet fever 90 67 75 53 87 105 36 57 46 319 297 616 Enteric(Typhoid) fever — — — 1 — — — — — — 1 1 Puerperal fever 2 2 1 1 1 1 — 2 — 6 4 10 Puerperal pyrexia 4 1 5 1 6 — 1 — 2 16 4 20 Ophthalmia neonatorum 3 3 3 1 3 2 2 5 1 12 11 23 Cerebro-spinal meningitis — — 1 — — — — 1 — 1 1 2 Polio-myelitis 1 1 1 — 1 — — — — 4 — 4 Polio-encephalitis — — — \— — — — — — — — — Encephalitis lethargica Malaria — — — — — — — 1 1 — 2 2 Dysentery — \— — — — — — — — — — — Acute primary pneumonia 49 47 47 17 39 51 11 20 14 182 113 295 Acute influenzal pneumonia 8 — 1 6 5 6 2 9 4 14 27 41 •Whooping cough 49 89 97 16 59 59 28 51 29 294 183 477 •Measles 482 442 471 206 489 400 147 220 165 1,884 1,138 3,022 Tuberculosis(all forms) 35 18 27 23 30 28 17 27 31 110 126 236 Totals 835 755 822 374 802 762 279 428 325 3,214 2,168 5,382 *Notifiable in Battersea since 1922. † See note, page 8. 47 Public Health (Treatment of Infectious Disease) Regulations, 1934. These Regulations, which came into force on 1st July, gave power to local authorities by whom hospitals for persons suffering from infectious disease are provided to admit to such hospitals persons temporarily resident in their districts. Public Health (Shellfish) Regulations, 1934. These Regulations, dated 7th December, and made by the Minister of Health, empower local authorities, in the case of illness attributable to shellfish, or where the consumption of shellfish is likely to cause danger to public health, to take measures to prohibit the sale of shellfish from suspected layings. Small-Pox. One case of mild small-pox (Variola minor) occurred in Battersea in 1934, as compared with 4 in 1933 and 13 in 1932. The patient was a boarder (unvaccinated) at a large school in the Borough, which was about to break up for the vacation. When the patient was notified most of the immediate contacts had already departed for their homes, and the Medical Officers of Health of the various districts were notified. So far as is known no further cases occurred. The usual precautions were taken. During the year 181 cases of small-pox were notified in England and Wales, including 146 in London. Two 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 lower in 1934, 616 cases being notified as compared with 826 in the previous year. The case-rate per 1,000 of the population was 4.08 and no death was registered from the disease. There were 6 deaths with a death-rate of 0.04 in 1933, 4 deaths and a death-rate of 0.03 in 1932, 6 deaths and a death-rate of 0.04 in 1931, and 2 deaths and a death-rate of 0.01 in 1930. Of the cases notified 596 or 96.8 per cent. were removed to hospital. The infected houses numbered 540. In 62 other notified cases (not included in the above total), the diagnosis of scarlet fever was not confirmed at hospital. 48 Diphtheria. The number of cases of Diphtheria notified in Battersea during 1934 was 557 as compared with 396 in 1933, 312 in 1932, 298 in 1931, and 489 in 1930. The number of deaths registered from the disease was 20, giving a death-rate of 0.13, as compared with 12 deaths and a deathrate of 0.08 in 1933, 9 deaths and a death-rate of 0.06 in 1932, 5 deaths and a death-rate of 0.03 in 1931, and 15 deaths and a death-rate of 0.09 in 1930. All the 557 cases notified were removed to hospital. The infected houses numbered 487. In 61 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 3.69 as compared with 2.57 in 1933, 1.99 in 1932, 1.86 in 1931, and 3.04 in 1930. The case-mortality was 3.59 per cent. as compared with 3.03 per cent. in 1933, 2.88 per cent. in 1932, 1.68 per cent. in 1931, and 3.07 per cent, in 1930. The incidence of the disease was highest in the Winstanley, Latchmere and Church Wards. Diphtheria anti-toxin, in accordance with the recommendation of the Ministry of Health, is supplied free of charge on the request of any registered medical practitioner, at any hour of the day or night. During the year 12 phials (approximately 118,000 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 50 Patients attending in 1934 (new 259) 353 Attendances 1134 „ (average per session) 22.7 Patients tested— New (including 3 second tests) 188 Old (including 15 second tests) 19 207 (Positive 138, negative on 1st test 44, on second 18, no reading 7) 49 Patients inoculated— Without test (2 old patients) 75 After positive test (old patients) 19 „ (new „ ) 131 225 Inoculations— Old patients 28 New „ 549 577 Total immunised (including 69 patients who attended in previous years) 130 Patients on register at end of year 206* Discontinued treatment 32 The total number of patients immunised or found by test to be immune is 174, out of a total of 353 patients who have attended during the year (49 per cent.). Since the opening of the clinic 1252 patients have attended, and of these 863 have been immunised or found immune by test (68.9 per cent.). Acute Polio-Myelitis and Polio-Encephalitis. Four cases of acute Polio-Myelitis were notified in Battersea during 1934. No death was recorded. At the beginning of the year there were 30 chronic cases on the register, which with the 4 newly notified cases make a total of 34 cases on the register at the end of the year. When first notified or reported 25 of these cases were under 5 years of age, and in 1934, 4 were over 16 years, 23 were of school age, and 7 under 5 years. Of the 23 school children 6 were scholars at elementary or secondary schools, 13 attended special schools for defective children, and 4 were at educational or cripple establishments outside London. Twenty of the 34 cases were receiving treatment at out-patient departments of various hospitals, 7 were receiving no treatment, 4 received in-patient treatment during the year, and 3 were inmates of institutions. No case of acute Polio-Encephalitis was notified during 1934. Puerperal Fever and Puerperal Pyrexia. Ten cases of Puerperal Fever were notified in Battersea in 1934, as compared with 3 in 1933, 4 in 1932, 6 in 1931, and 9 in 1930. One death occurred among the notified cases. * Includes 15 cases found negative on first test, who are to attend again for re-test. 50 Three deaths were registered as due to this disease, all of which occurred in Public Assistance Hospitals. Two of these deaths were due to septicaemia following abortion. Careful investigation was made in these three cases in connection with the Government's enquiry into maternal mortality (vide page 33), and the result forwarded to the Ministry of Health. In two of these cases no notification of Puerperal Fever was received, although one of them had been notified as Puerperal Pyrexia. The number of notified cases per 1,000 births (live and still) was 4.5, as compared with 1.29 in 1933, 1.67 in 1932, 2.36 in 1931, and 3.27 in 1930. The case-mortality was 25 per cent of the cases notified and reported, and the death-rate per 1,000 births was 1.4. There were 2,466 cases of Puerperal Fever notified in England and Wales during 1934, including 258 notified in London. A comparison of the incidence of Puerperal Fever in London and Battersea will be found on page 107. The number of cases of Puerperal,Pyrexia notified in Battersea during 1934 was 20, and the incidence per 1,000 births (live and still) was 9.0. There were 5,956 cases of Puerperal Pyrexia notified in England and Wales during the year, including 773 notified in London. 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 Puerperal Fever is provided by the London County Council in their North Western Hospital. Enteric Fever. During 1934 one case of Enteric Fever was notified in Battersea. Two other notifications were subsequently cancelled, the diagnosis not being confirmed at hospital. No death of a Battersea resident was registered during the year as being due to this disease. One case of " Continued Fever" was notified during the year, but was subsequently cancelled, the diagnosis after admission to hospital not being confirmed. Cerebro-Spinal Fever. During 1934, 2 cases of Cerebro-Spinal Fever were notified in Battersea, and both proved fatal. Encephalitis Lethargica. No notifications of this disease were received during 1934. One death, a contributory cause of which was certified to be 51 Parkinson's Syndrome, was registered during the year, and was ascribed to encephalitis lethargica. This case had not been notified. In London the number of cases notified during the year was 29, and in England and Wales (including London), 407. Ophthalmia Neonatorum. There were 23 cases of Ophthalmia Neonatorum notified in Battersea during 1934, as compared with 16 in 1933, 30 in 1932, 37 in 1931, and 34 in 1930. The rate per 1,000 births was 10.7. There were 9 severe cases amongst the 23 notified, which were removed to St. Margaret's (L.C.C.) Hospital for treatment. One case of probable injury to the eye was recorded during the year. During 1934 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 1,796. All cases were kept under systematic supervision by the Health Visiting staff, and 98 visits were made to the homes of these children. The following table shews the distribution of the cases notified :— Sub-Districts. Ward. Cases Births, (live) Rate per 1,000 Births. Year. Cases. Births. (live) Rate per 1,000 Births. N. Battersea 12 1,157 10.4 1929 43 2,619 16.4 S. Battersea 11 997 11.0 1. Nine Elms 3 365 8.2 1930 34 2,652 12.8 2. Park 3 263 11.4 1931 37 2,477 14.9 3. Latchmere 3 241 12.4 4. Shaftesbury 1 161 6.2 1932 30 2,319 12.9 5. Church 3 288 10.4 6. Winstanley 2 290 6.9 1933 16 2,263 7.1 7. St. John 2 108 18.5 Mean 1929-33 32 2,466 13.0 8. Bolingbroke 5 226 22.1 9. Broomwood 1 212 4.7 Borough 23 2,154 10.7 1934 23 2,154 10.7 Erysipelas. There were 75 cases of Erysipelas notified and 8 deaths were recorded from the disease during 1934 in Battersea, 7 of which were of notified cases. The case-mortality was 10.5 per cent. of the total recorded incidence, and the death-rate per 1,000 population was 0.05. 52 Measles. Measles recurred in epidemic form in London in 1934, and in Battersea 3,022 cases were notified under the Battersea (Measles and Whooping Cough) Regulations, 1922, and 697 additional cases were reported from schools and other sources, making a total of 3,719 cases, being 24.65 per 1,000 of the population. Thirty-two deaths from the disease were recorded, giving a death rate of 0.21, and a case-mortality of 0.86 per cent. of the total cases. The corresponding figures for 1933 were : cases 500, incidence per 1,000 population 3 .25, deaths 1, death-rate 0.006, case-mortality rate 0.2 per cent. Of the 3,719 cases, 632 were removed to hospital. The table below gives particulars, in two-yearly periods, of the previous biennial epidemics of measles which have occurred since the Regulations requiring the notification of measles in Battersea came into force. It will be seen that the epidemic of 1934 was severe in regard to the number of cases occurring, but that the death-rate is the lowest shown, with one exception, and the case-mortality rate is the lowest of the series. Incidence and Mortality of Measles in Epidemic Periods, 1921-1934. 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 1933-34 4,219 33 .72 .108 1383.9 0.78 The scheme of the London County Council for the control of measles in elementary schools during epidemic periods, was carried out by the Health Visitors in conjunction with the school medical and nursing staff, and 4,254 visits were made by the Health Visitors during the year to houses in which cases of measles had occurred. Whooping-Cough. During 1934 there were 477 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 205 additional cases were reported from the public elementary schools and other sources. The total number of cases notified or otherwise reported during 1934 was 682, as compared with 976 in 1933, 1,109 in 1932, 747 in 1931, and 537 in 1930, the decrease in 1934 compared with 1933 being 30.1 per cent. Of the total cases, notified and reported, 76 were removed to hospital. 53 There were 7 deaths registered from this disease, the deathrate being 0.05, as compared with 12 deaths and a death-rate of 0.08 in 1933, 11 deaths and a death-rate of 0.07 in 1932, 5 deaths and a death-rate of 0.03 in 1931, and 7 deaths and a death-rate of 004 in 1930. Vaccination. The Public Vaccinators and the areas for which they act are shown 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. A. B. Hewlett, 65 Battersea Park Road, S.W. 8.) 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.) 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. 54 TUBERCULOSIS. During the year ended 31st December, 1934, there were 236 cases of Tuberculosis (all forms) notified in Battersea as compared with 238 cases in 1933, 246 in 1932, 255 in 1931, and 286 in 1930. In addition 33 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making a total of 269 cases. The following table (required by the Ministry of Health) shows the age and sex distribution of the 269 cases of Tuberculosis notified or otherwise reported during the year ended 31st December, 1934, and the 132 deaths registered as due to the disease. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. Total M. F. Total M. F. Total : M. F. Total 0 — - - - 1 - 1 - - - 1 - 1 1 — - - - 2 4 6 - 1 1 1 1 2 5 — 1 2 3 6 6 12 1 - 1 1 1 2 10 — 2 3 5 5 2 7 1 1 2 2 - 2 15 — 14 13 27 5 2 7 4 4 8 2 - 2 20 — 30 22 52 2 2 4 13 8 21 2 2 4 25 — 30 25 55 3 4 7 10 9 19 2 2 4 35 — 19 10 29 - 1 1 10 5 15 2 - 2 45 — 16 6 22 1 1 2 22 8 30 1 1 2 55 — 12 3 15 1 2 3 6 - 6 - 1 1 65 and upwards 8 2 10 1 — 1 4 2 6 1 — 1 Totals 132 86 218 27 24 51 71 38 109 15 8 23 Deaths from non-respiratory forms of tuberculosis formed 17.4 per cent. of the total deaths from the disease. 55 PERIOD 1ST JANUARY TO 31ST DECEMBER, 1934. The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population of the 269 cases of tuberculosis notified or otherwise reported, and of the 132 deaths. SubDistrict. New Cases. Deaths. Respiratory Non-Respiratory Total Rate per 100,000 populn. Respiratory Non-Respiratory 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 60 45 105 15 13 28 75 58 133 181 37 22 59 9 4 13 46 26 72 98 South 72 41 113 12 11 23 84 52 136 175 34 16 50 6 4 10 40 20 60 77 Ward 1 19 13 32 5 4 9 24 17 41 170 12 3 15 4 2 6 16 5 21 87 2 11 3 14 5 3 8 16 6 22 138 8 6 14 3 — 3 11 6 17 106 3 17 13 30 2 1 3 19 14 33 190 7 8 15 — 2 2 7 10 17 98 4 17 7 24 1 1 2 18 8 26 195 9 3 12 — 2 2 9 5 14 105 5 13 16 29 3 5 8 16 21 37 234 10 5 15 2 — 2 12 5 17 107 6 18 10 28 2 1 3 20 11 31 171 11 2 13 4 1 5 15 3 18 99 7 9 5 14 2 4 6 11 9 20 247 4 2 6 — 1 1 4 3 7 86 8 10 10 20 3 4 7 13 14 27 155 6 2 8 1 — 1 7 2 9 52 9 18 9 27 4 1 5 22 10 32 156 4 7 11 1 — 1 5 7 12 58 Boro' 132 86 218 27 24 51 159 110 269 — 71 38 109 15 8 23 86 46 132 — Rate per 100,000 populn. 185 108 144 38 30 34 223 138 — 178 99 48 72 21 10 15 120 58 — 87.49 56 In the tables on pp. 115 to 117 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 269 new cases notified or reported in 1934 is summarised below :— Localisation of Disease. Pulmonary (218) Glands (16) Bones and Joints (17) Lungs 206 Neck 11 Finger 1 Lungs and Larynx 1 Neck and axilla 1 Hip 4 Lungs and Pleura 2 Neck and groin 1 Hip and Elbow 1 Lungs and Menin- Arm 1 Hip and Spine 1 ges 1 Unspecified 2 Knee 2 Lungs and Kidney 2 Knee and Hip 1 Lungs and Tb. Spine 6 Enteritis 1 Wrist 1 Larynx 1 Pleura 4 Abdomen (6) Uro-Genital (1) Brain (9) Abdomen 1 Renal and Tb. Brain and Spine 1 Intestines 2 cystitis 1 Meninges 8 Peritoneum 2 Peritoneum and Skin and sub-cuta- intestines 1 Disseminated (1) neous Tissue (1) General 1 Palmar ganglion 1 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 8 years 1927-1934 :— 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 1934 7 17 2 7 33 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 other action during 1934 in this connection. Deaths from Tuberculosis. The death-rate from Tuberculosis was considerably lower in 1934 than in the previous year, being 87.49 per 100,000 population, 57 as compared with 94.8 in 1933, 104.5 in 1932, 108.3 in 1931, 100.8 in 1930, and 127.3 in 1929. This is the lowest rate yet recorded in Battersea, the previous lowest being in 1933. During 1934 deaths from Tuberculosis registered as belonging to the Borough of Battersea numbered 132, 109 (i.e. 82.6 per cent.) being due to pulmonary tuberculosis, 8 (i.e. 6.0 per cent.) to tubercular meningitis and 15 (i.e. 11.4 per cent.) to other forms of the disease. The allocation of the deaths in 1934 according to age and sex, and in the Wards and Sub-Districts is shown on pp. 54 and 55. In 1933 the number of deaths from tubercular diseases was 146 and it will be noted that there was a considerable decrease in 1934 in the mortality from Tuberculosis as compared with the previous year. Of the fatal cases 14 were notified within one month before death ; in 17 cases the notifications were received after death, and 9 cases were not formally notified. Of the 9 cases in respect of which no primary notification was received 7 (5 pulmonary, 2 non-pulmonary) were patients who died in hospitals or infirmaries. The remaining 2 cases (1 pulmonary, 1 non-pulmonary) died at home. Of the 17 cases notified after death 10 (4 pulmonary, 6 nonpulmonary) were from Public Assistance Institutions ; 6 cases (3 pulmonary, 3 non-pulmonary) died in other hospitals, and the remaining case (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 1934 are given in the following table :— Years. Pulmonary. NonPulmonary. Total. 1901-1905 134.8 49.2 184.0 1906-1910 116.4 41.8 158.2 1911-1915 124.2 33.8 158.0 1916-1920 134.8 30.0 164.8 1921-1925 92.6 23.0 115.6 1926-1930 91.1 14.2 105.3 Average (30 years) 115.7 32.0 147.7 1931 89.5 18.8 108.3 1932 89.8 14.7 104.5 1933 81.2 13.6 94.8 1934 72.2 15.2 87.5 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. 58 London County Council Tuberculosis Scheme. In November the Council considered a draft forwarded by the London County Council of a revised scheme drawn up by them for the treatment of tuberculosis in London, and decided to make no observations thereon. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary under the provisions of these Regulations during 1934. Revision of Notification Register. In accordance with the suggestion of the Ministry of Health the Tuberculosis Notification register is periodically revised, and during 1934 the names of 97 patients were removed from the register as compared with 42 in 1933. The County of London (Tuberculosis) Regulations, 1930. Seven children were, by arrangement with the Invalid Children's Aid Association, boarded out under the scheme of the London County Council under the above Regulations. In June the County Council decided that for the future no charge should be made to parents or guardians for this service. TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary was carried on with the usual routine during 1934. The annual contribution made by the London County Council towards the cost of the dispensary treatment of tuberculosis amounts to £1,037. The staff engaged on Tuberculosis work at the Dispensary will be found on pages 3 and 4. The Dispensary is affiliated to St. Thomas's Hospital, and cases presenting special difficulties in diagnosis are referred to that institution for X-ray examination. The dispensary treatment of school children is carried on in close co-operation with the school medical service, and Springwell House Open Air School on Clapham Common North Side, has, in this connection, carried on useful work during the year. The Tuberculosis Medical Officer and one of the tuberculosis nurses are employed part-time in the medical inspection of children attending the school. 59 Patients and Attendances. In 1934, 728 new cases were added to the dispensary records, 10 more than in 1933. These consisted of 498 persons who were referred by medical practitioners, otherwise presented themselves for examination, or were receiving treatment under the London County Council's tuberculosis scheme ; 209 who had been in contact with cases of tuberculosis ; and 21, already notified in other districts, who had moved into Battersea. Of these 728 cases 463 were discharged as non-tuberculous (including 199 of the contacts), 190 were found to be suffering from the disease, and 75 (including 10 contacts) were kept under observation for diagnosis. Particulars of the 190 positive cases are given under the next heading, and also in form T.145 on page 118. Notifications of 169 of these were sent to the Medical Officer of Health. Old patients to the number of 667 also attended during the year, and the total number of attendances at the Dispensary during the year was 3,577 (of which 2,849 were of old patients), as compared with 3,545 in 1933. Visits to the homes of dispensary patients were made by the Tuberculosis Officers in 290 instances, and 4,200 visits were made by the Dispensary nursing staff. The number of deaths of dispensary patients was 95 as compared with 106 in 1933. Sixty-six of the patients were discharged as " recovered " or " diagnosis not confirmed " during the year, and 30 others ceased to attend, in addition to 72 patients who removed to other districts. New Patients. The five following tables contain particulars of the 190 new cases found to be suffering from tuberculosis. In the first table 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 thoses 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. As in previous years, it will be noted that in the Pulmonary group the incidence is highest in the age period 16.25, being 39.4 per cent. of the total cases. 60 A.—Pulmonary Tuberculosis—Age Groups. 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 3 15 16 6 1 2 — 44 Group T.B. . plus Group I — — — 13 6 — — 2 — 21 Group II — 1 1 34 20 15 9 6 — 86 Group III — — 1 5 6 1 4 — 2 19 Total — 2 5 67 48 22 14 10 2 170 B.—Non-Pulmonary Tuberculosis—Age Groups. Years. 0-5 6-10 11-15 16-25 26-35 36-45 46-55 56-65 over 65 Total Bones and joints 2 2 — 2 2 — — — — 8 Abdominal — 1 — — — — — — — 1 Peripheral glands 3 3 1 1 2 — — — — 10 Skin and other organs — — — — 1 — — — — 1 Total 5 6 1 3 5 — — — — 20 C.—Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 93 54.71 " Influenza " 8 4.71 Pleurisy 17 10.00 Pleurisy with effusion 3 1.76 Haemoptysis 31 18.23 Other modes 18 10.59 Totals 170 100.00 The large proportion of cases in which the first noticed symptom was haemoptysis (blood-spitting) is again to be noted. 61 D.—Occupations in the 170 cases of Pui.monary Tuberculosis. Occupation. No. of Patients. Occupation. No. of Patients. Housewives 29 Clerks (various) 14 School Children 7 Bakers 4 Domestic Workers 10 Cinema Attendant 1 Barmen, &c. 2 Milkman 1 Laundry Workers 4 Electricians 3 Shop Assistants 7 Compositor 1 Needleworkers 4 Porters 2 Messengers 3 Bookbinder 1 Salesmen 3 Marble Polisher 1 Drivers, Carmen, &c. 8 Warehousemen 2 Engineers (various) 9 Piano Remover 1 Builders and Decorators 6 Waiters and Waitresses 3 Stone Mason 1 Farm Worker 1 Carpenters 2 Hairdresser 1 Labourers (various) 9 Street Traders 2 Factory Workers (various) 18 Auctioneer's Foreman 1 Caretaker 1 Waterman 1 Nurse 1 No occupation 5 Teacher 1 E.—Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. Pulmonary 59 3 108 Non-Pulmonary 5 3 12 Totals 64 6 120 Of the 190 cases, therefore, a history of Tuberculosis in a near relative was elicited in 34 per cent. and in a remote relative in 3 per cent. In all 37 per cent. gave a family history of Tuberculosis. Institutional Treatment. In June the London County Council (who are the authority for the provision of institutional treatment for tuberculosis in London), decided that, subject to the approval of the Minister of Health, no contributions should be asked for from patients or persons legally responsible for them, for institutional treatment. The Council concurred. Contributions of patients undergoing institutional treatment collected by the Dispensary staff and remitted to the County Council up to August, 1934, amounted to £284 15s. Voluntary contributions collected after that date totalled £4. The number of patients who received institutional treatment under the scheme of the London County Council was 157, and the 62 average length of stay was 95 days. The average period of waiting before admission was 10 days. Of these patients, 98 were discharged during the year, leaving 59 under treatment at the end of the year. Definite improvement as a result of institutional treatment was shown in 47 cases. Thirty-five patients discharged themselves while undergoing institutional treatment. The results of treatment in 96 of the cases discharged from sanatorium during the year are shown in the following table :— Results of Institutional Treatment. Grade. Quiescent. Much Improved. Improved. In statu quo. No material 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 9 — 2 1 2 1 1 2 1 — — — 1 B. i — — 2 1 5 2 — 2 1 3 — 1 1 B. ii — — 14 4 1 BD 3 4 1 4 3 5 — 1 6 B. iii — — — — — — — — — — — — 1 Non-Pulmonary 2 — — 1 1 BD 2 1 — — — 1 1 1 1 T.c. = treatment completed. O.R.—own request. B.D. = breach of discipline. Tuberculosis Dental Clinic. 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 Officers. The number of sessions held during 1934 was 49, and 230 attendances were made, the average attendance per session being 4.69. The work carried out included :—Extractions, 41 ; scalings, 9 ; fillings, 24 ; dentures supplied—whole sets 6, partial sets 3 ; repairs to dentures, 3; dressings, 26; advice, 69 (average per session, 3.69) ; total, 181. The net cost to the Council during the financial year 1934-35 for this service was £116 1s. 2d. Extra Nourishment. The amount expended by the Council during the financial year ended 31st March, 1935, upon the provision of extra nourishment for 95 necessitous patients upon the Dispensary books was £205 9s. 4d. In July the London County Council informed the Council that it had been decided that the procedure laid down for the supply of extra nourishment by the Public Assistance Committee to persons in receipt of relief who are suffering from tuberculosis should be followed in the case of applicants for relief who are or have been in intimate contact with cases of tuberculosis. 63 Artificial Pneumo-thorax Treatment. The number of dispensary patients who received artificial Pneumo-thorax treatment during the year was 51, as compared with 52 in 1933, and the refills given numbered 657, the cost to the Council amounting to £344 18s. 6d. The number of refills given at the seven hospitals attended by these patients was as under :— Brompton Hospital 376 Margaret Street Hospital 6 St. Thomas's Hospital 220 City of London Hospital 9 Colindale Hospital (L.C.C.) 28 Grove Park Hospital (L.C.C.) 8 St. George's Hospital 10 Examinations and Reports. Bacteriological examinations made during the year numbered 795, 309 of the specimens examined coming from medical practitioners. The number of positive results was 182, or 22.9 per cent. Reports to public bodies were made to the number of 1,202. Consultations with medical practitioners at the homes of patients and reports made on patients sent to the Dispensary totalled 619, while reports received in respect of insured persons numbered 119 (Form G.P. 36—119, form G.P. 17—0). There were 139 patients referred to hospitals, including 123 sent to St. Thomas's for X-ray examination. Artificial Sunlight Treatment. During the year 12 Dispensary patients received treatment at the Council's artificial sunlight treatment centre at Southlands (vide page 40). In 8 cases treatment was completed, the average period of treatment being 82 days, and in 6 cases definite improvement was reported. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. Shelters. In addition to the shelters which have for some years been available for loan to patients for use in their gardens, in cases in which it is considered desirable to provide separate sleeping accommodation, the Council have provided four open-air shelters in the grounds of Southlands adjoining the Dispensary, for the use of patients recommended by the Tuberculosis Officer. Dispensary Statistics. On pages 118 to 124 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 1934, and Form T. 145a, which shows 64 in a summarised form the condition of all patients whose case records were in possession of the Dispensary at the end of 1934, arranged according to the years (from 1921 to 1934) in which the patients first came under public medical treatment for pulmonary and non-pulmonary tuberculosis. The Tuberculosis Care Committee. This Committee, the constitution of which is set out on page 2, met fortnightly throughout the year at the Dispensary. The following is a summary of the work carried out by the Committee during 1934 :— Battersea Borough Council—extra nourishment, 108 ; dentures, 8 116 Public Assistance Committee—financial assistance, 4 ; nourishment, 5; clothing, 11 ; dentures, 1 ; boarding-out children, 1 ; other assistance, 1 23 Charity Organisation Society—financial assistance, 2 ; clothing, 1 ; boarding out of children, 1 4 United Services Fund and British Legion—financial assistance, 4; clothing, 3 7 Other Agencies—financial assistance, 2 ; dentures, 3 ; clothing, 5 10 Training and Employment—Charity Organisation Society, 2 ; other suitable agencies, 3 5 The following are some illustrations of the work done by the Care Committee throughout the year :— M.L., aged 53. A widow living with her daughter, aged 15, in one room, unwilling to receive institutional treatment on account of leaving daughter alone, had no income, was badly in need of clothing, and daughter wished to complete her training at a commercial school. The Committee arranged for care of daughter by relatives with whom they kept in touch. Clothing was supplied and rent of room paid to enable home to be retained. Daughter's fare paid to enable her to visit mother. Separate bed provided for daughter when mother discharged. M.F., aged 58. A single woman living alone in one room, only income disablement benefit, drawing on her savings and unwilling to apply for assistance or accept institutional treatment. The Committee obtained for her extra nourishment, paid her fares for a holiday with relatives and granted her pocket money while there. T.S., aged 24. A labourer living with widowed mother, of whom he was the main support, demurred to institutional treatment on account of his mother. The Committee obtained financial help for the mother throughout son's absence, paid her fares to visit patient at intervals and also obtained his fares home when granted week-end leave. C.B., aged 24. A daily worker living at home and partly supporting her mother. Patient unable to obtain sufficient nourishment while waiting for a vacancy in hospital, was also in need of clothing, not entitled to sickness benefit on account of arrears of contributions. The Committee obtained a grant of extra nourishment and provided clothing. They also advanced the arrears of her insurance contributions and patient then received full benefit. 65 A.M., aged 29. Married woman, was unable to meet cost of artificial dentures she required, unwilling to accept sanatorium treatment because of her three children, the youngest being 11 months old. The Committee obtained sufficient help to cover cost of dentures, and (the husband having provided for the care of two children) arranged for the boarding-out of the baby. They also helped patient to provide clothing which she needed. Non-Dispensary Cases. At the end of the year there were 184 patients on the notification register who were not in attendance at the Dispensary, i.e., 18 per cent. of the total notified cases. It was formerly the custom for such cases to be visited by the sanitary inspectors, male and female, but in October the duty of visiting these patients was placed upon the Dispensary nursing staff, with a view to the better co-ordination of the tuberculosis work of the Borough, and with the hope of inducing them to attend the Dispensary. Prior to October, 575 visits had been paid to these patients, and since that date they have been periodically visited by the Dispensary nurses. DEATHS FROM ZYMOTIC DISEASES. The principal zymotic diseases are small-pox, measles, scarlet fever, diphtheria (including membranous croup), whooping-cough, enteric fever and diarrhœa. The deaths from these causes in 1934 numbered 91, as compared with 58 in 1933, an increase of 57 per cent. There was a corresponding increase in the zymotic death-rate from 0-376 in 1933 to 0.603 in 1934. The mean death-rate from each of the principal zymotic diseases for the ten years 1914-1923, and for the ten years 19241933, are compared with the corresponding rates for 1933 and 1934 in the following table :— Zymotic Diseases Number of Deaths from each of the principal Zymotic Diseases in 1933 and 1934, with corresponding Death Rates for those years and for the 10 years 1914-23 and 1924-1933. No. of Deaths. Death-rate per 1,000 population. Mean Death-rate per 1,000 population. Increase ( + ) or Decrease ( —), 1934 over 1934. 1933. 1934. 1933. 19141923. 19241933. Previous year. 19241933. Small Pox — — — — .001 — — — Measles 32 1 .212 .006 .324 .123 + .206 + .089 Scarlet Fever — 6 — .039 .043 .026 - .039 — .026 Diphtheria 20 12 .133 .078 . 196 .096 + .055 + .037 Whooping-cough 7 12 .046 .078 .203 .095 - .032 — .049 Enteric fever — 2 — .013 .016 . 006 -.013 — .006 Diarrhœa and enteritis 32 25 .212 .162 .405 .153 + -050 + .059 Total 91 58 .603 .376 1.188 499 + -227 + -10- 66 NON-NOTIFIABLE 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. 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 1934 there were 457 cases of chicken-pox reported, as compared with 790 in 1933, 422 in 1932, 492 in 1931, and 469 in 1930. Diarrhœa. During 1934 the total number of deaths from diarrhoea of children under 2 years of age was 27, equivalent to a fatality-rate of 0.18 per 1,000 of the population. In 1933 there were 22 deaths and a fatality-rate of 0.14. The rate per 1,000 registered births in 1934 was 12.5, as compared with 9.72 in 1933, 9.49 in 1932, 3.63 in 1931, and 7.92 in 1930. Seven of these deaths occurred in the Church Ward, and 7 in the Winstanley Ward, where proper means of storage and protection of food from contamination are frequently absent or unsuitable. Influenza. There were 15* deaths registered as being due to Influenza during 1934, as against 71 in 1933, 40 in 1932, 56 in 1931, and 14 in 1930. The mortality-rate per 1,000 population was 0.0, as compared with 0.6 in 1933, 0.5 in 1932, 0.5 in 1931, and 0.9 in 1930. Influenzal Pneumonia was less prevalent in 1934 than in the previous year, 41 cases being notified as against 86 in 1933, 60 in 1932, 67 in 1931, and 43 in 1930. The death-rate was 0.3 per 1,000 of the population, as compared with 0.2 in 1933. Cancer. During 1934 the number of deaths of Battersea residents from Cancer was 240 (males 126, females 114) as compared with 289 in 1933, 268 in 1932, 283 in 1931, and 242 in 1930. The death-rate from the disease per 1,000 of the population was 1.59. The deaths from cancer constitute 12.8 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 1928 1.51 1901-5 0.88 1929 1.50 1906-10 0.95 1930 1.51 1911-15 1.11 1931 1.77 1916-20 1.28 1932 1.71 1921-25 1.33 1933 1.88 1926-30 1.51 1934 1.59 * 5 of these deaths were ascribed to Influenzal Pneumonia. 67 The following table shews the localisation of the disease in the case of the 240 deaths recorded in 1934. Localisation. No. of deaths. Total. Percentage of Total. Male Female Buccal cavity 13 1 14 5.83 Stomach, liver, peritoneum, intestines and rectum 69 54 123 51.25 Respiratory system 22 7 29 12.08 Female genital organs — 13 13 5.42 Breast — 25 25 10.42 Skin 1 3 4 1.67 Genito-urinary organs (male) 19 — 19 7.91 Other and unspecified organs 2 11 13 5.42 Total 126 114 240 100.00 Diabetes. For some years past, with the sanction of the Ministry of Health, the Council has borne the cost of insulin required by certain necessitous patients who were receiving treatment for diabetes at London hospitals. During 1934 insulin was supplied to three such cases. Bacteriological Examinations. The bacteriological examination of clinical material (with the exception of specimens of sputum, which are dealt with at the Tuberculosis Dispensary, vide page 63) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1934 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 2,059 (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 313 1,745 2,058 Enteric fever — 1 1 Gonorrhœa — — — Total 313 1,746 2,059 The cost of these examinations is borne by the Council, and in 1934 amounted to £263 6s. 10d., as compared with £252 12s. l1d. in 1933. 68 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1934. Complaints received and attended to 4,332 Number of house inspections 34,295 House to house inspections 725 Houses let in separate tenements on register 66 No. of inspections of do. 757 Premises improved, cleansed and repaired 2,202 Underground sleeping rooms : Use discontinued Defects remedied Overcrowding abated 20 Leaky house-roofs and gutters repaired 527 Yards and forecourts paved and repaired 239 Drains laid to new houses and tenements 50 Drains tested—Smoke tests 552 Do. Water tests 1,142 Drains relaid 113 Drains cleansed and repaired 406 Frontage drains constructed or re-constructed 58 Mews and stables drained and paved 3 Soil pipes and drains ventilated 168 Sink and rain-water pipes disconnected or repaired 227 Houses inspected and certificates granted (Sec. 48) 50 Houses supplied with water and fittings repaired 66 Cisterns covered, cleansed and repaired 124 Additional water supplies to upper floors 21 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 44 Water closets cleansed and repaired 614 Cesspools abolished 1 Dust receptacles provided 770 Urinals—inspections 155 Do. altered, repaired or water laid on 49 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 6 Keeping of animals in unfit state discontinued 10 Gipsy van inspections 70 Factories, Workshops, &c., inspections 2,643 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 38) 49 Bakehouse inspections 97 Bakehouse nuisances abated 15 Smoke observations 61 Premises disinfected 2,954 Houses supplied with disinfectants 413 Certificates of disinfection granted 6,562 Intimation notices (Sec. 3) 3,175 Notices served under Sec.4,&c. 1,318 Notices served under Sees. 62 & 65 4,457 Proceedings ordered by Council and Health Committee 3,205 Summonses issued 23 Magisterial Orders obtained and enforced 14 Samples taken under the Food and Drugs (Adulteration) Act 1,200 Miscellaneous 1,683 Total Sanitary Operations 66,589 69 Legal Proceedings. Legal proceedings were taken by the Council during 1934 in respect of 21 offences against the provisions of various Acts, byelaws, &c., administered by the Health Department. Particulars of each case are set out below. Public Health (London) Act, 1891 and Bye-Laws made thereunder. Nature or Offence or Claim. Failure to abate nuisance at No. 33 Gideon Road, i.e. dirty and defective condition of walls and ceilings of ground floor passage and scullery, after service of notice under the Act. Failing to comply with Magistrate's order to abate a nuisance at No. 33 Gideon Road. Failure to abate nuisance at No. 31 Stanmer Street, i.e. ground floor scullery and w.c.—defective plaster and dirty walls and ceilings, &c., after service of notice under the Act. Failure to abate nuisance at No. 51 Weybridge Street, i.e. damp wall in ground floor back room, after service of notice under the Act. Failure to abate nuisance at No. 55 Weybridge Street, i.e. furred condition of w.c. pan and trap causing continual chokage, after service of notice under the Act. Failure to abate nuisance, i.e. defective tallboy causing smoke nuisance to ground floor kitchen at No. 42 Dashwood Road, after notice served under the Act. Failing to comply with a notice to abate a nuisance at No. 34 Wadhurst Road. Failure to abate a nuisance at No. 1 Garfield Road. The like at No. 2 Garfield Road. The like at No. 31 Garfield Road. Result of Proceedings. Part of nuisancc having been abated since service of summons, order to abate remainder of nuisance in 7 days and to pay £2 2s. costs. Fined £2. £1 1s. costs to be paid defendant. Nuisance having been abated since service of summons, summons dismissed on payment of £1 1s. costs. Nuisance having been abated since service of summons, summons dismissed on payment of £1 1s. costs. The like. Summons withdrawn as necessary work had been carried out. Summons withdrawn as the nuisance had been abated. Summons withdrawn on defendants undertaking to carry out work during the course of the week. Summons withdrawn on defendants undertaking to carry out work during the course of the week and to pay £1 1s. costs to the Council. Summons withdrawn, as the nuisancc had been abated before hearing of su mmons. 70 Public Health (London) Act, 1891, &c.—continued. Nature of Offence or Claim. Result of Proceedings. Failing to comply with a notice to abate a nuisance at No. 56 Castle Street. The notice having been complied with since service of summons, summons dismissed under Probation of Offenders Act. £1 1s. costs awarded to the Council. Having deposited on his premises for the purpose of sale toffees which had been seized and condemned as unsound. Plea of "guilty." Defendant discharged under the Probation of Offenders Act, 1907. £1 1s. costs awarded to the Council. Milk and Dairies Order, 1926. Milk and Dairies (Consolidation) Act, 1915. Nature of Offence or Claim. Result and Remarks. Carrying on the trade of a dairyman without being registered. Fined £1. Selling milk from a vehicle not conspicuously inscribed with his name and address. Fined 10s. 6d. Using a hand-can containing separated milk which was not marked with the words "Separated Milk" in large and legible type. Fined £1. £1 1s. costs to be paid by defendant. Using a churn containing separated milk which was not marked with the words "Separated Milk" in large and legible type. Summons dismissed. Food and Drugs (Adulteration) Act, 1928. Sale of Milk Regulations, 1901. Nature of Offence or Claim. Result and Remarks. Selling milk deficient in fat to the tent of 6 per cent. of the permitted minimum. Dismissed under Probation of fenders Act, 1907. £2 2s. costs to be paid by defendant. Second defendant cautioned. Selling milk deficient in fat to the extent of 14 per cent. below the permitted minimum. Dismissed on payment by the defendent of £1 1s. costs. 71 London County Council (General Powers) Act, 1908. Byelaws made thereunder. Nature of Offence or Claim. Result and Remarks. While carrying on business of a rag and bone dealer distributed a toy. Summons dismissed as the person appearing to the summons was not the real defendant. Ditto (second summons). Plea of "guilty." Defendant discharged under the Probation of Offenders Act, 1907. £1 1s. costs awarded to the Council. London Government Act, 1899. Nature of Offence or Claim. Result and Remarks. Contravention of Council's Bye-law as to fouling of footway by dogs. Plea of "guilty." Defendant discharged under Probation of Offenders Act, 1907. £1 1s. costs awarded to the Council. Children Acts, 1908 to 1932. Nature of Offence or Claim. Result and Remarks. Having undertaken for reward, between 10th August and 30th September, 1934, the nursing and maintenance of an infant under the age of nine years apart from its parents, failed to give notice thereof to the Council within the required period. The defendant not appearing in answer to the summons, warrant issued. Adjourned hearing—fined £2. £1 1s. costs awarded to the Council. 72 Summary of Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department during 1934 in respect of 21 offences against various Acts and bye-laws, &c. Acts and Regulations under which Proceedings taken. Cases. Persons prosecuted including employees. Convictions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act. 1891, and bye-laws made thereunder 12 9 4 2 0 0 9 9 0 Food and Drugs (Adulteration) Act, 1928 2 3 1 - 3 3 0 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 1926 4 1 3 2 10 6 1 1 0 London Government Act, 1899 1 1 1 - 1 1 0 London County Council (General Powers) Act, 1908 1 1 1 - 1 1 0 Children and Young Persons Acts 1 1 1 2 0 0 1 1 0 Total 21 16 11 6 10 6 16 16 0 New Legislation, &c. During 1934, the following new Acts and Orders affecting the work of the Public Health Department came into force :— (a) Acts of Parliament— (1) Milk Act, 1934, Section 10 of which amends the Milk and Dairies (Amendment) Act, 1922. (2) Shops Act, 1934 (vide page 73). (b) Orders and Regulations— (1) Public Health (Treatment of Infectious Disease) Regulations, 1934 (vide p. 47). (2) Public Health (Shellfish) Regulations, 1934 (vide p. 47). (3) Milk (Special Designations) Order, 1934, which amends the Order of 1923. (4) Orders made under the Agricultural Produce (Grading and Marking) Acts relating to various foodstuffs. 73 Shops Act, 1934. This Act came into force on 30th December, 1934. In London most of its provisions are administered by the London County Council, but the duty was placed upon the Borough Council to enforce the requirements of the Act relating to the provision and maintenance of (1) suitable and sufficient means of ventilation, (2) a reasonable temperature, and (3) sanitary accommodation. Power is given to the Council to issue certificates of exemption from the requirements as to sanitary accommodation if they are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable for such a certificate to be in force, and that suitable accommodation is otherwise conveniently available. The Council may subsequently withdraw such certificate, subject to the right of the occupier to appeal to the County Court. Common Lodging Houses. The Transfer of Powers (London) Order, 1933, placed upon the Council, as from the 1st April, 1933, various duties relating to common lodging houses and the enforcement of the bye-laws made by the London County Council relating thereto. The common lodging houses in Battersea are three in number, and details relating thereto are set out in the following table:— Premises Lodgers authorised. Inspections. Notice Prosecutions. Served. Complied with. Males— 75 Falcon Road 67 40 — — — 134 High Street 54 44 — — — Females. 67 Winstanley Rd. 66 9 — — — Total 187 93 — — — Systematic inspection of these houses is carried out by the Council's inspectors, and, generally speaking, they are found to be in a sanitary condition and conducted in accordance with the requirements of the bye-laws. At the request of the London County Council a special inspection was carried out at midnight of the 16th February, when the number of beds occupied was found to be, men 76, women 25. Applications for the renewal for one year of the existing licences were granted by the Committee in June in the case of two of the houses. In the third case (134, High Street) the licensee having died, the licence was transferred to his executor. There are no seamen's lodging houses in the Borough. 74 Drainage Work. The bye-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 water- closets, &c., are enforced by the Council. The former were revised by the London County Council on 14th March, 1934. During the year new drains were constructed to 149 new buildings, or additions to existing buildings, and the drains of 113 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. During 1934, 15 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 7 cases liability, wholly or in part, was admitted by the Council, and the expenditure incurred by them under this head amounted to £242 16s. 10d. In 6 cases liability was not admitted, and 2 cases were still under consideration at the end of the year. The total number of plans of proposed drainage work deposited during 1934, as compared with 1933, was as under:— 1933 1934 Re-construction or repair of existing drains 96 68 New buildings or additions to existing buildings 79 104 175 172 In 4 cases the Health Committee gave directions for proceedings to be instituted if necessary against builders who had failed to submit plans of drainage works executed by them, but in no case was it found necessary to take legal action. In 16 cases work to drains and sanitary fittings was found to have been carried out without notice having first been given or plans submitted to the Council in accordance with the requirements of the drainage bye-laws. These cases were reported to the Health Committee, who in the circumstances reported to them ordered the offenders to be cautioned. During the year 1934, drains were tested by smoke on 552 occasions and in 107 cases the drains were found defective. The water test was applied on 1,142 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and drains were ventilated in 168 instances. Water closets were provided in 44 cases and existing closets repaired in 614 cases. The total number of drains relaid during the year was 113. Those cleansed and repaired numbered 406. 75 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 year ended 31st December, 1934, was as follows:— House refuse. Tons. Trade refuse. Tons. Burned at destructor 1,139 1,230 Removed by barge 28,278 1,973 29,417 3,203 There are no earth-closets, privies or cesspools in the Borough. Houses Let in Separate Tenements. Bye-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 bye-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 757 inspections of these premises were made in 1934. Sanitary Conveniences attached to Licensed Premises. During 1934 the number of public-house urinals under inspection was 118. In 70 instances the accommodation is accessible to the general public as well as the users of the houses, and in 48 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 12 notices were served to remedy defects discovered, and were duly complied with. Smoke Nuisances. During the year 61 observations were made and 10 complaints received. Eight preliminary and 2 statutory notices were served by the Council under the provisions of the Public Health (Smoke Abatement) Act, 1926, to abate smoke nuisances. Effluvium, &c., Nuisances. During the year, complaints were received, chiefly from inhabitants of a neighbouring Borough, as to nuisance caused by the emission of noxious fumes from a large factory in Battersea near the river Thames. The complaints were reported to the Committee on several occasions and were the subject of careful investigation, 76 The firm in question installed special electrical apparatus for the purpose of eliminating noxious fumes arising in the process of manufacture, and since its installation, at the end of the year, fewer complaints have been received. Offensive Trades. There are three premises in Battersea at which scheduled offensive trades are carried on, viz.: fat melters 2, soap boilers 1, all of which have been established for many years and are generally well-conducted. During the year 5 inspections were made of the registered premises in the Borough. Removal of Offensive Matter. The bye-laws of the London County Council with regard to the removal of offensive matter are enforced by the Borough Council. No contraventions of the bye-laws were reported during the year. Water Supply. During 1934 certificates of water supply in respect of 50 houses or tenements were issued in accordance with Section 48 of the Public Health (London) Act. 1891. In 21 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. During 1934, 39 notices were sent to the Metropolitan Water Board of waste of water observed at various premises during the course of inspection. Van Dwellings. The number of van dwellings in the Borough in 1934 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 2 4 Mills' Yard, adjoining 80 Sheepcote Lane 6* 9 8 Mills' Yard, Culvert Road 19* 19 21 164 Falcon Road (rear of) 7 10 8 Manley's Yard, 45a Cabul Road 31 21 22 82 Usk Road (rear of) 1 1 1 Van dwellings are frequently inspected. Seven vans were unoccupied. *Including Sheds. 77 Rag and Bone Dealers. Three offences against that part of the bye-laws of the London County Council which prohibits the giving of toys in exchange for rags, &c., were reported during 1934, the offenders in each case being itinerant traders. In one case a false name and address had been given and the delinquent could not be traced. The second case was dealt with by cautionary letter, and in the third legal proceedings were instituted, the result of which is shown on page 71. 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 1934. 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 1934 under the Council's Rat Repression Scheme is summarised as follows :— Premises visited 1,952 Contracts made or Poison baits used 17,150 renewed 10 Dead rats found 1,278 Value of contracts £177 0 0 Cash for poison bait, &c. £8 5 4 Total expenditure (financial year 1934-35) £493 18 6 Income (financial year 1934-35) £132 8 1 Drains were tested at 96 premises in connection with this work, and in 72 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" (5th to 10th 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. Destruction of Pigeons. By section 52 of the London County Council (General Powers) Act, 1927, the Council have power to destroy doves or pigeons congregating in such numbers as to cause nuisance, annoyance or damage, subject to certain limitations imposed by the Act. During 1934, at the request of the Southern Railway Co., the Council undertook the destruction of pigeons infesting and causing damage and loss at the Company's goods depot at Vauxhall, Over 2,000 birds were destroyed. 78 The destruction of pigeons causing nuisance at one of the London County Council's elementary schools was also successfully undertaken. Fouling of Footways by Dogs. In November proceedings were instituted in respect of an offence (reported by the Police) against the bye-law made by the Council in 1927 (and renewed in 1929) with regard to the fouling of footways by dogs. The defendant was ordered to pay £1 1s. costs. The application of this bye-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 1934, there were 3,780 children and 209 adults cleansed and treated at the station. Of the 3,780 children attending, 941 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,706 attended from the public elementary schools in the Borough by arrangement with the London County Council, who have entered into a contract with the Borough Council for the use of their Personal Cleansing Station. The cleansing and treatment of the school children is carried out under the supervision of officers of the London County Council while the disinfestation of the clothing and of the homes is carried out concurrently by the Borough Council's sanitary staff. There was an increase in the number of infested persons treated at the station as compared with the previous year. The following table shows the numbers of persons cleansed and treated at the Personal Cleansing Station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun. Number of Baths, &c. Year. Adults. Children. *Expenditure *Amount Contributed. Verminous and Scabies. Verminous and Scabies. £ £ 1906-1915 10,443 6,430 1,037 303 1916-1925 3,269 39,117 5,007 3,155 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 1934 209 3,780 730 401 15,922 81,049 13,778 £7,102 *Financial year ending 31st March. 79 Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1934. Total premises disinfected 2,954 Rooms disinfected 3,736 Staircases disinfected 139 Schools disinfected 41 Number of articles laundered 32,240 „ ,, destroyed 2,987 „ verminous, etc., persons (including 3,706 school children) 3,989 „ infectious disease contacts 868 ,, library books collected 555 Articles. No. Weight. Tons. cwts. qrs. lbs. Bedding, &c., disinfected 58,106 115 19 0 8 Ditto (articles from shelters and Cleansing Station, &c.) 15,590 (not weighed) Bedding, &c., lent 1,476 4 9 3 20 Verminous clothing, &c. 10,974 2 8 3 5 Articles from Welfare Centres 1,779 (not weighed) Total 87,925 122 17 3 5 Coroner's Court and Mortuary. In the Annual Report for 1933 reference was made to the improvement of the public mortuary by the provision of a large refrigerating plant. During 1934, electric extraction fans and a trolley were installed. The provision of an improved form of post-mortem table was deferred until 1935, and with this addition it is hoped that the Mortuary may be regarded as one of the most completely equipped in the country. Details as to the number of inquests held at the Coroner s Court, and bodies received into the Mortuary during 1934 are set out in the following table:— 80 Details of Bodies Received. Usual Place of Residence. Total sea. Wands -worth Elsewhere. Residence unknown Inquest at Coroner's Court— Post-mortem at Mortuary 30 69 29 4 132 Post-mortem elsewhere 16 40 25 — 81 No post-mortem 22 34 21 — 77 Body not received — 2 2 — 4 Post-mortem at Mortuary— No inquest (Coroner's certificate) 72 114 20 — 206 No inquest (doctor's certificate) — — — — — Other bodies received— Sanitary reasons 8 — — — 8 Total bodies received 148 257 95 4 504 Total inquests held 68 145 77 4 294 Total post-mortems held at Mortuary 102 183 49 4 338 VERDICTS AT INQUESTS HELD— Natural causes 4 20 7 1 32 Accident and Misadventure— Abortion—shock — — — — — Anæsthesia, operation, &c. — 1 — — 1 Asphyxia 2 1 2 — 5 Burns and scalds 3 9 1 — 13 Drowning 1 1 — — 2 Fall 15 26 17 — 58 Overlying - 2 — — 2 Injuries (various) 5 5 2 — 12 Poisoning—Coal gas 1 — 1 — 2 ,, Food — — — — — „ Lead — — — — — Railway and street 18 30 29 — 77 Open Verdict— Asphyxia — — — — — Blow — — — — — Burns — — — — — Drowning — 1 2 — 3 Fall 1 — — — 1 Inattention at birth — — — — — Diphtheria, &c. 1 — — — 1 Poisoning—Carbon monoxide — — — — — „ Drugs, &c. — 2 1 — 3 Railway — — — — — Still-born — — — 1 1 Sepsis of unknown origin — 1 1 — 2 Unknown cause and various 3 1 3 2 9 Suicide— Cut throat 1 8 — — 9 Drowning 1 1 1 — 3 Electrocution — — — — — Firearms — 3 — — 3 Hanging 1 1 1 — 3 Jump from high place — 2 1 — 3 Poisoning—Coal gas 9 20 2 — 31 Drugs, &c. 1 9 6 — 16 Railway — — — — — Homicide— Infanticide — 1 — — 1 Manslaughter 1 — — — 1 Grand Total 68 145 77 4 294 81 Changes in Staff, 1934. Medical Officer of Health.—Dr. G. Quin Lennane, M.C., for 28 years Medical Officer of Health of the Borough, was superannuated as from 1st October, 1934. Dr. George Macdonald, M.A., formerly Deputy Medical Officer of Health and Tuberculosis Officer, was appointed Medical Officer of Health from the same date. The post of Deputy Medical Officer of Health and Tuberculosis Officer vacated by Dr. Macdonald had not been filled at the end of the year. Health Visitors.—Miss Mona Carr, whose appointment dated from 1921, was superannuated in March on the ground of ill-health. Her place was filled temporarily by the appointment of Miss J. Sweeney. Sanitary Inspectors.—Mr. H. E. Wheeler, Housing Inspector since 1920, died on 15th March. Mr. R. J. McCarthy was appointed to the vacant post in July. A temporary Inspector was employed from May to August. Clerical Staff.—Miss G. E. Newton, grade A clerk, who had been absent since September, 1932, through continuous illness, was superannuated in March. Mrs. R. Bower (née Dove), grade A clerk, retired on 31st October, following her marriage. Maternity Hospital.—The appointment of Resident Medical Officer was held by the following:—Dr. K. W. Aylwin Gibson, June, 1933, to 2nd February; Dr. J. A. T. Johnstone, 2nd February to Kith April ; Dr. M. J. Lyon, 13th April to 4th July; Dr. D. J. Healey, 4th July to 31st December. Miss J. Brown, sister at the Hospital, resigned in August, and Miss D. Anthony commenced duty in her place on 15th September. Miss M. L. Thompson was appointed District Midwife as from 22nd January, in place of Miss K. Morrison, whose resignation was recorded in the Annual Report for 1933. 82 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 1934:- Food. Quantity. Food. Quantity. Fish. Fruit, Vegetables, etc. Dabs 1 box. Plaice 1 box. Apples 68 cases. Skate 1 box. Mushrooms 3 handles. Skate Wings 3½ stones. Peaches 12 boxes. Winkles 1 sack. Pears 3 boxes. Tomatoes 55 boxes. Meat &. Poultry. Ox Liver 56 lbs. Pig 1 Proceedings were, by order of the Committee, instituted against a shopkeeper on whose premises a quantity of toffees, in maggoty condition, was deposited for the purpose of sale. These were seized by the Sanitary Inspector and subsequently condemned by the magistrate as unfit for human consumption. The defendant pleaded guilty, and was ordered to pay £1 1s. costs. 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. Four cases of suspected food poisoning were notified to the Medical Officer of Health during the year, 3 being in one family. Enquiries were made, but in no case was a portion of the food suspected available for bacteriological investigation. In each case notified the patient recovered. 83 In two other cases (un-notified) a portion of the suspected food (meat-pie), which had been purchased in a neighbouring borough, was bacteriologically examined, but was found to contain no specifically pathogenic organisms. Slaughterhouses and Knackers' Yards. The duty of licensing knackers and slaughterers of cattle and horses, and the premises used by them, was transferred to the Metropolitan Borough Councils in 1933. The licences for the two slaughterhouses remaining in Battersea were renewed by the Council for 1 year from 1st July, 1934, and one additional slaughterman's licence was issued during the year under the Slaughter of Animals Act, 1933. These two slaughterhouses have been kept under systematic inspection by the staff, and during the year 1934, 122 inspections were made by the Council's inspector. The carcases of 145 animals (calves 4, sheep 97, and pigs 44) were examined after slaughter. 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 1934 was 106. Deducting 3, which were closed during the year, there remained 103 on the register at 31st December. There are in addition a number of premises where the sale of cooked meats is carried on, as well as grocers' and provision merchants' shops at which 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, 1,537 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. It was not found necessary during 1934 to institute legal proceedings for any contravention of the Public Health (Meat) Regulations, 1924, but, by order of the Committee, three vendors were cautioned in regard to the exposure of meat in a manner contravening the requirements of the Regulations. 84 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 1934 was 759, of which 5 or 0.67 per cent. were certified by the Public Analyst to be adulterated. In addition to the foregoing, 441 informal samples were procured, of which 22 or 5 per cent. were reported by the Public Analyst as being adulterated or containing preservatives in contravention of the provisions of the Public Health (Preservatives, &c., in Food) Regulations. The percentage of samples reported by the Public Analyst to be adulterated during the quinquennia 1921—1925 and 1926—1930, and in each year from 1926 onwards, is given in the following table. 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 1.0 0.5 1934 0.67 5.0 It will be seen from this table that the percentage of adulteration of formal samples in the year under review, is the lowest recorded, and consequently the improvement in the food supply of the Borough, referred to in previous reports, is well maintained. The rise in the percentage of adulteration of informal samples was largely due to adverse reports on one article, viz., tinned sardines, 16 informal samples of which were found to contain small quantities (from 3 to 30 parts per million) of lead. This subject is more fully referred to on page 89. 85 The following tables give details of the articles of which samples were obtained for the purpose of analysis. Main Statement. TABLE I. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Bread — 8 8 — 0 0 Butter 6 61 67 0 0 0 Cheese — 4 4 — 0 0 Cocoa — 16 16 — 0 0 Coffee — 9 9 — 0 0 Confectionery and Jam — 12 12 — 0 0 Cream — 28 28 — 0 0 „ (Tinned) — 8 8 — 0 0 Flour — 2 2 — 0 0 Flour, Self-raising — 4 4 — 0 0 Margarine — 24 24 — 0 0 Milk 748 — 748 5 — 5 ,, Separated 2 — 2 0 — 0 ,, Condensed (Full Cream) — 3 3 — 0 0 ,, ,, (Machine Skimmed) - 2 2 - 0 0 Mustard — 6 6 — 0 0 Tea — 20 20 — 0 0 Vinegar 1 — 1 0 — 0 Drugs — 28 28 — 1 1 Other Articles 2 206 208 0 21 21 Total 759 441 1200 5 22 27 TABLE II. Drugs. Examined. Adulterated. Nature of Sample. Formal. Informal. Total. Formal. Informal. Total. Aspirin Tablets — 4 4 — 0 0 Bicarbonate of Soda — 4 4 — 0 0 Camphorated Oil — 4 4 - 0 0 Cream of Tartar — 4 4 — 0 0 Iodine, Paint — 1 1 — 0 0 ,, Tincture — 3 3 - 0 0 Ointment, Boric - 4 4 — 1 1 „ Zinc — 4 4 — 0 0 Total — 28 28 — 1 1 86 TABLE III. Other Articles. Nature of Sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground — 4 4 — 0 0 Arrowroot — 5 5 — 0 0 Cream, manufactured — 1 1 — 0 0 Custard Powder — 19 19 — 0 0 Dripping — 8 8 — 0 0 Fish Paste — 8 8 — 0 0 ,, canned - 24 24 — 16 16 Fruits, dried — 23 23 — 0 0 Ginger, ground — 5 5 — 0 0 Gravy Thickening — 4 4 — 0 0 Jelly, table — 4 4 — 0 0 Junket Crystals — 1 1 — 0 0 „ Powder — 3 3 — 0 0 Lard - 4 4 — 0 0 Lemonade Powder — 4 4 — 3 3 Mince Meat — 6 6 — 0 0 Mustard Compound — 1 1 — 0 0 „ Condiment — 4 4 — 0 0 Olive Oil — 4 4 — 0 0 Parsley, dried — 4 4 — 0 0 Peel, Candied (mixed) — 6 6 — 0 0 Pepper — 2 2 — 0 0 Rice — 17 17 — 0 0 Sago — 1 1 — 0 0 Sausages — 8 8 — 2 2 „ preserved 2 — 2 0 — 0 Sponge Cakes — 7 7 — 0 0 Spice, Mixed — 4 4 — 0 0 Suet — 1 1 — 0 0 „ Shredded — 7 7 — 0 0 Tapicoa — 3 3 — 0 0 Vegetables, canned — 10 10 — 0 0 Wines, non-alcoholic — 4 4 — 0 0 Total 2 206 208 0 21 21 Adulterated Samples. The total number of samples taken in 1934 and certified by the Public Analyst to be adulterated or not to comply with the requirements of the various Orders or Regulations, was 27, as follows:— Milk.—5 formal samples. (See following pages.) Boric Ointment.—1 informal sample deficient in boric acid to the extent of 19.3 per cent. Lemonade Powder.—3 informal samples contained tartaric acid. Sardines (tinned).—16 (out of 24) informal samples were reported to contain lead. (See page 89.) 87 Sausages.—2 informal samples, not sold as " Preserved Sausage," contained a sulphite preservative. It is interesting to note that no sample taken in the last quarter of the year was certified to be adulterated. Milk. Of the 750 samples of milk (all formal and including 2 of separated milk) submitted during the year, 5 or 0.7 per cent. were reported as adulterated, 3 of these samples being deficient in milk fat and 2 containing extraneous water. The percentages of extraneous water found in the 2 adulterated samples were 1 per cent. and 3½ per cent. respectively, whilst the deficiency in milk fat in the 3 samples so reported against ranged from 2 to 14 per cent. In the 5 years 1929-33, and in 1934, the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1929 603 11 1.8 1930 707 18 2.5 1931 777 28 3.6 1932 760 13 1.7 1933 768 6 0.8 Mean 723 15.2 2.1 1934 750 5 0.7 A considerable proportion of the milk supply of London is received at Clapham Junction and the South Lambeth Goods Station and samples are systematically taken on the arrival of the milk at these two stations. Such samples are included in the return on page 85. The average composition of the 743 samples of milk (all formal), excluding separated milk, reported as genuine, proved to be as under:— Total milk solids 12.37 per cent. Milk fat 3.58 „ Non-fatty solids 8.79 „ 88 The content of milk fat in these 743 samples ranged as follows: 4 per cent. and over 57 samples or 7.7 per cent. Between 3.9 and 4.0 per cent. 24 „ „ 3.2 „ „ 3.8 „ 3.9 „ 43 „ „ 5.8 „ „ 3.7 „ 3.8 „ 88 „ „ 11.8 „ „ 3.6 „ 3.7 „ 94 „ „ 12.6 „ „ 3.5 „ 3.6 „ 168 „ „ 22.6 „ „ 3.4 „ 3.5 „ 121 „ „ 16.3 „ „ 3.3 „ 3.4 „ 86 „ „ 11.6 „ „ 3.2 „ 3.3 „ 43 „ „ 5.8 „ „ 3.1 „ 3.2 „ 17 „ „ 2.3 „ „ 3.0 „ 3.1 „ 2 „ „ 0.3 „ 743 100.0 All samples were systematically tested for the presence of preservatives and colouring matter but with negative results. Milk sampling was carried out on 5 Sundays during the year, and 21 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 44 were taken during the year. Many of these samples were taken at Clapham Junction (S.R.) or South Lambeth (G.W.) Railway Stations. Samples of milk to the number of 73 were taken in course of delivery to hospitals and elementary schools in the Borough, all of which were certified to be genuine. The supply of milk to hospitals and institutions is kept under careful supervision and samples are periodically taken for chemical and bacteriological analysis. During the year 23 samples of milk were taken for bacteriological examination. Of these 21 were of certified or pasteurised milk, and 2 of ungraded milk. The results of the bacteriological examination showed that 22 of the samples complied with the requirements, but in one case of certified milk the sample was certified to contain bacteria in excess of the permitted number. Seventeen samples were taken in course of delivery during the year at the request of the Medical Officers of Health of neighbouring Boroughs under the provisions of Secs. 21 and 29 and the second schedule of the Food and Drugs (Adulteration) Act, 1928, which permits the vendor to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. During the year advantage was also taken of these provisions by 5 Battersea milk purveyors in regard to 8 samples of milk. 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 70. The Council in November had before them a request from the Milk Marketing Board that the Council would provide the necessary veterinary and bacteriological services required in connection with 89 their Accredited Producers Scheme. In Battersea veterinary service is hardly likely to be needed, but the Council informed the Board that they were willing to provide such assistance as might be required. Condensed Milk. During the year 5 informal samples of Condensed Milk were submitted for examination, of which 3 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. Tinned Sardines. During the past year the presence of lead in tinned sardines has been investigated as the result of a report from the Medical Officer of Health of the Port of London. Twenty-four informal samples of different brands were analysed, and of these 16 were found to contain lead in quantities varying from 3 to 30 parts per million. The source of lead in tinned sardines has been investigated by a firm of analysts, and their conclusion (published in December, 1933) was that the method of preparation, i.e. the cooking of the fish on the grills, caused the contamination, the lead being derived from the metal used in tinning the grills. It is hoped that improved methods of treating sardines before canning will eliminate this defect. There is, as yet, no authoritative statement as to the amount of lead in sardines which would render them injurious to health. If sardines were an article of every-day consumption the presence of lead, even in small amounts, would probably be detrimental to health, but, as they cannot fairly be so described, it is an open question whether traces of this metal up to, say, 30 parts per million could be regarded as a source of potential danger. Ice Cream. There were at the end of the year 212 premises in the borough used for the manufacture, storage, or sale of ice cream. Nine new premises were registered during the year and one, referred to on the next page, was removed from the register, the number of registered premises therefore being increased by 8. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 99 inspections were made, and, except in the case referred to below, it was not found necessary to serve notices in respect of these premises. 90 In one case it became necessary to remove from the register premises which were unsuitable on account of the disregard of cleanliness by the occupier in the conduct of the business. One unregistered vendor also, who was carrying on the business of an ice cream vendor was cautioned by order of the Committee. 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 Acts 1915 and 1922. Milk and Dairies Order, 1926. The provisions of the above-named Acts and Order continued to be enforced by the Council during the year under report. Legal proceedings were instituted in 1 case during the year for various offences against these Acts and Order, details of which are set out on page 70; and in 3 other cases cautionary letters were addressed to vendors in respect of the offence of trading in the Borough without being registered therein. Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to issue licences (other than "producers'" licences) under the above-named Order. The licences so granted are available for a period up to the end of the year in which they are issued. There is a scale of fees payable to the Licensing Authoritv bv applicants for licences. The number of licences in force during 1934 was as follows:— Full. Supplemental. Certified milk 10 — Grade A (Tuberculin tested) milk 42 1 Grade A milk 6 — Pasteurised milk 63 2 121 3 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. Cautionary letters were, by order of the Committee, addressed to six vendors who were found to be dealing in milk labelled "pasteurised milk" without holding the necessary licence. The bacteriological examination of samples of certified and pasteurised milk is referred to on page 88. 91 Milk Shops. The number of premises registered in Battersea for the sale of milk is 129 (including 7 wholesalers' premises). Two 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, and 4 premises previously registered for the sale of milk in sealed receptacles only were granted full registration. There are also 8 premises registered for the sale of cream only. All milk shops are kept under systematic inspection, and during the year 180 inspections were carried out and 5 intimation notices were served to remedy defects found on inspection. These mainly referred to dirty premises. Forty-six vendors whose registered premises are without the Borough are registered as purveyors within Battersea. In addition to the above there are 177 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 1934 contraventions of the Regulations were reported in the case of 2 samples of sausages, which are referred to on page 87. Preserved Food Premises. The duty of registering premises in which preserved foods are prepared or manufactured was placed upon Metropolitan Borough Councils by the London County Council (General Powers) Act, 1932. There were 176 premises upon the register at the end of 1933, and 3 additional premises were registered in 1934, making a total of 179 registered premises. Agricultural Produce (Grading and Marking) Act, 1928. No legal action was found necessary during the year under review in regard to the various Orders made under this Act. 92 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. Two offences were reported during 1934, the offenders being cautioned by order of the Committee. New Orders were made in 1934 dealing with imported bacon and ham and imported dead poultry, and imported meat respectively. Artificial Cream Act, 1929. Only one shop is registered under the provisions of this Act for the sale of artificial cream. These premises are periodically inspected. Fish Shops. Fish shops in which fish either cooked or uncooked is sold, or in which the curing of fish intended for sale is carried on number 78 (two less than at the end of 1933). All these premises are kept under systematic inspection. Inspections made during 1934 numbered 184, and 10 notices (9 intimation and 1 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 1934 was 128, 6 being added to the register and 4 removed during the year. The number of inspections carried out in 1934 was 249, and in 30 cases it was found necessary to serve notices (including 9 statutory notices) to remedy various defects. Street Stalls for Sale of Food. There are 193 street stalls in the borough for the sale of foodstuffs of varied character. 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, and no offences against the statutory requirements with regard to the food exposed on these stalls were reported during the year. Inspections numbering 65 were made of the premises used by street vendors for the storage of their stocks, and 8 intimation and 1 statutory notice was served to remedy defects found. 93 Factories, Workshops, Workplaces and Homework. 1.—Inspections of Factories, Workshops and Workplaces (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances), 1934. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 494 28 - Workshops (including Workshop Laundries) 502 42 _ Workplaces (other than Outworkers' premises referred to on page 97) 1,174 89 _ Total 2,170 159 - 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 54 54 - - Want of Ventilation - - - - Overcrowding - - - - Want of drainage of floors 2 1 - - Other nuisances 180 175 - - Sanitary accommodation {Insufficient 5 5 - - {Unsuitable or defective 42 40 - - {Not separate for the sexes 4 4 - - Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (Sec. 101) - - - - Other Offences (excluding Offences relating to Outworkers which are referred to on page 97) - - - - Total 287 279 - - 94 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1934:— Bakehouses 10 Bootmakers 32 Dressmakers 16 Laundries 3 Milliners 4 Tailors 42 Other Trades 193 Total number of workshops 300 4.—Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 2 Notified by H.M. Inspector 3 Underground Bakehouses (Section 101), in use at end of the year 19 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1934:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults Young Persons. Baker 51 257 38 29 36 Barge builder 3 22 — — — Bootmaker 45 86 9 — — Builder 4 87 9 — - Butter blender 1 211 16 42 30 Chaff & forage 2 36 — 9 2 Chemical works 1 2 — — — Coachbuilder 3 11 — — — Cycle maker 2 4 — — — Dyer 3 50 4 43 — Engineer 21 1,150 137 27 37 Firewood cutter 11 36 5 12 — Flour mills 2 133 6 14 — Foundry 2 28 2 — — Lift maker 2 33 3 — — Mason 7 411 42 — — Mineral water 2 18 4 28 3 Motor repairer 22 230 8 10 — Printer 20 82 19 19 9 Steam laundry 16 77 12 485 146 Other trades 91 3,946 574 1,529 470 Total 311 6,910 888 2,247 733 95 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. One new factory premises was added to the register during the year, dealing with various trades, and 7 were removed. During the year 25 preliminary and 3 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, and all were duly complied with. Workshops. The following is a list of the workshops on the register at the end of 1934 :— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 10 10 14 — 1 — Blindmaker 5 6 12 1 1 — Bootmaker 32 32 38 — — — Carpenter 5 5 10 1 — — Coach builder 6 9 25 — — — Cycle maker 8 12 18 3 — 3 Dressmaker 16 20 — — 43 14 Embroiderer 2 3 — — 14 — Farrier & smith 9 9 17 — — — Firewood cutter 3 3 4 1 — — Florist 5 5 — — 11 — Laundry 3 8 2 — 8 — Mason 3 3 5 1 — — Milliner 4 4 — — 7 — Motor repairer 26 29 83 10 — — Musical instru ment maker 3 4 9 — — 4 Photographer... 4 9 5 1 1 — Picture framer 3 5 3 1 — — Rag sorter 24 40 64 7 27 — Saddler 1 1 1 — — Tailor ... 42 49 68 6 46 5 Upholsterer ... 13 13 27 — 10 1 Other trades ... 73 112 221 14 48 10 Totals 300 391 626 46 217 37 96 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 1934 the number of her inspections amounted to 128. Thirty-six intimation and 6 statutory notices were served during the year for various defects in workshops found on inspection, all of which were complied with. Of these, 7 intimation notices were served by the female inspector. Fourteen new workshops were added to the register, dealing with the following trades :— Baker 1 Florist 1 Blindmaker 1 Motor Repairer 2 Carpenter 1 Rag Sorter 1 Dressmaker 1 Tailor 1 Embroiderer 1 Other trades 4 The following are particulars relating to workshops in which ' protected persons " were employed, notice of which was duly sent to H.M. Inspector during 1934 :— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Blindmaker 1 1 — 1 Dressmaker 1 2 — 2 Outworkers. During 1934, 102 lists of outworkers were received, viz., 54 from Battersea employers, containing 143 names, and 48 from the Medical Officers of Health of other districts, containing 239 names. After eliminating outworkers not residing in Battersea (of whom 73 names were forwarded to the Medical Officers of the districts concerned) and duplicated entries there remained the names and addresses of 141 Battersea outworkers. The total number of registered outworkers in the Borough is 145, of whom 14 are " contractors," i.e., employers of labour for the purpose of the home-work received by them, and many of the premises are workshops in the meaning of the term as used in the Factory and Workshop Act. 97 The following table gives details of the outworkers' premises in the Borough, most of which are visited by the female sanitary inspector. The figures in brackets indicate the premises visited by the male inspector, which are included in the totals shown. Trade. Number on Register. Persons Employed. Premises. Workrooms Blousemaker 1 2 1 Bootmaker 16 (16) 18 (18) 24 (24) Dressmake 24 25 26 Embroiderer 29 29 32 Fancy goods 6 6 6 Fancv boxes 6 6 6 Fine needlework 3 3 3 Glovemaker 1 1 1 Knitting and crochet 1 1 1 Tailor 46 (32) 53 (39) 88 (71) Underclothing 2 2 2 Other trades 10 (1) 10 (1) 12 (3) Female Inspector 96 98 104 Male 49 58 98 Total 145 156 202 There were 23 new outworkers' premises added to the register during 1934, and 43 were removed, there being thus a decrease of 20 in the number registered. There were 473 inspections of outworkers' premises during the year, of which 450 were by the female inspector. It was not found necessary to serve any notices for sanitary defects. Only one case of infectious disease (measles) occurred in these premises during 1934, for which the usual precautionary measures were taken. Bakehouses. There were 61 bakehouses on the register at the end of 1934. Of these 51 use power, and are therefore technically factories. Forty-two of the bakehouses are above ground, and 19 are under ground. One underground bakehouse was removed from the register, being no longer so used, and 1 was added, this being above ground. Inspections made during the year numbered 97, of which 84 were to factory bakehouses, and 16 intimation and 2 statutory notices were served, mainly for failure to carry out the half-yearly lime-whiting of the bakehouses within the statutory period. 98 Warehouses and Wharves. At the end of 1934, there were 58 premises on the register, including railway yards. These premises are systematically inspected, and during the year 38 inspections were made. Two intimation notices were served to remedy nuisances found on inspection, and were complied with. 99 Housing. New Working Class Dwellings. During the year 29 tenements were erected by the Council as part of their housing programme as under :— Holgate Avenue 9 tenements. York Road *8 „ Darien Road 12 „ These flats, are primarily intended for rehousing the tenants from the houses on the Stewarts Lane site, which has been compulsorily acquired for redevelopment and the inclusive rents fixed by the Council for these dwellings are 8s. 6d. and 10s. fid. per week, for 3 and 4 rooms, respectively. In addition 2 flats were constructed by the Council over the new electric sub-station in Grayshott Road for certain employees of the electricity department. The necessary negotiations for the acquisition of the property in Stewarts Lane (referred to in the Annual Report for 1933), and the arrangements for the removal of the tenants were practically completed by the end of the year. Plans and estimates for the 1st and 2nd blocks of flats were approved by the Council during the year, and it is anticipated that the flats will be ready for occupation during the present year. Houses Erected by Private Enterprise. Nineteen houses, all situate in Broomwood Ward, were erected by private enterprise during the year. Clearance Areas. Consideration has been given during the year to the various areas which have from time to time been represented as suitable for consideration as Clearance Areas, and in June the Council approved the following report and recommendation of the Housing Committee as to their programme :— In February, last (See C.M., Vol. XXXIV., page 224), the Council approved the plans for the first block of tenements to be erected on the Stewarts Lane site. The total number of families to be displaced at Stewarts Lane is 45 and there will be available at Hope Street and Darien Road accommodation for 29 families. The first block at Stewarts Lane will accommodate 23 families. There will thus be 7 tenements to spare together with those in the remaining blocks at Stewarts Lane, a total of 85 tenements for clearance schemes. We have carefully considered again the several areas which have been represented to us for clearance and reports of the Medical Officer of Health and Borough Surveyor thereon, and the four most important in order of precedence appear to us at present to be as follows :— 100 Area. Accommodation. At present. Proposed re-housing. 1. Sheepcote Lane 84 houses 137 families 140 new flats 2. Lothair Street 9 „ 14 „ 3. Linford Street 125 ,, 186 ,, 276 new flats. 4. Nine Elms 155 ,, 305 ,, 250 ,, ,, It will be seen that this programme would enable the Council to satisfy the Minister of Health (as required by Section 1 of the Housing Act, 1930), that the Council can provide such accommodation in advance of the displacements which will from time to time become necessary as the demolition of buildings proceeds. We have been in communication with the London County Council therefore as to the first of these areas (Sheepcote Lane), and they are willing on behalf of this Council to make the necessary clearance or compulsory purchase orders and to purchase the properties, leaving it to this Council to clear the area and to re-house the persons displaced, on the understanding that no application will be made to them for supplemental contribution towards the cost of this re-housing. We recommend— That the Council agree to the Sheepcote Lane area being so dealt with and that the County Council be asked to commence proceedings as early as practicable. The cost of acquisition is estimated at £12,000. The necessary preliminary action in regard to Sheepcote Lane was commenced by the London County Council but was not completed by the end of the year. Didcot Street Area. As mentioned in the Annual Report for 1933, the London County Council intimated their intention of dealing with the Didcot Street Area in view of its proximity to their East Hill Estate. The site comprised two areas, one consisting of Didcot Street and St. Peters Place, and the other of Nos. 45-69 Usk Road, and other houses in Usk Road were compulsorily acquired to render a more satisfactory development possible. A local inquiry was held on 25th July, and the clearance and compulsory purchase orders were subsequently confirmed by the Minister of Health. Underground Rooms. During the year a special survey of the underground rooms in the borough was undertaken, the result of which is set out below:— (1) No. of houses with underground rooms 2,345 (2) No. of underground rooms 3,279 (3) (a) No. of underground rooms which ply with the regulations made in regard to such rooms 732 (b) No. of such rooms used for sleeping purposes 182 101 (4) (a) No. of underground rooms which do not comply with the regulations above referred to 2,547 (b) No. of such rooms used for sleeping purposes. 654 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. The subjoined table, extracted from the 1931 Census Report, indicates the position of the metropolitan boroughs in regard to overcrowding on the basis of persons per room. Housing Statistics. Extract from Census Report, 1931. Borough. Population in Private Families. No. of Families. No. of Occupied Dwellings. No. of Occupied Rooms. Average No. of Persons Per Room. Battersea 155,004 44,618 27,219 158,118 .98 Bermondsey 108,488 28,766 18,305 86,654 1.25 Bethnal Green 105,700 27,916 18,156 78,466 1.35 Camberwell 242,604 68,435 42,114 253,360 .96 Chelsea 52,374 16,332 10,966 66,525 .79 Deptford 104,181 29,248 17,750 105,823 .98 Finsbury 67,459 19,059 10,369 47,641 1.42 Fulham 146,071 43,153 26,245 150,313 .97 Greenwich 94,066 25,144 18,114 99,863 .94 Hackney 208,728 59,143 34,155 208,779 1.00 Hammersmith 127,938 37,345 22,307 126,466 1.01 Hampstead 78,763 23,709 14,758 112,014 .70 Holborn 27,524 9,355 6,177 25,622 1.07 Islington 309,216 93,613 43,162 276,592 1.12 Kensington 158,491 47,713 28,999 197,256 .80 Lambeth 280,885 83,777 48,873 290,666 .97 Lewisham 213,950 58,673 46,739 263,155 .81 Paddington 125,430 40,714 19,281 139,600 .90 Poplar 149,800 38,901 23,340 120,000 1.25 St. Marylebone 84,453 27,352 17,575 103,695 .81 St. Pancras 178,341 56,929 24,980 158,489 1.13 Shoreditch 94,521 25,084 13,678 65,330 1.45 Southwark 164,274 46,372 27,168 128,558 1-28 Stepney 214,061 54,657 35,671 161,570 1-33 Stoke Newington 49,443 14,908 8,196 55,219 .90 Wandsworth 333,863 95,383 71,566 421,286 .79 Westminster 101,442 33,056 22,536 132,882 .76 Woolwich 137,979 38,176 29,870 156,050 .88 City of London 7,590 2,499 2,359 8,300 .91 Total 4,122,639 1,190,030 730,628 4,198,292 —— Average 142,160 41,036 25,194 144,768 0.98 102 It will be noted that the average number of persons per room in Battersea, viz., 0.98, is the same as that for London as a whole. During the year, 22 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 1934. Total. Families accommodated 2 11 13 Offer declined or applicant otherwise suited 2 2 4 Recommendation not accepted by the London County Council 5 3 8 Still under consideration — 6 6 Totals 9 22 31 It is the practice of the London County Council to notify the Medical Officer of Health of the families resident in the borough who have been accommodated on their estates. During the year 365 Battersea families were provided with accommodation on London County Council Estates—mainly St. Helier and Becontree— outside the Borough. In the case of 10 other Battersea families accommodation was provided by them at Battersea Bridge Buildings or Durham Buildings. 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 1934 will be found summarised on pages 104 to 106. 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 1934 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. 103 Demolition Orders. Demolition orders were made by the Council during the year in respect of 5 houses, viz., No. 2 Berkeley Street, No. 28 Plough Road, and Nos. 3, 4 and 5 Foots Row, under section 19 of the Housing Act, 1930. These houses were duly demolished. One other house (Creek Street) was represented with a view to a demolition order being made in respect thereof, and the matter was under consideration at the end of the year. Closing Orders. No Closing Orders were made by the Council during 1934, but one property in Lavender Road was represented with a view to such action being taken, and the matter was under consideration at the end of the year. Increase of Rent, Etc., Acts. During 1934, 13 applications were received from tenants for the certificate, and 6 from owners for the report of the Sanitary Authority under the above mentioned statutes. The application for a certificate was granted in 10 cases and refused in 3 cases; that for a report was granted in each case. Action under Section 5 of the Housing Act, 1925. During 1934, in 9 cases (relating to 11 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. Structural Defects. The attention of the District Surveyor of the London County Council was drawn, in 81 instances, to structural defects observed by the Sanitary Inspectors during the course of their duties. 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 1934:— 104 Street. Houses dealt with. Street. Houses dealt with. Street. House, dealt with. No. 1 District. • No. 3 District—(con td.) No. 4 District—(con td.) Ascalon Street 1 Frances Street 2 Mantua Street 3 Foots Row 3§ Goulden Street 3 Meyrick Road 9 Dashwood Road 21 Granfield Street 2 Musjid Road 3 Porson Street 23 Green Lane 1 Nepaul Road 2 Savona Place 1 Henning Street 1 Shillington Street 1 Wadhurst Road 1 Home Road Hyde Lane 5 1 Speke Road Winstanley Road I 1 No. 2 District. In worth Street 8 York Road 10 Alfred Street 2 Orbel Street 2 Anerley Street 1 Parkham Street 1 No. 5 District. Arthur Street 1 Radstock Street 1 Nil — Austin Road 1 Trott Street 1 Latchmere Street 1 No. (i District. Longhedge Street 6 No. 4 District. Darien Road 1 Creek Street 1§ Linda Street 17 Currie Road 1 Mendip Road 1 No. 3 District. Falcon Grove 4 Plough Road 2§ Balfern Street 48 Harroway Road 5 Sewell Road 7 Bolingbroke Road 2 Heaver Road I Speke Road 1 Bournes Place 14 Ingrave Street 1 Bridge Road West 1 Kambala Road 4 No. 7 District. Bullen Street 2 Kerrison Road 1 Bennerley Road 1 Castle Street 1 Lavender Road Church Road 1 Lombard House 6 No. 8 District. Edna Street 2 Lubeck Street 3 Darley Road 1 Summary. District No. 1 6 streets 50 houses ,, ,, 2 6 „ 12 „ ,, ,, 3 20 „ 99 „ ,, ,, 4 *19 „ 60 „ ,, ,, 5 — - ,, ,, 6 ... *6 „ 29 „ ,, ,, 7 1 street 1 house ,, ,, 8 1 1 „ Total *58 streets 252 houses Statistics for the Year ended 31st December, 1934. Number of New Houses or Tenements erected during the year :— (1) By the Local Authority 31 (2) By other Local Authorities Nil (3) By other bodies and persons 19 * Speke Road in both Nos. 4 and 6 Districts. § Vide page 103 (Demolition and Closing Orders). 105 Number of Houses Demolished during the year :— (1) In pursuance of demolition orders 5 (2) Voluntarily 22 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) 8,726 (b) Number of inspections made for the purpose 27,191 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,056 (b) Number of inspections made for the purpose 22,384 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation ... ... 6 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,667 2. Remedy of Defects during the Year without Service of formal Notices :— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 218 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 19 (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 2,421 (2,990 intimation notices) 106 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,285 (2,849 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 5 (2) Number of dwelling houses in respect of which an undertaking was accepted under subsection 2 of section 19 Nil (3) Number of dwelling houses demolished in pursuance of Demolition Orders 5 (d) Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (e) Number of representations made to Local A uthority with a view to:— (a) Service of notice requiring the execution of works 126 (relating to 246 houses) (b) The making of Demolition Orders 3 (relating to 5 houses) (c) The making of Closing Orders 1 (relating to 1 house) 107 Maternal Mortality in the County of London and in Battersea, 1921-1934. Year. London. (Rate per 1,000 live births.) Battersea. (Rate 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 1934 1.34 1.46 2.80 1.39 1.86 3.25 Mean (1931-1934) (4 years) 1.59 1.72 3.31 1.51 1.80 3.31 Puerperal Fever Notifications in the County of London and in Battersea, 1921-1934. Year. London. (Rate per 1,000 live births.) Battersea. (Rate per 1,000 live 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 1934 4.48 4-.64 Mean (1931-1934) (4 years) 4.23 2.53 108 Vital Statistics of Whole District during 1934 and Previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. * of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate.* Number Rate per 1,000 Nett Births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1934 150,870 2,765 2,154 14.3 2,789 18.5 1,414 507 132 61 1,882 12.5 Area of District In acres (land and inland water), 2,163 arrrs. 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. (Required by the Ministry of Health to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease (excluding Tuberculosis) notified during the Year 1934, and Deaths from such Diseases. Notifiable Disease. Cases Notified in Battersea. at Ages (Years). Admitted to Hospital from each Sub-District. Deaths. 0 1 2 3 4 5 10 15 20 35 45 65 & over Total N. S. Smallpox ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 223 ... Diphtheria 4 25 29 61 66 233 71 26 32 7 3 557 334 20 Erysipelas 3 1 1 5 13 9 28 12 75 18 20 8 Scarlet fever 6 15 54 52 77 238 83 33 37 15 6 616 313 283 ... Enteric fever ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 3 6 1 io 6 4 3 Puerperal pyrexia ... ... ... ... ... ... ... 1 15 4 ... ... 20 11 3 ... Meningococcal meningitis 1 1 ... ... ... ... ... ... ... ... ... ... 2 1 ... 2 Ophthalmia neonatorum 23 ... ... ... ... ... ... ... ... ... ... ... 23 5 4 ... Polio-myelitis, &c. ... 1 ... 2 ... ... 1 ... ... ... ... ... 4 4 ... ... Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Polio-encephalitis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... i ... ... 2 ... ... ... Dysentery ... ... ... ... ... ... ... ... ... 11 5 ... 41 ... 12 ... Acute Influenzal pneumonia ... ... 1 2 1 ... 4 1 1 10 5 3 5 Acute Primary pneumonia 35 23 25 17 11 27 17 8 42 23 45 22 295 96 59 102 Whooping-cough 47 63 63 74 101 125 1 1 1 ... ... 1 477 42 22 7 Measles 125 304 336 431 542 1101 112 22 46 ... 3 3022 373 157 32 Totals 244 434 509 638 797 1729 291 100 203 71 90 40 5146 1207 788 180 109 110 111 Deaths Registered from all Causes for the Year 1934. Causes of Death. Sex. All Ages. 0 — 1 — 2- 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — 1. Typhoid and paratyphoid fevers - — - - - - - - - - 2. Measles M. 16 1 10 4 1 - - - - - - - f. 16 3 6 3 3 - - 1 - - - - 3. Scarlet fever — - - - - - - - - - - - 4. Whooping cough M. 2 1 - - 1 - - - - - - - f. 5 2 2 1 - - - - - - - - 5. Diphtheria M. 11 - 1 4 5 - - - - 1 - - f. 9 — 1 4 3 1 - - - - - - 6. Influenza M. 7 1 - - - 1 - 1 2 2 f. 8 2 - 1 - - - 1 2 2 7. Encephalitis lethargica M. 1 — — — — - - 1 - - f. — — - - - - - - - - - - 8. Cerebro-spinal fever M. 1 1 — — - - - - - - f. 1 — 1 — - - - - - - 9. Tuberculosis of respiratory system M. 71 — — — 2 17 10 10 22 6 3 1 f. 38 — — 1 1 12 9 5 8 - - 2 10. Other tuberculous diseases M. 15 1 1 3 4 2 2 1 - 1 - f. 8 1 1 2 2 - 1 1 - - 11. Syphilis M. 1 - - - - 1 - - - - f. 3 1 - - - 1 - - - 1 - - 12. General paralysis of the insane, tabes dorsalis M. 8 - - - 1 - - 3 3 1 - f. 2 - - - - 2 - - - 13. Cancer, malignant disease M. 126 - - 1 - 2 4 16 34 53 16 f. 114 - - 2 5 15 33 33 26 14. Diabetes M. 4 - - - - - - 1 1 2 f. 15 - 1 - 1 1 1 8 3 15. Cerebral hæmorrhage, etc. M. 18 — - - - - 3 4 5 6 f. 30 - - - - - - 3 5 12 10 16. Heart disease M. 251 - - - 2 3 6 7 17 51 79 86 f. 297 - - - 1 10 4 14 13 31 82 142 17. Aneurysm M. 8 - - - - - - - 3 3 - 2 f. 4 - - - - 1 1 1 1 18. Other circulatory diseases M. 33 — — — - 2 9 12 10 f. 36 - - - - - - - 4 4 7 21 19. Bronchitis M. 65 6 - - - - 1 1 6 20 14 17 f. 42 1 — — — 1 2 2 7 11 18 20. Pneumonia (all forms) M. 50 9 5 2 — 1 4 2 11 5 10 1 f. 50 14 6 4 1 2 1 3 1 2 6 10 21. Other respiratory diseases M. 9 — — — — 1 - 1 1 l 3 2 f. 6 — - - - - - - 1 — 3 2 22. Peptic ulcer M. 21 — — — — 2 7 11 1 — f. 12 - - - - - - 4 7 1 — 23. Diarrhœa, &c. M. 22 18 1 — 1 — — — 2 — — — f. -10 7 1 — — — — — — — 2 — 24. Appendicitis M. 5 - — — — 2 — — 1 — 2 — f. 5 — — — — — 1 — 3 — - 1 25. Cirrhosis of liver M. 4 — - - - - - - - 2 2 — f. 1 - - - - - - - - 1 — 26. Other diseases of liver, &c. M. 3 - — — — — — 1 — 2 — f. 7 — - - - - - - 3 3 1 27. Other digestive diseases M. 16 - 1 — 1 — — — — 7 3 4 f. 21 - — 1 1 2 1 3 4 3 6 28. Acute and chronic nephritis M. 36 — — 1 3 1 3 9 9 10 f. 28 — — — — — — 1 3 5 13 6 29. Puerperal sepsis f. 3 — — — — 1 2 — - - - - 30. Other puerperal causes f. 4 - — 4 - - - - - 31. Congenital debility, premature birth, malformation &c. M. 29 28 - 1 — — — — — — f. 33 29 1 — 2 1 — — — — — — 32. Senility M. 7 - - - - - - - - - 1 6 f. 17 _ - - - - - - - - - 17 33. Suicide M. 13 — — — — 1 1 4 4 2 1 f. 2 - - - - - 1 1 — — — — 34. Other violence M. 46 3 1 7 7 5 2 4 7 8 2 p_ 20 - - - 2 2 2 2 3 9 35. Other defined diseases M. 60 4 - 3 2 3 3 4 6 8 16 11 f. 76 - 2 1 2 6 5 10 17 19 14 36. Causes ill-defined, or unknown M. - - — — — — — — — — — — All Causes M. 959 73 19 14 27 40 37 39 113 188 230 179 f. 923 59 18 16 16 35 35 41 77 125 210 291 Totals 1,882 132 37 30 43 75 72 80 190 313 440 470 112 North Battersea. Infant Mortality, 1934. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 3 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1... ... ... ... 2 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 Meningococcal Menin- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Menin- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 3 2 1 2 2 3 2 1 1 4 2 2 3 6 10 10 6 Pneumonia (all forms) ... ... ... ... ... ... 1 1... ... ... 1 1 1 1 1 Diarrhoea & Entritis ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature 4 4 ?, ? ... ... ... 1 ... ... 6 7 ... ... ... ... ... ... ... ... 6 7 Congenital Malformation ... 2 2 1 1 1 5 ... 1 1 ... ... ... ... 2 6 Congenital Dedebility ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Atelectasis and As- phyxia Neonatorum ... 2 ... 1 1 ... ... ... ... 1 3 ... ... ... ... ... ... ... ... 1 3 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unbilical Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 4 8 3 6 1 1 2 2 ... 10 17 2 3 8 7 9 6 9 7 38 40 12 9 2 4 ... 27 5 15 15 16 78 Nett Births in the year. Nett Deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1,112 45 1,157 71 7 78 113 South Battersea. Infant Mortality, 1934. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 Small-pox M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... PulmonaryTuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 ... ... 3 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 ... 2 2 ... ... ... 3 4 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 1 1 ... 1 ... 8 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 7 4... ... 3 ... 1 ... 1 ... ... 7 9 ... ... ... ... ... ... ... ... 7 9 Congenital Malformation ... ... ... ... 1 ... 1 ... ... 1 2 1 2 1 1 1 ... ... ... 6 2 Congenital Debility ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Icterus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Atelectasis & Asphyxia Neonatorum ... ... 1 1 ... 1 ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Lack of Care Umbilical Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Totals 9 4 2 4 1 1 2 1 ... 2 14 12 6 2 8 3 4 2 3 ... 35 19 13 6 2 3 2 26 8 11 6 3 54 Nett Births in the year. Nett Deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 953 44 997 49 5 54 114 Borough of Battersea. Infant Mortality, 1934. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 houn. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year. Percentage ot Total. 1-2 2-3 3-4 1-3 3-6 6-3 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 ... ... ... 2 ... 1.52 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 3 3.03 Entreic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... 1 2 2.27 Diphtheria and Croup Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... I 2 ... ... 1 2 2.27 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... MeningococcalMeningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.76 Pulmonary Tubercu- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0.76 Other Tuberculous ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 1 1 1 ... 6 1 5.30 Pneumonia (all forms) ... ... ... ... ... ... 1 1 ... 1 1 2 2 2 1 5 4 3 1 2 9 14 17.42 Diarrhoea & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 3 7 3 3 2 5 2 18 7 18-94 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.76 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 11 8 2 5 ... 1 ... 2 ... ... 13 16 ... ... ... ... ... ... ... ... 13 16 21.97 Congenital Malformation ... ... 1 2 1 1 2 ... ... 1 3 1 6 2 2 2 1 1 ... ... ... 8 ? 8 12.12 1.51 Ictrus Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... 1 1 ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 2.27 Atelectasis & Asphyxia Neonatorum ... ... 1 2 1 ... 1 ... ... ... 3 4 ... ... ... ... ... ... ... ... 3 4 5.30 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbilical Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.76 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 0-76 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 0 .76 Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 0.76 Other Causes 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.76 13 12 5 10 2 2 4 3 ... 2 24 29 8 5 16 10 13 8 12 7 73 59 100-00 Totals 25 15 4 7 2 53 13 26 21 19 132 ... Percentage of Total 190 11.4 3.0 5.3 1.5 40.2 9.8 19.7 15.9 14.4 M.55.3 F.44.7 Nett Births in the year Nett Deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M 1,055 47 1,102 67 6 73 F. 1,010 42 1,052 53 6 59 Totals 2,065 89 2,154 120 12 132 115 Form T137 1 9 3 4. Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1934, to the 31st December, 1934, 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 13 30 28 18 10 11 7 119 170 ,, Females — — 1 2 12 20 24 9 6 3 2 79 117 Non-Pulmonary Males — 1 5 4 3 2 3 — — 1 1 20 23 „ Females — 3 5 2 2 1 3 1 — 1 — 18 18 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) NOTES—Part i. (a) Formal twtifications 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 bis 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 he recorded as a duplicate notification. 116 Supplemental Return. Part II.—New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — — 1 — 1 — 2 1 6 1 1 13 „ Females — — 1 1 1 2 1 1 — — — 7 Non-Pulmonary Males ... 1 1 1 1 2 — — — 1 — — 7 1) „ Females — 1 1 — — 1 1 — 1 1 — 6 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 f from local Registrars 5 1 \ transferable deaths from Registrar-General 1 Posthumous notifications 10 7 " Transfers " from other areas (other than transferable deaths) 3 4 Other sources if any (specify).—Admission notice 2 — NOTES.—Part II. (a) New cases of tuberculosis first coming to knowledge otherwise than by formal notification may, in some instances, afterwards be formally notified under the Regulations. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the Medical Officer of Health, it should be recorded as a " Primary Notification," and excluded from the Supplemental Return. If the formal notification is received in a subsequent year, such notification should be regarded as duplicate, as the case has already been included in the Supplemental Return for a previous year. (b) A formal notification which is not received until after the death of the patient should be included in the Supplemental Return as a " posthumous notification." (c) 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 included both in the Summary of Notifications and in the Supplemental Return for the same year. (e) In Counties, the particulars for the purposes of this Return should be obtained by the procedure suggested in paragraph 2 of Part II. of Circular 549. 117 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, 1934, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough. 416 326 742 139 131 270 1,012 Number of cases removed from the Register during the year bv reason inter alia of :— 1. Withdrawal of notification 1 - 1 - 1 1 2 2. Recovery from the disease 24 21 45 29 23 52 97 3. Death 80 42 122 13 12 25 147 notes.—part iii. In Counties, the information should be compiled from the quarterly statements for the year 1934, which are required to be furnished to the County Medica 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 figure6 included in his Return, he should record the fact, giving reasons. 118 Form T 145 TREATMENT OF TUBERCULOSIS. BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1934. (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 88 59 3 2 5 3 4 5 93 62 7 7 169 *(b) Diagnosis not completed — — — — — — — — 14 28 8 15 65 (c) Non-tuberculous — — — — — — — — 58 104 50 52 264 B.—Contacts examined during the (a) Definitely tuberculous — — — — — — — — — — — — — *(b) Diagnosis not completed — — — — — — — — 3 3 2 2 10 (c) Non-tuberculous — — — — — — — — 28 60 62 49 199 C.—Cases written off the Dispensary (a) Recovered 11 5 7 9 3 6 12 9 14 11 19 18 62 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 96 189 120 109 514 D.—Number of cases on Dispensary Register on December 31st (a) Definitely tuberculous 331 244 22 30 34 42 75 50 365 286 97 80 828 (6) Diagnosis not completed — — — — — — — — 19 40 16 — 105 1. Number of cases on Dispensary Register on January 1st 965 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 34 3. Number of cases transferred to other areas, cases not desiring further assistance under the Scheme, and cases " lost sight of " 102 4. Cases written off during the year as Dead (all causes) 95 5. Number of attendances at the Dispensary (including Contacts) 3,577 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 179 7. Number of consultations with medical practitioners :— (a) Personal + (b) Other 10 304 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) + 290 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,200 10. Number of (a) Specimens of sputum, &c., examined (b) X-ray examinations made in connection with Dispensary work ... 536 ( + 259 others) 123 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above... 3 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 404 (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.] t 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. 119 Form T145a. TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time Condition at the time of the last record made during the year to which the Return relates Previous to 1921 1921—6 1927 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 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) 1 (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. F. 6 1 — — 1 1 3 1 3 — 4 6 1 1 2 — 3 1 — 2 — 2 1 5 — — — — — — Children ... 7 1 — — 1 2 — 1 1 — — — — — Disease not arrested. Adults—M. F. 1 1 6 6 — 12 — 11 15 1 27 3 1 2 — 3 3 2 — 5 2 6 7 2 15 3 1 2 1 4 Children ... 1 2 — — 2 4 1 — — 1 — — — — Condition not ascertained during the year 12 3 2 — 5 14 2 5 1 8 2 3 5 Total on Dispensary Register at 31st December 29 16 12 — 28 26 22 36 4 62 7 5 9 1 15 —(6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. — — All classes 62 8 5 3 8 1 1 F. — — — — 66 12 — — — — — — — — — Children — — — — 238 11 3 — — 3 2 — — — — Lost sight of, or otherwise removed from Dispensary Register — — 581 110 52 111 40 203 23 2 27 3 32 DEAD. Adults—M. F. — — — — 248 27 14 25 146 155 326 2 2 26 23 51 — — — — 185 15 71 112 198 5 — 21 19 40 Children — — — — 43 8 1 6 6 13 1 — 3 — 3 Total written off Dispensary Register ... — — — — 1423 190 101 337 313 751 33 5 77 45 127 Grand Totals — — — — 1480 216 123 373 317 813 40 10 86 46 142 120 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 (iroup Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. F. 1 — 2 — 2 4 2 — — 2 — 1 — — 1 3 — 1 — 1 2 1 1 — 2 — — — — Children ... 1 — — — — — — — — — — — — — — Disease not arrested. Adults—M. W F. 6 11 17 3 4 3 7 6 9 6 15 2 6 6 5 3 5 1 9 8 3 4 7 Children — — — — — 2 — — — — 4 — — — Condition not ascertained during the year 3 — 4 — 4 6 2 3 — 5 6 2 2 — 4 Total on Dispensary Register at 31st December 10 6 24 — 30 22 12 12 1 25 24 15 12 — 27 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. F. 3 — — — — 2 — 1 — 1 1 — — — — — — — — — 1 — — — — — — — — — Children ... — — — — — — — — — —— — — — — — Lost sight of, or otherwise removed from Dispensary Register 15 9 17 9 35 11 15 23 5 43 14 6 23 5 34 DEAD Adults—M. F. 6 3 22 19 44 4 5 32 28 65 8 3 27 18 48 6 3 18 28 49 6 3 17 22 42 5 1 14 14 29 Children 1 — — — — 1 — 1 1 2 1 — — 2 2 Total written off Dispensary Register ... 31 15 57 56 128 25 23 74 56 153 29 10 64 39 113 Grand Totals 41 21 81 56 158 47 35 86 57 178 53 25 76 39 140 121 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. 1934. Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 1 — — — — 2 — 2 — 2 — — — — — — — — — — F. 1 1 — — 1 — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — Disease not arrested. Adults—M. 4 6 6 — 12 5 7 8 2 17 11 5 22 — 27 16 15 44 2 61 F. 6 10 5 1 16 9 6 11 1 18 11 6 16 1 23 22 5 16 3 24 Children 6 — — — — — — — — — 2 1 — — 1 1 1 .1 1 3 Conditions not ascertained during the year 3 3 — — 3 1 — 3 — 3 4 1 5 — 6 — — — — — Total on Dispensary Register at 31st December 21 20 11 1 32 17 13 24 3 40 28 13 43 1 57 39 21 61 6 88 (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 10 15 4 29 18 6 11 1 18 10 6 11 — 17 3 1 7 — 8 DEAD. Adults—M. 6 12 19 4 35 4 5 16 3 24 2 4 14 9 27 — — 4 7 11 F. 6 9 9 6 24 2 4 8 6 18 3 — 11 5 16 — — 3 4 7 Children 2 — — — — 1 — — — — — — — — — 1 — — 1 1 Total written off Dispensary Register 19 31 43 14 88 25 15 35 10 60 15 10 36 14 60 4 1 14 12 27 Grand Totals 40 51 54 15 120 42 28 59 13 100 43 23 79 15 117 43 22 75 18 115 122 NON-PULMONARY TUBERCULOSIS. Form T145a-(Contd.). Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of all Patients remaining on the Dispensary Register; and (6) 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. — — — — — — 1 1 — 2 — — — — — F. — — — — — — — — — — — — — 1 1 Children — — — 1 1 3 2 — 13 18 1 — 1 1 3 Disease not arrested. Adults—M. 1 — — — 1 1 — — — 1 1 — — 1 2 F. — — 1 — 1 1 — 1 1 3 — — — — — Children — — — 2 2 2 1 1 8 12 — 1 — 1 2 Condition not ascertained during the year 2 — — 2 4 3 1 4 7 15 1 — — 2 3 Total on Dispensary Register at 31st December 3 - 1 5 9 10 5 7 29 51 3 1 — 6 11 Transferred to Pulmonary 1 — — — 1 2 1 1 — 4 — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults—M. 1 — 1 1 3 2 1 1 3 7 2 — — — 2 F. — — — — — 1 1 — 4 6 — — 1 1 2 Children 5 3 2 29 39 15 10 2 60 87 1 1 1 1 4 Lost sight of, or otherwise removed from Dispensary Register 21 7 15 47 90 27 8 10 59 104 2 3 4 8 17 DEAD. Adults—M. 1 — — — 1 4 — 2 — 6 3 — — — 3 F. 1 1 — 3 5 1 1 4 2 8 — — — 1 1 Children 1 — — 8 9 4 1 1 3 9 1 — — — 1 Total written off Dispensary Register 30 11 18 88 147 54 22 20 131 227 9 4 6 11 30 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 41 123 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 Total (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. — — — — — — — — — — 1 — — — 1 F. 1 — — — 1 1 — — —- 1 — — — 1 1 Children 2 — — — 2 1 — — 2 3 1 1 2 1 5 Disease not arrested. Adults—M. — — — — — — — — — — — — — — — F. — — 1 — 1 — — 1 — 1 — — 1 2 3 Children 1 1 — 1 3 — — — 6 6 2 3 — 1 6 Condition not ascertained during the year — — 1 1 2 1 1 — — 2 4 — 1 2 7 Total on Dispensary Register at 31st December 4 1 2 2 9 3 1 1 8 13 8 4 4 7 23 Transferred to Pulmonary — — — — — — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom Discharged as Recovered. Adults—M. 2 — — — 3 — — — 3 3 — 1 — 1 2 F. — 1 — — 1 1 — — 3 4 — — — 1 1 Children 1 — — 1 2 — 1 1 — 2 — — — 1 1 Lost sight of, or otherwise removed from Dispensary Register 3 1 3 7 14 3 1 — 5 9 1 2 — 8 11 DEAD. Adults—M. — — — — — — — — — — 2 — 1 — 3 F. — — — — — 1 — — — 1 1 — — — 1 Children — — 1 — 1 — — — — — 1 — — — 1 Total written off Dispensary Register 6 3 4 8 21 5 2 1 11 19 5 3 1 11 20 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 10 4 6 10 30 8 3 2 19 32 13 7 5 18 43 124 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 1934 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults—M. 1 — — — 1 — — — — — — — — — — — — — — — F. 1 — — — 1 1 — — — 1 — — — — — — — — — — Children 1 — — 1 2 1 — — 2 3 — — — — — — — — — — Disease not arrested. Adults—M. 1 — — — 1 5 — 2 1 8 — — 1 1 2 3 — — 1 4 F. 1 — — — 1 1 1 3 1 6 2 2 — 3 7 — — 1 1 2 Children — — 2 3 5 4 2 — 7 13 2 — — 3 5 3 1 — 5 9 Condition not ascertained during the year 4 — — 1 5 2 — 1 — 3 4 — 1 1 6 — — — — — Total on Dispensary Register at 31st December 9 — 2 5 16 14 3 6 11 34 8 2 2 8 20 6 1 1 7 15 Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults—M. — — — — — — — — — — — — — — — — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 5 1 1 3 10 4 — 3 — 7 2 1 1 2 6 1 - - 1 2 DEAD. Adults—M. — — — — — 2 — 2 — 4 1 — 1 — 2 — — — — — F. 2 2 — — 4 — — — — — — — — — — — — — — — Children 1 — — — 1 — 1 — 1 2 — — — — — — — — — — Total written off Dispensary Register 8 3 1 4 16 6 1 5 1 13 3 1 2 2 8 1 — — 1 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 17 3 3 9 32 20 4 11 12 47 11 3 4 10 28 7 1 1 8 17 125 INDEX. (Chief references in heavy type.) PAGE Adulteration of food 84-89 Agricultural Produce (Grading, &c.) Acts. 72, 91 All Saints' Hall centre 19,21,28,32 Ambulances 22 Analysis of food, &c. 84-89 Analyst 3, 84 Animals 68 Ante-natal clinics 19, 28-34, 35, 42, 43 Appeals (housing) 102 Artificial Cream Act 92 Artificial light treatment—see Solarium. Bacteriological examinations 63, 67, 84 , 88 Bakehouses 68, 93, 94 , 95 , 97 Battersea General Hospital 23, 43 Battersea Polytechnic 20 Battersea School for Mothers 18, 19, 21, 43 Births 7, 8-10, 14-17, 20, 108, 112-114 Bolingbroke Hospital 23, 29 Boric ointment 85, 86 Breast feeding 28, 44 British Dental Hospital 3, 39, 40 Brompton Hospital 63 Butchers 83 Cancer 66, 110 Census 7, 101, 108 Centres—see Ante-natal, Denial, Maternity, Post-natal. Cerebro-spinal fever 45, 46, 50. 109, 110, 112, 114 Charing Cross Hospital 23 Charts 16, 47-8 Chatham Road centre 19, 20, 21 Chelsea Health Society 40 Chicken pox 27, 66 Children's Acts—see Infant life protection. Chislehurst (St. James's) Mission 18, 19, 21, 44 City of London Hospital 63 Clearance areas 99 Clerical staff 3, 81 Closing orders 103, 106 Colindale Hospital 63 Combined drain claims 74 Common lodging houses 73 Complaints 68 Condensed milk 85, 89 Consultants 3, 33, 35, 36, 50 Convalescence 26, 43 Coroner's Court 79, 80 Cream and artificial cream 85, 92 Creche—see St. Margaret's Day Nursery. Darien Road site 99 Dairymen 70, 91 Day Nursery—see St. Margaret's. Deaths 7,9,10-14,15,16,17,65,108-111 Demolition orders 103, 105, 106 Density of population 8, 101 Dental treatment 19, 20, 39-40, 43 Diabetes 67 Diarrhœa 7,27,65,66,111-114 Didcot street site 100 126 PAGE Dinners for mothers and children 19, 26, 42-3 Diphtheria 20, 46, 48, 65, 109, 110 Disinfection 68, 79 District midwife 4, 29, 38-9, 43 Dr. Barnardo's Homes 23 Dogs, nuisances by 71, 78 Drains 68, 74, 77 Drugs, analysis of 85, 86 Dust collection., &c 68, 75 Effluvium nuisance 75 Elizabeth Garrett Anderson hospital 23 Encephalitis lethargica 46,50, 109, 110 Enteric (typhoid) fever 45, 46, 50, 65, 109 Erysipelas 27, 46, 50, 109, 112—114 Factories 68, 93 95 Fat melters 76 Fathers' Council 19, 44 Fish shops 92 Food. — Poisoning 82 Preservatives in 88,91 Protection of supply 70, 82-92 Street stalls 92 Unsound 70, 82 Foster Mothers and Children.—See Infant Life Protection. General Lying-in hospital 23 Gideon Road centre 19, 21 Gipsy vans 68, 76 Grants 18 Grayshott road flats 99 Grove Park Hospital 63 Health Committee 1 Health Visitors 3, 20, 44, 52, 81 Holgate Avenue tenements 99 Home helps 24 Hope Street tenements 99 Hospitals 22-3, 63, 75, 88 Houses erected 99, 104 Houses let in separate tenements 68, 75 Houses, number of 7, 101, 104 House to house inspections 68, 105 Housing 99-106 Housing Committee 1 Ice Cream 89 Illegitimate births and deaths 7, 10, 14, 112-114 Increase of rent, &c., Acts 2, 103 Infant Life Protection 20, 41-2, 71 Infant mortality 7, 12-14, 15, 16, 17, 20, 108-114 Infectious disease 20, 45-67 Influenza 18, 66, 110, 112-114 Inquests 80 Inspections (see also under subject) 68, 105 Insulin 67 Invalid Childrens' Aid Association 18, 26, 44, 58 Invalid Kitchens Association 26 King's College Hospital 23 Kitchens 92 Knackers' yards 83 Laundries 93, 94, 95 Legal proceedings 68-72 127 PAGE Lemonade powder 86 Light treatment.—See Solarium. Linford Street area 100 Lodging Houses 73 Lothair Street area 100 Malaria 46, 109 Margaret Street Hospital 63 Marriages 10 Massage 24, 41, 44 Maternal mortality 7, 20, 33-35, 107, 111 Maternity and Child Welfare 18-44 Maternity Centres 18-21,22,79 Maternity Hospital 4, 19, 28, 29, 32. 35-38, 81 Maternity—Specialist advice 35 Measles 7, 20, 22, 27, 44, 45. 46. 52, 65, 109, 110, 112-114 Meat 82-83, 92 Medical Officer of Health 3, 5, 81 Merchandise Marks Acts 92 Metropolitan Boroughs statistics 17, 101 Metropolitan hospital 23 Middlesex hospital 23, 29 Midwives (see also District midwife) 26, 35 Milk.— Condensed 85, 89 Milk and Dairies Acts and Orders 70, 90 Milk Marketing Hoard 88 Sampling and analysis 70, 85, 86, 87-89 Shops 91 Special designations 25, 72, 90 Supply to schools and hospitals 88 ,, mothers and children 24-26 Tradesmen 70, 91 Mortuary 79, 80 Mothercraft classes 19, 20, 44 Mumps 27 National Heart Hospital 23 National Orthopaedic Hospital 23 Nine Elms housing site 100 Non-notifiable diseases 66 Notices served (see also under subject) 68 Notification of Births Acts 14 Nurse children—See Infant Life Protection. Nursing 27, 43, 51 Offensive matter, removal 76 Offensive trades 76 Ophthalmia neonatorum 27, 37, 47, 51, 109 Outworkers 96-97 Overcrowding 68, 101 Pemphigus neonatorum 27 Personal Cleansing Station 78 Pigeons 77 Plough Road Centre 19, 21, 28, 32 Pneumonia 27, 46, 66, 109, 111, 112-114 Polio-myelitis and -encephalitis 46, 49, 109 Population 7, 8, 9, 15, 101 Post-natal clinic 19, 36 Preservatives in food 91 Public Analyst 3, 84 Public Assistance Committee 25-6, 62 128 PAGE Public cleansing 75 Public Health Regulations and Orders.— Condensed milk 89 Infectious disease 47, 72 Meat 83 Preservatives, &c., in food 84, 91 Shellfish 47, 72 Public Houses 75 Public Institution deaths 11 Puerperal fever and pyrexia 7, 27, 33, 37, 46, 49, 107, 109, 111 Pupil health visitors 20 „ midwives 36 Rag and bone dealers 71, 77 Rag Flock Acts 77 Rateable value 7 Rats and mice 77 Registration Sub-Districts 8, 9, 12, 46, 51, 55, 109, 112-113 Rent-books 103 Rent and Mortgage Restrictions Acts 1, 103 Restaurant kitchens 92 Royal Free Hospital 23 St. Bartholomew's Hospital 23 St. George's Hospital 23, 63 St. James's Hospital 8, 23, 31, 43 St. Margaret's Day Nursery, &c. 18, 22 St. Margaret's (L.C.C.) Hospital 51 St. Mary's House 18, 24 St. Peter's Place area 100 St. Thomas's Babies Hostel 18, 22, 23, 28 St. Thomas's Hospital 23, 58, 63 Sampling of food 84-89 Sanitary Inspectors 3, 81 Sardines 84, 86, 89 Sausages 86, 87 Scarlet fever 46,47,65 Schick test clinic 19, 48 Schools 75, 78, 88 Senile mortality 11, 12 Sheepcote Lane site 99-100 Shops Act, 1934 72, 73 Slaughter of Animals Act, 1933 83 Slaughter-houses 83 Slaughtermen 83 Small-pox 45, 46, 47, 65, 109 Smoke nuisance 68, 75 Soap boilers 76 Solarium 19,40-41,63 Southlands centres 19,20,21,24,28,30,32,42 South London District Nursing Association 27, 43 South London Hospital for Women 23, 29, 30 Southwark Diocesan Association 18, 23 Specialists.—See Consultants. Staff 3, 36, 81 Stewarts Lane site 99 Still-births 7, 10, 14, 20, 37, 39 Streets stalls 92 Structural defects 103 Tenement houses 68,75 Tuberculosis.— Artificial light treatment 63 „ pneumo-thorax 63 129 Tuberculosis.—(contd.) page Bacteriological examinations 63, 118 Boarding out 58 Care Committee 2, 64 Deaths 54-57,110,112,114,118-124 Dental treatment 62 Dispensary 23, 29, 31, 58-65 Extra nourishment 62 Institutional treatment 61 Localisation 56 L.C.C. Tuberculosis scheme 58 New cases 59-61 Non-dispensary patients 65 Notifications 46,54-56,58,115,116 Open-air School 58 Recovery from disease 59,118-124 Register of cases 58, 117 Shelters 63 Statistics 54-55, 115-124 Tuberculosis Officers 3,58,63 Tuberculosis Regulations 58 X-ray examinations 58, 63 Typhoid fever.—See Enteric fever. Underground rooms 68, 100, 106 University College Hospital 23 Unmarried mothers—see Southwark Diocesan Association. Unsound food 70, 82 Urinals 68, 75 Usk road area 100 Vaccination 47, 53 Vans 68,76 Venereal disease 20, 31, 33-34 Vermin78, 79 Victoria Hospital for Children 18, 22, 23, 43 Vincent Square Hospital 23 Vital Statistics 7, 17, 107-114 Voluntary Centres (Maternity and Child Welfare) 19, 21, 42-44 Wards 8, 9, 12, 46, 51, 53, 55, 109 Warehouses 98 Water-closets 68, 74 Water supply 68, 76 Westminster hospital 23 Wharves 98 Whooping-cough 7, 27, 46, 52,65, 109, 110, 112-114 Women's Holiday Fund 44 Women's League of Service 18, 19, 21, 26, 28, 42 Workshops and workplaces 68,93-96 York Road tenements 99 Zymotic diseases 65