H AC 4384 BAT 36 Metropolitan Borough of Battersea, REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1937. BY G. MACDONALD, M.A., M.B., D.P.H., MEDICAL OFFICER OF HEALTH. Wightman & Co., Ltd., Printers, Regency Street, S.W.i, and Dugdale Street, S.E.5 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1937. 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, 1936. As constituted 9th November, 1937. Chairman: Chairman: Councillor Mrs. A. A. Burton Councillor Mrs. A. A. Burton. His Worship the Mayor His Worship the Mayor (Councillor C. Barrington, j.p.) (Councillor H. W. J. Miles, j.p.) Councillor Mrs. K. S. D. Baker. Councillor Mrs. K. S. D. Baker Alderman Mrs. H. Bowler. Alderman Mrs. H. Bowler. Councillor Mrs. E. A. Cooper. Councillor Mrs. E. S. Burton. Alderman Mrs. J. F. Dye. „ Mrs. E. A. Cooper. Councillor G. Fineran. „ Dr. H. L. Gulati „ Dr. H. L. Gulati. T. J. Hines. „ T. J. Hines. Alderman Mrs. H. E. Hughes. „ F. J. Lamb. Councillor F. J. Lamb. Alderman G. Lauriks. „ R. Moore. Councillor R. Moore. „ Mrs. M. J. Robinson. „ Mrs. M. J. Robinson. „ Mrs. E. Stone. Housing Committee. As constituted 9th November, 1936. As constituted 9th November, 1937. Chairman: Chairman: Councillor I. O. Thomas. Councillor I. O. Thomas. His Worship the Mayor His Worship the Mayor (Councillor C. Barrington, j.p.) (Councillor H. W. J. Miles, j.p.) Alderman A. E. Amey. Councillor Mrs. K. S. D. Baker. Councillor Mrs. K. S. D. Baker. „ R. G. H. Blundell. „ J. W. Cook. „ Mrs. E. S. Burton. Alderman H. Harling. „ J. W. Cook. Councillor A. W. Inman. Alderman H. Harling. „ J. F. Lane, jun. Councillor A. R. Higgins. „ G. F. Meecham. „ J. F. Lane, jun. „ E. S. Strange, j.p. „ C. E. Lang. „ E. J. Sullivan. „ G. F. Meecham. ,, H. T. Vincent. Alderman T. Pocock, j.p. „ W. J. Wye. Councillor W. J. Wye. 2 Tuberculosis Care Committee. As constituted 9th November, 1936. As constituted 9th November, 1937. Chairman— Chairman— Councillor Mrs. M. J. Robinson. Councillor Mrs. M. J. Robinson. Alderman Mrs. H. Bowler. Councillor Mrs. E. S. Burton. Councillor G. Fineran. „ Mrs. F. M. Glanvill. Dr. H. L. Gulati. „ Dr. H. L. Gulati. „ H. T. Vincent. ,, Mrs. E. Stone. Other Member: Other Member: Mrs. F. Young. Mrs. F. Young. Representatives of the Local Public Representatives of the Local Public Assistance Committee: Assistance Committee: Councillor Mrs. E. A.Cooper. Councillor Mrs. E. A. Cooper. Mrs. F. E. Mrs. F. E. Mullings. Mullings. Representative of the London Insurance Committee: Representative of the London Insurance (Vacant.)* Committee: Mr. H. B. Robinson. Members of the late Voluntary Care Committee: Members of the late Voluntary Care Miss B. Home. Committee: Miss E. Morris. Miss B. Home. Miss E. Morris.* Consultative Members: Consultative Members: L.C.C. District Organiser for Children's Care Committee Work (Miss Thomas). L.C.C. District Organiser for Children's Care Committee Work (Miss Burton) L.C.C. Divisional Medical Officer (Dr. Atlee) L.C.C. Divisional Medical Officer (Dr. Atlee). Representative of the Invalid Chil- dren's Aid Association, Southlands Representative of the Invalid Child- (Miss Denham) ren's Aid Association, Southlands (Miss Denham). Representative of the War Pensions Committee (Dr. F. H. Whitehead). Representative of the War Pensions Committee (Dr. F. H. Whitehead). Lady Almoner, Brompton Hospital (Miss Marx) Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Spencer). Tuberculosis Almoner, St. George's Hospital (Miss Spencer). Lady Almoner, St. Thomas's Hospital (Miss C Morris) Lady Almoner, St. Thomas's Hospital (Miss C. Morris). Lady Almoner, Victoria Hospital (Miss E. W. White) Lady Almoner, Victoria Hospital (Miss E. W. White). Representative of the South London District Nursing Association (Miss Representative of the South London A. M. Stanford). District Nursing Association (Miss A. M. Stanford). Representative of the British Red Cross Society (Mrs. C. E. Peach). Representative of the British Red Cross Society (Mrs. E. Horn). * Mr. H. B. Robinson, appointed 24th March, 1937. * Resigned 9th December, 1937. 3 Staff of public Health Department. (At 31st December, 1937). Deputy M.O.H. and Tuberculosis Officer STANLEY KING, m.d., m.r.c.p., d.p.h. Assistant Medical Officer (Maternity and Child (Miss) M. L. HAMILTON, m.b., Welfare) ch.b., d.p.h. Assistant Medical Officer (Tuberculosis and (Mrs.) M. J. O'FLYNN, b.a., m.b., M. & C.W.) b.ch., b.a.o. Resident Medical Officer, Borough Maternity (Miss) B. H. BAKEWELL, m.b , Hospital B.ch. Consultant Gynecologist, Borough Maternity (Miss) ALICE BLOOMFIELD, Hospital m.d.. f.r.c.s., f.c.o.G. Consultant Obstetrician, Borough Maternity F. W. ROQUES, m.d., m.ch , Hospital f.r.c.s., f.c.o.G. Consultant Medical Officer, Ante-Natal (V.D.) H. CORSI, f.r.c.s., m.a., m.b.. Clinic b.ch., l.r.c.p. Medical Officer, Nine Elms Centre. (Miss) E. M. SAXTON, m.d. Medical Officer, Diphtheria Immunisation F. PORTER SMITH, m.r.c.s., Clinic 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. Senior Sanitary Inspector . F. H. CHUTER (a c). Sanitary Inspectors: District. Other. 1. W. E. Selway (b c). (Miss) B. L. Kaye (a d f) Also Health 2. G. Weeks (b c). „ J. Round (a d) Visitors. 3. A. Webb (b c). 4. P. D. O'Grady (b c). 5. J. R. Glover (b c). (Food) J. A. H. Brownlow (b c). 6. C. Binding (a c). (Workshops) I. R. Lewis (b c). 7. (Senior Inspector). (Housing) R. J. McCarthy (a c). 8. J. R. Holloway (a c). Organising Rat Officer—A. E. Tubby. Health Visitors: (Miss) B. L. Kaye (a d f) sanitary (Miss) H. A. Blackburn (b e f g h). ,, J. Round (a d) Inspectors. ” ” Prager (e f g h). N. Playne (af g). ” ”. I. M. J. Sweeney (ef g ). „ D. Heap (a e). .. M. C. H. Wilkie (e f g). „ F. B. Goodall (a d f g). ” ” E. L. Flemons (e f g). A. Bannerman (d f). ” ”I. B. Abbott (e f g). „ V. Ventris (efg) „ K. I. Brown (e f g ). (For notes see next page.) 4 Clerical Staff— Chief Clerk—F. E. WARD. J. W. Brown (Statistical). P. Brocking. E. Cole. H. N. Carter. H. C. Godfrey (a). (Miss) M. A. Weller (M. & C.W. W. Halstead. Records). R. Graham. (Miss) K M Hone F. Pedrick. one temporary clerk. Two office youths. Maternity Home— Matron—(Miss) M. Fevyer (f g). Sisters—(Miss) F. M. Cooper (f g) and (Miss) R. Osborn (f g)—3 Staff Nurses. Borough Midwife (District Service)—(Miss) M. L. Thompson (f g). Tuberculosis Dispensary— Tuberculosis Nurses—(Miss) M. Schotborgh (e g h), (Miss) B. O'Connor (g), (Miss) C. Thompson (f g). Secretary and Clerk—(Miss) L. Wadham (a d). Dispenser—(Miss) E. F. Davies. Clerks—(Miss) C. Turner. (Mrs.) M. E. Werrett. Disinfecting Station—Superintendent—T. Farrow. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer—See page 56. (а) Sanitary Inspectors' certificate of the Sanitary Inspectors' Examination Board. (b) Sanitary Inspectors' certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (c) Meat and other Foods certificate, Royal Sanitary Institute, or Sanitary Inspectors' Examination Board. (d) Health Visitor's certificate, Board of Education. (e) „ „ ,, Royal Sanitary Institute. (f) Central Midwives' Board certificate. (g) State registered nurse. (h) Tuberculosis certificate. 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Batter sea. 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 during 1937. A summary of the principal statistics for the year is given on page 7. It will be noted that the birth rate is somewhat higher and the death rate slightly lower than for the previous year. The maternal mortality rate is also lower, and it is pleasing to note that no maternal death was recorded during the year as due to puerperal sepsis. The infant mortality rate, unfortunately, has risen to a figure which is the highest recorded since the year 1921, and I have made some comments on this in the text (page 14). There is every reason to think that the infant death rate for the year is an abnormal one, and is unlikely to continue at this high level. I have no special comments to make on the general work of the Public Health Department, which is fully set out in the text of the Report, and which indicates the extent of the health services rendered to the Borough by the Council. I wish to thank the Mayor and Members of the Borough Council, and more particularly the Chairman and Members of the Public Health and Housing Committees, for the continued encouragement and assistance that I have received from them during the year. I gratefully acknowledge, also, the help I have received from the Chief Officers of the Council and the loyal service so readily rendered by the whole 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. June, 1938. 6 CONTENTS. page General 1-6 Vital and Social Statistics 7-21 Maternity and Child Welfare 22-52 Infectious and Other Diseases 53-77 General Sanitary Administration 78-97 Food Supply 98-107 Factories and Workshops 108-113 Housing 114-121 Appendices 122-141 (See Index at end.) 7 Summary of Statistics, 1937. 1. General. Area of Borough— (Including land and inland water) acres 2,163 (Excluding water) acres 2,139.9 Population—(Registrar-General's estimate, midyear 1937) 143,500 Structurally separate occupied dwellings on rate books at end of 1937 28,045 Rateable value (1937) £1,160,667 Sum represented by a penny rate £4,728 2. Extracts from Vital Statistics of the Year. Births— Males. Females. Total. Legitimate 1,058 1,000 2,058 Illegitimate 42 44 86 Live births 1,100 1,044 2,144 Still births 35 28 63 Live birth-rate (per 1,000 population) 14. 94 Still-birth-rate (per 1,000 births live and still) 28.5 Deaths—Males, 947 ; females, 903 1,850 Death-rate (per 1,000 population) 12.89 Number of women dying in or in consequence of childbirth— From sepsis Nil. Other puerperal causes 4 Maternal mortality rate (per 1,000 births live and still) 1. 81 Deaths of infants under 1 year— Legitimate, 145; illegitimate, 6 151 Infant mortality rate (per 1,000 live births)— Legitimate, 70 .46; illegitimate, 69.77. All deaths under 1 year 70.43 Deaths from Cancer (all ages) 244 „ Measles (all ages) 3 „ Whooping-cough (all ages) 9 „ Diarrhoea (under 2 years of age) 30 3. Census— Private Inhabited Population. families. dwellings. 1911 167,743 39,439 24,321 1921 167,739 42,988 27,191 1931 159,552 44,618 27,219 8 Vital Statistics. The Registrar-General's estimate of the mid-year population of Battersea (1937) was 143,500 as compared with 145,500 in 1936. The population of Battersea at the Census taken in April, 1931, was 159,552, and the Registrar-General's estimate for 1937 therefore indicates a decrease of 16,052 (or 10 per cent.) since the Census, and 2,000 during 1936-7. The Registrar-General's estimate of the mid-year population of the Borough (143,500) 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 each of the nine wards into which the Borough is divided, is set out in the following table:— Area. Acres. Estimated mid-year population, 1937. Males. Females. Total. Density per acre Wards. 1. Nine Elms 407 11,349 11,551 22,900 56·3 2. Park 316 7,164 8,034 15,198 48·1 3. Latchmere 182 7,885 8,657 16,542 90·9 5. Church 171 7,449 7,620 15,069 88·1 North Battersea 1,076 33,847 35,862 69,709 64·8 4. Shaftesbury 140 6,108 6,581 12,689 90·6 6. Winstanley 126 8,535 8,722 17,257 137·0 7. St. John 117 3,364 4,334 7,698 65·8 8. Bolingbroke 205 7,534 9,088 16,622 81·1 9. Broomwood 499 8,520 11,005 19,525 39·1 South Battersea 1,087 34,061 39,730 73,791 67·9 Borough 2,163 67,908 75,592 143,500 66·3 BIRTHS. The number of live births registered in the Borough during 1937 was 2,771 (1,409 male, 1,362 female), an excess of 47 males. Of this number 1,014 were transferred out, the permanent residence of the parents being outside the Borough, and 387, registered outside the Borough, were transferred in, giving on balance a total of 2,144 births (1,100 male, 1,044 female) relating to Battersea residents, and a corrected (live) birth-rate of 14.94 per 1,000 of the population. This is an increase of 0.31 on that of 1936. The tables on the next two pages give the distribution of the births and the birth-rate per l,000 of the population in the subdistricts and in the wards for the year 1937, and figures relating to the previous decennium 1927-36:— * 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. 9 BIRTHS and DEATHS, 1937. In Sub-Districts and Wards. Rates for 1937 and 10 previous Years (per 1,000 Population). Area. Estimated Population 1937 Births (live) 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. 1927 18·5 12·.1 14·6 12·4 16·6 12·2 North Battersea 69,709 1,124 16·1 893 12·8 1928 19·0 12·0 14·5 11·9 16·7 11·9 South Battersea 73,791 1,020 13·8 957 13·0 1929 18·5 14·4 13·9 14·0 16·2 14·2 Wards. 1930 17·8 11·7 15·2 11·3 16·5 11·5 No. 1, Nine Elms 22,900 343 15·0 285 12·4 1931 16·5 12·2 14·5 11·9 15·5 12·1 No. 2, Park 15,198 257 16·9 207 13·6 1932 16·0 11·9 13·6 12·2 14·8 12·1 No. 3, Latchmere 16,542 269 16·3 217 13·1 1933 15·1 12·3 14·3 12·7 14·7 12·5 No. 4, Shaftesbury 12,689 154 12·1 183 14·4 1934 15·8 12·0 12·9 13·0 14·3 12·5 No. 5, Church 15,069 255 16·9 184 12·2 1935 15·2 11·5 13·3 12·5 14·2 12·0 No. 6, Winstanley 17,257 246 14·3 205 11·9 1936 15·2 12·7 14·1 13·4 14·6 13·1 No. 7, St. John 7,698 143 18· 6 76 9·9 Mean 19271936 16·8 12·3 14·1 12·5 15·4 12·4 No. 8, Bolingbroke 16,622 233 14·0 216 13·0 No. 9, Broomwood 19,525 244 11·1 277 14·2 Borough 143,500 2,144 14·9 1,850 12 ·9 1937 16·1 12·8 13·8 13·0 14· 9 12·9 10 Vital Statistics of Whole District during 1937 and Ten 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 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 1935 148,200 2,876 2,104 14·2 2,860 19·3 1,456 380 137 65 1,784 12·0 1936 145,500 2,855 2,128 14·6 2,869 19·7 1,365 396 126 59 1,900 13·1 1937 143,500 2,771 2,144 14·9 3,037 21·2 1,554 367 151 70 1,850 12·9 Area of District in acres (land and inland water), 2,163 acres. Total population of 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. 11 Of the Battersea births (live and still) which occurred within the Borough in 1937, 795 were "domiciliary births." The birth-rate shows a decline in four Wards of the Borough and an increase in the five remaining Wards. The birth-rate in Battersea was 0·5 per 1,000 lower than the average for the previous decennium 1927-1936. Illegitimate births numbered 86 or 4·01 per cent. of the live births. The number of births occurring in each quarter of the year is shown in the table on page 13. The live birth-rate for the County of London was 13·3 per 1,000 of the population, and for England and Wales the rate was 14·9. Still-births. The registration of still-births became compulsory under the provisions of the Births and Deaths Registration Act, 1926. During 1937 there were 85 still-births registered in Battersea, of which 48 were of Battersea parents. Fifteen still-births occurring outside the Borough were registered as belonging to Battersea, making 63 in all, representing a still-birth rate of 28·55 per 1,000 births (live and still) registered. Of the 63 still-births 3 (4·8 per cent.) were registered as illegitimate. The number of Battersea still-births registered, and the stillbirth rates, from 1928 to 1937, were as under:— No. Rate. No. Rate. 1928 90 31·8 1933 65 27·9 1929 71 26·4 1934 65 29·3 1930 103 37·4 1935 69 31·8 1931 66 26·0 1936 60 27·4 1932 72 30·1 1937 63 28·5 Notification of Births. During 1937 the number of notifications of live births received belonging to the Borough was 2,094. The corrected number of Battersea births registered during the year was 2,144. The proportion of notified to registered births was, therefore, 97·7 per cent. Notifications of 340 live births of Battersea children occurring outside the Borough were received from the districts in which the births occurred, these cases being included in the total of 2,094 above. Fifty-seven still-births were notified under the provisions of the Public Health (London) Act, 1936, during the year, including 13 cases occurring outside the Borough, the number notified being 90·5 per cent. of the total Battersea still-births registered. The homes from which births are notified are visited and revisited by the Council's official health visitors or the health visitors of the voluntary organisations included in the Council's Maternity and Child Welfare scheme. A weekly return of all births notified is forwarded to the London County Council, in accordance with the requirements of the Public Health (London) Act, 1936. 12 MARRIAGES. The marriages registered in Battersea during 1937 numbered 1,409. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 19.6. Year. Marriages. Marriage-Rate. 1932 1,300 16·6 1933 1,376 17·9 1934 1,432 19·0 1935 1,446 19·5 1936 1,364 18·7 Mean, 1932-36. 1,384 18·3 1937 1,409 19·6 DEATHS. The number of deaths registered in the Borough during 1937 was 3,037. Of these 1,554 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 367 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,850 (males 947, females 903). This gives a recorded death-rate of 12.89 compared with 12.3 for London, and 12.4 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 1937 this factor is 0.99, and the adjusted death-rate for the purpose of such comparison is therefore 12.76. 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. The following table shows the age and sex distribution of the total deaths (corrected) in Battersea during 1937:— Under 1 year. 1 - 5 - 10 - 15 - 25 - 45 - 65 + Total. M 91 16 12 6 22 79 281 440 947 F 60 21 8 5 34 64 196 515 903 Ttls. 151 37 20 11 56 143 477 955 1850 % of Total 8·2 2·0 1·1 0·6 3·0 7·7 25·8 51·6 100 13 It is well known that in almost all districts the average age at death tends to increase. The position of Battersea in this respect is illustrated by the following figures:— Average Age at Death, 1928-1937. 1928 51·5 1932 55·7 1935 57·5 1929 53·0 Mean, 1928-32 53·8 1936 57·7 1930 53·7 1933 56·8 1937 57·9 1931 55·3 1934 55·7 Mean, 1933-37 57·1 During 1937 the deaths of 955 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths, which constituted 51·6 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 96 99 76 100 12 32 184 231 415 South Battersea 138 105 95 127 23 52 256 284 540 Borough 234 204 171 227 35 84 440 515 955 The number of deaths and infant deaths registered in each quarter of the year is set out in the following table, in which, for convenience, the corresponding figures for births have also been inserted:— Quarter. Births (live). Infant Deaths (under 1 year). All Deaths. No. Per cent. of total. No. Per cent. of total. No. Per cent. of total. 1 500 23·32 46 30·46 608 32·86 2 604 28·17 38 25·17 430 23·24 3 562 26·21 27 17·88 337 18·22 4 478 22·30 40 26·49 475 25·68 Total 2,144 100·0 151 100·0 1,850 100·0 The death-rate during 1937 was lowest in the St. John Ward (9·9), and highest in Shaftesbury Ward (14·4). Decreased deathrates were recorded in five wards of the Borough. The natural increase of population (that is excess of births over deaths) was 294 in 1937 as compared with 228 in 1936. The causes of the 1,850 deaths occurring in 1937, classified in various age groups, are shown in the Appendix, pages 126-7. 14 Deaths in Public Institutions. During 1937 the deaths of Battersea residents occurring in public institutions numbered 1,167. Of this number 827 occurred within and 340 outside the Borough. Of the total Battersea deaths in institutions 930 occurred in the general hospitals of the London County Council. Infant Mortality. During 1937 the deaths of 151 infants under 1 year of age were registered as belonging to Battersea. The total number of live births registered during the year was 2,144, giving an infant mortality rate of 70.43 per 1,000 live births, as compared with 59·21 in 1936, 65·11 in 1935. 61·28 in 1934, and 49·49 in 1933. The distribution of the 151 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 1,124 54 36 90 80·07 South Battersea 1,020 37 24 61 59·80 The Borough 2,144 91 60 151 70·43 Ward. 1. Nine Elms 343 14 11 25 72·89 2. Park 257 17 5 22 85·60 3. Latchmere 269 15 12 27 100·37 4. Shaftesbury 154 8 6 14 90·91 5. Church 255 8 8 16 62·75 6. Winstanley 246 14 7 21 85·37 7. St. John 143 2 3 5 34·97 8. Bolingbroke 233 10 3 13 55·79 9. Broomwood 244 3 5 8 32·79 The infant mortality rates in the County of London and in England and Wales during 1937 were 60 and 57 respectively. It will be noted that in the sub-districts the rate was lower in South Battersea (59·8) than in North Battersea (80·1). In the wards, Broomwood showed the lowest rate (32·8) and Latchmere Ward the highest (100·4). The infant mortality rate of 70·43 per 1,000 live births is the highest that has been reached in Battersea since 1921, and although this rate is one which fluctuates considerably from year to year, it is difficult to find any simple explanation of the heavy increase in 1937. 15 On page 131 the causes of the 151 deaths of infants are set out in detail, and a close examination of this table and comparison with the similar tables of previous years indicate the diseases to which most of the increase is due. On the average rates for the 10 years 1927 to 1936 the number of infant deaths which might have been anticipated in 1937 among 2,144 births was 125, or 26 less than actually occurred. Using the same average rates the number of deaths assigned to those causes usually termed "developmental" would have been 58 instead of 72, while diarrhoea and enteritis would have accounted for 16 instead of 29 deaths. These two causes, therefore, in the main account for the higher infantile mortality rate during the year. Among the developmental diseases, while "prematurity" has less than the average rate, "congenital malformations" show considerably more deaths than would be expected. The deaths from developmental diseases were 72 as compared with 61 in 1936. Of the 151 infant deaths 76 per cent. occurred in hospital, and in the case of those babies who died from diarrhoea and enteritis no less than 28 out of 29 died in hospital. It is interesting to note that, although the death rate for infants under one year was so high, deaths of children under 5 years of age (including the infants) were less by eight than might have been anticipated from the rate which prevailed in the previous 10 years. There were 62 deaths of infants during the first four weeks of life (or 41.1 per cent. of the total infant deaths) as compared with 61 deaths (or 48·4 per cent.) in 1936 and a percentage for the quinquennium 1932-1936 of 44·3. Table showing Deaths of Infants under 1 day, under 1 week and under 4 wekks from 1932 to 1937. 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 1932 16 20 16 52 38·8 1933 21 11 13 45 40·2 1934 25 15 13 53 40·2 1935 38 26 9 73 53·3 1936 18 22 21 61 48·4 Mean 23·6 18·8 14·4 56·8 44·3 1937 23 23 16 62 41·1 The causes of the 151 infant deaths are shown in detail in the appendix, pages 129-131. The number of infant deaths in each quarter of the year is shown in the table on page 13. Deaths of Illegitimate Infants. The death-rate amongst illegitimate children during 1937 was 69·77 per 1,000 births, as compared with 57·5 in 1936, 160·9 in 1935, 134·8 in 1934, and 69·3 in 1933. The corresponding deathrate of legitimate children in 1937 was 70·46, the ratio of mortality rate of illegitimate infants to that of legitimate being 99 to 100. 16 COMPARATIVE STATISTICS OF BIRTHS, MORTALITY, &c. Year. Mean population for year. Live 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 16·7 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 27·4 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 1935 148,200 2,104 1,784 320 14·2 12·0 65·1 1936 145,500 2,128 1,900 228 14·6 13·1 59·2 1937 143,500 2,144 1,850 294 14·9 12·9 70·4 Census years in heavy type. * Population as estimated for purpose of (B) Birth-rate, (D) Death-rate. † Decrease. 17 Birth, Death and Infantile Mortality Rates in Battersea from 1861. 18 Comparative Statistics, London Boroughs. (Compiled by the Medical Officer of Health of Poplar and re-produced by his kind permission.) Cities and Boroughs. Estimated resident population (mid-1937) Live births, annual rate per 1,000 population. Deathrate per 1,000 population. Deaths of infants under one year to 1,000 births. LONDON 4,094,500 13·4 12·5 60 West Districts. Crude Adjusted Paddington 138,300 13·65 13·05 12·91 66 Kensington 175,600 12·1 13·3 12·4 83 Hammersmith 126,500 15·1 12·6 13·0 68 Fulham 138,900 13·9 13·08 13·2 56 Chelsea 56,510 10·8 14·1 12·0 59 City of Westminster 124,300 8·2 11·5 11·8 58·7 North Districts. St. Marylebone 92,110 9·36 13·10 12·98 73 Hampstead 90,690 11·2 11·6 10·9 54 St. Pancras 181,900 13·0 12·7 13·0 62 Islington 295,400 15·25 12·9 13·02 66 Stoke Newington 50,250 14·9 12·5 12·0 37·5 Hackney 206,700 13·8 11·1 11·7 43·38 Central Districts. Holborn 34,600 8·09 11·85 12·68 79 Finsbury 58,700 13·8 14·6 15·9 71 City of London 8,980 6·1 11·2 12·4 36·3 East Districts. Shoreditch 82,240 14·86 12·47 13·72 54 Bethnal Green 94,560 13·3 12·5 14·1 54 Stepney 203,100 13·5 12·2 14·2 60·5 Poplar 136,800 15·5 12·6 14·0 61 South Districts. Southwark 147,400 14·7 13·6 14·1 64 Bermondsey 98,790 14·4 12·3 14·0 59 Lambeth 273,800 14·1 13·2 13·0 68 Battersea 143,500 14·94 12·89 12·76 70·43 Wandsworth 341,700 11·53 12·36 11·43 62 Camberwell 224,800 14·08 12·83 12·83 58 Deptford 96,580 15·1 11·8 12·3 45 Greenwich 95,990 13·88 12·03 12·27 50 Lewisham 226,000 13·9 10·8 10·9 46 Woolwich 149,400 14·2 11·1 11·7 40 Note.—The information relating to London supplied by the RegistrarGeneral and that for individual Boroughs by the Medical Officers of Health. 19 SOCIAL CONDITIONS. Battersea is in the main a working-class Borough, and though there are two or three large factories within its borders, the majority of the inhabitants travel to other areas for their daily work. Some indications of the economic conditions prevailing in the Borough are to be found in the following figures:— Residents of Battersea registered as unemployed:— 20th January, 1936 4,559 25th January, 1937 3,382 27th April, „ 3,573 19th April, „ 2,850 20th July, „ 2,890 26th July, „ 2,634 26th October, „ 2,998 18th October, „ 3,089 Out-door relief granted at various dates:— 1936 Cases Persons 1937. Cases Persons 28th March 1,545 2,794 27th March 1,560 2,721 27th June 1,458 2,516 26th June 1,451 2,368 26th Sept 1,461 2,529 25th Sept 1,412 2,260 26th Dec. 1,532 2,624 25th Dec. 1,506 2,444 There were, in addition, a small number of persons who received medical relief only. The first of the above tables shows a decline of 15, and the second of 6½ per cent. for the year 1937 compared with 1936. I am indebted to the Chief Officers of the London County Council for the second of the above tables, and for those on the next two pages relating to the inspection of elementary school children. On the average 246 children per month received free dinners in the elementary schools, and 904 per month received free milk, apart from the numbers who obtained cheap milk under the scheme of the Milk Marketing Board. These two figures taken together represent an increase of 30 per cent. on those for 1936. Other facts bearing on the social and economic conditions of the inhabitants of the Borough may be inferred from various paragraphs in this report, e.g., page 29 dealing with the supply of milk by the Council, and pages 109, &c., as to factories, &c., and the numbers employed therein. 20 Routine Medical Inspection of Elementary School Children in Battersea, 1937. BOYS. GIRLS. Total. Percentage. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Batt. London. Number examined 822 754 763 755 795 816 763 796 6,264 – – Clothing and boots— Good 581 528 500 465 556 562 578 568 4,338 69·3 55·6 Fair 239 225 262 289 238 254 184 227 1,918 30·6 44·1 Poor 2 1 1 1 1 – 1 1 8 0·1 0·3 Nutrition— Good 49 55 55 68 97 85 93 145 647 10·3 16·5 Average 710 596 641 620 646 661 607 609 5,090 81·3 77·4 Below normal 62 102 67 67 51 68 62 42 521 8·4 6·1 Bad 1 1 – – 1 2 1 – 6 Cleanliness of head— Clean 819 748 759 751 784 808 751 787 6,207 99·1 97·6 Nits 3 6 3 4 9 6 10 6 47 0·7 2·1 Pediculi – – 1 – 2 2 2 3 10 0·2 0·3 Cleanliness of body— Clean 821 751 759 755 792 815 762 796 6,251 99·8 99·1 Dirty 1 3 4 – 3 1 1 – 13 0·2 0·9 Pediculi – – – – – – – — – – 0·0 Teeth— All sound 409 467 545 557 387 490 544 569 3,968 63·4 70·2 Less than 4 decayed 303 230 206 191 313 274 208 220 1,945 31·0 26·3 Four or more decayed 110 57 12 7 95 52 11 7 351 5·6 3·5 Vision— 6/6 in both eyes. – 563 543 544 – 594 523 585 3,352 72·3 67·6 6/9 in either or both eyes – 98 91 70 – 129 90 82 560 12·1 19·0 6/12 or worse in both eyes – 92 129 140 – 88 150 127 726 15·6 13·4 21 Examination of Elementary School Children in Battersea, 1937. BOYS. girls. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number examined 822 754 763 755 795 816 763 796 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 8 7 12 9 11 5 1 1 6 3 15 12 9 7 2 1 Skin disease 14 10 8 7 10 8 3 1 9 8 6 6 4 4 3 3 Defective teeth – 402 – 277 – 209 – 196 – 400 – 318 – 215 – 225 Enlarged tonsils 75 35 58 33 30 15 8 7 95 43 64 35 40 22 12 8 Adenoids 3 2 2 2 – – – – 3 2 – – – – 1 1 Enlarged tonsils and adenoids 25 22 13 11 3 2 – – 25 22 12 11 6 5 2 2 Other nose and throat defects 6 3 10 7 2 1 2 2 1 – 6 1 4 2 1 1 Enlarged glands 13 4 5 3 2 – – – 9 1 4 2 2 1 – – Eye disease 29 19 6 3 9 5 4 4 21 11 11 4 11 8 6 6 Vision defect – – – 53 – 90 – 87 – – – 51 – 105 – 81 Otorrhoea 9 7 6 4 4 4 5 2 8 6 2 1 5 4 1 1 Other ear disease 3 3 2 1 2 2 – – 5 3 3 2 4 3 3 2 Defective hearing – – 3 1 2 2 1 1 – – 1 1 2 2 – – Speech defects 5 5 3 – 3 1 1 – – – 1 – – – – – Heart defects 9 1 9 1 7 – 7 2 6 – 7 – 8 – 4 – Anaemia 4 4 3 2 – – 1 – 2 2 1 1 3 3 3 3 Lung defects 24 18 13 8 4 1 1 – 27 15 8 6 3 2 – – Nervous defects 2 – 4 3 1 – 1 – – – 3 1 2 2 2 1 Phthisis – – – – – – – – – – – – – – – – Other Tb. disease – – – – – – – – – – – – – – – – Rickets 2 2 – – – – – – 1 – 2 – – – – – Spinal deformities – – 2 – 3 1 1 – – – 1 – 4 3 1 1 Other deformities 9 4 4 – 4 1 2 2 9 2 3 2 1 1 1 – Other defects 8 3 19 13 9 5 5 4 10 6 9 4 15 10 6 3 Number of children noted for treatment 478 360 306 274 446 387 333 305 * Defects however slight are included under "cases"; those severe enough to require treatment are shown under * 22 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 Districts. For administrative purposes, the Borough is divided into districts, for each of which a health visitor is responsible. Following upon the appointment of two additional health visitors (vide page 26) a fresh division was made in 1937, the number of districts being increased from twelve to fourteen. There are nine Maternity and Child Welfare centres (municipal, 7; voluntary, 2). The situation and times of opening of the centres, municipal and voluntary, and the work carried out thereat, are set out in the tables on the next two pages. Grants and Contributions. Ancillary services included in the scheme are:— (1) St. Mary's Hostel, Macaulay Road, Clapham Common (vide page 44). (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road (vide page 48). The annual contributions which the Council are to make to the voluntary bodies, under the Local Government Act, 1929, during the quinquennium ending March, 1942, which had been under review in 1936 by the Minister of Health, were fixed at the following amounts:— The Women's League of Service for Motherhood. £546 The Chislehurst Mission £28 The St. Margaret's Day Nursery £500 The Council made other contributions in the financial year 1937-38 in connection with their Maternity and Child Welfare scheme as under:— Invalid Children's Aid Association (vide page 49) £50 National Baby Week Council £2 2s. St. Thomas's Babies' Hostel (vide page 46) £150 South London District Nursing Association (vide page 47) £300 Southwark Diocesan Association for Moral Welfare (vide page 44) £150 Victoria Hospital for Children £100 23 MATERNITY AND CHILD WELFARE CENTRES (AT 31ST DECEMBER, 1937.) Name and Situation of Clinic. (Italics indicate voluntary centre). Times of Opening. Monday. Tuesday. Wednesday. Thursday. Friday. Ante-natal— Maternity Hospital, Bolingbroke Grove — 1.30 p.m. 9.30 a.m. 2.0 p.m 9.30 a.m. — Southlands, Shuttleworth Road — — — — 9.30 a.m. All Saints' Hall, Prince of Wales Drive — 9.30 a.m. — — — Plough Road Institution — — — 9.30 a.m. — Women's League of Service, Southlands — 2.30 p.m.* — — — Infant Welfare (Mother and Child)— 1.30 p.m. Southlands, Shuttleworth Road 1.30 p.m. (a) — — All Saints' Hall, Prince of Wales Drive — 1.30 p.m. — 1.30 p.m. — Plough Road Institution 1.30 p.m. — — 1.30 p.m. — Chatham Hall, Chatham Road — 1.30 p.m. — — 1.30 p.m. Gideon Road disused School (L.C.C.) — — 1.30 p.m. 1.30 p.m. 55 Mundella Road — 1.30 p.m. — 1.30 p.m. (a) — Women's League of Service, Southlands — 2.30 p.m.* 2.30 p.m. — Chislehurst (St. James' s) Mission, Ponton Road — — — 2.0 p.m.** " Toddlers," Southlands — 2.0 p.m. — — — Post-natal, Maternity Hospital — 10.0 a.m. — • — — Dental, Southlands — 10.30 a.m.f 10.30 a.m. — 10.30 a.m. 2.0 p.m. 2.0 p.m. Diphtheria Immunisation (Schick test), Southlands — — 1.30 p.m. — — Sunlight and Massage, Southlands 9.30 a.m. (a) — 9.30 a.m. (a) — 1.30 p.m. (a) Mothercraft and Hygiene Classes— Southlands, Shuttleworth Road 2 p.m. (a) — — — — Plough Road Institution — — — — 2.0 p.m. (a) Chatham Hall, Chatham Road — — 2.0 p.m. (a) — — Gideon Road disused School 2.0 p.m. (a) — — — — 55 Mundella Road 2.0 p.m. (a) — — — — Women's League of Service, Southlands 2.30 p.m. (a) — — 2.30 p.m. (a) 2.30 p.m. (a1 * Fortnightly. ** A Medical Officer attends fortnightly. † Children only. A Medical Officer attends each session except those marked (a) 24 Summarised Statistics Relating to Infant Welfare Centres, 1937. Municipal. Voluntary. Grand Total. Southlands. Plough Road. Fast Battersea. Chatham Road. Gideon Road. Mundella Road. Total. Chislehurst (St.James's) Mission. Women's League of Service. Total Municipal and Voluntary. Sessions held 99 99 100 101 101 100 600 51 70 121 721 Weights recorded 3,031 5,519 5,528 6,553 4,778 3,172 28,581 675 2,164 2,839 31,420 Advice only given 659 853 964 999 388 463 4,326 215 60 275 4,601 Total attendances 3,690 6,372 6,492 7,552 5,166 3,635 32,907 890 2,224 3,114 36,021 Average per session 37 64 65 75 51 36 55 17 32 26 50 „ „ week 71 123 125 145 99 70 633 17 43 60 693 First attendances 214 360 352 455 267 212 1,860 31 155 186 2,046 Children attended 357 687 675 743 480 386 3,328 72 282 354 3,682 Doctor's attendances 52 95 92 99 97 51 486 28 70 98 584 ,, interviews. 836 2,252 2,139 2,685 1,931 1,252 11,095 232 1,274 1,506 12,601 ,, average per attendance 16 24 23 27 20 25 23 8 18 15 22 (Summary of the work carried out at other centres will be found as under:— Ante-natal Clinic, page 32 ; Dental Clinic, pages 31, 73; Light Treatment Centre, pages 47, 74; Anti-diphtheria Clinic, page 58; Massage Centre, page 48; Mothercraft classes, page 25; Toddlers' Clinic, page 50.) 25 At each of the centres a clinic is held once or twice weekly with a woman Medical Officer in attendance, as shewn in the tables on the previous pages. Each centre is under the supervision of a trained Health Visitor and voluntary helpers assist in the work. The voluntary centres are conducted on similar lines to those of the municipal centres. Mothercraft Classes. Instruction in mothercraft has been given weekly at 5 centres during the year, the average attendance being respectively:— Southlands 3.3 55 Mundella Road 14.2 Gideon Road 14.7 Women's League of Chatham Road 18.2 Service (Southlands) 16.4 Plough Road 17.7 The class at Southlands was commenced on 4th October, 1937. In total there were 263 meetings with a total attendance of 4,157, giving on average 15.8 attendances per session. Voluntary Centres. Women's League of Service.—The Battersea centre of this League (formerly held at 111 Bridge Road West) was established in 1911, and was transferred to Southlands in 1928. The League hold a formal lease from the Council of a portion of the building. The district served by the League is a populous one adjoining the Thames, and situate between Battersea Bridge Road and Battersea High Street. Slight alterations in the boundary of this district were made at the time of the general alterations referred to on page 22. A qualified Health Visitor (Miss F. Pethybridge) undertakes the usual duties of a health visitor within the district. In November the Council reappointed Mrs. M. J. Robinson to represent them upon the Committee of the Association. The 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. The Council during the year provided an exit, with external staircase, from the rooms occupied by the League, in order to give direct access to the grounds of Southlands. The cost of the work amounted to £29 9s. 0d., towards which the League contributed £10. An important feature of the work of the League is the provision of dinners for nursing and expectant mothers and children at a minimum charge or free. 26 Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Ante-natal Clinics.—27 sessions were held with a total attendance of 289, average 10.7. Infant Clinics.—70 sessions were held with a total attendance of 2,224 ; average attendance 31.8. Holidays.—15 mothers were sent to a convalescent home for one week, and 3 for two weeks. Twenty-two children were sent to the seaside for two weeks, and 3 children were sent, through the I.C.A.A., for 3 months. Toddlers' dinners are a special feature of the Centre, and include children from 10 months up to school age. The results are proving very satisfactory. 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. A woman medical officer attends fortnightly. Details of the work carried out will be found in the table on page 24. The Council make an annual grant of £28 towards the expenses. Battersea School for Mothers.—During the year the Health Committee came to an arrangement with the trustees in charge of the surplus fund of the late Battersea School for Mothers, under which grants were made by the trustees towards the relief of necessitous cases nominated by the Committee and living in the area formerly administered by the School. In all, grants amounting to £40 5s. 4d. were expended during 1937 among the deserving cases nominated. Battersea Fathers' Council. This Council which was founded in 1930, and in 1937 had a membership of 57, continued to meet monthly at the Mundella Road centre during the year, the average attendance being 18. A public meeting was held on 11th March at St. Andrew's Hall, when Miss Lillian Barker, c.b.e., j.p., spoke on "The Causes of Juvenile Delinquency." The activities of the Council are of a social and educational nature, and although not officially recognised as an integral part of the Maternity and Child Welfare Scheme, the work is of definite value, and is looked upon with approval by the Ministry of Health. At the end of the year the formation of a branch of the Council in the area served by the Southlands Centre was under consideration. Health Visitors. The Health Visiting Staff was increased during the year from 12 to 14 full time Health Visitors, two of whom are partly employed as women Sanitary Inspectors. 27 The increase, which became necessary in view of the extension of the maternity work of the Council, and particularly because of their decision to establish toddlers' clinics, is referred to in the previous annual report. The personnel of the health visiting staff is set out on page 3. 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 nine 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. Seven of these passed the qualifying examination. The home visiting carried out during 1937 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. Expectant mothers 4,111 264 4,375 Notified births 11,989 637 12,626 Still-births 95 5 100 Children aged 1-5 years 9,076 578 9,654 Infant deaths 135 19 154 Notifiable infectious disease 2,515 104 2,619 Non-notifiable disease 263 13 276 Prevention of diphtheria 151 32 183 Dental cases 70 1 71 V.D. cases 3 — 3 Maternal deaths 5 — 5 Foster mothers and children 985 — 985 Other 1,203 87 1,290 Totals 30,601 1,740 32,341 Hospital Provision. In addition to the provision of midwifery services, hospital and district, the Council have made provision 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 46). The Council make an annual grant to these Hospitals in respect of the facilities afforded (vide page 22). 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. 28 By arrangement with the London County Council the treatment of minor ailments found in children attending the centres may be carried out at the school clinics of the County Council, of which there are three serving Battersea. The Council's health visiting staff also visit and report on the home conditions of Battersea women and children receiving treatment in the obstetric, gynaecological and other departments of the various hospitals. The following table presents a summary of the number of cases referred to 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. Other. Total. Battersea General 9 — 1 1 Belgrave 4 — 1 1 Bolingbroke 13 — — — Charing Cross — 12 — 12 General Lying-in — 293 — 293 Guy's 1 — — — Hammersmith (L.C.C.) — 14 — 14 King's College — 3 — 3 Lambeth, Brook St. (L.C.C.) — 1 — 1 Middlesex 3 6 — 6 Royal Waterloo 1 — — — St. George's 2 64 3 67 St. James's (L.C.C.) 56 1,093 — 1,093 St. Luke's (L.C.C.) 1 — — — St. Mary Abbotts (L.C.C.) — 21 — 21 St. Mary's, Paddington — 2 — 2 St. Stephen's (L.C.C.) — 103 — 103 St. Thomas's 73 222 77 299 St. Thomas's, Babies 263 — — — South London, for Women 17 7 — 7 Victoria, Chelsea . 645 — 150 150 Vincent Square 11 — 10 10 Westminster 5 21 — 21 Westminster Ophthalmic 1 — — — Women's, Chelsea 1 — — — Battersea Tuberculosis Dispensary 8 — — — Wandsworth Dispensary 1 — — — Other Societies 4 — 8 8 Totals 1,119 1,862 250 2,112 29 Milk for Necessitous Persons. Under the provisions of the Public Health (London) Act, 1936, milk both fresh and dried is provided by the Council for necessitous expectant and nursing mothers and children under 5 years of age. The following tables give various particulars of the supply for the past five years:— A.—Number of Persons Supplied, 1932-7. Year. Mothers. Children. (Years.) Total Persons Exp. Nursing. 0— 4— 11— 3—5 1932 272 512 81 663 572 80 2,180 1933 263 463 64 619 553 64 2,026 1934 205 356 58 488 434 76 1,617 1935 198 388 64 495 392 53 1,590 1936 257 319 59 548 376 57 1,616 1937 267 284 98 558 393 78 1,678 [The classification in this table is based on the condition of the mother or the age of the child when milk was first supplied during the year.] B.—Qantity and Cost of Milk Supplied. [###. Liquid (pints). Dried (lbs.) % Supplied. Cost to Council.[/]###] Free At reduced price. 1932 273,103 5,184 87.6 12.4 £4,372 1933 237,629 3,642 90.7 9.3 £3,280 1934 153,906 2,483 90.0 10.0 £2,045 1935 162,824 3,473 86.1 13.9 £2,718 1936 170,177 2,704 80.2 19.8 £2,753 1937 170,955 4,254 81.4 18.6 £2,882 [The figures in both these tables (except as to cost) include the supply made through the Public Assistance Committee under the arrangement referred to below.] Care is taken to see that there is no abuse of the facilities provided, and investigations are made into the financial circumstances of applicants. The supply of liquid milk is in the form of tuberculin tested milk, which 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. The scheme of the London County Council under which milk or special nourishment is provided for expectant or nursing mothers or delicate children where the family is already in receipt of public assistance (in addition to the relief ordinarily given) continued in force during 1937. 30 During the year 144 persons in 112 families who came within its terms were supplied with Tuberculin tested or dried milk through the Public Assistance Authority. The quantity of milk supplied to these families was about 12,969 pints of liquid, and 124 lbs. of dried milk. The cost involved was approximately £244, which was borne by the London County Council. These figures (except as to cost) are included in the foregoing tables. Under another arrangement with the London County Council the Council undertakes 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. During the year 1,139 pints of Tuberculin tested milk were supplied under this scheme, the number of mothers affected being 23. These figures are also included in the foregoing tables. In addition to the grant of milk, at reduced rates or free of charge, it has been the practice to issue dried milk at cost price to those mothers attending the welfare centres whose income though not entitling them, under the Council's scale, to purchase it at reduced prices, does not enable them to afford the full retail prices. The Committee in 1935 approved a scheme by which vouchers issued by two manufacturers were distributed at the welfare centres in suitable cases entitling the holders to purchase dried milk at chemists' shops at reduced prices. During 1937 vouchers for 8,871 lbs. of dried milk were issued, and in addition 80 lbs. were sold at cost price. For the benefit of the more necessitous families the Council have an arrangement with two bodies, the Women's League of Service, at Southlands, and the Invalid Kitchens of London Association, who have a hall in Henley Street, whereby dinners are provided for mothers and children in need of nourishment. The numbers of such meals supplied at the cost of the Council during 1937 were:— Women's League of Service (children 161 Invalid Kitchens Association (women) 294 ,, „ ,, (children) 1,059 a total of 1,514, the cost to the Council being £29 8s. 3d. A number of other cases informally referred to the dining rooms of the Women's League of Service from the centres have received meals without cost to the Council. The Ministry of Health in April issued to all Maternity and Child Welfare Authorities an important circular letter (No. 1519) which referred to the recently issued First Report of the Advisory Committee on Nutrition and, in particular, to the emphasis laid in 31 Part VI of the Report on the nutritional value of milk and requested the Council to take an early opportunity of reviewing their arrangements in connection with the Maternity and Child Welfare services in the light of the Report and to inform him as soon as possible of the result of their consideration of the circular. The Council had always placed a liberal interpretation upon the various instructions issued by the Minister with regard to the supply of milk to necessitous expectant and nursing mothers and children. They had also for many years supplied various medicinal preparations of nutritive value at their infant welfare centres, free where necessary, and in other cases at approximately cost price. They nevertheless, in September, revised the scale of assessment, in order to widen its scope, and they also authorised an increase in the quantity of milk which, in suitable cases, could be supplied. Dental Clinic. This clinic was established in 1920 as an integral part of the Council's scheme for Maternity and Child Welfare to provide facilities for the dental treatment of expectant and nursing mothers and children under 5 years of age. Five sessions are held weekly in addition to one for tuberculous patients (vide page 93). 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 1937 is summarised as follows:— Women. Children. Total. Sessions held 202 48 250 No. of patients treated 429 537 966 No. of new patients 301 489 790 Total attendances 2,210 1,070 3,280 Work carried out:— Extractions— Ordinary — — 28 With local anaesthetic 24 4 ,, general anaesthetic 426 174 600 Totals 450 178 628 32  Women. Children. Total. No. of teeth extracted 1,183 879 2,062 Scaling and polishing 68 — 68 Fillings 140 22 162 Upper dentures 60 — 60 Lower dentures 54 — 54 Denture visits 378 — 378 Dressings and treatment to gums 144 1 145 Repairs to dentures 17 — 17 Advice 960 879 1,839 Owing to the operation of the new toddlers' clinic (vide page 50) the number of children who attended the dental clinic during 1937 greatly increased, being 537 as against an average of 245 for the five years 1932-1936. Approximately 370 children from the toddlers' clinic were examined and 101 of these were found to have defective teeth. The Council have, since 1927, undertaken the dental treatment at scale charges of Chelsea patients referred by the Chelsea Health Society for the purpose and the payments of the Society, during the financial year 1937-8 (exclusive of the cost of dentures, shewn below), amounted to £16 12s. 6d. The cost of dentures supplied during the financial year amounted to £198 0s. 6d. and the sums received from various sources were as under:— £ s. d Contributed by patients 93 15 6 Payments by Chelsea Health Society 21 13 6 Grants from British Dental Hospital 7 9 0 Grants from Saturday and Sunday Hospital Funds 28 15 6 Public Assistance 2 10 0 Contribution by the Council 43 £198 17 0 0 6 The net cost to the Council of this service during 1937-38 was £513 17s. 6d. Ante-Natal Clinics. 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 Bloom field, m.d., f.r.c.s., f.c.o.g.). 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 (All Saints') centres, which are attended by the Assistant Medical Officer (Maternity and Child Welfare); and the Women's League of Service, whose work is referred to on page 25, also holds an ante-natal clinic at their Southlands premises. 33 Booklets of advice for expectant mothers were purchased during the year and made available free of charge at each infant welfare centre. Each mother who applies for admission to the Borough Maternity Hospital, or for attendance by the Borough district midwife in her own home, is required to attend the ante-natal clinic periodically before her confinement, and is seen at least once by the consultant gynaecologist. Doctors and private midwives practising in Battersea are encouraged to send their maternity patients to her at the central ante-natal clinic at the Borough Maternity Hospital for examination and report without charge. Miss Bloomfield (Consultant Gynaecologist) reports:— Tuesday Afternoon (Special) Clinic. Number of sessions held 52 Number of attendances 752 Number of first attendances 710 Average attendance per clinic (approx.) 14.5 Number of new A.N. cases 708 Number of old A.N. cases 39 Number of new P.N. cases 2 Number of old P.N. cases 3 Blood was taken for the Wassermann reaction in 697 cases with results as follows—negative 683 positive 7 + 7 Gynecological Cases. Ante-natal cases examined new 10, old 11 Post-natal cases examined new 2, old 0 Cases of vaginal discharge examined (including 1 postnatal) 6 and of these 5 cases required treatment on one or more further occasions, and films had to be taken in 1 case. Cases attending for the diagnosis of pregnancy 25 Cases attending for diagnosis and treatment of retroversion of the gravid uterus 1 Other cases numbered some 11, and included cases of— Prolapse of cervical polypi (necessitating removal); unhealed perinea; fibroids complicating pregnancy or puerperium; catheter specimens, etc. Examinations under anesthesia. These are carried out after this clinic and numbered 11. Of these 2 were for diagnosis of presentation and 9 were for external version (successful, 5; unsuccessful, 4). 34 Wednesday and Thursday Morning Clinics. Number of sessions 10 Total attendances 3,042 Average per session 29.2 New cases (primiparae, 254; multiparae, 207) 461 Average new cases per clinic (approx.) 4-5 Return cases—88 (i.e., 42.5 per cent.). Arrangement for confinement— Borough Maternity Hospital 384 District Midwife 75 Other 1 Not pregnant 1 Period of pregnancy when first seen— 1-6 months, 418; 6-8 months, 37; over 8 months, 5; not pregnant, 1. The following were among the abnormalities seen— Small pelvis 21 Raised blood pressure 12 Albuminuria 21 Varicose veins 4 Cardiac disease 2 Other (Tb., etc.) 39 Cases referred to Dental clinic 152 Cases referred to other hospitals 39 Cases referred to own doctor 4 Friday Morning Clinic. Number of sessions 51 Total attendances 713 Average per session 14 New cases (primiparae, 80 ; multiparae, 151) 231 Average new cases per clinic (approx.) 4.5 Return cases—72 (i.e., 47.6 per cent.) Arrangement for confinement— Borough Maternity Hospital 124 District midwife 95 Other 12 Period of pregnancy when first seen— 1-6 months, 204; 6-8 months, 25; over 8 months, 2. The following were among the abnormalities:— Small pelvis 1 Albuminuria 2 Cardiac disease 5 Other, including (3 ? Tb.) 7 Cases referred to Dental clinic 97 Cases referred to other hospitals 8 Cases referred to own doctor 3 35 In-Patients in Relation to Ante-Natal Work. Number of toxaemias admitted to Borough Maternity Hospital 26 Results— Mothers—Clear on 14th day, 22; residual symptoms, 4 ; no cases of eclampsia. Babies—All well, 25 ; still-born (ante-partum haemorrhage), 1. Induction of labour— Medical—8. Results—All satisfactory (mothers and babies). Surgical—22 (rupture of membranes). Results—All satisfactory (mothers and babies). Bougies—No cases. Reasons for induction— Medical— Toxaemia 1 . Post-maturity 2 Apparent disproportion 3 Uterine inertia 1 After correction of recurrent breech 1 Surgical— Toxaemia 20 Post-maturity 1 Large foetus with maternal distress 1 Forceps deliveries— 26 Results—Mothers, all good. Babies, 23 good; 3 stillborn. Reasons for interference— Trial labour and prolonged second stage 7 Prolonged labour with no disproportion 10 Fœtal distress 3 Persistent occipito posterior 4 Breech—forceps to aftercoming head 1 Cardiac decompensation 1 Cardiac cases— 2 Results—Mothers and babies satisfactory. Antepartum hemorrhage—accidental 5 Results—Mothers, all well. Babies, 4 well; 1 stillborn. Placenta previa 0 36 Breech deliveries at term 8 Undiagnosed 3 Version failed 4 Twins 1 Cesarean sections 12 Results—Mothers, all well Babies, all well. Trial labours 48 Results—Mothers, all well. Babies, all well. Termination of labour—spontaneous, 38; forceps, 7; Cesarean section, 3. The subjoined table shows in summary the number of attendances, &c., during 1937, at the municipal ante-natal clinics (excluding the special clinic referred to below). Clinics held at Maternity Hospital. Southlands. Plough Road. All Saints' Hall. Total. Sessions 103 51 51 49 254 Attendances 3,042 713 579 470 4,804 „ average 29.5 14.0 11.4 9.6 18.9 New cases 461 231 11 6 709 Interviews by doctor 3,042 695 526 442 4,705 Average per session seen by doctor 29.5 13.6 10.3 9.0 18.5 The work of the ante-natal clinic of the Women's League of Service is referred to on page 26. The work of visiting and reporting upon Battersea cases, which is done by the Council's health visiting staff for the obstetric and gynaecological departments of several of the larger hospitals is summarised on page 28. Ante-Natal (V.D.) Clinic. This special treatment clinic was established in connection with the 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 1937 is summarised in the table on page 38. 37 Mr. Corsi reports as follows:— During 1937 the Wassermann blood test was performed on 697 prospective mothers. Of these seven gave a full positive, and were accordingly treated. Seven mothers gave an uncertain positive result; it was considered that this did not call for treatment. Of the seven treated, four were delivered of healthy looking babies, whose certain escape from infection was subsequently proved by blood examination. The remaining three mothers have either only just come to term or are still "expecting " at the time of writing. The cases dealt with this year were inclined to be psychologically difficult subjects; fortunately there were no incidents. It is interesting that after one or two visits this infantile type of patient becomes the easiest of all to handle. Number of W.R. tests 697 Number positive 7 Per cent. 1 Number treated 7 Babies. Healthy negative 4 Not yet tested or not yet born 3 Still-born (so far) 0 Ambulance Service. The ambulance service of the London County Council is available at all hours for the conveyance of maternity cases to hospital without charge, and patients entering the Borough Maternity hospital make full use of the facilities provided. Midwives. So far as can be ascertained there were, immediately before the coming into force (1st January, 1938) of the Midwives Act, 1936 only 9 registered midwives who resided in Battersea or adjoining districts and practised in the Borough, apart from those employed in the County or Borough Council's maternity services. There were also the extern services of St. Thomas's and the General Lying-in Hospitals. Four Battersea midwives who had practised in the Borough for many years surrendered their certificates under the provisions of clause 5 of the Act. There then remained within the Borough boundary only one private midwife and one maternity nursing home employing three midwives, apart from those on the staff of the Borough Maternity hospital and St. James's hospital. Compensation.—In only one case was compensation paid to a private midwife during 1937, this being in respect of a woman who was removed to hospital on the order of a doctor called in by the midwife at the confinement. 38 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1937. 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. 1922-7 2,502 54 2.2 53 37 12 3 1* 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 0 1935 613 12 1.9 3 0 2 0 1 (Syphilitic) 1936 684 5 0.7 6 0 6 0 0 1937 697 7 1.0 7 4 0 0 0 [W.R.—Wassermann reaction.] * Not syphilitic. 39 Midwives Act, 1936. The position which was created in London by the passing of the Act continued to be the subject of discussion during the year between the Metropolitan Boroughs Standing Joint Committee, representing the Borough Councils, and the London County Council. The scheme put forward by the County Council for the establishment of a salaried service of midwives in the County was opposed by the Standing Joint Committee, but the Minister of Health, after considering the representations of both parties gave his decision in favour of the County Council, whose scheme was approved in its entirety. On the 1st January, 1938, therefore, Battersea will become part of area D (one of five areas into which for the purpose of the midwifery service London is to be divided) and in company with the Boroughs of Bermondsey, Lambeth, Southwark and Wandsworth, will have the services of a panel of County midwives numbering 12. Borough Midwife.—The. position of the district midwife already employed by the Council (see page 40) was also the subject of considerable discussion. The County Council were willing either to absorb her into their service, or to enter into an arrangement under which she would continue to be employed by the Council but as part of the service to be provided by the London County Council, the Council to receive payments on a per capita basis in respect of the cases attended by her. It is probable that the Council would have agreed to this alternative but for the fact that the County Council limited their offer to the existing midwife, and were not willing to extend it to any future holder of the office. On the 29th December therefore the Council decided to retain their district midwife apart from the service to be provided by the County Council. Her salary and conditions of appointment were adjusted to place her on an equal footing with the salaried midwives, and the scale of fees in use by the London County Council was adopted. In the meanwhile the Minister, on 27th October, had informed the Council that he would not be prepared to sanction the appointment in the future of any additional midwives for domiciliary midwifery or maternity nursing service. Training of Midwives. In the previous year, 1936, the Central Midwives' Board gave notice of their intention to make revised rules in regard to the training of pupil midwives. The revised rules were duly made and submitted to the Minister of Health in 1937, and approved by him, but they had not come into force by the end of the year. The object of the revision was to provide for more complete training of future midwives, and to this end the course (formerly six months for trained nurses and 12 months for other women) was extended to 12 40 and 24 months respectively. Moreover, the course was divided into two parts, the first (mainly theoretical) of 6 or 18 months' duration, and the second, chiefly practical, lasting 6 months. Only large maternity institutions having 500 or more confinements annually are to be approved for the first period of training. The Borough Maternity Hospital, which has since 1922 been an approved institution for the training of pupil midwives is not of sufficient size to enable it to be approved for the first period of training, and accordingly application was made in April for its approval as an institution for the second period. Up to the end of 1937 the approval of the Board had not been given. District Midwifery Service. During 1937 there were 150 cases attended in their own homes by the District Midwife as compared with 165 in the previous year. Particulars relating to this service during the year are set out below:— Total number of cases attended in the district 150 (Booked in 1936, 49 ; booked in 1937, 101) Average number of visits to each case 18 Number of cases:— (a) Delivered by midwife (133 infants) 133 (b) „ doctor 1 (c) Born before arrival (14 infants) 14 (d) Referred to hospital (2 infants) 2 Total births (live, 148 ; still, 2) 150 Total number of bookings in 1937 184 Number thereof cancelled or transferred 30 „ confined during 1937 101 ,, not confined in that year 53 184 Number of cases where medical assistance was summoned with reasons for requiring assistance:— (a) Ante-natal—1. (ic) After labour—8. Albuminuria 1 Post-partum haemorrhage 4 — Do. with collapse and severe vomiting 1 1 Ruptured perineum 3 8 (6) During labour—17. (d) For infant—9. Prolonged labour 12 Sticky eyes 1 Malpresentation 1 Asphyxia 1 Adherent placenta, &c. 1 Septic spots 1 Post-partum haemorrhage 1 Prematurity 2 Prolapse of cord 1 Abrasion of head 1 Extended breech 1 Other reasons 3 17 9 41 Number of cases of— Puerperal sepsis Nil Puerperal pyrexia Nil Maternal deaths Nil Still births 2 Deaths of infants within 10 days Nil Since January, 1936, each mother who booked the district midwife has been supplied with a sterilised maternity outfit. Twenty-seven of the 150 cases attended during the year were dealt with by the relief midwife. 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. A district midwifery service for the attendance of the district midwife on patients in their own homes is also directed from the hospital. The fees for the hospital are fixed according to a scale adopted by the Council. A sub-committee of the Health Committee meets monthly to consider, amongst other matters, appeals against the assessments made. The nursing staff consists of a matron, two sisters and 3 staff nurses. There is accommodation also in the hospital for 8 pupil midwives undergoing training, the hospital having been approved as a training institution since 1922. The position of the hospital under the new rules of the Central Midwives' Board is referred to on page 40. The central ante-natal clinics and the special treatment clinic are held at the out-patient department of the hospital. A post-natal clinic is also held at the hospital. During 1937 there were 50 sessions held and 422 attendances were made, 364 being of new cases. The average attendance per session was 8.4. Arrangements have been made for Mr. F. W. Roques, m.ch., f.r.c.s., f.c.o.g., 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 him to 24 patients during the year for the following reasons:— Ante-partum haemorrhage 1 Caesarean section 12 Forceps deliveries 3 Pyrexia 5 Toxaemia of pregnancy 1 Trial labour 1 Other reasons 1 In pursuance ot the arrangement made in 1936 and referred to in the last annual report, Mr. Roques pays routine visits to the hospital. During 1937 477 cases were admitted to the hospital as compared with 418 cases during 1936 (in which year the home was closed during a period of ten weeks), 489 in 1935, 493 in 1934, and 543 in 1933. 42 Particulars relating to the cases dealt with during 1937 are as follows:— (a) Persons admitted— New cases (i.e., cases first admitted 1937) 471 1936 cases confined during 1937 6 Total persons admitted - 477 (b) Number of admissions— For confinement 468 For ante-natal treatment (47 patients) 52 Total admissions - 520 (c) Number of confinements— Admitted 1936, confined 1937 4 Admitted and confined 1937 467 Total confinements - 471 Admitted but not yet confined at end of year 1 Received ante-natal treatment only 5 Number of deliveries— By midwives 450 ,, doctors 21 - 471 Number born before arrival Nil Total births (including 8 pairs of twins) 479 Number of maternal deaths Nil Number of cases notified as Ophthalmia Neonatorum with result of treatment Nil Number of infants not entirely breast fed 30 Number of cases notified as puerperal sepsis Nil Number of cases notified as puerperal pyrexia 12 Number of infant deaths (11 still-born, 2 within 10 days of birth) and their causes 13 Still-birth. Died within 10 days— No foetal heart on admission, and foetus macerated 4 Bronchitis; congenital debility 1 Ante-partum haemorrhage, toxic 1 Prematurity, weakness 1 Died during 2nd stage— Extended breech 1 Persistent O.P. position; forceps delivery 2 No reasons assigned 3 11 2 In the seventeen years (approximately) from February, 1921, to the end of 1937 (since the opening of the Borough Maternity Hospital) 10 maternal deaths have occurred in the hospital among 8,480 births (live and still). The maternal mortality rate for deaths occurring in the hospital, i.e., the rate per 1,000 births (live and still) is therefore 1.18 compared with 1.25 for the whole Borough during the same period. 43 In the District Midwifery service, also inaugurated in 1921, only 2 maternal deaths had been recorded at the patient's home to the end of 1937, the rate per 1,000 cases being 0.83. Cost of Maternity Hospital. I am indebted to the courtesy of the Borough Treasurer for the following statement of the cost of the Hospital during the financial year ended 31st March, 1938:— Maternity Hospital, 1937—8. Total beds (excluding cots, labour and isolation beds), 30; total cases admitted and discharged during year, 467; average number of beds occupied during such period, excluding cots, labour and isolation beds, 18.3; number of weeks spent in Institution by patients admitted and discharged during year, 914.7. A statement* showing expenditure tor the year ended 3lst March, 1937, in respect of the Maternity Hospital is given below. Item. Total. Per patientweek. Salaries " Medical £ £ s. d. 548 0 11 4 Nursing 883 0 18 3 Domestic and other 841 0 17 5 Superannuation (Council's contribution) 92 0 1 11 Provisions 755 0 15 8 Drugs and other medical requisites 215 0 4 5 Fuel, lighting and water 448 0 9 3 Laundry 343 0 7 1 Repairs and renewals Domestic 191 0 3 11 Structural 377 0 7 10 Miscellaneous items— Telephones, stationery, etc., and sundries 175 0 3 7 Totals, excluding rates, insurance and loan charges 4,868 5 0 8 Rates and insurance 76 0 1 7 Loan charges 995 1 0 7 Gross cost 5,939 6 2 10 Income ( Pupil Midwives (including training grant) 280 0 5 9 Patients' payments 2,189 2 5 4 Other 96 0 2 0 Net cost 3,374 3 9 9 * This statement does not take into account the Government Grant. 44 Southwark Diocesan Homes. For some years past the Council has contributed towards the cost of maintaining before, during and after confinement unmarried mothers and their children resident in the district, in St. Mary's House, Macaulay Road, Wandsworth, which is an institution conducted by the Southwark Diocesan Association for Moral Welfare, and affiliated to the Council's Maternity and Child Welfare scheme. They also contribute to the cost of Battersea unmarried mothers who are sent into other approved homes by the Association. The Council have since 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 1937 was 6, and 2 admitted during 1936 remained for some part of 1937. These eight mothers were maintained for 578 days in all during the year. Home Helps. Facilities are provided by the Council in suitable cases for assistance in the home during the mother's lying-in period, or in case of temporary illness of an expectant or nursing mother, 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. This service, however, was not used during 1937. Maternal Mortality. During 1937, there were 4 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 1.81 per 1,000 births (live and still), as compared with 5 deaths and a fatality rate of 2.29 in 1936. The certified causes ofdeath were:— Ectopic gestation 1 Ruptured uterus 1 Post partum haemorrhage 1 do. and retained placenta 1 Three of these deaths occurred in hospital and one at home. In addition there was one maternal death in hospital not ascribed to causes directly associated with the puerperium. The rates for London and England and Wales in 1937 were 2.22 and 3.11 respectively. 45 Maternal Deaths in Child-birth, and Maternal Mortality Rate per 1,000 Births (Live and Still). Year. Puerperal sepsis. Other puerperal causes. Total. No. Rate. No. Rate. No. Rate. 1932 2 0.83 2 0.84 4 1.67 1933 4 1.72 1 0.43 5 2.15 1934 3 1.35 4 1.80 7 3.15 1935 — — 4 1.84 4 1 .84 1936 3 1.37 2 0.91 5 2.29 Mean, 1932-36 2.4 1.05 2.6 1.16 50 2.22 1937 4 1.81 4 1 .81 It will be noted that the maternal mortality in the borough was, in total, below the average for the previous quinquennium. Following the usual procedure, and in accordance with the instructions of the Ministry of Health, each of the 4 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, and arrangements are made for X-ray examinations to be carried out at the hospitals of the London County Council, without charge to the mother in necessitous cases. Printed booklets of advice to expectant mothers are provided free of charge. 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 appreciable extent. The Council have also agreed 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. Arrangements have also been made as suggested by the Ministry to place at the disposal of medical practitioners practising in Battersea, specialist advice in difficult maternity cases. This service was requisitioned in one case during 1937. In July the Council had before them a circular letter (1622) from the Minister of Health, dated 7th May, drawing attention to the Report on Maternal Mortality which he had recently presented to Parliament and stating that he would be glad if the Council 46 would give early consideration to the Report and to the suggestions made in the circular and inform him of the action proposed to be taken. The Council decided to inform the Minister that they were alive to the necessity of maintaining a comprehensive, efficient and progressive maternity organisation and had carefully and sympathetically considered the circular letter and report and that, while of opinion that the suggestions contained therein were in the main already provided for in the Council's scheme, they would continue to give the subject their earnest consideration with a view to the development of the scheme on the lines suggested. Convalescent Homes. During 1937 accommodation was provided for 10 mothers and 10 children attending the Maternity and Child Welfare clinics at four approved convalescent homes. The cost incurred by the Council amounted to about £20 14s. 0d., and three of the families concerned were charged with the balance of £2. Seventeen other children attending the Council's Welfare Centres were sent away for a period of convalescence through the agency and at the cost of the Invalid Children's Aid Association In addition to the above a number of mothers and children attending the centres of the Women's League of Service were sent away for convalescence, the cost of which was not borne by the Council (vide page 26). St. Thomas's Babies' Hostel. Since 1926 cases have been sent from the Borough Maternity and Child Welfare clinics to this Hostel for the encouragement of breast feeding. The result of this work during 1937 is as follows:— Test Feeds. Number of cases, 183, comprising : Mothers, 183 ; babies, 184. Number of attendances, 602. 16 of these cases received in-patient treatment. In-Patient Treatment. Battersea cases received— 16 mothers and 28 babies sent by Council. 1 mother and 4 babies sent from other sources. Period of stay. Cases sent.by Council—16 mothers and 28 babies, 1,382 days; average, mothers 21 days, babies 37 days. Other cases—1 mother and 4 babies, 228 days; mother 25 days, babies (average) 57 days. A contribution of £150 is made by the Council annually in respect of the work carried out by the Hostel for Battersea mothers. 47 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 Part XII of the Public Health (London) Act, 1936, and also of patients suffering from certain infectious illnesses. A payment of £300 per annum is made to the Association in respect of their services. During 1937 the total number of attendances made by the nurses of the District Nursing Association in connection with cases of infectious disease was :- Nursing Service, 1937. Name of Disease. Age. Total. Under 5 years. Over 5 years. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia neonatorum, &c. 130 2,288 - - 130 2,288 Measles 9 64 3 19 12 83 Whooping cough 10 44 3 23 13 67 Diarrhœa & vomiting 11 41 — — 11 41 Chicken pox 1 2 2 13 3 15 Mumps - - - - - - Pemphigus neonatorum 4 51 - - 4 51 Puerperal pyrexia — — — — — — Pneumonia 15 172 32 543 47 715 Influenza 1 14 93 372 94 386 Erysipelas — — 4 113 4 113 Totals 181 2,676 137 1,083 318 3,759 Many of these cases were referred to the Association by medical practitioners. Solarium. The Light Treatment centre was established at Southlands in 1929. The Centre is housed in a portion of the Southlands building which has been specially adapted and equipped for the purpose. The equipment consists of:— 2 carbon arc lamps. 4 general radiation lamps. 2 mercury vapour lamps. 4 couches. 48 During the year 125 sessions were held for patients from the maternity and child welfare clinics, the number of patients on the roll at the end of the year being 45. The total attendances numbered 2,146, the average number per session being 17.2. A medical officer attended 18 of the sessions, at which she conducted 262 examinations. The number of persons who received treatment during the year (excluding tuberculous children) was 98, including 10 who commenced treatment in nrevious vears. The ages of the 88 new cases who attended first in 1937 were as follows:— Under 1 year 17 1 to 2 years 47 2 to 3 „ 24 The reasons for their treatment were:— Prevention of Rickets 76 Debility 11 Retarded development 1 Treatment in these cases was by the mercury vapour lamps. The treatment by massage of children attending the light treatment centre follows immediately after their treatment by light. Particulars relating to tuberculous patients treated at the clinic during the year will be found on page 74. Massage Treatment. For many years the Council have provided facilities in suitable cases for massage treatment for children attending their various centres, this service being now provided without charge. A certificated masseuse conducts the whole of the massage treatment carried out by the Council, three sessions weekly being held at the Southlands Centre. Treatment is carried out in a room adjoining the artificial sunlight centre, and massage treatment is therefore immediately available for those patients who attend the Council's light centre (see above). During 1937, 150 massage sessions were held, at which the attendances numbered 1,398, an average per session of 9-3. Day Nursery. The only Day Nursery in the Borough is the St. Margaret's Day Nursery at 10 and 12 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. 49 During 1937 the attendances at the Nursery totalled 5,304, and the number of children admitted to the guest house was 68. 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 22). The temporary creche, organised by the Society of Day Nurseries, was, for a third year, held in Battersea Park during the month of August and part of September. Young children were admitted at a nominal charge, and play pens, &c., provided. A matron, with voluntary helpers, was responsible for the ment. A letter was received from the Metropolitan Boroughs Standing Joint Committee stating that the National Society of Day Nurseries had applied to the London County Council for permission to provide open air day nurseries in various parks and open spaces under the control of the County Council, similar to that just referred to, that the appropriate Committee of the County Council felt that the scheme might well form a basis of a valuable social service and were prepared to consider recommending the County Council to seek power to allocate by enclosure portions of open spaces within which the Borough Councils or Voluntary Associations could provide day nurseries under properly controlled conditions but, before considering the matter further, desired to have the views of the Standing Joint Committee and the Metropolitan Borough Councils on the proposal. The Council expressed themselves in favour of the promotion of legislation on the lines suggested. Reference was made in the Annual Report for 1936 (page 49) to the suggestion made by the Ministry of Health that the Council should consider the question as to whether there was need for further day nursery accommodation in the Borough. In February an enquiry was received from the Ministry as to the position of the matter, and the Committee decided to inform them that the Council were bearing in mind the possible need for another day nursery if a suitable site could be found. Invalid Children's Aid Association. The Battersea Branch of this Association has since 1929 been granted, rent-free, the use of a room at Southlands as an office. The Council also make an annual grant of £50. In November the Chairman of the Health Committee (Mrs. A. A. Burton) was re-appointed to represent the Council upon the Committee of the Association. I am indebted to the Secretary of the Battersea Branch for the following report on the work of the Branch during 1937 :— The Invalid Children's Aid Association is a voluntary organisation whose aim is to give to " Every Child a Chance " to grow up into a healthy 50 man or woman. It provides convalescent home treatment and surgical appliances and undertakes a considerable amount of home visiting for hospitals, &c. The I.C.A.A. works in close co-operation with statutory bodies and other voluntary organisations. During 1937, 357 children (in addition to many re-applications) were referred to the Battersea Branch ; of this number 52 came to them from Borough sources and 57 from the School Medical Officers and Care Committees. In 1937, 165 children were sent for convalescence to the seaside and country for an average stay of 8 weeks, at a cost of £778, and 25 surgical instruments were provided, which cost £18 17s. 105 new children under the age of 5 years were referred to us from the Infant Welfare Centres, Hospitals, &c. for convalescence and other help. 51 of these were materially helped at a cost of £250. The Battersea Branch receives a grant of £50 from the Borough Council towards this part of their work. Last year 40 children were referred from the Tuberculosis Dispensary, 22 for convalescence and 18 to be boarded out under the Contact Scheme. In these cases the I.C.A.A. make the arrangements and the London County Council bear the cost of maintenance. The Mayor of Battersea in July asked us to send a girl away for convalescence as she was found not to be well enough to go with his party for a week's holiday. She went to Ascot for three weeks, and the cost was borne by the Mayor's Holiday Fund. The Branch is fortunate in being allowed to use the grounds at Southlands each summer for their Fete. Last year it made a profit of £26 1s. Od. The I.C.A.A. is always very glad to co-operate with the Borough Council in the care of the invalid and cripple children of the Borough, and they would like to record their most grateful thanks for all the help that they have received from the Council. Toddlers' Clinic. In the Annual Report for 1936 an account of the establishment of the special Toddlers' Clinic at Southlands is given on page 50. The clinic, the first session of which was held on 3rd November, 1936, continued to meet weekly throughout the year, at the Southlands centre. In November I submitted to the Health Committee (in accordance with their previous instructions) a report as to the work done by the clinic during the first nine months of its existence. The chief items of interest in the report, which is set out in full on pages 122 to 125 are (a) that for the reasons set out only children at the age of 3 had been dealt with, (b) that 32 per cent, of the children invited attended the clinic, (c) that 42 per cent, of those who attended were recommended for treatment for various conditions found on examination, (d) and that 30 per cent, of the toddlers had never previously attended a child welfare centre. The Committee accepted the conclusions set out in the report and the Council, on their recommendation, adopted them, and arrangements were accordingly put in train to hold a weekly toddlers' clinic at each of the Council's six welfare centres, commencing with the new financial year. 51 Summary of the work carried out during 1937 is as under :— (1) Children invited at age of 3 1,171 (Net number, after deducting returned letters, &c.) (2) Children who attended— (a) Invited (31·4 per cent.) 368 (b) Uninvited (various ages) 16 384 (3) Number of sessions 48 (4) Attendances (first 384; subsequent 30) 414 (5) Average per session (first 8·0; subsequent ·6) 8·6 (6) Children who had not previously attended a centre (26·3 per cent.) 101 (7) Referred elsewhere for treatment, including dental treatment (40·1 per cent.) 154 (8) (a) Advised to attend Schick clinic 307 (b) Did so (17·6 per cent.) 54 (9) Recommended for grant of milk 19 Result of Medical Inspection. Nutrition—normal 357 poor 27 Defective teeth 101 Enlarged tonsils and adenoids 55 Enlarged glands 10 Eye defects (a) squint 9 (b) infective 2 Otorrhœa 1 Skin conditions 27 Knock knee 38 Heart (organic 2: functional 6) 8 Lung defects 19 Nervous defects 8 Phimosis 21 Eneurisis 15 Hernia (a) umbilical 1 (b) inguinal 1 Acute tonsillitis 3 Evidence of past rickets 28 Naevus 8 Miscellaneous deformities 6 Child Life Protection. The statutory provisions relating to infant life protection, so far as London is concerned, are now embodied in the Public Health (London) Act, 1936. 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 1937 to foster mothers and children was 985. 52 At the end of 1936 there were 105 Battersea foster-mothers known to the Council, 57 of whom had nurse children in their care to the number of 96. During 1937, 19 new foster-mothers gave notice of their intention to receive children ; and 4 were reported to the Committee as having given up the practice of receiving nurse children. After making adjustments for deaths, removals from the Borough, and those cases where no children had been taken for over two years, there remained at the end of the year 114 fostermothers, of whom 54 had nurse children in their care to the number of 94. The ages of the 94 children were as under :— Under 1 year 11 1 to 5 years 41 Over 5 and under 9 years 42 Of the children under 5 years of age 24 were attending the infant welfare centres at the end of the year. The whole number of nurse children who were under observation during 1937 was 186. The power of fixing the maximum number of nurse children permitted to be kept by a registered foster-mother was not exercised during the year, but two applications to remove limits previously fixed were refused. Two foster children died during the year after removal to hospital, and 8 cases of infectious disease occurred. No legal proceedings were instituted during the year under report, but in 14 cases foster mothers were cautioned for the undermentioned offences:— Failure to give prescribed notice of— Reception of nurse child 9 Removal of nurse child 4 Removal of foster mother and child into Borough 1 In one case the Committee authorised the taking of action to secure the removal of a foster child from the care of an unsatisfactory foster-mother, but in this case the object was secured without recourse to legal action. The protection of child life is, of course, one of the main objects of the Council's child welfare scheme, and apart from the special activities recorded above, the Health Visitors do much useful work for the well-being of children. In those cases (fortunately rare) of active cruelty or culpable neglect the National Society for the Prevention of Cruelty to Children is informed, and I am happy to acknowledge the invaluable help they have given in such cases. 53 Notifiable Infectious Diseases. During 1937 under the notification clauses of the Public Health (London) Act, 1936, and the Orders and Regulations made thereunder, 2,083 cases of infectious diseases (excluding tuberculosis) were notified, including cerebro-spinal fever 9, enteric fever 4. In 1936 the total was 3,862. The decrease in the number of cases notified during" 1937 was chiefly due to the comparative quiescence of measles. The following is an alphabetical list of the diseases compulsorily notifiable in Battersea:— Anthrax. Ophthalmia neonatorum. Cerebro-spinal fever. Plague. Cholera. Pneumonia, acute influenzal. Continued fever. „ acute primary. Diphtheria. Polio-encephalitis, acute. Dysentery. Polio-myelitis, acute. Encephalitis lethargica, acute. Puerperal fever. Enteric (typhoid) fever. „ pyrexia. Erysipelas. Relapsing fever. Glanders. Scarlet fever. Hydrophobia. Small pox. Malaria. Tuberculosis. Measles. Typhus fever. Membranous croup. Whooping cough. Excluding tuberculosis, measles and whooping cough, there were 900 infectious cases notified, which occurred in 809 houses. Of these cases 704, or 78.2 per cent., were removed to the isolation hospitals of the London County Council or to other institutions and 196, or 21·8 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 on the next page, and the distribution of the cases notified in the registration sub-districts and the wards is shown in the table on page 55. Cases of " Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. Cases of Infectious Disease (excluding Tuberculosis) notified during the Year 1937, 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. Small-pox - - - - - - - - - - - - - - - - Diphtheria 4 6 17 23 22 117 29 8 19 5 1 — 251 180 70 9 Erysipelas 1 2 1 1 — 4 1 1 7 12 29 20 79 22 22 1 Scarlet fever 2 10 16 18 19 88 25 8 18 8 3 — 215 118 89 1 Enteric (typhoid) fever — — — — — 1 — 2 — — 1 — 4 2 1 1 Continued fever - - - - - - - - - - - - - - - - Puerperal fever - - - - - - - - - 1 - - 3 2 1 — Puerperal pyrexia - - - - - - - 2 15 — — 18 9 9 - Meningococcal meningitis 2 — 1 — 1 1 — 3 — 1 — — 9 5 4 3 Ophthalmia neonatorum 12 - - - - - - - - - - - 12 2 1 - Polio-myelitis, &c. — — 1 1 — — — — — — — — 2 1 1 — Polio-encephalitis - - - - - - - - - - - - 1 1 - 1 Encephalitis lethargica - - - - - - - - - - - - - - - 2 Malaria — — — — — — — 1 1 — 1 - 3 2 1 — Dysentery 1 — 3 1 — 1 1 1 — — — — 8 7 1 — Acute primary pneumonia 22 13 17 6 14 19 12 4 25 21 38 28 519 73 52 88 Acute influenzal pneumonia 4 — — — 1 — 1 3 19 11 25 12 76 19 9 22 Whooping-cough 82 97 79 96 108 162 4 2 1 1 — 1 633 56 40 9 Measles 40 57 45 79 105 199 14 5 5 1 — — 550 78 30 3 Totals 170 185 180 225 270 593 87 40 113 61 98 61 2083 577 331 140 54 55 Notifications of Infectious Diseases, 1937, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts.† Totals. 1 2 3 4 5 6 7 8 9 N S Small-pox - - - - - - - - - - - - Diphtheria 49 27 33 8 71 35 7 16 5 180 71 251 Erysipelas 20 12 6 6 7 3 8 8 9 45 34 79 Scarlet fever 38 22 36 12 24 27 9 31 16 120 95 215 Enteric (typhoid) fever 2 — — 1 — — — 1 — 2 2 4 Continued fever - - - - - - - - - - - - Puerperal fever 1 — 1 — — 1 — — — 2 1 3 Puerperal pyrexia 3 2 3 1 1 1 1 4 2 9 9 18 Meningococcal meningitis 3 1 — — 1 3 — 1 — 5 4 9 Ophthalmia neonatorum 3 — 1 1 1 1 1 2 2 5 7 12 Polio-myelitis, &c. - — 1 — — — 1 — — 1 1 2 Polio-encephalitis - - - - 1 - - - - 1 — 1 Encephalitis lethargica - - - - - - - - - - - - Malaria — — 1 — 1 — — — 1 2 1 3 Dysentery 3 — 4 - - - - - 1 7 1 8 Acute primary pneumonia 34 40 28 10 27 43 14 15 8 129 90 219 Acute influenzal pneumonia 14 9 12 4 6 5 1 6 19 41 35 76 *Whooping cough 148 48 111 49 81 74 25 62 35 388 245 633 *Measles 195 29 82 58 59 54 32 29 12 365 185 550 Tuberculosis (all forms) 29 20 27 12 22 25 18 42 31 98 128 226 Totals 542 210 346 162 302 272 117 217 141 1,400 909 2,309 * Notifiable in Battersea since 1922. † See footnote, page 8. 56 Small-Pox. No case of small-pox was notified in Battersea during 1937. During the year four cases were notified in England and Wales, but none in London. No vaccinations were performed by the Medical Officer of Health during the year under report. 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.) District No. 3 (Latchmere and Church Wards).—Dr. P. Purcell, 154 Battersea High Street, S.W. 11. (Deputy—Dr. M. Sayers.) 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 (Deputy—Dr. E. J.Walsham), 61 Clapham Common West Side, S.W. 4. District No. 6 (St. James's Hospital).—Dr. W. L. Maccormac (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 (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. The number of successful vaccinations by the Public Vaccinators during 1937 was as under :— Primary vaccinations— Under 1 year 1,098 1 year and upwards 45 1,143 Re-vaccinations 22 1,165 Certificates issued, children under 14 (including children born in other districts) 1,726 Statutory declarations of conscientious objection received during the year 743 57 Full statistics for the year 1937 had not been prepared at the time this report went to print, the last figures available being for the year 1936, as under:— Children whose births were registered during the year ended 31st December, 1936— Number of births registered 2,856 Successfully vaccinated 1,585 Insusceptible of vaccination 5 Had small-pox — Statutory declarations of conscientious objection 701 Died unvaccinated 143 Postponement by medical certificate 50 Removed to other districts 281 Removals untraced, &c. 61 Not yet accounted for 30 2,856 Scarlet Fever. The incidence of scarlet fever was much lower in 1937, 215 cases being notified as compared with 437 in the previous year. One death was registered from the disease. In 63 other notified cases (not included in the above total), the diagnosis of scarlet fever was not confirmed at hospital. Of the cases notified 207, or 96·3 per cent., were removed to hospital. Particulars of the incidence of scarlet fever during 1937 and the four preceding years are shown in the following table:— Year. Cases. Houses Invaded. Deaths. Notified. Per 1,000 Population Registered Per 1,000 Population Per 100 Cases. 1933 826 5·36 726 6 0·04 0·73 1934 616 4·08 540 - - - 1935 417 2·81 361 - - - 1936 437 3·00 391 1 0·01 0·23 1937 215 1·50 200 1 0·01 0·47 Average 502 3·38 444 1·6 0·02 0·32 The incidence of the disease was highest in Latchmere, Nine Elms and Bolingbroke Wards. Diphtheria. In 1937 there were 251 cases of diphtheria notified (excluding 64 other cases in which the diagnosis was not confirmed after removal of the patient to hospital). There were 9 deaths registered as due to the disease. Of the 251 cases, 250 were removed to hospital. 58 Particulars of the incidence of this disease during 1937 and the four preceding years are shown in the following table :— Year. Cases. Houses Invaded. Deaths. Notified. Per 1,000 Population Registered Per 1,000 Population Per 100 Cases. 1933 396 2·57 344 12 0·08 3·03 1934 557 3·69 487 20 0·13 3·59 1935 383 2·58 330 9 0·06 2·35 1936 280 1·92 245 7 0·05 2·50 1937 251 1·75 220 9 0·06 3·59 Average 373 2·52 325 11·4 0·08 3·05 The incidence of the disease was highest in the Church, Nine Elms and Winstanley wards. Diphtheria anti-toxin, in accordance with the recommendation of the Ministry of Health, is supplied free of charge on the request of any registered medical practitioner, at any hour of the day or night. During the year 23 phials (approximately 124,000 units) of anti-toxin were supplied, on request, to medical practitioners practising in the Borough. Schick Clinic. The Diphtheria Immunisation (Schick) Clinic, established at the close of 1927, is held weekly at the Southlands Maternity and Child Welfare centre. The work is carried on under the supervision of Dr. F. Porter Smith, m.r.c.s., l.r.c.p. The result of the year's work is summarised as follows:— Sessions held 51 Patients attending in 1937 (new 392) 520 Attendances 1,767 „ (average per session) 34·6 Number of tests for susceptibility (including 9 of old patients) 191 (Positive 149, negative on 1st test 31, on second 9, no reading 2) 59 Diphtheria and Scarlet Fever in Battersea from 1916. (a) No. of cases per 1,000 population. (b) No. of deaths per 100 cases 60 Patients inoculated— Without test 210 After positive test (old patients) 12 „ „ „ (new „ ) 149 371 Inoculations— Old patients 31 New „ 1,024 1,055 Tests after inoculation— Old patients 123 New „ 122 245 (Readings—Negative, 230; positive, 4; no reading, 11) Patients immune or immunised— On primary test 31 After inoculation 230 261 Patients on register at end of year 234 Discontinued treatment 81 The total number of patients immunised or found by test to be immune was 261, out of a total of 520 patients who have attended during the year (50·2 per cent.). Since the opening of the clinic 2,406 patients have attended, and of these 1,719 have been immunised or found immune by test (71·4 per cent.). Acute Polio-myelitis and Polio-encephalitis. Two cases of acute Polio-myelitis were notified in Battersea during 1937. Three other cases (in the chronic stage) came to the knowledge of the Department by other means. No death was recorded. Cases of Polio-myelitis are also kept under observation after they have passed the acute stage, and during 1937 37 cases were visited by the Council's woman sanitary inspector, who paid 113 visits during the year. At the end of the year there remained 27 cases on the register. One case of acute Polio-encephalitis, which proved fatal, was notified. Puerperal Fever and Puerperal Pyrexia. Three cases of Puerperal Fever were notified in Battersea in 1937, as compared with 3 in 1936, 4 in 1935, 10 in 1934, and 3 in 1933. No death was registered as due to this disease in 1937. The number of notified cases per 1,000 births (live and still) was 1·36, as compared with 1·37 in 1936, 1·84 in 1935, 4·5 in 1934, and 1·29 in 1933. 61 There were 1,582 cases of Puerperal Fever notified in England and Wales during 1937, including 228 in London. A comparison of the incidence of Puerperal Fever in London and Battersea will be found on page 128. The number of cases of Puerperal Pyrexia notified in Battersea during 1937 was 18, and the incidence per 1,000 births (live and still) was 8·16. There were 7,267 cases of Puerperal Pyrexia notified in England and Wales during the year, including 820 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. The consultant obstetrician was not called to any case during 1937. Hospital accommodation for the treatment of Puerperal Fever is provided by the London County Council in their North Western Hospital. Enteric Fever. During the year 4 cases of Typhoid Fever, 3 of which were of Paratyphoid B, were notified, excluding 1 other case in which the original diagnosis was not confirmed. There was one death of a Battersea resident, which occurred in a Mental Hospital outside London. This case was not notified in Battersea. Cerebro-Spinal Fever. During 1937, 9 cases of Cerebro-Spinal Fever were notified in Battersea, and three proved fatal. One other notification was subsequently cancelled. All the patients were removed to hospital. Encephalitis Lethargica. No notification of this disease was received during 1937, but two deaths were ascribed to post encephalitis lethargica. In London the number of cases notified during the year was 10, and in England and Wales (including London), 226. Ophthalmia Neonatorum. There were 12 cases of Ophthalmia Neonatorum notified in Battersea during 1937, as compared with 29 in 1936, 21 in 1935, 23 in 1934, and 16 in 1933. The rate per 1,000 live births was 5.6. There were 3 severe cases amongst the 12 notified, of which 1 was removed to St. Margaret's (L.C.C.) Hospital for treatment, and 2 received treatment in other hospitals. 62 All cases notified during the year were reported to be cured without damage to sight. During 1937 the number of visits paid by district nurses, under arrangements made by the Council, to cases of Ophthalmia Neonatorum or other inflammatory condition of the eyes of the newlyborn was 2,288. All cases were kept under systematic supervision by the Health Visiting staff, and 58 visits were made to the homes of these and other children suffering from eye affections. The following table shews the distribution of the cases notified:— Sub-Districts. Wards. Cases. Births (live). Rate per 1000 Births. Year. Cases. Births (live). Rate per 1,000 Births. N. Battersea 5 1,124 4·4 1932 30 2,319 12·9 S. Battersea 7 1,020 6·9 1933 16 2,263 7·1 1. Nine Elms 3 343 8·7 2. Park — 257 — 1934 23 2,154 10·7 3. Latch mere 1 269 3·7 4. Shaftesbury 1 154 6·5 1935 21 2,104 10·0 5. Church 1 255 3·9 6. Winstanley 1 246 4·1 1936 29 2,128 13·6 7. St. John 1 143 7·0 8. Bolingbroke 2 233 8·6 Mean 24 2,194 10·9 9. Broomwood 2 244 8·2 1932-36 Borough 12 2,144 5·6 1937 12 2,144 5·6 Amending regulations—the Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937—were made by the Ministry of Health during the year. The Regulations require notifications of this disease to be sent to authorities administering the Notification of Births Acts instead of, as before, to the sanitary authorities. The change does not, however, affect the London boroughs. Erysipelas. There were 79 cases of Erysipelas notified, 44 of which were treated in hospital. One death was recorded from the disease during 1937 in Battersea. Measles. In 1937, 550 cases of Measles were notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, and 82 additional cases reported from schools and other sources, making a total of 632 cases, being 4.4 per 1,000 of the population ; 3 deaths from the disease were recorded, or 0·02 per 1,000 of the population. The corresponding figures for 1936 were : cases 2,613, incidence per 1,000 population 18·0, deaths 23. Of the 632 cases, 111 were removed to hospital. 63 The table below gives particulars in two-yearly periods of the biennial epidemics of measles which have occurred since the Regulations requiring the notification of measles in Battersea came into force. Incidence and Mortality of Measles in Epidemic Periods, 1921-1936, and in 1937. Cases. Deaths. Period. Notified or reported. Per 1,000 population. No. Per 1,000 population. Per 100 cases. Under 10. All ages. 1921-2 3,209 9·483 68 1·13 ·201 2·12 1923-4 4,111 12·035 75 1·28 ·220 1·82 1925-6 4,997 14·526 47 ·87 ·137 0·94 1927-8 4,197 12·600 37 ·70 ·111 0·88 1929-30 3,921 12·158 43 ·83 ·133 1·10 1931-2 3,002 9·476 25 ·51 ·079 0·83 1933-4 4,219 13·839 33 ·72 ·108 0·78 1935-6 2,702 9·200 23 ·54 ·078 0·85 1937 632 4.404 3 ·14 ·021 0·47 The Health Visitors paid 958 visits to the cases notified, reported or suspected. Whooping-Cough. During 1937 there were 633 cases of Whooping-Cough notified under the Battersea (Measles and Whooping-Cough) Regulations, 1922, to the Medical Officer of Health and 284 other cases were reported from the public elementary schools and other sources. The total number of cases notified or otherwise reported during 1937 was 917, as compared with 783 in 1936, 1,065 in 1935, 682 in 1934 and 976 in 1933, the increase in 1937 compared with 1936 being 17 per cent. Of the total cases, notified and reported, 104 were removed to hospital. There were 9 deaths registered from this disease, the deathrate being 0·06. Whooping-Cough, 1937, and Ten Previous Years. Year. Cases. Deaths. Notified or reported. Per 1,000 population. Registered. Per 1,000 population. Per 100 cases. 1927 749 4·43 15 0·089 2·00 1928 1,228 7·48 14 0·085 1·14 1929 1,317 8·14 43 0·266 3·26 1930 537 3·34 7 0·044 1·30 1931 747 4·67 5 0·031 0·67 1932 1,109 7·06 11 0·070 0·99 1933 976 6·34 12 0·078 1·23 1934 682 4·52 7 0·046 1·03 1935 1,065 7·19 9 0·061 0·85 1936 783 5·38 11 0·076 1·40 Average 919 5·86 13 0·085 1·39 1937 917 6·39 9 0·063 0·98 64 TUBERCULOSIS. During the year ended 31st December, 1937, there were 226 cases of Tuberculosis (all forms) notified in Battersea as compared with 232 in 1936, 237 in 1935, 236 in 1934 and 238 in 1933. In addition 21 cases were reported, or otherwise came to the knowledge of the Medical Officer of Health during the year, making a total of 247 cases. The following table (required by the Ministry of Health) shows the age and sex distribution of the 247 cases of Tuberculosis notified or otherwise reported during the year ended 31st December, 1937, and of the 123 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 - 2 - 2 1 - 1 1 - 1 1 - 1 1 - 3 1 4 3 5 8 2. - 2 1 2 3 5 - 2 1 3 - 2 2 - - - - - - 10 - — 2 2 2 2 4 - - - - - - 15 - 8 12 20 5 5 10 1 6 7 1 2 3 20 - 17 24 41 2 1 3 5 11 16 - - - 25 - 36 26 62 4 4 8 14 15 29 1 1 2 35 - 14 9 23 1 2 3 8 7 15 1 - 1 45 - 15 8 23 1 - 1 18 5 23 1 1 2 55 - 15 6 21 1 — 1 13 4 17 — — — 65 and upwards 4 1 5 — — — 1 — 1 — — — Totals 116 90 206 20 21 41 63 48 111 6 6 12 Deaths from non-respiratory forms of tuberculosis formed 9.8 per cent, of the total deaths from the disease. In the tables on pages 132 to 134 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 247 new cases notified or reported in 1937 was as under:— Pulmonary 206 N on-Pulmonary— Bones and joints 10 Abdomen 4 Other organs 17 Peripheral glands 10 41 PERIOD 1ST JANUARY TO 31ST DECEMBER, 1937. The following table shows the distribution in sub-districts and wards, and the rates per 100,000 of the population, of the 247 cases of tuberculosis notified or otherwise reported, and of the 123 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 50 38 88 9 12 21 59 50 109 156 31 24 55 4 3 7 35 27 62 89 South 66 52 118 11 9 20 77 61 138 187 32 24 56 2 3 5 34 27 61 83 Ward 1 17 11 28 4 2 6 21 13 34 148 19 7 26 3 2 5 22 9 31 135 2 10 7 17 2 4 6 12 11 23 151 7 5 12 1 1 2 8 6 14 92 3 14 11 25 2 2 4 16 13 29 175 1 5 6 - - - 1 5 6 36 4 5 5 10 1 1 2 6 6 12 95 4 5 9 - 1 1 4 6 10 79 5 9 9 18 1 4 5 10 13 23 153 4 7 11 - - - 4 7 11 73 6 9 10 19 5 2 7 14 12 26 151 8 7 15 - - - 8 7 15 87 7 8 10 18 2 1 3 10 11 21 273 4 4 8 - - - 4 4 8 104 8 22 17 39 2 3 5 24 20 44 265 11 5 16 1 1 2 12 6 18 108 9 22 10 32 1 2 3 23 12 35 179 5 3 8 1 1 2 6 4 10 51 Borough 116 90 206 20 21 41 136 111 247 — 63 48 111 6 6 12 69 54 123 — Rate per 100,000 populn. 171 119 144 29 28 29 200 147 172 172 93 63 77 9 8 8 102 70 85·71 85.71 65 66 Deaths from Tuberculosis in Battersea, from 1901 (per 1,000 population). 67 Non-Notification of Tuberculosis The following table gives particulars in regard to non-notification of Tuberculosis for the 10 years 1928-1937:— Year. Not notified (dead). Notified after Death. Notified on Form I. & II. (Primary Notification not received). Reported from other sources Total 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 1935 8 19 — 7 34 1936 15 8 1 2 26 1937 9 8 - 4 21 In accordance with the suggestions contained in the circular letter of the Ministry of Health, dated 22nd December, 1924, 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 1937 in this connection. Deaths from Tuberculosis. During 1937 deaths from Tuberculosis registered as belonging to the Borough of Battersea numbered 123, of which 111 (i.e. 90.2 per cent.) were due to pulmonary tuberculosis, 5 (i.e. 4.1 per cent.) to tubercular meningitis and 7 (i.e. 5·7 per cent.) to other forms of the disease. The death-rate from Tuberculosis was lower in 1937 than in any previous year except 1935, being 85·71 per 100,000 population as compared with 100·34 in 1936, 85·02 in 1935, 87·5 in 1934 and 94·8 in 1933. The death-rate for the non-pulmonary form of the disease was the lowest yet recorded. The allocation of the deaths in 1937 according to age and sex, and in the Wards and Sub-Districts is shown on pages 64 and 65, while the chart on the following page shows the death-rates from tuberculosis since 1901. Of the fatal cases 20 were notified within one month before death; in 8 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 were patients who died in hospitals or other institutions, while 2 died at home. 68 Of the 8 cases notified after death, six were from Public Assistance Institutions, and 2 from other hospitals. The death-rates per 100,000 of the population during the 37 years ended 1937 in quinquennial averages and in 1936 and 1937 are given in the following table:— Years. Pulmonary. NonPulmonary. Total. 1901-1905 138·1 50·9 189·0 1906-1910 126·8 45·9 172·7 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 1931-1935 81·8 14·4 96·2 Average (35 years) 112·8 30·3 143·1 1936 87·2 13·1 100·3 1937 77·3 8·1 85·7 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary during 1937 under the provisions of these Regulations, which relate to the occurrence of Tuberculosis among persons engaged in the handling of milk. Revision of Notification Register. In accordance with the suggestion of the Ministry of Health the Tuberculosis Notification register is periodically revised, and during 1937 the names of 38 patients were removed from the register as compared with 81 in 1936. The County of London (Tuberculosis) Regulations, 1930. Eighteen 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 addition to four sent in the previous year whose period extended into 1937. TUBERCULOSIS DISPENSARY. The Tuberculosis Dispensary, which was founded by a voluntary society in 1911, is situate at Southlands, Shuttleworth Road. The staff engaged on Tuberculosis work at the Dispensary will be found on pages 3 and 4. 69 The Tuberculosis Officer continues to act as honorary Tuberculosis Consultant to St. James's Hospital, and visits the hospital every week. Patients are found to be readier to enter hospital when they know this arrangement exists. In addition to the patients in the tuberculosis wards many special cases are seen in other wards at the request of the Medical Superintendent. In November, the London County Council announced that owing to the great pressure on the accommodation available in St. James's Hospital it would be necessary to transfer the tuberculosis wards from that hospital to St. John's. The change had not however become effective in the early months of 1938. The Tuberculosis Medical Officer and one of the tuberculosis nurses are employed part-time in the medical inspection of children attending Springwell House Open Air School, Clapham Common North Side. Children exposed to infection in their homes are now eligible for admission to the school, in addition to notified cases. The contribution made by the London County Council towards the cost of the dispensary treatment of tuberculosis is revised triennially, and for the three financial years 1936 to 1939 is £1,084 per annum. The investigations of a scholar appointed by the Royal College of Physicians into the early stages of tuberculosis (referred to in the annual report for 1935) were continued at the Dispensary during the year. Patients and Attendances. In 1937 863 additional names were recorded at the dispensary, 5 more than in 1936. These related to 573 persons who had been referred by medical practitioners, otherwise presented themselves for examination, or were receiving treatment under the London County Council's tuberculosis scheme; 268 who had been in contact with cases of tuberculosis; and 22 already notified in other districts who had come to reside in Battersea. Of these 863 cases 673 were discharged as non-tuberculous (including 265 of the contacts), 175 were found to be suffering from the disease, and 15 (including 1 contact) were kept under observation for diagnosis. Particulars of the 175 positive cases are given under the next heading, and also in form T.145 on page 135. Old patients to the number of 525 also attended during the year, and the total number of attendances at the Dispensary in 1937 was 4,837 (of which 3,974 were of old patients), as compared with 4.024 in 1936. 70 Visits to the homes of dispensary patients were made by the Tuberculosis Officers in 362 instances, and 4,171 visits were made by the Dispensary nursing staff, including 287 to patients not on the Dispensary register. The number of deaths of Dispensary patients was 89 as compared with 98 in 1936. Thirty-five of the patients were discharged as " recovered " during the year, and 84 patients removed to other districts or ceased to attend. New Patients. The five following tables contain particulars of the 175 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 in the sputum. (2) Group T.B. plus. In those cases Tubercle bacilli have been found in the sputum at some time. Group T.B. plus is sub-divided under three headings :— Group I.—early cases. Group II.—intermediate cases. Group III.—advanced cases. For the second year in succession in the Pulmonary group the incidence is highest in the age period 26-35, being 31·5 per cent. of the total cases, this differing from previous experience. 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 2 3 2 15 10 4 6 2 — 44 Group T.B. plus Group I — — — 3 5 - — — — 8 Group ii — — 3 25 29 16 11 4 2 90 Group III — — 2 3 - 1 1 — 7 Total 2 3 5 45 47 20 18 7 2 149 71 B.—Non-Pulmonary Tuberculosis—Age Groups. Years. 0-5 6-10 11-15 16-25 26-35 36-45 46-55 56-65 65 + Total Bones and joints 2 — 1 3 1 — — — — 7 Abdominal — — — 2 1 — — — — 3 Peripheral glands 3 — 1 1 1 1 — — — 7 Skin and other organs 1 — 1 3 3 — — 1 — 9 Total 6 — 3 9 6 1 — 1 — 26 C.—Mode of Onset in Pulmonary Cases. Mode of Onset. Number of Cases. Percentage. Cough 93 62.42 " Influenza " 3 2.01 Pleurisy 4 2.68 Pleurisy with effusion 6 4.03 Haemoptysis 29 19.46 Other modes 14 9.40 Totals 149 100.00 The large proportion of cases in which the first noticed symptom was haemoptysis (blood-spitting) is again to be noted. D.—Occupations in the 149 cases of Pulmonary Tuberculosis. Occupation. No. of Patients. Occupation. No. of Patients. Artist 1 Laundry Workers 4 Bakers 2 Musician 1 Barman 1 Needle workers 3 Carpenters 5 No occupation 6 Cinema Attendant 1 Painters 3 Clerks, various 17 Photographer 1 Compositors 2 Porters 2 Domestic Workers 9 Railway Workers 2 Drivers, Carmen, &c. 5 School Children 5 Engineers, various 10 Shop Assistants 7 Factory Workers, various 12 Stall Keepers 4 Flusher 1 Street Trader I Glazier 1 Surveyor's Assistant 1 Hairdresser 1 Waiters 4 Housewives 24 Watchmen 2 Infants 2 Window Cleaner 1 Labourers, various 8 72 E.—Family History ok Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near Relative. Remote Relative. No Family History. Pulmonary 38 7 104 Non-Pulmonary 9 — 17 Totals 47 7 121 Of the 175 cases, therefore, a history of Tuberculosis in a near relative was elicited in 26.9 per cent, and in a remote relative in 4.0 per cent. In all 30.9 per cent, gave a family history of Tuberculosis. Contacts. All contacts are asked to attend the Dispensary for examination. Home contacts of infectious cases are encouraged to attend the Dispensary every six months. Institutional Treatment. The London County Council are the authority for the provision of institutional treatment for Tuberculosis in London, and such treatment is supplied free of charge. The number of patients who received institutional treatment under the scheme of the London County Council was 170, and the average length of stay was 84 days. The average period of waiting before admission was 7 days. Of these patients, 113 were discharged during the year, leaving 57 under treatment at the end of the year. Definite improvement as a result of institutional treatment was shown in 46 cases. Thirty-three patients discharged themselves while undergoing institutional treatment. The results of treatment in 106 of the cases discharged from sanatoria 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 2 - 1 2 5 1 - - - 1 - - 4 B. i 2 - 2 - - - - - 1 - - - - B. ii 6 - i 6 13 8 1 3 11 1 - 10 B. iii - - - - 1 - - - - - - 1 12 N on-Pulmonary 3 1 - - - - - 1 - - - - T.C. = treatment completed. O.R.=own request. 73 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 1937 was 50, and 316 attendances were made, the average attendance per session being 6-3. The work carried out included :—Extractions, 112; scalings, 16; fillings, 62; dentures supplied—whole sets 7, partial sets 4; repairs to dentures, 2; dressings, 36; advice, 51 (average per session, 5.8); total, 290. The net cost to the Council during the financial year 1937-38 for this service was £90 3s. 2d. X-ray Examinations. Since October, 1936, the Council has made use (at scale charges) of the X-ray apparatus at St. James's hospital for the examination of tuberculous patients, and during 1937 the Tuberculosis Officer carried out 779 X-ray examinations and screenings at that hospital. Two afternoon sessions and one in the evening are held weekly at St. James's Hospital for this purpose. In September the London County Council informed the Council that they had decided to raise no objection to the installation of X-ray apparatus in the borough dispensaries, if the Councils so desired, and to allow expenditure in connection therewith to rank for grant, it being understood that the apparatus would be for routine examination and straightforward cases, and that arrangements should be maintained with approved hospitals for the examination of doubtful or difficult cases. Artificial Pneumo-thorax Treatment. The County Council also permit artificial pneumo-thorax treatment to be given by the Tuberculosis Officers (without charge) at St. James's Hospital. During 1937, the Tuberculosis Officer attended at that hospital and himself carried out the artificial pneumo-thorax treatment for which patients had previously to visit various institutions. Only patients who had not previously received this form of treatment, however, were sent to St. James's Hospital, the others continuing to visit the hospital they were already attending. In all 55 patients were treated during the year (as compared with 48 in 1936) and the refills given numbered 768, the numbers at each of the hospitals being as under:— Brompton Hospital 335 Grove Park Hospital (L.C.C.) 13 St. Thomas's Hospital 59 St. James's Hospital 346 Colindale Hospital (L.C.C.) 15 74 Two sessions for this treatment are held weekly at St. James's Hospital, one being an evening session. The cost incurred by the Council in regard to the 22 patients sent to hospitals other than St. James's amounted to £221 11s. 0d. as compared with £297 13s. 6d. in 1936. Examinations and Reports. Bacteriological examinations made during the year numbered 871, the specimens in 315 cases coming from medical practitioners. The number of positive results was 185, or 21.2 per cent. Reports to public bodies numbered 878. Consultations with medical practitioners at the homes of patients and reports made on patients sent to the Dispensary totalled 938, while reports received in respect of insured persons on forms G.P. 36 and G.P. 17 numbered 136. There were 12 patients referred to hospitals, other than for X-ray examination. Artificial Sunlight Treatment. During the year 4 Dispensary patients received treatment at the Council's artificial sunlight treatment centre at Southlands (vide page 47). In 1 case treatment was completed, the usual period of treatment being from three to four months, and in 3 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 and Beds. Provision is made by the Council for the loan, in suitable cases, of shelters for the use of patients to enable them to sleep in their gardens. In addition, two shelters are available at Southlands, adjoining the dispensary, for use during the day by patients selected by the Tuberculosis Officer. These patients are provided with dinners at a small cost to the Council. Arrangements are also made for the supply by the Council of beds and bedding in necessitous cases. Extra Nourishment. The amount expended by the Council during the financial year ended 31st March, 1938, upon the provision of extra nourishment for 91 necessitous patients upon the Dispensary books was £322 13s. 7d. Dispensary Statistics. On pages 135 to 141 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 1937, and Form T. 145a, which shows in a summarised form the condition of all patients whose case 75 records were in possession of the Dispensary at the end of 1937, arranged according to the years 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 1937 :— Battersea Borough Council—extra nourishment, 127 ; dentures, 4 ; bed and bedding, 2 133 Public Assistance Committee—financial assistance, 42 ; clothing, 3 ; dentures, 3 ; other assistance, 1 49 Charity Organisation Society—financial assistance, 2 ; clothing, 1 ; other assistance, 2 5 British Legion—financial assistance, 4 ; clothing 5 9 Other Agencies—assistance, 5 5 Training and Employment—suitable agencies, 2 2 Non-Dispensary Cases. All the Tuberculosis visiting for the Borough is undertaken by the Dispensary staff. Of the 829 patients on the tuberculosis register at 31st December 120 were not on the dispensary register, i.e.. 14.5 percent, of the total notified cases. Visits to the number of 287 were paid to these patients during 1937 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 diarrhoea. The deaths from these causes in 1937 numbered 58, as compared with 69 in 1936, a decrease of 16 per cent. There was a corresponding decrease in the zymotic death-rate from 0.474 in 1936 to 0.404 in 1937. The following table shows the zymotic death-rate (per 1,000 population) in Battersea for each of the last five years :— Battersea London 1933 0.38 0.32 1934 0.60 0.40 1935 0.26 0.29 1936 0.47 0.50 1937 0.40 0.32 Mean 0.42 0.37 76 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. Many of these cases of infectious illness shown on such returns are 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 1937 there were 547 cases of chicken-pox reported, as compared with 426 in 1936, 178 in 1935, 457 in 1934 and 790 in 1933. Diarrhoea. During 1937 the total number of deaths from diarrhoea of children under 2 years of age was 30, equivalent to a fatality-rate of 0.21 per 1,000 of the population. In 1936 there were 22 deaths and a fatality-rate of 0.15. Influenza. There were 43* deaths registered as being due to Influenza during 1937, as against 20 in 1936, 18 in 1935, 15 in 1934 and 71 in 1933. The mortality-rate per 1,000 population was 0.30, as compared with 0.14 in 1936, 0.12 in 1935, 0.10 in 1934 and 0.46 in 1933. Influenzal Pneumonia was more prevalent in 1937 than in the previous year, 76 cases being notified as against 43 in 1936, 47 in 1935, 41 in 1934 and 86 in 1933. The death-rate was 0.15 per 1,000 of the population. Cancer. During 1937 the number of deaths of Battersea residents from Cancer was 244 (males 130, females 114) as compared with 260 in 1936, 265 in 1935, 240 in 1934 and 289 in 1933. The death-rate from the disease per 1,000 of the population was 1.70. The deaths from cancer constitute 13.2 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 1921-25 1.33 1901-5 0.88 1926-30 1.51 1906-10 0.95 1931-5 1.75 1911-15 1.11 1936 1.79 1916-20 1.28 1937 1.70 * 22 of these deaths were ascribed to Influenzal Pneumonia. 77 The following table shews the localisation of the disease in the case of the 244 deaths recorded in 1937. Localisation. No. of deaths. Total. Percentage of total. Male Female Buccal cavity 13 2 15 6.15 Stomach, liver, peritoneum, intestines and rectum 63 52 115 47.13 Respiratory system 25 2 27 11.07 Female genital organs — 26 26 10.65 Breast — 22 22 9.01 Skin 3 3 6 2.46 Genito-urinary organs (male) 20 — 20 8.20 Other and unspecified organs 6 7 13 5.33 Total 130 114 244 100 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 1937 insulin was supplied to four such cases. Thirty-one deaths from this disease were registered in Battersea in 1937. 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 74) is carried out by the Clinical Research Association, of Watergate House, Strand. During 1937 the number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 1828 (exclusive of the specimens dealt with at the tuberculosis dispensary). The following table gives particulars of the bacteriological examinations carried out during the year :— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 143 1,659 1,802 Enteric fever 3 9 12 Tuberculosis 2 12 14 Total 148 1,680 1,828 The cost of these examinations is borne by the Council, and in 1937 amounted to £237 4s. 6d., as compared with £213 10s. 7d. in 1936. 78 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1937. (Public Health (London) Act, 1936, &c.) Complaints attended to 3,906 Number of house inspections 35,893 House to house inspections 1,128 Houses let in separate tenements on register 65 No. of inspections of do. 331 Shops Act inspections 43 Premises improved, cleansed and repaired 2,863 Underground rooms : Use discontinued 1 Defects remedied 8 Overcrowding abated 12 Leaky house-roofs and gutters repaired 865 Yards and forecourts paved and repaired 595 Drains laid to new houses and tenements 200 Drains tested—Smoke tests 268 Do. Water tests 1,206 Drains relaid (wholly or partly) 104 Drains cleansed and repaired 277 Frontage drains constructed or re-constructed 25 Mews and stables drained and paved 2 Soil pipes and drains ventilated 229 Sink and rain-water pipes disconnected or repaired 607 Houses inspected and certificates granted (Sec. 95) 200 Houses supplied with water and fittings repaired 49 Cisterns covered, cleansed or repaired 103 Additional water supplies to tenement houses 25 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 28 Water closets cleansed and repaired 894 Cesspools abolished — Urinals—inspections 172 Do. cleansed, altered, repaired or water laid on 50 Dust receptacles provided 528 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 5 Keeping of animals in unfit state discontinued 7 Gipsy van inspections 90 Factories, workshops, &c., inspections 4,307 Sanitary conveniences provided or improvements effected in Factories and Workshops (Sec. 106) 62 Bakehouse inspections 137 Bakehouse nuisances abated 26 Smoke observations 173 Premises disinfected 2,240 Houses supplied with disinfectants 134 Certificates of disinfection granted 2,528 Intimation notices 3,297 Statutory Notices— Sections 197 & 200 1,799 Fifth schedule, &c. 1,568 Proceedings ordered by Council and Health Committee 3,320 Summonses issued 58 Magisterial Orders obtained and enforced 40 Samples taken under the Food and Drugs (Adulteration) Act 1,200 Miscellaneous 3,947 Total sanitary operations 70,375 79 Legal Proceedings. Legal proceedings were taken by the Council during 1937 in respect of 57 offences against the provisions of various Acts, bylaws, &c., administered by the Health Department, and for the recovery of expenses incurred by them in default of owners in 3 instances. Particulars of each case are set out below. Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, 1936. By-laws made thereunder. Failing to abate a nuisance at No. 38 Woodgate Street after service of a notice under the Act. The notice having been complied with, summons withdrawn. The like at No. 26 Wickersley Road. The notice having been complied with, summons withdrawn. Failing to comply with a notice under the Act to abate a nuisance at No. 52 Speke Road. Order to abate the nuisance within 21 days. 10s. 6d. costs awarded to the Council. Failing to comply with a notice under the Act requiring the provision of a dustbin at No. 117 Northcote Road. The notice having been complied with, summons dismissed under the Probation of Offenders' Act, 1907. 10s. 6d. costs awarded to the Council. Failing to comply with a notice requiring the provision of suitable and sufficient sanitary conveniences at Octagon Works. The necessary work being now in hand, the defendants fined £2. i11s, costs awarded to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 46 York Road. Order to abate the nuisance within 7 days. 10s. 6d. costs awarded to the Council. The like at No. 479 Battersea Park Road. Failing to comply with a notice under the Act requiring the provision of a proper and sufficient supply of water for domestic purposes in the top storey at No. 479 Battersea Park Road. Order to abate the nuisance within 28 days. 10s. 6d. costs awarded to the Council. Order to comply with the notice within 28 days. Failing to comply with a notice under the Act relating to the cleansing of a verminous room at No. 479 Battersea Park Road. Defendant fined £3. Being the builder intending to execute certain works, namely, the fitting of a new pan to the ground floor water closet at No. 175 Broomwood Road, failed to give notice thereof to the Council. Fined 10s. 10s. 6d. costs awarded to the Council. 80 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, (contd.) Failing to comply with a notice to abate a nuisance at No. 110 Kyrle Road. Order to abate nuisance within 14 days. The like at No. 268a Battersea Park Road. Order to abate nuisance within seven days. 10s. costs ordered to be paid to the Council. Failing to efficiently repair or renew the yard paving at 268a Battersea Park Road, after service of a notice. Summons withdrawn. Failing to keep and maintain in a proper state of repair drainage work at No. 58 St. Johns Hill Grove. The repairs having been carried out, summons dismissed under Probation of Offenders Act, 1907. 10s. 6d. costs ordered to be paid to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 12 North Side, Wandsworth Common. The notice having been complied with, summons withdrawn. Defendant paid 2s. costs of summons. The like in re No. 70 Honeywell Road. Summons adjourned sine die. The like in re No. 123 Maysoule Road. The notice having been complied with, summons withdrawn. Defendant paid 2s. costs of summons. Failing to comply with a notice under the Act to provide an extra w.c. at No. 36 Granfield Street. Fined £1. 10s. 6d. costs ordered to be paid to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 304 Battersea Park Road. The notice having been complied with, summons withdrawn. Failing to provide a sufficient ashpit at No. 304 Battersea Park Road, after service of a notice under the Act. The notice having been complied with, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 38 Gorst Road. The notice having been complied with, summons withdrawn. 2s. costs paid before hearing. The like at No. 29 Benfield Street. The notice having been complied with, summons withdrawn. Recovery of cost of re-constructing frontage drain at No. 40 Home Road. (£19.) The claim having been paid before the hearing of the summons, £5 5s. costs ordered to be paid to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 65 Livingstone Road. The notice having been complied with, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. 81 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, (contd.) Cost of repairing waste pipe to sink at No. 77 St. Johns Road in default of defendant after service of a notice under the Act (£1 6s. 10d.). Judgment for claim and £1 1s. costs. Cost of re-constructing frontage drain serving Nos. 35 and 37 Shelgate Road in default of defendant after service of a notice under the Act £9 4s. 3d.). Claim paid before date of hearing. Failing to comply with a notice under the Act to abate a nuisance at No. 26 St. Johns Hill Grove. The notice having been complied with before hearing, summons withdrawn. Defendant paid £1 Is. costs to the Council. The like at No. 28 St. Johns Hill Grove. The notice having been complied with before hearing, summons withdrawn. Failing to keep and maintain in a proper state of repair drainage work at No. 26 St. Johns Hill Grove. The drainage work having been repaired before hearing, summons withdrawn. Failing to keep in proper repair the yard paving at No. 26 St. Johns Hill Grove. The yard paving having been repaired before hearing, summons withdrawn. The like at No. 28 St. Johns Hill Grove. The like. Failing to deposit plans of drainage work carried out at No. 24 Granard Road. The plans having been deposited, summons withdrawn. Defendant paid 7s. 6d. costs to the Council. Executing drainage work at No. 37 Shelgate Road, contrary to the by-laws. Fined £1. £1 Is. costs ordered to be paid to the Council. Constructing a trap to a waste pipe of a sink at No. 23 Balfern Street, contrary to the by-laws. The trap having been re-constructed so as to conform to the by-laws before hearing, summons withdrawn. Defendant paid 10s. 6d. costs to the Council. Failing to give notice of intention to carry out drainage work at No. 23 Balfern Street. Summons withdrawn. Defendant paid 10s. 6d. costs to the Council. Fitting to a sink at No. 23 Balfern Street a cast iron waste pipe not protected against corrosion, contrary to the by-laws. The waste pipe having been reconstructed so as to conform to the by-laws before hearing, summons withdrawn. Defendant paid 10s. 6d. costs to the Council. Constructing the joint of a pipe with the trap of a sink at No. 23 Balfern Street with putty contrary to the by-laws. The joint having been reconstructed so as to conform with the by-laws before hearing, summons withdrawn. Defendant paid 10s. 6d. costs to the Council. 82 Nature of Offence or Claim. Result of Proceedings. Housing Act, 1936, &c. Application for warrant of possession of No. 23 Livingstone Road in order that the demolition order made by the Council on 15th July, 1935, might be carried out. Order made for a warrant for possession to operate within 28 days. The like. The like. The like. The like. Using the front basement room at No. 6 Brougham Street in contravention of a closing order made by the Council on 24th February, 1937. Summons dismissed under Probation of Offenders Act, 1907. Permitting the said room to be so used. The like. London Government Act, 1899. Contravention of Council's by-law as to fouling of footway by dogs. Fined 7s. 6d. The like. Fined 20s. The like. Fined 2s. 6d. London County Council (General Powers) Act, 1908. By-laws made thereunder. While carrying on the business of a rag and bone dealer distributed a toy. Fined 10s. The like. Summons dismissed under Probation of Offenders Act, 1907. The like. The like. The like. Defendant absconded. Food and Drugs (Adulteration) Act, 1928. Sale of Milk Regulations, 1901. Selling milk deficient in fat to the extent of 13 per cent, below the permitted minimum. Defendant fined £1. £1 Is. costs awarded to the Council. Selling milk alleged to be adulterated with 3 per cent, extraneous water. Summons dismissed under the Probation of Offenders Act, 1907. £1 Is. costs awarded to the Council. Selling milk alleged to be adulterated with 18 per cent, extraneous water. Fined £5. £5 5s. costs awarded to the Council. Selling milk deficient in fat to the extent of 8 per cent, below the permitted minimum. Summons dismissed. 20s. costs awarded to the Council. 83 Nature of Offence or Claim. Result of Proceedings. Food & Drugs (Adulteration) Act (contd.). Selling milk deficient in fat to the extent of 17 per cent, below the permitted minimum. Fined 5s. 10s. 6d. costs awarded to the Council. Selling milk alleged to be adulterated with 1½ per cent, extraneous water. Summons dismissed. 10s. 6d. costs awarded to the Council. Selling milk alleged to be adulterated with 1½ per cent, extraneous water. Fined £20. £1 1s. costs ordered to be paid to the Council. Milk and Dairies Acts and Order. Milk (Special Designations) Order, 1936. Selling " Pasteurised " milk at No. 549 Battersea Park Road, on 30th November, 1936, without a licence from the Council authorising the use of the designation " Pasteurised " in relation to milk sold from those premises. Fined £1. £1 1s. costs awarded to the Council. The like on 2nd January, 1937. Summons not dealt with. Selling milk under the designation " Pasteurised " without a licence from the Council. Fined 5s. £1 1s. costs ordered to be paid to the Council. Carrying on the trade of a dairyman without being registered. Fined 5s. Using the premises No. 1 Latchmere Grove as a dairy without such premises being registered. Summons withdrawn. Summary of Legal Proceedings. Acts and Regulations under which proceedings taken. Cases. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, and by-laws made thereunder 37 7 10 0 17 9 0 Housing Acts 5 — — Food and Drugs (Adulteration) Act, 1928 7 26 5 0 10 9 0 London County Council (General Powers) Act, 1908 4 0 10 0 — London Government Act, 1899 3 1 10 0 — Milk and Dairies 4 1 10 0 2 2 0 Total 60 37 5 0 30 0 0 84 New Legislation, &c. During 1937, the following new Acts and Orders affecting the work of the Public Health Department were passed or came into force :— (a) Acts of Parliament— (1) Air Raid Precautions Act, 1937. (2) Factories Act (vide page 113). (3) Hydrogen Cyanide (Fumigation) Act, 1937 (vide page 92). (4) London County Council (General Powers) Act, 1937, which besides making some minor amendments in the Public Health (London) Act, 1936, contains a clause bringing a nuisance from noise within the nuisances which can be dealt with summarily under the last named Act. (b) Orders and Regulations— (1) Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937 (vide page 62). (2) Poisons (Amendment) Rules, 1937 (vide page 85). (3) Poisons List Amendment Order, 1937 (vide page 85). (4) Public Health (Imported Food) Regulations, dated 16th April, which revoked the regulations previously in force and re-enacted them with amendments. Metropolitan Borough Councils will only be affected by these if the Minister of Health by order so decides. (5) Other imported food regulations dealing with official marks recognised for the certification of meat imported from various countries. (6) Housing Acts (Extinguishment of Public Right of Way) Regulations, 1937. (7) Orders made under the Agricultural Produce (Grading and Marking) Acts, relating to various foodstuffs. (8) Public Health (London) (Repealed Enactments) Order, 1937, which declared that the effect of Section 346(2) of the Public Health Act, 1936, was the repeal of certain clauses of the Public Health (London) Act, 1936, and of other Acts relating to epidemic diseases. Shops Act, 1934. The functions of Metropolitan Borough Councils under this Act are limited to enforcement of the provisions relating to (1) ventilation, (2) heating, and (3) sanitary accommodation. As stated in the last annual report the number of premises in Battersea which are subject to the provisions of the Shops Acts is approximately 2,574, that being the number inspected by the sanitary inspectors in the first survey during the years 1935 and 1936. 85 Inspection of certain shops (principally those dealing in food stuffs) is carried out as a routine measure, and the total number of inspections carried out solely for the purposes of the Shops Act amounted to 43, arising out of which 13 intimation notices were served. These related to defective, insufficient or unsuitable— Ventilation 1 Heating 6 Sanitary accommodation 8 two of the notices relating to more than one defect. Eighteen statutory notices were served and all were duly complied with. In the case of 3 shops the Committee gave certificates of exemption from the requirements of the Act of 1934, relating to sanitary accommodation. There were at the end of the year 39 of such certificates remaining in force. Pharmacy and Poisons Act, 1933. The Health Committee has been empowered to act on behalf of the Council in the execution of this Act, and the Medical Officer of Health and Sanitary Inspectors are appointed Inspectors for the purposes of the Act. The Council as sanitary authority are required to keep a register of sellers of poisons comprised in Part II of the Poisons List (i.e., those poisons the sale of which is not restricted to registered pharmacists). As mentioned in the last annual report, 88 applications for registration had been received and granted up to the end of 1936. Some of these applications were not renewed for the following year, and after deducting these, and allowing for 9 new applications in 1937, change of occupation, and businesses closed down, etc., there were registered at 31st December, 1937, 71 traders occupying 88 shops. The trades carried on in these premises may be thus classified:— Grocery 35 Oils and colours 32 Hairdressers 7 Hardware 4 Others 10 Only one infringement of the requirements of the Rules was reported to the Committee during the year, and in that case the Committee gave directions for the persons concerned to be cautioned. A slight amendment of the original rules was made by the Poisons (Amendment) Rules, 1937, and the Poisons List (Amendment) Order made certain alterations in the Schedules to the rules which determine by which persons the various poisons may be sold. 86 Common Lodging Houses. There are now only two common lodging houses in Battersea, of which particulars are as under:— Premises Lodgers authorised. Inspections. Notices. Prosecutions. Served. Complied with. Males— 75 Falcon Road 67 29 — — — Females. 67 Winstanley Rd. 66 12 1 1 — Total 133 41 1 1 — 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 by-laws. At the request of the London County Council an annual inspection was carried out at midnight on the 20th February, when the number of beds occupied was found to be, men 55, women 25. Applications for the renewal for one year of the existing licences were granted by the Committee in June. There are no seamen's lodging houses in the Borough. Public Lavatory Accommodation. Six public conveniences for both sexes are provided by the Council in various parts of the Borough, two being underground. In addition to the usual lavatory accommodation (at least one free water-closet being provided for each sex) facilities for washing are also provided. One of the three public urinals maintained by the Council, was demolished early in the year. The London County Council in July informed the Council that they had decided to provide additional lavatory accommodation in Battersea Park near the entrance at the junction of Albert Bridge Road and Prince of Wales Drive. As recorded previously, the Council had already made representations to the County Council on this subject. Drainage Work. The by-laws made by the London County Council under the Metropolis Management Acts with regard to drainage, and also those under the Public Health (London) Act relating to waterclosets, &c., are enforced by the Council. 87 During the year new drains were constructed to 338 new buildings, or additions to existing buildings, and the drains of 104 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. During 1937, 5 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 4 cases liability, wholly or in part, was admitted by the Council. The total expenditure incurred in these four cases amounted to £256 19s. 5d., being on average £64 4s. lOd. per case. This may be compared with an average for the ten years 1928-1937 of £161 6s. 9d. per annum and £35 Is. 6d. per case. In the other case liability was not admitted. The total number of plans of proposed drainage work deposited during 1937, as compared with 1936, was as under:— 1936 1937 Re-construction or repair of existing drains 97 75 New buildings or additions to existing buildings 168 144 265 219 In 44 cases the Health Committee gave directions for steps to be taken against various builders to enforce the deposit of plans of drainage works executed by them, but in no case was it found necessary to take legal action. In 38 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 and other by-laws. These cases were reported to the Health Committee, who in the circumstances reported to them ordered the offenders to be cautioned except in two cases where legal proceedings (the result of which is shown on pages 79 and 81) were instituted. During the year 1937, drains were tested by smoke on 268 occasions and in 78 cases the drains were found defective. The water test was applied on 1,206 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and drains were ventilated in 229 instances. Water closets were provided in 28 cases and existing closets repaired in 894 cases. The total number of drains relaid during the year was 104. Those cleansed and repaired numbered 277. 88 Public Cleansing. I am indebted to the Borough Surveyor for the information on this subject which is summarised below. 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 done more frequently. Since the closing in 1935 of the Council's destructor, the refuse is wholly disposed of by barging to suitable " tips " outside London. The removal is carried out under contract which imposes stringent conditions for the avoidance of nuisance. The horse-drawn vehicles used for collection are gradually being replaced by the latest type of mechanically propelled freighters, and recently the " Container " system has been introduced. By this system, the refuse at public institutions, housing estates, blocks of flats, &c., is deposited into containers of 1¼ yard capacity, and such containers with the refuse are collected daily, and clean containers left for the next day's collection. The used containers, after being emptied, are washed at the wharf. For the cleansing works the beat system is in operation. A number of roads are allocated to each sweeper, and he is responsible for the cleansing of such roads. Orderly barrows, with four bins each, which when full are taken to a street receptacle and replaced by empty bins, are provided. The refuse is collected by motor freighters, augmented as occasion requires with horse vans. As in the case of house and trade refuse the street refuse is disposed of by contract and carted away to suitable tips. The total quantity disposed of during the year ended 31st December, 1937, was :— Tons. Tons. House refuse 29,571 Trade refuse, stalls 2,095 Street refuse 2,697 do. shops 1,074 There are no earth closets, privies, or cesspools in the Borough. Houses Let in Separate Tenements. The by-laws of the London County Council with regard to houses let in separate tenements, so far as they are applicable, are enforced by the Council. There are 65 premises in Battersea registered as houses let in separate tenements and 331 inspections of these premises were made in 1937. 89 Sanitary Conveniences attached to Licensed Premises. The number of public-house urinals kept under inspection during the year was 119. In 68 instances the accommodation is accessible to the general public as well as the users of the houses, and in 51 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 8 notices were served to remedy defects discovered, and were duly complied with. Smoke Nuisances. During the year 173 observations were made and 12 complaints received. Nine preliminary and 4 statutory notices were served by the Council under the provisions of the Public Health (London) Act to abate smoke nuisances. Effluvium, &c., Nuisances. The complaints received during 1937 of nuisance from effluvium were two in number and after investigation no action was found necessary thereon. 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 8 inspections were made of the registered premises in the Borough. Removal of Offensive Matter. The by-laws of the London County Council with regard to the removal of offensive matter are enforced by the Borough Council. No contraventions of the by-laws were reported during the year. Water Supply. During 1937 certificates of water supply in respect of 200 houses or tenements were issued in accordance with Section 95 (2) of the Public Health (London) Act, 1936. In 25 cases the upper floors of tenement houses were provided with a water supply, where required by the Council under the provisions of Section 95 (5) of the Public Health (London) Act, 1936. During 1937, 26 notices were sent to the Metropolitan Water Board of waste of water observed at various premises during the course of inspection. 90 Public Baths. The swimming baths provided by the Council are situated at the Latchmere Road and Battersea Park Road (Nine Elms) establishments. Modern filtration plant has been installed at both premises, that at the Nine Elms establishment having been inaugurated in May, 1937. Removal of the Aged or Infirm. Section 224 of the Public Health (London) Act, 1937, contains power to secure, on Order of the Court, the removal to hospital or suitable institution of persons who are aged, infirm or physically incapacitated or suffering from grave chronic disease, and who are unable to receive proper attention, and are living in insanitary conditions. It was not found necessary during 1937 to utilise these provisions of the Act, although 20 such cases were dealt with during the year. Ten of these (women) were persuaded to enter a suitable institution, 6 (women) died during the year, and 4 (2 men, 2 women) were still under observation at the end of the year. Van Dwellings. The number of van dwellings in the Borough in 1937 was 63. In the following table are set out the situations of the dwellings and number of occupants:— Situation of Vans. No. of Vans. Occupants M. F. Mills' Yard, adjoining 88 Sheepcote Lane 4 3 4 Mills' Yard, adjoining 80 Sheepcote Lane 6* 8 9 Mills' Yard, Culvert Road 18* 12 20 164 Falcon Road (rear of) 6 6 5 Manley's Yard, 45a Cabul Road 29 24 23 Van dwellings are frequently inspected. One van was unoccupied at the date of the last inspection. The revised by-laws relating to tents, vans, sheds and similar structures used for human habitation which, as briefly noted in the last annual report, were submitted to the Ministry of Health for confirmation in 1936, were duly confirmed and came into force on 1st April, 1937. Rag and Bone Dealers. Six offences against that part of the by-laws of the London County Council which prohibits the giving of toys in exchange for rags, &c., were reported during 1937, the offenders in each case * Including Sheds. 91 being itinerant traders. Two cases were dealt with by cautionary letter, and legal proceedings were ordered in the 4 others, the result of which is shown on page 82. 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 1937. Rats and Mice (Destruction) Act, 1919. This Act imposes on local authorities and occupiers of premises responsibilities in connection with rat repression. The work carried out during 1937 under the Council's Rat Repression scheme is summarised as follows :— Premises visited 1,782 Contracts made or Poison baits used 9,900 renewed 10 Dead rats found 1,436 Value of contracts £128 0 0 Cash for poison bait, &c. £7 6 0 Total expenditure (financial year 1937-38) £521 16 0 Income (financial year 1937-38) £129 11 0 Drains were tested at 66 premises in connection with this work, and in 54 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 " (1st to 6th November). Bait was laid in the sewers, and was supplied to all applicants during the week free of charge. The co-operation of the public was invited by posters and advertisements, and the results were good, considerable numbers of rats being found dead. Destruction of Pigeons. By Section 121 of the Public Health (London) Act, 1936, 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. Only in one case was any action taken under this section. Vermin. Sections 122 to 127 of the Public Health (London) Act, 1936, confer upon Metropolitan Borough Councils powers for dealing with premises, articles or persons infested with vermin. 92 In regard to premises the Council have for years undertaken at the request of the owners, to disinfest dwelling-houses which were badly infested without charge, provided the preliminary work of preparation, such as the stripping of walls, &c., was first carried out. During 1937, 337 premises were so disinfested, 96 of these being dwellings on the Council's own estates. After disinfestation of any of the Councils flats, the tenant is advised how to keep his home free from vermin in future, and is occasionally visited to see that re-infestation has not occurred. In order more effectively to cope with the disinfestation of the furniture of tenants about to move into the Council's flats, it was necessary to provide a chamber in which the process of fumigation could be carried out. There being no building adequate for the purpose within the control of the Health Committee, an arrangement was made with the Baths Committee by which a suitable building near the Latchmere Road baths was utilised. A disused lavatory was adapted to take the place of this building. The cost of the alterations required to both buildings was £96 13s. Od. The Hydrogen Cyanide (Fumigation) Act of 1937, which came into force in July does not as yet affect the Council, who have never employed this substance for disinfestation purposes. Under Section 4 of the Act, however, power is given to apply the provisions of the Act (or some of them) by Order in Council, to fumigation by substances other than hydrogen cyanide. Particulars of the action of the Council in regard to verminous persons is to be found under the next heading. Personal Cleansing Station. During the year 1937, there were 4,256 children and 389 adults cleansed and treated at the station. Of the 4,256 children attending, 1,729 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 4,212 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 (if necessary) of the homes is carried out concurrently by the Borough Council's sanitary staff. 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:— 93 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 1935 194 3,791 787 401 1936 265 4,524 723 403 1937 389 4,256 729 403 16,770 93,620 £16,017 £8.309 * Financial year ending 31st March. Other columns, calendar year. Disinfecting Department. Summary of work carried out by the Disinfecting Department during 1937. Total premises disinfected 2,240 Rooms disinfected 2,256 Staircases disinfected 92 Schools disinfected 5 Number of articles laundered 18,593 „ „ destroyed 321 „ verminous, etc., persons (including 4,212 school children) 4,645 „ infectious disease contacts 358 „ library books collected 230 Articles. No. Weight. Tons cwts qrs. lbs Bedding, &c., disinfected 39,035 94 4 0 11 Ditto (articles from shelters and Cleansing Station, &c.) 8,192 (not weighed) Bedding, &c., lent 1,649 5 1 0 7 Verminous clothing, &c. 21,000 4 13 3 2 Articles from Welfare Centres 2,658 (not weighed) Total 72,534 103 18 3 20 94 Battersea Mortuary, 1937. Details of bodies received. Usual place of residence. Battersea. Wands -worth Elsewhere Residence unknown Total. Inquest at Coroner's Court— Post-mortem at Mortuary 28 64 20 10 122 Post-mortem elsewhere 21 60 27 108 No post-mortem 13 35 16 1 65 Post-mortem at Mortuary— No inquest (Coroner's certificate) 81 127 10 2 220 Other bodies received— Sanitary and other reasons 1 1 2 — 4 Total bodies received 144 287 75 13 519 Total inquests held 62 159 63 11 295 Total post-mortems held at Mortuary 109 192* 30 12 343 VERDICTS AT INQUESTS HELD— Natural causes 6 16 5 1 28 War injuries 1 5 6 Accident and Misadventure— Anaesthesia, operation, &c. 1 1 1 3 Asphyxia 1 3 4 Burns and scalds 3 9 3 15 Drowning — 1 1 Fall 10 36 13 59 Injuries (various) 5 5 2 12 Poisoning—Gas — 2 2 Railway and street 17 30 23 70 Other accidents Open verdict— Abortion 4 — 4 Inattention at birth 4 4 Drowning 3 — 3 Poisoning 5 5 Electric shock 1 — 1 Still-born ___ 6 6 Sepsis of unknown origin 1 1 — 2 Suicide— Cutting 2 2 Drowning 1 3 4 8 Firearms 1 — 1 Hanging 2 . 3 5 Jump from high place 3 1 4 Poisoning—Coal gas 10 25 — 35 „ Drugs, &c. 1 8 — 9 Railway 2 1 2 5 Homicide— Manslaughter 1 1 Wilful murder — — — — — Grand Total 62 159 63 11 295 *Two post-mortem examinations held in one case. 95 Coroner's Court and Mortuary. In June the London County Council were given permission to make use of the mortuary as and when required during the summer months for the reception of bodies from St. James's Hospital in view of the absence of cooling facilities at that hospital. Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1937 are set out in the table on the preceding page. Fouling of Footways by Dogs. Three offences against the Council's by-law with regard to the fouling of footways by dogs were reported during the year, and by order of the Committee proceedings were instituted against the offenders. The result is shown in the table on page 82. The application of this by-law to the Borough appears undoubtedly to have effected a diminution of this objectionable form of nuisance on the public footways. Propaganda. The Council in common with other local authorities throughout the Kingdom, were invited by the Ministry of Health to take part in a national campaign to advertise the health services provided and maintained by public bodies for the maintenance of the nation's health. The campaign was inaugurated by a broadcast speech of the Prime Minister delivered on 30th September. The Council agreed to co-operate, and the posters, leaflets, book-marks, &c., issued free to them by the Government through the agency of the Central Council for Health Education were distributed and displayed in public notice boards and on hoardings to the best advantage. The campaign was designed to last for 6 months, October, 1937, to March, 1938, and during October was devoted to advertising the health services in general, and in November and December, the Maternity and Child Welfare services in particular. In 1938 the subjects are to be the School Medical services and Tuberculosis. Notices were also placed in the post offices giving general information as to the various health services provided by the Council. A proposal by the proprietors of " Better Health " that a local edition of that journal should again be issued through the agency of the Council, was before the Health Committee in December but was not adopted. 96 From 1929 to 1933 by arrangement with the then printers of the journal such an edition had been distributed by the Council through the public libraries, &c., but the printers discontinued the Battersea edition in May, 1933. The booklet enumerating the various activities of the Public Health Department was revised during the year and re-distributed. Various leaflets with regard to diphtheria, measles, &c., were issued to families in which these diseases occurred, and posters were exhibited from time to time with regard to child life protection, rats and mice, &c. The Council during 1937 made a grant of £10 to the Central Council for Health Education in furtherance of their work of education in the principles of health. Conferences. The Council as health authority were represented at the following conferences on various health subjects held during the year:— General subjects—convened by the Royal Sanitary Institute; held at Birmingham 12th to 17th July; delegates, Mrs. M. J. Robinson and the Medical Officer of Health. Health Education—convened by the Central Council for Health Education; held in London 30th September and 1st October ; delegates, Mrs. A. A. Burton (Chairman of the Health Committee) and the Medical Officer of Health. Housing—convened by the National Housing and Town Planning Council; (1) held in London, 4th June; (2) held at Harrogate 26th to 29th November; delegates, Mr. I. O. Thomas (Chairman of the Housing Committee) and the Town Clerk. Maternity and Child Welfare—convened by the National Association for the Prevention of Infant Mortality; held in London 1st to 3rd June; delegates, Mrs. A. A. Burton (Chairman of the Health Committee) and the Assistant Medical Officer for Maternity and Child Welfare. 97 Milk (Special Designations) Order, 1936—convened by the Royal Sanitary Institute; held in London, 28th January; delegates, Mrs. A. A. Burton (Chairman of the Health Committee) and the Medical Officer of Health. Sanitary Inspectors—convened by the Sanitary Inspectors Association; held at Brighton 30th August to 4th September; delegates, Mr. R. Moore and Inspector Selway. Tuberculosis—(7) convened by the Overseas League and the Papworth Village Settlement; held in London 2nd to 4th May; delegates, Mrs. M. J. Robinson and the Tuberculosis Medical Officer (2) convened by the National Association for the Prevention of Tuberculosis; held at Bristol 1st to 3rd July; same delegates. Changes in Staff, 1937. Medical Staff.—In July the Council, on the recommendation of the Health Committee, appointed Dr. S. King, Tuberculosis Officer and Assistant Medical Officer of Health, to be Deputy Medical Officer of Health, and the appointment was subsequently approved by the Ministry of Health. Health Visitors.—In the last annual report it was recorded (page 51) that the Council had decided to appoint two additional Health Visitors in connection with the increased work necessarily resulting from the establishment of "toddlers" clinics at each centre. At their meeting in April the Council, on the recommendation of the Health Committee, appointed Miss I. B. Abbott and Miss K. I. Brown to the new appointments, and they commenced duty on the 3rd May and 8th June respectively. Clerical Staff.—Mr. R. Graham, Grade A clerk, was promoted to Grade B in December. Maternity Hospital.—Dr. J. O. French's period of appointment as resident medical officer expired on 31st March, and on 1st May (the appointment being held by a locum tenens in the interval) Dr. M. Swain, m.b., ch.b., took up duty and held the office until 31st October, when she was succeeded by Dr. B. H. Bakewell, m.b., ch.b. Miss I. Greetham, who held the appointment of sister at the hospital from September, 1936, left the service of the Council on 28th May, 1937, and after advertisement Miss R. Osborn was appointed to the vacant post and commenced duty on 6th October. Tuberculosis Dispensary.—Miss E. F. Davies, who had held the post of dispenser at the Tuberculosis Dispensary since it was taken over by the Council in 1921, was certified to be unfit for further duty on account of illness, and at their December meeting the Health Committee decided to recommend the Council to grant her a superannuation allowance. The matter, however, did not come before the Council until their meeting in January, 1938. 98 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 180 of the Public Health (London] Act, 1936, were brought to the notice of the Sanitary Inspectors and voluntarily surrendered during 1937:— Food. Quantity. Food. Quantity. Fish. Fruit, Vegetables, etc. Haddock 2 boxes. Dates 1 case and 20 Prawns 10 lbs packets. Roes 7 boxes. Lettuces 1 crate. Winkles 1 sack. Pears 6 boxes. Food Poisoning. Under Section 182 of the Public Health (London) Act, 1936, 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. Two such cases were notified to the Medical Officer of Health during the year, neither of which presented features of special interest. The foods suspected were submitted to bacteriological examin- ation but no pathogenic organisms were found, and in each case the patient recovered. 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. One of the two slaughterhouses remaining in Battersea (No. 205 St. Johns Hill) closed its doors in 1937. At the beginning of this century there were nine premises licensed as slaughterhouses. By the end of the War these had been reduced to three, and the only one now remaining is at No 345 Battersea Park Road at which only a few animals are slaughtered from time to time. The licence of these premises was renewed by the Council in June, and the application of two slaughtermen for the renewal of their licences under the Slaughter of Animals Act, 1933, was granted in December. 99 The two slaughterhouses have been kept under systematic inspection by the staff, and during the year 1937, 99 inspections were made by the Council's inspector. The carcases of 27 sheep 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 1937 was 99. Deducting 3, which were closed during the year, there remained 96 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, 1,365 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. It was not found necessary during 1937 to take action for any contravention of the Public Health (Meat) Regulations, 1924. By-laws as to Food. The by-laws made under the London County Council (General Powers) Act, 1932, section 6, which has been re-enacted in Section 183 of the Public Health (London) Act, 1936, came into force on 1st January, 1937, and are administered by the Metropolitan Borough Councils. No offence against these by-laws was reported during the year. 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) is carried out by the Public Analyst for the Borough, at his laboratory at 325 Kennington Road, S.E. 11. 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 1937 was 746, of which 8 or 1.1 per cent. (as in 1936) were certified by the Public Analyst to be adulterated. In addition to the foregoing, 454 informal samples were procured, of which 4 or 0.9 per cent. were reported against. 100 The percentage of samples reported by the Public Analyst to be adulterated during the quinquennia 1921 to 1935 and yearly from 1936, is given in the following table. Year. Formal samples, (per cent.) Informal samples, (per cent.) Mean 1921—1925 6.4 7.4 „ 1926—1930 3.3 2.4 „ 1931—1935 1.8 2.1 „ 1936 1.1 2.2 „ 1937 1.1 0.9 The Public Analyst points out that the year under review yields results closely similar to those of the two preceding years with a slight improvement in the case of informal samples, and there seems little doubt that the frequent and crude adulteration of former times is rapidly becoming a thing of the past. The following tables give details of the articles of which samples were obtained for the purpose of analysis. TABLE I Main Statement. Nature of sample Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Butter 5 45 50 0 0 0 Cheese — 8 8 — 0 0 Cocoa — 14 14 — 0 0 Coffee — 17 17 — 0 0 Confectionery — 8 8 — 0 0 Cream — 23 23 — 0 0 Cream, Tinned — 13 13 — 0 0 Flour — 4 4 — 0 0 Flour, self-raising — 4 4 — 0 0 Jam — 7 7 — 0 0 Lard — 20 20 — 0 0 Margarine — 16 16 — 0 0 Milk 740 — 740 8 — 8 „ (pasteurised) — 6 6 — 1 1 „ condensed (full cream) — 3 3 — 0 0 „ ,, (machine skimmed) — 7 7 — 0 0 Mustard — 4 4 — 2 2 Sugar — 12 12 — 0 0 Tea — 30 30 — 0 0 Vinegar — 4 4 — 0 0 Drugs — 27 27 — 0 0 Other articles 1 182 183 0 1 1 Total 746 454 1,200 8 4 12 101 TABLE II. Drugs (all informal). Nature of sample. Examined. Adulterated. Epsom salts 6 0 Ointment, Boric 13 0 Seidlitz powder 4 0 Tincture, ammoniated, of quinine 4 0 Total 27 0 TABLE III. Other Articles. Nature of sample. Examined. Adulterated. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground — 4 4 — 0 0 Barley, pearl — 1 1 — 0 0 Butter on bread 1 2 3 0 1 1 Cakes, sponge — 12 12 — 0 0 Cheese and tomato paste — 1 1 — 0 0 Cornflour — 1 1 — 0 0 Dripping — 12 12 — 0 0 Fish, canned — 9 9 — 0 0 „ paste — 11 11 — 0 0 Fruits, dried — 19 19 — 0 0 Honey — 5 5 — 0 0 „ prepared — 2 2 — 0 0 Jelly, table — 12 12 — 0 0 Junket crystals — 3 3 — 0 0 Lemonade (cube and crystals) — 4 4 — 0 0 Meat paste — 4 4 — 0 0 Mincemeat (fruit) — 4 4 — 0 0 Olive oil — 4 4 — 0 0 Peel, candied, mixed — 4 4 — 0 0 Pepper — 8 8 — 0 0 Powder, blancmange — 2 2 — 0 0 „ custard — 18 18 — 0 0 Rice — 15 15 — 0 0 Sago — 1 1 — 0 0 Spice, mixed — 4 4 — 0 0 Sponge mixture — 4 4 — 0 0 Suet, shredded — 4 4 — 0 0 Tapioca — 4 4 — 0 0 Vegetables, Tinned (peas) — 4 4 — 0 0 Wines, non-alcoholic — 4 4 — 0 0 Total 1 182 183 0 1 1 102 Adulterated Samples. The total number of samples taken in 1937 and certified by the Public Analyst to be adulterated, or not to comply with the requirements of the various Orders or Regulations, was 12, as follows— Milk.—Eight formal samples. (See following pages.) Milk, Pasteurised.—One informal sample which failed to pass the phosphatase test. Butter on Bread.—One informal sample consisting of margarine on bread. Mustard.—Two informal samples containing 5 per cent. and 10 per cent, wheaten flour respectively. Milk. Of the 740 samples of milk, all of which were formal samples, 8, or 1.1 per cent. were reported as adulterated. Three of the samples were reported to be deficient in milk fat to the extent of 8, 13 and 17 per cent. respectively and five to contain extraneous water, in four cases not exceeding 3 per cent., and in the remaining case 18 per cent. In the 5 years 1932-36, and in 1937, the percentage of adulterated (formal) samples of milk was as under:— Year. Samples taken. Adulterated. No. Percentage. 1932 760 13 1.7 1933 768 6 0.8 1934 750 5 0.7 1935 738 6 0.8 1936 736 7 0.95 Mean 750 7.4 0.99 1937 740 8 1.1 A considerable proportion of the milk supply of London is received at Clapham Junction and South Lambeth Goods Stations and samples are systematically taken on the arrival of the milk at these two stations. Such samples are included in the return on page 100. The average composition of the 737 samples of milk (including five informal samples of pasteurised milk) reported as genuine, proved to be as under:— Total milk solids 12.41 per cent. Milk fat 3.62 ,, Non-fatty solids 8.79 ,, 103 The Analyst reports that the content of milk fat in these 737 samples ranged as follows:— 4 per cent, and over 75 samples or 10-2 per cent. Between 3.9 and 4.0 per cent. 37 ,, ,, 5.0 ,, ,, 3.8 „ 3.9 ,, 79 ,, ,, 10.7 ,, ,, 3.7 „ 3.8 ,, 85 ,, ,, 11.5 ,, ,, 3.6 „ 3.7 ,, 147 ,, ,, 19.9 ,, „ 3.5 „ 3.6 ,, 128 ,, ,, 17.4 ,, ,,3.4 „ 3.5 ,, 105 ,, ,, 14.3 ,, ,, 3.3 „ 3.4 ,, 54 ,, ,, 7.3 ,, ,, 3.2 ,, 3.3 ,, 19 ,, ,, 2.6 ,, ,, 3.1 „ 3.2 ,, 5 ,, ,, 0.7 ,, ,, 3.0 „ 31 ,, 3 ,, ,, 0.4 ,, 737 100.0 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 38 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 10 were taken during the year. Thirty-nine samples of milk were also 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 30 samples of milk were taken for bacteriological examination. Of these 19 were of pasteurised milk and 11 of ungraded milk. The last mentioned samples were tested for the tubercle bacillus but with negative result. The results of the bacteriological examination showed that all the samples complied with the requirements. Under the provisions of sections 21 and 29 and the second schedule of the Food and Drugs (Adulteration) Act, 1928, a vendor from whom a sample has been purchased for the purpose of analysis is permitted to require (within 60 hours) the Council to take samples from a corresponding delivery or milking. During the year advantage was taken of these provisions by five Battersea milk purveyors in regard to 13 samples of milk. No requests were received from the Medical Officers of Health of neighbouring Boroughs for the taking of such samples in the course of delivery. Proceedings with regard to adulteration were taken in seven instances, particulars relating to which will be found set out in the table on pages 82 and 83. 104 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. Four cases in which milk was being sold by unregistered purveyors—in one of the cases from unregistered premises—were reported to the Committee, and in one case proceedings were instituted in respect of the offence committed (vide page 83). In the three other cases the vendors were cautioned. Milk (Special Designations) Order. Under the Milk (Special Designations) Order, 1936, the following designations are used:— "Tuberculin Tested."—This is milk from cows which have passed a veterinary examination and a tuberculin test, and it may be bottled on the farm or elsewhere. If pasteurised, the milk must be described as "Tuberculin Tested Milk (Pasteurised)." If it is bottled on the farm, the word "(Certified)" may be added to its description. "Accredited."—This is raw milk from cows which have passed a veterinary examination; it may be bottled on the farm or elsewhere. It must satisfy the same bacteriological tests as are prescribed for raw Tuberculin Tested milk. "Pasteurised."—This designation is applicable both where "Accredited" milk and where ungraded milk is pasteurised in accordance with the requirements of the Order. The conditions are substantially the same as in the Order of 1923, except that further conditions are imposed with regard to thermometers and temperature records. The Metropolitan Borough Councils are the sole licensing authorities within their respective areas. The number of licences valid during 1937 was as follows:— Full. Supplemental. "Tuberculin Tested" milk 48 3 Accredited milk — — Pasteurised milk 53 8 101 11 One licence to bottle Tuberculin Tested milk, and two to pasteurise milk, were granted and are included in the above figures. In so far as graded milk is concerned 29 of the premises in respect of which full licences were valid during the year were used for the purveyance of both "Tuberculin Tested" and "Pasteurised" milk. Of the remainder 19 were used for "Tuberculin Tested" milk only (one for bottling) and 24 for "Pasteurised" milk. 105 Cautionary letters were, by order of the Committee, addressed to two vendors who were found to be dealing in designated milk without holding the necessary licence, and in two other cases proceedings were taken for similar offences (vide p. 83). The bacteriological examination of samples of milk is referred to on page 103. Milk Shops. The number of premises registered in Battersea for the sale of milk is 120 (including 10 wholesalers' premises). Two wholesale and one retail dairy premises were added to the register and 2 removed therefrom on the purveyors restricting the sale to milk purchased already bottled. In 8 cases registration was transferred on account of change of proprietorship. There are also 8 premises registered for the sale of cream only. All milk shops are kept under systematic inspection, and during the year 522 inspections were carried out and 3 intimation and 4 statutory notices were served to remedy defects found on inspection. Twenty-five vendors whose registered premises are without the borough are registered as purveyors within Battersea. In addition to the above there are 181 persons registered for the sale of milk in sealed receptacles only, eight being added and 10 removed from the register during the year, while in 9 cases the registration was transferred. The condition of premises in the borough in which milk is sold or stored remains at a satisfactory sanitary standard. Condensed Milk. During the year 10 informal samples of condensed milk were submitted for examination, of which 3 were described as "fullcream" and 7 as "machine-separated." All were found to be genuine and to comply with the requirements of the Public Health (Condensed Milk) Regulations, 1923. Artificial Cream Act, 1929. Only 2 shops are registered under the provisions of this Act for the sale of artificial cream. These premises are periodically inspected. Ice Cream. There were at the end of the year 231 premises (excluding street stalls) in the borough used for the manufacture, storage, or sale of ice cream, 11 more than at the end of 1936. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. 106 During the year 330 inspections were made, and it was found necessary to serve 1 intimation notice. In one case it was reported that the name and address of the vendor was not inscribed on the barrow from which the ice cream was sold. A cautionary letter was sent to the offender. 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. 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 1937 no contravention of the regulations was reported. Preserved Food Premises. The duty of registering premises in which preserved foods are prepared or manufactured is placed upon Metropolitan Borough Councils by Section 187 of the Public Health (London) Act, 1936. There were 168 premises upon the register at the end of 1937, 4 new premises having been registered and 10 removed from the register during the year. Thirty-one inspections were made and one sanitary notice was served during the year in respect of this class of 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. 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 the year against Orders, one relating to tomatoes and the other to imported meat. In each case the Committee directed that cautionary letters should be addressed to the offenders. 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 70, 4 being added to the register, and 1 removed. All these premises are kept under systematic inspection. Inspections made during 1937 numbered 308, and 8 notices (6 intimation and 2 statutory) were served for various defects found on inspection. 107 Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1937 was 130, 10 having been added to the register and 6 removed during the year. The number of inspections carried out in 1937 was 343, and in 3 cases it was found necessary to serve intimation notices to remedy various defects. Street Stalls for Sale of Food. There are 171 street stalls in the borough for the sale of food stuffs 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 192 were made of the premises used by street vendors for the storage of their stocks, and in 4 cases defects were discovered calling for the service of intimation notices by the Council. 108 Factories, Workshops, Workplaces and Homework. 1.—Inspections of Factories, Workshops and Workplaces (including Inspections made by Sanitary Inspectors or Inspectors of Nuisances), 1937. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory laundries) 721 40 1 Workshops (including Workshop laundries) 909 23 Workplaces (other than outworkers' premises referred to on page 111) 1,956 75 Total 3,586 138 1 2.—Defects found in Factories, Workshops and Workplaces Particulars. Found on Inspection. Remedied. Referred to H.M. Inspector. Number of Prosecutions. 1 2 3 4 5 Nuisances under the Public Health Act— Want of cleanliness 32 32 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors 6 6 — — Other nuisances 154 150 — — Sanitary accommodation Insufficient 5 5 — 1 Unsuitable or defective 58 57 — — Not separate for the sexes — — — — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (Sec. 101) — — — — Other offences (excluding offences relating to outworkers which are referred to on page 111) — — — — Total 255 250 — 1 109 3.—Registered Workshops. Workshops on Register (Section 131) at end of 1937:— Bakehouses 5 Bootmakers 6 Cycle makers 8 Dressmakers 17 Laundries 3 Milliners 5 Motor repairers 24 Rag sorters 16 Tailors 39 Other trades 99 Total number of workshops 222 4.—Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Section 133) 3 Notified by H.M. Inspector — Underground Bakehouses (Section 101), in use at end of the year 14 Factories and Workshops. Factories. The following is a list of the factories on the register at the end of 1937:— Trade. Number of Factories on Register. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 47 247 28 31 39 Barge builder 2 23 1 — — Bootmaker 28 74 8 — — Builder 5 98 14 — — Butter blender 1 220 16 60 35 Chaff and forage 2 35 1 11 2 Chemical works 1 3 — — — Coachbuilder 2 12 2 — — Chocolate, &c., maker 5 38 2 71 24 Cycle maker 1 2 — — — Dyer 3 44 4 54 4 Engineer 26 1,248 151 49 41 Firewood cutter 8 39 4 11 1 Flour mills 2 159 11 26 7 Foundry 2 29 4 — — Lift maker 2 39 2 — — Mason 7 424 49 — — Mineral water 2 22 8 43 11 Motor repairer 20 215 10 4 — Printer 18 82 22 23 15 Steam laundry 16 80 12 524 161 Other trades 89 4,271 618 1,820 495 Total 289 7,404 967 2,727 835 110 The number of factories included in the foregoing table is 289, as compared with 275 in the corresponding table in the last annual report, 20 new factories having been opened in 1937, and 6 removed. 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. During the year 39 preliminary and 1 statutory notices were served under the Public Health (London) Act, 1936, for defects found on factory premises, for the most part relating to defective or insufficient sanitary accommodation, and in one case it became necessary to resort to legal proceedings (vide page 79) to enforce the requirements of the Council. Workshops. The following is a list of the workshops on the register at the end of 1937:— Trade. No. of Workshops. No. of Workrooms. Persons Employed. Males. Females. Adults. Young Persons. Adults. Young Persons. Baker 5 5 10 — — — Blindmaker 5 6 9 — 2 1 Bootmaker 6 6 15 — — — Builder 6 7 10 5 — — Carpenter 4 4 15 4 — — Coach builder 4 5 25 — — — Cycle maker 8 10 25 5 — — Dressmaker 17 17 — — 31 5 Embroiderer 1 2 — — 7 — Farrier & smith 5 5 13 — — — Florist 5 7 — — 21 1 Laundry 3 8 2 — 6 — Mason 1 1 3 1 — — Milliner 5 5 — — 9 4 Motor repairer 24 29 104 18 — — Musical instrument maker 3 4 9 — — — Photographer 2 6 6 4 2 — Poster and sign writer 6 10 22 3 — — Rag sorter 16 33 49 19 18 4 Tailor 39 50 73 2 65 6 Upholsterer 8 8 19 — 7 — Other trades 49 103 160 19 48 3 Totals 222 331 569 80 216 24 1ll 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 1937 the number of her inspections amounted to 132, while those of the male inspector numbered 777. Fourteen intimation and 8 statutory notices were served for various defects in workshops found on inspection, all of which were complied with. Of these, 4 intimation notices were served by the female inspector. Sixteen new workshops were added to the register, dealing with the following trades:— Baker 1 Motor repairer 4 Bootmaker 1 Tailor 6 Dressmaker 2 Other trades 2 Seven workshops were closed, the total number of workshops being increased to 222. The following are particulars relating to workshops in which "protected persons" were employed, notice of which was duly sent to H.M. Inspector:— Trade. No. of Workshops Protected Persons Employed. Women. Young Persons. Total. Ornamental sugar 1 4 — 4 flowers Dressmaker 1 1 — 1 (alterations) Gowns 1 1 1 2 Tailor 2 2 — 2 Outworkers. During 1937, 115 lists of outworkers were received, viz., 55 from Battersea employers, containing 144 names, and 60 from the Medical Officers of Health of other districts, containing 248 names. After eliminating outworkers not residing in Battersea (of whom 85 names were forwarded to the Medical Officers of the districts concerned) and duplicated entries there remained the names and addresses of 144 Battersea outworkers. The total number of registered outworkers in the Borough is 181, of whom 21 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. 112 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 2 2 2 Bootmaker 14 (14) 21 (21) 24 (24) Dressmaker 32 32 37 Embroiderer 25 25 29 Fancy goods 13 13 13 Fancy boxes 6 6 6 Fine needlework 3 3 3 Glovemaker 1 1 1 Knitting and crochet 3 3 3 Tailor 60 (44) 70 (54) 108 (91) Underclothing 3 3 4 Other trades 19(2) 19(2) 21 (4) Female Inspector 121 121 132 Male „ 60 77 119 Total 181 198 251 There were 43 new outworkers' premises added to the register and 39 were removed, there being thus an increase of 4 in the number registered. There were 721 inspections of outworkers' premises, of which 536 were by the female inspector. Two intimation notices were served for sanitary defects found on inspection. Three cases of infectious disease occurred in these premises during 1937, and the usual precautionary measures were taken to prevent the spread of infection. Bakehouses. There were 55 bakehouses in Battersea at the end of 1937, at three of which no person other than the proprietor was employed. Of this total 47 use power and are therefore technically factories. Fourteen of the 55 are underground bakehouses. Additions to and removals from the list during 1937 were:— New bakehouses Factories—3. „ ,, Workshops—1. Premises closed Factories—2 (1 underground and 1 above ground) „ „ Workshops—2 (above ground). 113 Inspections made numbered 137, of which 120 were to factory bakehouses, and 25 intimation notices were served, mainly for failure to carry out the half-yearly cleansing or lime-whiting of the bakehouses within the statutory period. Warehouses and Wharves, &c. At the end of 1937 there were 61 premises on the register, including railway yards, mews and stables. These premises are systematically inspected, and during the year 108 inspections were made. Three intimation notices were served to remedy nuisances found on inspection, and were complied with. Factories Act, 1937. This Act, which is to come into force on 1st July, 1938, repeals and consolidates existing Factory, &c., Acts, and revises the existing law in conformity with modern standards and conditions. It also provides for improved arrangements for the safety, health and welfare of factory workers. It contains a revised and extended definition of "factory," which now includes inter alia building operations and engineering construction works coming within the definition of the Act, and also laundry and dyers' receiving offices where sorting of articles is carried out. Distinctions which previously existed between a factory and a workshop and between textile and non-textile factories are abolished, only the one term "factory" being used. The Metropolitan Borough Councils are, as previously, to enforce the provisions with regard to sanitary conveniences in all factories, and in factories where mechanical power is not employed (i.e., "workshops") they are to enforce the clauses relating to cleanliness, overcrowding, temperature, ventilation and drainage of floors. Of these items, temperature is new. The provisions as to overcrowding are made more stringent, but for a period of five years existing workrooms are to be subject to the present standard. There is also a requirement that a supply of drinking water shall be available for employees in factories. 114 Housing. New Working Class Dwellings. During the year 18 tenements were erected by the Council as part of their housing programme. These were on the site of Nos. 231 to 253 York Road, which had been acquired by the Council with a view to extension of the Plough Road Improvement Scheme. One hundred and sixty-two tenements were erected by the Peabody Trust on the site of the Royal Masonic School for Girls, St. Johns Hill, and seven flats were erected by the Battersea Housing Association at Condell (late Sterndale) Road. In addition to the foregoing 13 dwellings were erected by private enterprise. The Council endeavoured to purchase land in Sheepcote Lane, the site of the disused Waterloo branch of the West London Extension Railway, but the railway company were not for the time being prepared to dispose of the land. In connection with the Savona Street Clearance Orders made by the London County Council, a small piece of land, suitable for the erection of two tenements, which was not required by the County Council for redevelopment, was offered to this Council. The offer was accepted. Overcrowding. In order to be in a position to supply landlords of property with the "permitted number" for the dwellings—which information must be inserted in the rent books—the Council engaged additional temporary staff to measure rooms and obtain particulars of occupancy. In all, the rooms of some 18,600 houses were measured, and in addition particulars of occupancy of nearly 4,000 houses measured during the preliminary survey in 1935 were reviewed. In this way it was ascertained that over 900 cases of overcrowd ing previously recorded had been abated, but over 400 new cases were registered. During the year certificates as to "permitted numbers" were issued in respect of 9,664 houses containing 15,143 dwellings. The Minister of Health, on 1st January, 1937, issued a circular on the subject of overcrowding. The following excerpt from this circular is indicative of the spirit in which the duties imposed upon the Council are being carried out:— "The Minister is confident that, when local authorities come to the discharge of their new duties after the appointed day, he can rely on them to carry out this difficult task of administration with discretion and sympathy. The essence of the matter is to realise that most families are overcrowded through no fault of their own, and the object of the Act is to help such people and not to injure them." 115 During the year five cases of overcrowding in such circumstances as to create an offence under the Act were reported, but in only two of them was it necessary to serve notice upon both the landlord and the tenant requiring the abatement of the overcrowding. These notices had not expired at the end of the year. In two of the other cases the overcrowding was abated by removal, and in the remaining case by a reduction in the number of persons residing in the dwelling. During the year 16 families who were living under overcrowded or other insanitary conditions were accommodated on the Council's Housing Estates on the recommendation of the Medical Officer of Health. In addition 151 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 1937. Total. Families accommodated 23 36 59 Offer declined or applicant otherwise suited 11 10 21 Recommendation not accepted by the London County Council 8 14 22 Still under consideration 40 91 131 Totals 82 151 233 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 273 Battersea families were provided with accommodation on London County Council estates outside the Borough. Accommodation was also provided by them at Peterhead House, Battersea Bridge Buildings or Durham Buildings for 73 other Battersea families. Clearance Areas. Lothair Street Area and Livingstone Road and Winstanley Road Area.—The dwelling houses comprised in these areas, reference to which was made in the annual report of the Medical Officer of Health for 1936, were demolished during the year. With regard to the buildings in Winstanley Road, which, as recorded, were excluded from the Order made by the Minister of Health after public inquiry, the owners gave the necessary formal undertaking which enabled the Council to deal with the premises under Demolition Order procedure (vide page 117). 116 Sheepcote Lane Area.—This area, as mentioned in previous Annual Reports, had been the subject of a Clearance Order and Compulsory Purchase Order made by the London County Council, and by arrangement the land was subsequently to be transferred to this Council. The orders became operative during the year, and progress is being made in the acquisition of the property. Mendip Road Area.—This area, which, as in the case of the Sheepcote Lane Area, was dealt with by the London County Council on behalf of this Council, was the subject of a local inquiry on the 18th January. The Order was duly confirmed by the Minister and the acquisition of the property was progressing at the end of the year. Provisional lay-out plans have been approved, and on this site, which comprises some 45 houses, will be erected 90 tenements. (a) Rush Hill Mews and Marmion Mews; (b) Doddington Road; (c) Culvert Road; and (d) Miles Cottages, Spicer Street, Areas.— During the year the Medical Officer of Health represented these areas with a view to Clearance Orders being made by the Council. In all some 25 dwellings are involved and the re-housing of some 82 persons will become necessary. The Orders had not been made by the Council at the end of the year. A fifth small area, consisting of 10 dwellings, was also represented, but at the request of the London County Council was not, for the time being, proceeded with. Savona Street Area.—The houses in this area in respect of which the Clearance and Compulsory Purchase Orders made by the London County Council were confirmed in 1936 were in course of demolition during 1937. Hibbert Street (Nos. 1 and 2) Areas.—Towards the end of the year the London County Council declared two areas to be clearance areas. Area No. 1, including additional lands, was 8.66 acres in extent and comprised 262 houses. It is proposed to redevelop this area and erect a school and approximately 270 dwellings on the site. Area No. 2 was .26 acres in extent and comprised 15 houses which were to be dealt with by clearance order only, the site being too small for housing redevelopment. Repair of Unfit Houses. 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 1937 will be found summarised on pages 119 to 121. In no case was it found necessary for the Council to enter and carry out, in default of the owner, the repairs necessary to secure compliance with notices served under the Housing Acts. A list of works proposed to be carried out at certain premises in the borough was submitted on behalf of the owner, and an 117 opinion was requested under Section 51 of the Housing Act, 1936, as to whether, after the execution of such works, the house would be in all respects fit for habitation, and, with reasonable care and maintenance, would remain so fit for a period of at least five years, in which case the premises could not be included in a Clearance Area or dealt with by Demolition Order procedure during the specified period. The owner's representative was informed of the necessary amendments which would be required to his list of works, but the matter did not proceed further. Appeals. No appeals were lodged against notices served under section 9 of the Housing Act, 1936, during 1937. Demolition Orders. In connection with the Winstanley Road Clearance Area (vide page 115) 3 shops with dwelling accommodation over were excluded from the Clearance Order. The owners subsequently gave an undertaking under Section 11 (3) of the Housing Act, 1936, to demolish the dwelling portion, leaving one-storey shops. This undertaking was duly carried out. Another house in Winstanley Road, which was represented in 1936 with a view to a demolition order being made, was rendered fit by the owner, following an undertaking given by him. Two other houses were represented with a view to the making of demolition orders, but action was not concluded by the end of the year. Closing Orders. Five Closing Orders were made during the year in respect of parts of buildings which were unfit for habitation—3 in Brougham Street and 2 in Battersea Park Road. In addition 33 other houses in various parts of the borough were represented with a view to the closing of part of the houses, but these cases were still under consideration at the end of the year. Increase of Rent, Etc., Acts. During 1937, 9 applications were received from tenants for the certificate, and 4 from owners for the report of the Sanitary Authority under the above mentioned statutes. The application for a certificate was granted in 8 cases and refused in the other; that for a report was granted in each case. Action under Section 4 of the Housing Act, 1936. During 1937, in 15 cases (relating to 15 houses) contraventions of section 4 of the Housing Act, 1936, 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 118 proceedings were considered necessary, but the Housing Committee directed that cautionary letters should be sent to the offenders. Action under Section 62 of the Housing Act, 1936. Section 62 of the Housing Act prescribes that every rent book or similar document shall contain a summary of the overcrowding provisions of the Act, together with a statement as to the "permitted number" for the dwelling. During the year in 19 cases (relating to 19 houses) this section was found to have been contravened. Satisfactory explanations having been received, and the rent books having been put in order, cautionary letters were, by the direction of the Housing Committee, addressed to the offenders. Structural Defects. The attention of the District Surveyor of the London County Council was drawn, in 85 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 9 of the Housing Act, 1936, or under the provisions of section 12 of the Act, during 1937 Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District— No. 3 Dist. (cont.) No. 6 Dist. (cont.) Chalmers Street 10 Parkham Street 3 Ingrave Street 7 Corunna Road 1 Petworth Street 3 Louvaine Road 1 Gonsalva Road 29 Radstock Street 1 Meyrick Road 5 Motley Street 46 Surrey Lane 1 Newcomen Road 1 Stewarts Road 1 Winstead Street 52 St. Johns Hill No. 2 District— No. 4 District— Grove 44 Winstanley Road 1 Austin Road 1 Afghan Road 3 York Road 1 B. Park Rd. 3 Cabul Road 4 Dagnall Street 1 Candahar Road 1 No. 7 District— Henley Street 1 Harroway Road 2 Gowrie Road 1 Landseer Street 2 Ingrave Street 4 Lavender Sweep 1 Latchmere Road 1 Kambala Road 10 Marney Road 1 Latchmere Street 3 Mantua Street 6 Longhedge Street 6 Musjid Road 3 No. 8 Distyict— Newtown Street 1 Rowena Crescent 2 Almeric. Road 1 Orkney street 2 Stainforth Road 1 Bennerley Road 1 Ravenet Street 2 Rollo Street 2 No. 5 District— Boutflower Road 1 St. James Grove 1 Beaufoy Road 4 BolingbrokeGrove 2 Boundaries Road 1 Dorothy Road 1 No. 3 District— Buckmaster Road 17 Queens Road 1 B. Bridge Rd 3 St. Philip Street 1 Darley Road 1 B. High Street 1 Hillier Road 1 Tennyson Street 1 Bridge Rd. West 4 Honeywell Road 2 Tyneham Road 17 Ethelburga Street 17 Leathwaite Road 3 Granfield Street 1 No. 6 District— Mallinson Road 12 Henning Street 1 Andoe Road 1 Salcott Road 2 Hyde Lane 8 Cologne Road 2 Sangora Road 1 Orbel Street 2 Darien Road 1 Strathblaine Rd. 3 119 Summary. No. 1 District 5 streets 87 houses. „ 2 „ 13 „ 26 „ „ 3 ,, 13 „ 97 „ „ 4 „ *10 „ 36 „ „ 5 ,, 6 „ 25 „ ,, 6 „ *10 „ 64 „ „ 7 ,, 3 „ 3 „ „ 8 „ 14 „ 48 „ Totals *73 „ 386 „ * One street included in both Nos. 4 and 6 Districts. Statistics for the Year ended 31st December, 1937. Number of New Houses or Tenements erected during the year:— (1) By the Local Authority 18 (2) By other Local Authorities Nil. (3) By other bodies and persons 182 Number of Houses Demolished during the year:— (1) In pursuance of demolition orders 2 (2) In connection with clearance areas 59 (3) Voluntarily 28 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) 5,108 (b) Number of inspections made for the purpose 31,644 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,204 (b) Number of inspections made for the purpose 9,315 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,001 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 395 120 3. Action under Statutory Powers during the Year (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling houses in respect of which notices were served requiring repairs 54 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 59 (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 2,650 (3,190 intimation notices) (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,593 (3,153 intimation notices complied with) (b) By Local Authority in default of owners 5 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses in respect of which an undertaking was accepted under subsection 3 of section 11 4 (3) Number of dwelling houses demolished in pursuance of Demolition Orders 2 (d) Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 5 (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) Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 1,365 (ii) Number of families dwelling therein 1,365 (iii) Number of persons dwelling therein 7,192½ 121 (b) Number of new cases of overcrowding reported during the year 432 (c) (i) Number of cases of overcrowding relieved during the year 940 (ii) Number of persons concerned in such cases 4.679½ (d) Number of cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil 122 APPENDIX. REPORT OF THE MEDICAL OFFICER OF HEALTH SUBMITTED TO THE COUNCIL ON 29th DECEMBER, 1937. Toddlers' Clinic. In September, 1936, the Council decided to establish a special weekly toddlers' clinic, to be held at " Southlands." The first clinic was held on 3rd November, 1936. I have pleasure, as instructed by the Committee, in submitting a report on the work of this clinic from its commencement until 27th July, a period of nine months. In my original report I suggested that children should be invited to attend for a complete medical examination on or about their 2nd, 3rd and 4th birthdays. It was, however, thought advisable in the first place to limit the invitations to the children at their third birthday, until it was known what response would be made. An average attendance of 8 to 10 per session is one which, in my opinion, is best suited for this type of clinic, as it allows the doctor to make a thorough investigation of each case ; and the average attendance has in fact been 8.3 per session. Pending the submission of this report, therefore, no attempt has been made to get children of other ages to the clinic, as this would have meant an additional session. Each child on its attendance is also examined by the Dental Surgeon and appointments made for treatment at the Council's dental clinic where necessary. Appointments are also made for re-attendance at the dental clinic at intervals of 3 to 6 months, in order that the earliest signs of dental caries or deformities may be detected and treated. The number of effective written invitations sent to mothers to attend these clinics with their children during the period referred to was 874, and 280 children (32 per cent.) attended for examination. The following tables summarise the work done at the Clinic since its commencement:— Toddlers' Clinic, 3rd November, 1936, to 27th July, 1937, inclusive. (1) Invitations (net number, after deducting returns through post, &c.) 874 (2) Children who attended— Invited 273 Not invited Aged 2-3 4 „ 4-5 3 7 280 123 (3) Attendances 300 (4) Number of children who have never attended a centre 84 (5) Clinics held 36 (6) Average attendance per clinic— New cases 7.77 Old cases .56 8.3 (7) Referred elsewhere for treatment (including dental treatment) 118 (8) (a) Advised to attend Schick Clinic 255 (b) Did so 29(11%) (9) Number of children recommended for grant of milk 8 Medical Inspection of Toddlers, 1936-7. Disease, defect or condition found— Nutrition—(a) Normal 270 (b) Poor 10 Defective teeth 80 Englarged tonsils and adenoids 54 Enlarged glands 13 Eye defects—(a) squint 6 (6) infective 2 Otorrhoea 1 Skin conditions 13 Knock knee 21 Heart—(a) organic 2 (6) functional 3 Lung defects 9 Nervous defects 3 Phimosis 12 Enuresis 13 Hernia—(a) umbilical 1 (b) inguinal 1 Nasal diphtheria 1 Evidence of past rickets 25 Nævus 5 The total attendances of children at the infant welfare clinics during the past three years were as follows :— Under 1. 1 to 5. 1934 16,357 9,551 1935 17,784 9,423 1936 18,563 8,681 From these figures it appears that, whilst there has been a steady rise in the attendance of children under 1, there has been a corresponding fall in the attendance of toddlers. I have been struck by the large number of children (30 per cent.) who have never been brought to any infant welfare centre, and I think that the value of a special toddlers' clinic is being increasingly realised by parents. At present toddlers attend the special clinic in response to a written invitation, the list of invitations being compiled from the register of births and deaths. Frequently, however, families have removed to an unknown address, and there are, in addition, many families, of which we have no information, who have removed into the Borough. The total number of children examined at the toddlers' clinic during the past 9 months is 280, and I have estimated that there are about 5,000 children between the ages of 1 and 5 in this Borough who are not attending an infant welfare centre and who are not under medical supervision at a nursery school. This experimental toddlers' clinic, therefore, only touches the fringe of the problem. As 42 per cent. of the toddlers who attended the clinic at the age of 3 have been recommended for treatment for one or more defects I think the necessity for a comprehensive scheme for the supervision of toddlers is established, and it appears 124 to me that in order to ensure that all toddlers receive adequate medical supervision a considerable extension of the present scheme is called for. If the Council agree to such an extension the question arises whether the work should be concentrated at a central clinic or spread among the existing centres. The advantages in having one central toddlers' clinic at Southlands are :— (1) Every case can be seen by the dental surgeon on the first attendance at the clinic. (2) No increased expense for rent of clinic. The disadvantages are :— (1) The distance from the outskirts of the Borough, e.g., the hardship to a mother who has a baby in addition to the toddler. (2) The previous Maternity and Child Welfare records of the child (which are filed at the respective centres) are not available to the doctor examining the case. (3) Mothers are sometimes unwilling to bring their children to a strange centre. It appears to me that the problem can only be adequately dealt with by holding a toddlers' clinic at each district Maternity and Child Welfare centre. If this is done, it will be possible to invite to the clinics— (1) Toddlers at ages of 2, 3 and 4—by written invitation ; (2) All toddlers over the age of 2 from the infant welfare centres ; and more time can then be devoted to the medical supervision of infants at the welfare centres. Such a clinic should be held weekly (for if it were held every two weeks, mothers would attend on the wrong day). An increased expenditure in rent or other charges would be involved in the case of the Chatham Hall, Plough Road, All Saints and Gideon Road Centres. Based on the amounts now paid for these premises, I estimate that an additional rent of £45 per annum would be required, while additional cleaning, &c., necessary would probably cost £55 per annum. Medical Staff.—A doctor with especial experience in children's diseases would be required for five sessions per week. The minimum rate of remuneration for such an appointment is one and a half guineas per session, involving an expenditure of £400 per annum. 125 I recommend that a toddlers' clinic be established at each of the Council's Maternity and Child Welfare centres in the Borough. The additional cost is estimated to amount to £500 per annum. (Signed) G. MACDONALD, Medical Officer of Health. Public Health Department, 204 Lavender Hill, S.W. 11. September, 1937. 126 Causes of Death at different Periods of Life in Battersea, 1937. The following table is supplied by the Registrar General at the request of the Ministry of Health:— Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. 947 91 11 5 18 22 36 43 104 177 234 206 F. 903 60 13 8 13 34 29 35 63 133 204 311 1. Typhoid and paratyphoid fevers M. - - - - - - - - - - - - F. 1 - - - - - - - - - - - 2. Measles M. - - - - - - - - - - - - F. 3 — 1 1 1 - - - - - - - 3. Scarlet fever M. 1 __ 1 - - - - - - - F. - - - - - - - - - - - - 4. Whooping cough M. 5 2 1 2 - - - - - - - - F. 4 2 2 - - - - - - - - 5. Diphtheria M 2 - - - 2. - - - - - - - F. 7 2 1 2 2 - - - - - - - 6. Influenza M. 22 1 - - - 1 2 3 9 3 3 F. 21 1 - - - - - 3 3 3 8 3 7. Encephalitis lethargica M. 1 - - - - - - - - - 1 - F. 1 - - - - - - 1 - - - - 8. Cerebro-spinal fever M. 2 2 - - - - - - - - - - F. 1 - - 1 - - - - - - - - 9. Tuberculosis of respiratory system M. 63 1 1 1 - 6 14 8 18 13 1 - F. 48 — — — — 17 15 7 5 4 - — 10. Other tuberculous diseases M. 6 1 1 1 1 1 1 - - - F. 6 — 1 1 — 2 1 — 1 — — — 11. Syphilis M 3 1 - - - - - 1 - - 1 F. 3 1 - - 1 - - 1 - - - - 12. General paralysis of the insane, tabes dorsalis M. 1 - - - - - - - - - 1 — F. 2 — — — — — — — 1 1 — — 13. Cancer, malignant disease M. 130 1 1 3 16 45 42 22 F. 114 — — — — 3 1 5 17 22 35 31 14. Diabetes M. 11 - - - - - - 1 1 3 5 1 F. 20 - - - - - - - 2 4 10 4 15. Cerebral hæmorrhage, etc. M. 17 - - - - - - - 1 2 3 11 F. 30 - - - - - - 1 1 6 10 12 16. Heart disease M. 247 2 2 3 5 16 40 84 95 F. 329 — — — 4 5 2 4 10 40 77 187 17. Aneurysm M. 5 - - - - - - 1 - 3 1 - F. 11 - - - - - - 1 1 3 5 1 127 Causes of Death, 1937—(contd.). Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 18. Other circulatory diseases M 31 - - - - - - - 1 5 18 7 F. 41 - - - - - - - 3 7 10 21 19. Bronchitis M 74 8 - - 1 __ 4 10 15 15 21 F. 32 - 1 - - - - - 1 4 9 17 20. Pneumonia (all forms) M 59 13 4 - 3 1 3 9 7 9 7 F. 29 8 2 1 1 1 1 — — 7 3 5 21. Other respiratory diseases M 6 - - - - - - - - - 1 2 F. 7 - - - - - - 1 — 2 1 3 22. Peptic ulcer M 23 - - - - - 1 3 6 4 6 3 F. 7 - - - - - - 1 — 2 2 2 23 Diarrhœa, &c. M 15 12 1 - __ i 1 — F. 20 17 - - - - - - - 2 1 — 24. Appendicitis M 8 - - - - - 1 — 2 2 2 1 F. 4 — — — 1 i — 2 — — — — 25. Cirrhosis of liver M. 8 - - - - - - - 2 3 3 — F. 2 — — — — — 1 — 1 — - 26. Other diseases of liver, &c. M 4 - - - 1 1 2 — F. 7 — — — — 3 — 1 1 — 2 27. Other digestive diseases M 8 - - 1 1 3 1 1 1 F. 9 1 — — — 1 1 2 2 1 1 28. Acute and chronic nephritis M 39 -- - - - 1 1 1 3 6 16 11 F. 24 - - - - - - - 4 7 12 1 29. Puerperal sepsis F. - -- - - - - - - - - -- - 30. Other puerperal causes F. 4 — — — — 3 1 — — — 31. Congenital debility, premature birth, malformation, &c. M. 48 47 1 - - - - - - -- - - F. 25 25 - - - - - - - - - - 32. Senility M. 3 - -- - - - - - - - - 3 F. 10 -- - - - - - - - - 1 9 33. Suicide M 11 1 2 1 3 2 2 — F. 6 - - - - - 1 — 1 2 1 1 34. Other violence M 29 2 3 4 2 4 3 5 3 3 F. 22 — 1 1 2 1 — — 3 3 5 6 35. Other defined diseases M 65 2 1 1 4 4 6 2 6 11 13 15 F. 53 3 4 1 1 4 — 5 7 10 13 - 36. Causes ill defined, or unknown M - - - - __ — — — — F. - - - -- - - - - - - - - 128 Maternal Mortality in the County of London and in Battersea, 1921-1937. 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. 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 04 606 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 1935 1.15 1.43 2.58 — 1.90 1.90 Mean (1931.1935) 1.50 1.66 3.17 1.21 1.82 3.03 1936 0.75 1.17 1.92 1.37 0.91 2.29 1937 0.84 1.45 2.29 — 1.87 1.87 Puerperal Fever Notifications in the County of London and in Battersea, 1921-1937. 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) 410 2.94 1931 4.44 2.42 1932 3.51 1.72 1933 4.51 1.33 1934 4.48 4.64 1935 4.32 1.90 Mean (1931-1935) 4.25 2.40 1936 3.19 1.41 1937 4.16 1.40 129 North Battersea. Infant Mortality, 1937. 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. r. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... 2 2 Diphtheria & croup ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Erysipelas ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Pulmonary Tuberculosis Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... .... ... ... 1 ... ... ... ... ... 1 ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 ... ... ... ... ... 5 ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 4 5 ... ... 3 8 7 Diarrhoea & Enteritis ... ... .... ... ... ... ... ... ... ... ... ... 1 2 3 3 3 4 ... 2 7 11 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. .. ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature birth 6 1 3 1 1 ... ... ... ... 9 3 2 1 ... ... ... ... ... ... 11 4 Congenital malformation ... ... 2 ... ... ... ... ... ... ... 2 ... 2. 1 1 ... ... ... ... ... 5 1 Congenital debility ... ... 1 ... ... ... ... ... 1 ... 2 ... ... 1 ... ... ... ... ... ... 2 1 Icterus neonatorum 1 ... ... 1 ... ... 1 ... 2 1 ... ... ... ... ... ... ... ... 2 1 Injury at birth 2 1 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 2 i Atelectasis and Asphyxia neonatorum ... 2 1 1 1 ... ... ... ... ... 2 3 ... ... ... ... ... ... ... ... 2 3 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Melæna neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Burns ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... i ... Other causes ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... 1 ... ... 2 1 8 4 9 2 1 2 2 2 — 22 8 10 5 10 ... 11 7 1 8 54 36 Totals 12 11 3 2 2 30 15 18 18 9 90 Nett births in the year. Nett deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1,075 49 1,124 87 3 90 130 South Battersea. Infant Mortality, 1937. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9 12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria & croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... 3 ... Pneumonia (all forms) ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 2 1 ... ... ... ... 5 1 Diarrhœa & Enteritis ... ... ... 1 ... ... ... ... ... ... ... 1 1 1 1 1 2 1 1 2 5 6 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature birth 3 2 1 3 1 ... 2 ... ... ... 7 5 1 ... ... ... ... ... ... ... 8 5 Congenital malformation ... 2 1 2 1 1 ... ... ... ... 2 5 2 ... 2 ... ... 1 ... ... 6 6 Congenital debility ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 Icterus neonatorum ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 Injury at birth 1 ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 Atelectasis & Asphyxia neonatorum 2 ... 2 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 4 ... Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage of newly born 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burns ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Totals 7 4 4 8 3 1 3 2 ... ... 17 15 8 1 8 3 2 3 2 2 37 24 11 12 4 5 ... 32 9 11 5 4 61 Nett births in the year. Nett deaths in the year(Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 983 37 1,020 58 3 61 131 Borough of Battersea. Infant Mortality, 1937. Nett Deaths from stated causes at various ages under 1 year. causes of death. age periods. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year. Percentage of Total. 1-2 2-3 3-4 1-3 3-a 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... 2 2 2.65 Diphther:a and croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1.33 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Intluenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0.66 MeningococcalMeningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 1.33 Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.66 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 0.66 Bronchitis ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... 5 ... ... ... ... ... 8 ... 5.30 Pneumonia (all forms) ... ... ... ... ... ... 1 ... ... ... 1 ... 4 ... 3 5 5 ... ... 3 13 8 13.91 Diarrhœa & Enteritis ... ... ... 1 ... ... ... ... ... ... ... 1 2 3 4 4 5 5 1 4 12 17 19.21 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0.66 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 0.66 Cancer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature birth 9 3 4 4 1 1 2 ... ... ... 16 8 3 1 ... ... ... ... ... ... 19 9 18.54 Congenital malformation ... 2 3 2 1 1 ... ... ... ... 4 5 4 1 3 ... ... 1 ... ... 11 7 11.92 Congenital debility ... ... 1 ... ... ... ... 1 1 ... 2 1 1 1 ... ... ... ... ... ... 3 2 3.31 Icterus neonatorum ... ... 1 1 ... 1 ... ... 1 ... 2 2 1 ... ... ... ... ... ... ... 3 2 3.31 Injury at birth 3 1 ... 1 ... ... ... ... ... ... 3 2 ... ... ... ... ... ... ... ... 3 2 3.31 Atelectasis & Asphyxia neonatorum 2 2 3 1 1 ... ... ... ... ... 6 3 ... ... ... ... ... ... ... ... 6 3 5.96 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Melæna neonatorum ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.66 Hæmorrhage of newly born 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 0.66 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 1.33 Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0.66 Burns ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0.66 Other causes ... ... ... ... ... ... 2 1 ... ... 2 1 ... ... ... ... ... 1 ... ... 2 2 2.65 15 8 13 10 4 3 5 2 2 - 39 23 18 6 18 11 13 10 3 10 91 60 100.00 Totals 23 23 7 7 2 62 24 29 23 13 151 ... Percentage of Total 15.2 15.2 4.7 4.7 1.3 41.1 15.9 19.2 15.2 8.6 M.60.3 F.39.7 Nett births in the year. Nett deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M. 1.058 42 1,100 87 4 91 F. 1,000 44 1,044 58 2 60 Totals... 2,058 86 2,144 145 6 151 132 Form T137 1937. Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937, in the area of the Metropolitan Borough of Battersea (to which this return relates). Age Periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males 1 1 2 — 7 17 36 14 14 13 4 109 135 ,, Females — 1 1 2 10 21 25 9 8 6 1 84 107 Non-Pulmonary Males — 2 — 2 5 1 3 1 — 1 — 15 16 „ Females 1 3 2 2 3 1 4 2 — — — 18 18 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) NOTES—Part I. (а) Formal notifications are notifications which are made in pursuance of Article 5 of the Public Health (Tuberculosis) Regulations, 1930, and should include notifications made by Naval, Military or Air Force Medical Authorities. (б) Primary notifications for the purpose of columns (2)—(13) relate to patients who have never previously been formally notified in the area to which the Return relates. A patient who changes his residence from one Sanitary District to another in the same County may properly be the subject of Primary Notification in each such District. Only the first of such notifications, however, should be recorded in columns (2)-(13) of the Return for the County concerned, the subsequent notification(s) being included in column (14). (c) Column (14). All formal notifications, whether duplicate or not, should be included in this column. General.—Patients notified as suffering from combined pulmonary and non-pulmonary tuberculosis should be included among the " pulmonary " returns only. If a patient already notified as suffering from one form of tuberculosis is subsequently notified to the Medical Officer of Health of the same Sanitary District as suffering from another form of tuberculosis, the fact should be noted in the Notification Register, but such notification should be recorded as a duplicate notification. 133 Supplemental Return. Part II.—New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males 1 2 — — 1 — — — 1 2 — 7 „ Females — — ' — — 2 3 1 — — — — 6 Non-Pulmonary Males ... 1 1 — — — 1 1 — 1 — • — 5 ,, Females — 1 — — 2 — — — — — — 3 The source or sources from which information as to the above-mentioned cases was obtained should be stated below :— Source of Information. No. of Cases. Pulmonary. N on-pulmonary. Death Returns from local Registrars 3 2 transferable deaths from Registrar-General 2 2 Posthumous notifications 6 2 " Transfers " from other areas (other than transferable deaths) 2 2 Other sources if any (specify) - - 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." (f) Particulars of cases coming to knowledge through the Death Returns, as well as of cases notified posthumously, are required by Article 10 (2) of the Regulations to be entered in the Notification Register. It follows that such cases will also be duly included in the number of cases removed from the Register during the year by reason of "death."—(of. Head 3 of the second section of Part III. of the form overleaf.) (d) No case should be included both in the Summary of Notifications and in the Supplemental Return for the same year. (e) In Counties, the particulars for the purposes of this Return should be obtained by the procedure suggested in paragraph 2 of Part II. of Circular 549. 134 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, 1937, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 350 290 640 95 94 189 829 Number of cases removed from the Register during the year by reason of :— 1. Withdrawal of notification 2 2 4 1 1 2 6 2. Recovery from the disease 13 12 25 10 3 13 38 3. Death (all causes) 69 48 117 7 7 14 131 4. Otherwise 49 39 88 6 12 18 106 NOTES.—Part III. In Counties, the information should be compiled from the quarterly statements for the year 1937, which are required to be furnished to the County Medical Officer of Health by the Medical Officer of Health of each District in the County, in pursuance of Article 10 (8) of the Regulations, and should represent the sum of the figures relating to each District in the County. If any of these quarterly statements has not been duly received by the County Medical Officer of Health, the Ministry should be furnished with particulars, including the name of the District concerned. Further, if the County Medical Officer of Health is in any doubt as to the accuracy of the figures included in his Return, he should record the fact, giving reasons. 135 Form T 145 TREATMENT OF TUBERCULOSIS. BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1937. (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 63 57 3 5 8 9 2 4 71 66 5 9 151 *(b) Diagnosis not completed - - - - - - - - - - 4 10 - - 14 (c) Non-tuberculous - - - - - - - - 148 164 47 49 408 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 — — — — -— — 1 1 — — 2 *(b) Diagnosis not completed - - - - - - - - - 1 -- - 1 (e) Non-tuberculous - - - - - - - - 43 85 70 67 265 C.—Cases written off the Dispensary Register as— (a) Recovered 10 11 2 1 2 1 7 1 12 12 9 2 35 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 198 253 117 117 685 D.—Number of cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 296 225 15 22 34 38 37 42 330 263 52 64 709 (6) Diagnosis not completed ... - - - - - - - - 4 11 — - 15 1. Number of cases on Dispensary 2. Number of cases transferred from Register on January 1st 739 other areas and cases returned after discharge under Head 3 in previous years 37 3. Number of cases transferred to 4. Cases written off during the year as other areas, cases not desiring further Dead (all causes) 89 assistance under the tuberculosis Scheme, and cases " lost sight of " 84 5. Number of attendances at the Dispen- 6. Number of Insured Persons under sary (including Contacts) 4,837 Domiciliary Treatment on the 31st December 137 7. Number of consultations with medical 8. Number of visits by Tuberculosis practitioners :— Officers to homes (including pcr- (a) Personal 7 sonal consultations) 362 (b) Other 400 9. Number of visits by Nurses or Health 10. Number of Visitors to homes for Dispensary (a) Specimens of sputum, &c., exam- 586 purposes 3,884 ined 285 (b) X-ray examinations made in con- non-dis) nection with Dispensary work ... 921 11. Number of "Recovered" cases re- 12. Number of "T.B. phis" cases on stored to Dispensary Register, and Dispensary Register on December included in A (a) and A (b) above... 2 31st 375 (B.)—Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) :— Provided by the Council One Provided by Voluntary Bodies — * i.e., remaining undiagnosed on 31st December. [See Memo. 37/T (Revised), p. 10, Sec. ii., Note 4.] All personal consultations, whether held at the homes of patients or elsewhere, should be included in item 7 (a) ; and all visits by Tuberculosis Officers to homes, whether or not accompanied by a personal consultation already included in item 7 (a), should be entered in item 8. 136 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 1937 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 pulmonarv 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—7 1928 1929 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 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 Group 2 Group 3 Total (Class T.B plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 2 3 4 — 7 3 — 2 - 2 - - 1 — 1 - 1 - — 1 F. 1 — 1 — 1 - — 1 - 1 - - 2 - 2 — 1 2 — 3 Children 1 - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults—M. - 4 1 - 5 1 5 6 1 12 - 1 6 - 7 — 2 1 — 3 F. - 2 1 - 3 - 2 3 - 5 - - 2 1 3 2 1 2 — 3 Children -- - - - - - - - - - - -- - - - - - - -- - Condition not ascertained during the year 3 1 2 — 3 6 3 3 3 9 i 1 3 — 4 5 1 1 — 2 Total on Dispensary Register at 31st December 7 10 9 — 19 " 11 15 4 30 • 2 14 1 17 7 6 6 - 12 (b) Not now on Dispensary Register and 1 reasons for removal therefrom. Discharged as recovered. Adults—M. - - - All classes 69 10 11 9 — 20 5 1 2 — 3 7 2 2 — 4 F. - - — - 73 21 3 6 - 9 3 — 2 2 5 2 1 — 3 Children. — — — 247 19 3 1 - 4 1 - - - - - -- - - - Lost sight of, or otherwise removed from Dispensary Register - - - -- 586 134 60 146 43 249 18 10 20 8 38 14 16 23 5 44 DEAD. Adults—M. -- - - - 252 30 30 181 178 389 6 5 27 19 51 5 7 35 29 71 F. — — — - 186 21 15 96 132 243 7 3 18 28 49 7 3 21 22 46 Children - - — - 44 9 1 9 6 16 1 - - - — 1 — 1 1 2 Total written off Dispensary Register — — — 1457 244 123 448 359 930 41 19 69 55 143 39 30 83 57 170 Grand Totals — — — — 1483 255 134 463 363 960 42 21 83 56 160 46 36 89 57 182 137 PULMONARY TUBERCULOSIS—(Contd.). Form T145a-(Contd.). Condition at the time of the last record made during the year to which the Return relates 1930 1931 1932 1933 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group Group 2 Group 3 Total (Class T.B. plus) Group Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 2 3 1 — 4 2 3 1 — 4 1 1 1 — 2 2 1 — — 1 F. 2 - — — - 2 1 1 - 2 3 1 2 - 3 2 — 1 — 1 Children - - - - - 3 - - - - - - - - - - - - - - Disease not arrested. Adults—M. 2 1 5 - 6 1 3 1 4 1 4 1 1 6 3 4 8 1 13 F. 4 2 5 - 7 3 3 4 7 4 1 2 1 4 2 5 2 - 7 Children 1 - - - - 1 - - - - - - - - - 2 1 — — 1 Condition not ascertained during the year 2 1 — — - 3 5 1 — 6 2 1 3 — 4 7 1 6 — 7 Total on Dispensary Register at 31st December 13 7 11 - 18 15 15 8 - 23 11 8 9 2 19 18 12 17 - 30 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. 2 1 — — 1 1 — — — — 2 — — — — — — — — — F. 1 - - 1 1 1 1 — - - - — - — Children. 1 - - - - 2 - - - - - - -- - - - - -- - - Lost sight of, or otherwise removed from Dispensary Register 21 10 25 5 40 8 13 20 4 37 21 7 17 1 25 21 8 22 - 30 DEAD Adults—M. 9 5 28 18 51 6 12 23 4 39 6 6 26 5 37 2 4 25 9 38 F. 6 2 16 14 32 7 10 10 7 27 3 8 11 6 25 4 — 19 6 25 Children ... 1 - - 2 2 2 -- - - - - - - - - - - - - - Total written off Dispensary Register 41 18 69 39 126 27 36 53 15 104 34 21 54 12 87 27 12 66 15 93 Grand Totals 54 25 80 39 144 42 51 61 15 127 45 29 63 14 106 45 24 83 16 123 138 PULMONARY TUBERCULOSIS—(Contd.). Form T145«—(Contd.). Condition at the time of the last record made during the year to which the Return relates 1934 1935 1936 1937 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. F. 4 2 - - - - - - - - - - - - - - - - - - - 1 - - 1 - - - -- - - - - - - - - - - - Children ... - - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults—M. F. 2 5 16 — 21 7 2 14 - 16 13 1 30 1 32 14 3 32 2 37 6 2 10 1 13 9 1 8 - 9 3 5 20 1 26 16 5 25 - 30 Children ... - 1 - - 1 2 - - - - 6 - - - - 1 - 3 — 3 Condition not ascertained during the year 10 2 3 — 5 2 4 4 — 8 5 1 2 — 3 - - - - - Total on Dispensary Register at 31st December 22 13 29 1 43 20 7 26 - 33 27 7 52 2 61 31 8 60 2 70 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. F. - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - Children ... - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 16 6 27 33 13 2 24 26 5 1 16 1 18 3 - 7 - 7 DEAD. Adults—M. F. - 5 25 11 41 6 1 12 9 22 2 1 19 3 23 3 - 8 2 10 2 - 10 8 18 3 - 11 7 18 1 14 6 20 2 — 4 2 6 Children ... 1 - 1 2 3 - - 1 - 1 -- - 1 - 1 - - - - -— Total written off Dispensary Register 20 11 63 21 95 22 3 48 16 67 . 8 2 50 10 62 8 — 19 4 23 Grand Totals 42 24 92 22 138 42 10 74 16 100 35 9 102 12 123 39 8 79 6 93 139 NON-PULMONARY TUBERCULOSIS. Form TI45a-(Contd.). Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 of all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the Return relates Previous to 1921 1921—7 1928 1929 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 — 1 3 - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - 1 Children - -- -- - - — 1 - 1 2 1 1 - - 2 — — — 4 4 Disease not arrested. Adults—M. - - - - - --- -- - 1 1 - - 1 - 1 2 - - - 2 F. - — 1 - 1 — - 2 — 2 - -- 1 - 1 — — — — — Children - - - 1 1 1 - 1 2 4 - - - - - - - - - - Condition not ascertained during the year 1 — — — - - — 1 7 9 — — — — — 1 _ 1 1 3 Total on Dispensary Register at 31st December 1 - 1 1 3 3 2 4 12 21 1 1 2 4 4 1 5 10 Transferred to Pulmonary 2 - - - 2 2 1 1 1 5 - - - - - - - - - - (b) Not now on Dispensary Registei and reasons for removal therefrom. Discharged as recovered. Adults—M. 1 — 1 1 3 5 1 2 4 12 2 1 — — 3 — 1 — 3 4 F. 2 1 1 6 10 — 1 — 1 1 — - 3 4 Children 6 3 2 30 41 22 15 4 78 119 4 - — 2 6 1 1 1 3 6 Lost sight of, or otherwise removed from Dispensary Register 21 7 15 50 93 30 10 17 70 127 4 1 4 8 17 3 1 - 5 9 DEAD. Adults—M. 1 — — 1 7 — 2 — 9 — — — — — — — — — F. 1 1 - 3 5 1 2 4 3 10 - - -- - - 1 — - - 1 Children ... 1 — 8 9 6 1 1 3 11 - - 1 - 1 - — - — - Total written off Dispensary Register 31 11 18 92 152 73 30 31 164 298 10 3 5 10 28 6 3 1 14 24 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 32 11 19 93 155 76 32 35 176 319 11 4 7 10 32 10 3 2 19 34 140 NON-PULMONARY TUBERCULOSIS—(Contd.). Form T145«-(Contd.). Condition at the time of the last record made during the year to which the Return relates 1930 1931 1932 1933 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 2 1 — 1 — 2 F. — — 1 - 1 - - - - — — — — 1 1 2 1 — — 3 Children 1 i 2 - - - 2 2 1 2 — 3 6 1 — — 1 2 Disease not arrested. Adults—M. - - - - - 1 - - - 1 - - - - - - - - 1 1 F. - - - - - 1 - — - 1 - — 2 - 2 — — — 1 1 Children — 2 - - 2 - - - - - - - - - - 2 - - - 2 Condition not ascertained during the year 2 1 — — 3 1 — — 1 2 9 — 2 1 12 — i i 2 4 Total on Dispensary Register at 31 st December 3 3 1 1 8 3 3 6 10 2 5 6 23 6 2 2 S 15 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. 1 1 - 1 3 - - - - - - - - - - - - - - 1 F. 1 — — 3 4 2 - — 1 3 1 - - - 1 - - - - - Children 2 1 2 4 9 1 - — 1 2 — — 2 2 Lost sight of, or otherwise removed from Dispensary Register 2 2 1 8 13 8 - 3 4 16 6 1 5 3 15 4 1 2 4 11 DEAD. Adults—M. 2 — 1 — 3 — — — — 3 — 2 — 5 2 — 1 — 3 F. 1 - - 1 2 2 2 — — 4 — — — 1 1 — — — - — Children 1 - - 1 1 - — — 1 - 1 - - 1 — — — 1 1 Total written off Dispensary Register 10 4 4 17 35 14 3 3 6 26 10 2 7 6 25 6 1 4 5 16 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 13 7 5 18 43 17 3 3 9 32 20 4 12 12 48 12 3 6 10 31 141 NON-PULMONARY TUBERCULOSIS— (Contd.). Form T145(Contd.) Condition at the time of the last record made during the year to which the Return relates 1934 1935 1936 1937 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total 1(a) Remaining on Dispensary Register on 31st December. Disease arrested Adults-M F. - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - Children 1 1 - 1 3 - - - - - - - - - - - - - - - Disease not arrested. Adults—M. F. 1 - - - 1 2 - - - 2 - - 1 1 2 2 - 6 1 9 1 - 2 1 4 1 1 - 1 3 1 - - - 1 2 3 1 1 7 Children 3 - - 1 4 4 1 2 3 10 1 - - 5 6 2 - - 1 3 Condition not ascertained during the year — — 1 2 3 1 — — 1 2 — — — — — — — — — — Total on Dispensary Register at 31st December 6 1 3 6 16 8 2 2 5 17 2 1 6 9 6 3 7 3 19 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 3 3 6 1 1 3 2 7 1 2 3 - - 1 1 2 DEAD. Adults—M. F. — - 1 - 1 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 Children - - - - - - - 1 - 1 - - - - - - - - - - Total written off Dispensary Register ... 3 — 1 3 7 2 1 4 2 9 — — 1 2 3 — — 1 2 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 9 1 4 9 23 10 3 6 7 26 2 — 2 8 12 6 3 8 5 22 142 INDEX. (Chief references in heavy type.) page Adulteration of food 82-83, 99-106 Aged and infirm persons 90 Agricultural Produce (Grading, &c.) Acts 84, 106 Air-raid precautions 84 All Saints' Hall centre 23-24, 32, 36 Ambulances 37 Analysis of food, &c. 99-106 Analyst 3, 99 Animals 78, 99 Ante-natal clinics 23, 26, 32-38, 41, 45 Anti-toxin 58 Appeals (housing) 117 Area of Borough, Wards, &c. .7,8,10 Artificial Cream Act 105 Artificial light treatment—see Solarium. Bacteriological examinations 61, 74, 77, 99, 103, 135 Bakehouses 78, 109-112 Baths (swimming) 90 Battersea General Hospital 28 Battersea Housing Association 114 Battersea Park .. 49, 86 Battersea Polytechnic 27 Battersea School for Mothers 26 Belgrave Hospital 28 Better Health 95 Births 5, 7, 8-11, 13, 16-18, 27, 129-131 Boarding out 50, 68 Bolingbroke Hospital 28 Breast feeding 46 British Dental Hospital 31 British Legion 75 Brompton Hospital 73 Butchers 99 Butter100, 101, 102 Cancer 7, 76, 126 Caravans—see Gipsy vans. Census 7, 8, 10 Central Council for Health Education 96 Centres—see Ante-natal, Dental, Maternity, Post-natal School treatment. Cerebro-spinal fever 53, 54-5, 61, 126 Charing Cross Hospital 28 Charity Organisation Society 75 Charts 17, 59, 66 Chatham Road centre 23-24, 25 Chelsea Health Society 32 Chicken pox 47, 76 Child Life Protection 27, 51-52 Chislehurst (St. James's) Mission 22, 23-24, 26 Clearance areas 115 Clerical staff 4, 97 Closing orders 117 Colindale Hospital 73 Combined drain claims 87 Common lodging houses 86 Complaints 78 Condell Road flats 114 143 PAGE Condensed milk 100, 105 Conferences 96 Consultants 3, 32, 36, 41, 45, 61, 69 Continued fever 54-5 Convalescence 26, 46, 50 Coroner's Court 94-5 Cream and artificial cream 100, 105 Creche—see St. Margaret's Day Nursery. Culvert Road 116 Dairymen 105 Day Nursery—see St. Margaret's Day Nursery. Deaths 7, 9, 10, 12-15, 16, 17, 18, 44, 64-7, 70,72, 94, 126-7 Demolition orders 82, 117, 120 Density of population 8 Dental treatment 3, 23, 27, 31, 73, 122 Deputy Medical Officer of Health 3, 97 Diabetes 77, 126 Diarrhoea 7, 15, 47, 76, 127, 129-131 Dinners for mothers and children 19, 25, 26, 30 Diphtheria 3, 23, 27, 54-5, 57 60, 77, 126, 129, 131 Disinfection and disinfestation 4, 78, 84, 91-93 District midwife 4, 33, 39, 40-41, 43 Doddington Road 116 Dogs, nuisances by 82, 95 Drains 78, 86, 91 Drugs, analysis of 101 Dust, collection, &c 78, 88 Dysentery 54-5 Effluvium nuisance 89 Encephalitis lethargica 54-5, 61, 126 Enteric (typhoid) fever 53, 54-5, 61, 77, 126 Erysipelas 47, 54-5, 62 Eyesight 20, 21, 51, 123 Factories 78, 79, 84, 108 111 Families 7, 10 Fat melters 89 Fathers' Council 26 Fish shops 106 Food By-laws 99 Imported 84 Poisoning 98 Preservatives in 103, 106 Protection of supply 78, 82, 98 107 Street stalls 88, 107 Unsound 98 Foster Mothers and Children—see Child Life Protection. General Ly:ng in hospital 28 Gideon Road centre 23-24,25 Gipsy vans 78, 90 Grants 22, 49, 69 Grove Park Hospital 73 Guy's Hospital 28 Gynaecologist 3, 32 Hammersmith Hospital 28 Health Committee 1 144 PAGE Health Visitors 3, 22, 25, 2ft-27, 51, 97 Hibbert Street 116 Home helps 44 Home-work—see Outworkers Hospitals 27-8, 73, 88, 103 Houses erected 114, 119 Houses let in separate tenements 78, 88, 89 Houses, number of 7, 10 House to house inspections 78, 119 Housing 84, 96, 114-121 Housing Committee 1 Housing estates 92 Hydrogen Cyanide (Fumigation) Act 84, 92 IceCream 105 Illegitimate births and deaths 7, 11,15, 129-131 Increase of rent, &c., Acts 117 Infant Life Protection—see Child life protection. Infant mortality 5, 7, 10, 13, 14-15, 16, 17, 18, 27, 41, 42, 126-7, 129 131 Infectious disease 27,53-77,112 Influenza 47, 71, 76, 126 Inquests 94 Inspections (see also under subject) 78, 119 Institutional deaths 14 Insulin 77 Invalid Children's Aid Association 22, 26, 46, 49, 68 Invalid Kitchens Association 30 King's College Hospital 28 Kitchens 107 Knackers' yards 98 Lambeth Hospital 28 Lavatories, public 86 Laundries 109-110 Legal proceedings 78, 79-83 Legislation 84 Light treatment—see Solarium. Livingstone Road area 115 Lodging Houses 86 London County Council estates 115 Longevity 13 Lothair Street area 115 Malaria 54-5 Marmion Mews 116 Marriages 12 Massage 23, 48 Maternal mortality 7, 27, 42. 44 46, 127, 128 Maternity and Child Welfare 3, 5, 22-52, 96, 122 Maternity Centres and districts 22-25, 93 Maternity Hospital3, 4, 23, 33, 35-36, 40, 41-43, 97 Maternity outfits 41 Maternity—Specialist advice 45 Meals 19, 26, 30 Measles 7, 47, 54-5, 62, 126 Meat 99 Medical Officer of Health 3, 5 Mendip Road area 116 Meningitis 54-5, 61, 67, 126, 129-131 145 PAGE Merchandise Marks Acts 106 Metropolitan Boroughs statistics 18 Middlesex Hospital 28 Midwives (see also District Midwife) 33, 37, 39, 45 Midwives Act, 1936 39 Miles" Cottages 116 Milk Condensed 100, 105 Milk and Dairies Acts and Orders 104 Sampling and Analysis 82-83, 100-104 Scale of assessment for 31 Shops 104, 105 Special designations 29, 83, 97, 104 Supply to schools and hospitals 19, 103 mothers and children 29-30 Tradesmen 105 Tuberculosis 68, 103 Mortuary 4,94-5 Mothercraft classes 23,25 Mundella Road centre 3, 23—24, 25 Mustard 100, 102 National Baby Week Council 22 National Society for Prevention of Cruelty to Children 52 Noise, nuisance from 84 Non-notifiable diseases 76-77 Notices, service of (see also under subject) 79,119-120 Notification of Births 11 Nurse children—see Infant Life Protection. Nursing 47, 62 Nutrition 20, 21, 30 Obstetrician 3 Offensive matter, removal 89 Offensive trades 90 Open Air School 69 Ophthalmia neonatorum 42, 47, 54-5, 61, 84 Out relief 19 Outworkers 111-112 Overcrowding 78, 114-5, 120, 121 Peabody Buildings 114 Pemphigus neonatorum 47 Personal Cleansing Station 92 Pharmacy and Poisons Act 85 Physicians, Royal College of 69 Pigeons 91 Plans, non-submission of 87 Plough Road centre 23-24, 25, 32, 36 Plough Road flats 114 Pneumonia 47, 54-5, 76, 127, 129-131 Poisons 84, 85 Polio-myelitis and -encephalitis 54-5, 60 Population 7, 8, 9, 10, 16, 18 Post-natal clinic 23, 41 Preservatives in food 103, 106 Propaganda 95 Protected persons 111 Public Analyst 3, 99 Public Assistance 19, 29, 75 Public Cleansing 88 Public Health (London) Act 84 146 PAGE Public Health Regulations and Orders— Condensed milk 105 Meat 99 Preservatives, &c., in food 106 Public Houses 89 Public Institution deaths 14 Public conveniences 86 Puerperal fever and pyrexia 7, 41-2, 45, 47, 54-5, 60, 127, 128 Pupil health visitors 27 Pupil midwives 41, 43 Rag and bone dealers 82, 90 Rag Flock Acts 91 Rateable value 7 Rats and mice 91 Refuse removal. 88 Registration Sub-Districts 8, 9, 14, 55, 62, 65, 129-131 Rent-books 117-8 Rent and Mortgage Restrictions Acts 117 Restaurant kitchens 107 Rickets 21, 48, 51, 123, 130, 131 Royal College of Physicians 69 Royal Masonic School for Girls 114 Royal Sanitary Institute 96 Royal Waterloo Hospital 28 Rush Hill Mews 116 St. George's Hospital 28 St. James's Hospital 8, 28, 56, 69, 73, 95 St. James's Mission 22, 23, 24, 26 St. John's Hospital 56, 69 St. Luke's (L.C.C.) Hospital 28 St. Margaret's Day Nursery, &c. 22, 48 St. Margaret's (L.C.C.) Hospital 61 St. Mary Abbots Hospital 28 St. Mary's Hospital 28 St. Mary's House 22, 44 St. Stephen's Hospital 28 St. Thomas's Babies' Hostel 22, 27, 28. 46 St. Thomas's Hospital 28, 73 Sampling of food 78, 99 106 Sanitary Inspectors 3, 26, 97 Savona Street area 114, 116 Scarlet fever 54-5, 57, 59, 126 Schick test clinic 23,51,58, 123 School children 19-21, 92-3 School treatment centres 28 Schools 88, 93, 103 Senile mortality 13, 126-127 Sheepcote Lane site 114, 116 Shops Act 78, 84 Slaughter of Animals Act, 1933 98 Slaughter-houses and slaughtermen 98 Smallpox 54-6 Smoke nuisance 78, 89 Soap boilers 89 Social conditions 19-21 Solarium 23, 47, 74 Southlands centres 23-24, 25, 32, 36, 68 South London District Nursing Association 22, 47 South London Hospital for Women 28 147 PAGE Southwark Diocesan Association 22, 44 Specialists—see Consultants. Springwell House School 69 Stables 78 Staff 3, 26, 41, 97 Still-births 7, 11, 27, 41, 42 Street cleansing 88 Street stalls 88, 107 Structural defects 118 Suicide 94, 127 Sunlight treatment—see Solarium. Swimming baths 90 Tenement houses 88 Tents, vans, &c.—see Vans. Toddlers' clinic 23, 26, 50, 122 25 Tuberculosis Artificial light treatment 74 „ Pneumo-thorax 73 Bacteriological examinations 74, 77, 135 Beds 74 Boarding out 50, 68 Care Committee 2, 75 Clothing 75 Conference 97 Contacts 69, 72, 135 Deaths 64-8, 70, 72, 126, 129, 131, 133, 135, 136 41 Dental treatment 73 Dispensary 4, 28, 68 75 Extra nourishment 74, 75 Grant 69 Institutional treatment 72 Investigation by Royal College of Physicians 69 Localisation 64 Milk 68, 103 New cases 64-66, 70-2, 133, 135 Non-dispensary patients 70, 75 Notification 55, 64-68, 132 Open-air School 69 Recovery from disease 70, 134-141 Register of cases 75, 134, 135 Shelters 74 Staff 97 Statistics 21, 55, 64-67, 70, 132 141 Tuberculosis Officers 3, 69, 97 Tuberculosis Regulations 68 Visiting 70, 75 X-ray examinations 73 Typhoid fever—see Enteric Fever. Underground rooms 78, 82, 120 Unemployment 19 Unmarried mothers—see Southwark Diocesan Association. Unsound food 98 Urinals 78, 86, 89 Vaccination 56-7 Vans 78, 90 Venereal disease 3, 27, 36-8, 126 Vermin 20, 79, 91 Victoria Hospital for Children 22, 27,28 Vincent Square Hospital 28 148 PAGE Vital Statistics 7, 8-18, 126-31 Voluntary Centres (Maternity and Child Welfare) 23-26 Wandsworth Tuberculosis Dispensary 28 Wards 8, 9, 11, 13, 14, 55, 57, 58, 62, 65 Warehouses 113 Water-closets 78, 85, 87 Water supply 78, 89 Westminster Hospital 28 Westminster Ophthalmic Hospital 28 Wharves 113 Whooping-cough 7, 47, 54-5, 63, 126, 129, 131 Winstanley Road area 115, 117 Women's Hospital, Chelsea 28 Women's League of Service 22-24, 25, 30, 32, 46 Workshops and workplaces 78, 108-111 X-ray examinations 45, 73 York Road tenements 114 Zymotic diseases 75