AC4384 Dear BAT 37 Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 1938 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. AcB Metropolitan Borough of Battersea. REPORT on the HEALTH of the Metropolitan Borough of Battersea, FOR THE YEAR 19 3 8 by G. MACDONALD, M.A., M.B., D.P.H., MEDICAL OFFICER OF HEALTH. 1 Health Committee (Acted also as the Maternity and Child Welfare Committee until 8th November, 1938.) As constituted 9th November, 1937. Chairman: Councillor Mrs. A. A. Burton. His Worship the Mayor. (Councillor H. W.J. Miles, j.p.) Councillor Mrs. K.S.D. Baker. Alderman Mrs. H. Bowler. Councillor Mrs. E. S. Burton. „ Mrs. E.A. Cooper. „ Dr. H.L. Gulati. „ T.J. Hines. Alderman Mrs. H.E. Hughes. Councillor F.J. Lamb. „ R. Moore. „ Mrs. M.J. Robinson. „ Mrs. E. Stone. As constituted 9th November, 1938. Chairman: Councillor Mrs. A.A. Burton. His Worship the Mayor (Councillor W.J. McIver, j.p.) Alderman Mrs. H.Bowler. Councillor Mrs. E.S. Burton. „ Mrs. E.A. Cooper. „ Dr. H.L. Gulati. „ T.J. Hines. „ F.J. Lamb. ,, J.F. Lane, jun. „ G. Lauriks. „ R. Moore. „ Mrs. M.J. Robinson. „ Mrs. E. Stone. Maternity and Child Welfare Committee. As constituted 9th November, 1938. Chairman: Alderman Mrs. H. Bowler. His Worship the Mayor (Councillor W.J. McIver, j.p.) Councillor A.E. Austin, b.a. „ Mrs. K.S.D. Baker. „ Mrs. S. Bramley. Councillor E.W. Coles. Alderman Mrs. H.E. Hughes. Councillor G. Lauriks. „ H. Mills. ,, Mrs. F.E. Mullings. Alderman A.A. Rignall. Councillor Mrs. M.J. Robinson. „ Mrs. M.E. Stone. Housing Committee. As constituted 9th November, 1937. Chairman: Councillor I.O. Thomas. His Worship the Mayor (Councillor H.W. J. Miles, j.p.) Councillor Mrs. K.S.D. Baker. „ R.G.H. Blundell. „ Mrs. E.S. Burton. „ J.W. Cook. Alderman H. Harling. Councillor A.R. Higgins. „ J.F. Lane, jun. „ C.E. Lang. ,, G.F. Meecham. Alderman T. Pocock, j.p. Councillor W.J. Wye. As constituted 9th November, 1938. Chairman: Councillor I.O. Thomas. His Worship the Mayor (Councillor W.J. McIver, j.p.) Councillor Mrs. K.S.D. Baker. „ R.G.H. Blundell. „ Mrs. A.A. Burton. „ Mrs. E.A. Cooper. Alderman H. Harling. Councillor A.R. Higgins. „ C.E. Lang. Alderman I.L. Lewis, m.a., b.sc. Councillor G.F. Meecham. Alderman T. Pocock, j.p. Councillor W.J. Wye. 2 Tuberculosis Care Committee. As constituted 9th November, 1937. Chairman— Councillor Mrs. M.J. Robinson. Councillor Mrs. E.S. Burton. „ Mrs. F.M. Glanvill. „ Dr. H.L. Gulati. „ Mrs. E. Stone. Other Member: Mrs. F. Young. Representatives of the Local Public Assistance Committee: Councillor Mrs. E.A. Cooper.* „ Mrs. F.E. Mullings. Representative of the London Insurance Committee: Mr. H.B. Robinson. Members of the late Voluntary Care Committee: Miss B. Home. Miss E. Morris.** Consultative Members: L.C.C. District Organiser for Children's Care Committee Work (Miss Burton) L.C.C. Divisional Medical Officer (Dr. Atlee). Representative of the Invalid Children's Aid Association, Southlands (Miss Denham). Representative of the War Pensions Committee (Dr. F.H. Whitehead). Lady Almoner, Brompton Hospital (Miss Marx). Lady Almoner, King's College Hospital (Miss Edmonds). Tuberculosis Almoner, St. George's Hospital (Miss Spencer). Lady Almoner, St. Thomas's Hospital (Miss C. Morris). Lady Almoner, Victoria Hospital (Miss E.W. White). Representative of the South London District Nursing Association (Miss A.M. Stanford). Representative of the British Red Cross Society (Mrs. E. Horn). *Alderman Mrs. H. Bowler appointed in place of Mrs. Cooper, 23rd February, 1938. **Resigned 9th December, 1937. Miss K. Bogue appointed 23rd March, 1938. As constituted 9th November, 1938. Chairman— Councillor Mrs. M.J. Robinson. Councillor Mrs. E.S. Burton. „ Mrs. F.M. Glanvill. „ Dr. H.L. Gulati. „ Mrs. F.E. Mullings. „ Mrs. E. Stone. Other Member: Mrs. F. Young. Representatives of the Local Public Assistance Committee: Alderman Mrs. H. Bowler. Councillor Mrs. M.J. Robinson. Representative of the London Insurance Committee: Mr. H.B. Robinson. Representative of the Charity Organisation Society: Miss K. Bogue. Member of the late Voluntary Care Committee: Miss B. Home. Consultative Members: L.C.C. District Organiser for Children's Care Commitee Work (Miss Burton). L.C.C. Divisional Medical Officer (Dr. Atlee). Representative of the Invalid Children's Aid Association, Southlands (Miss Denham). Representative of the War Pensions Committee (Dr. F.H. Whitehead). Lady Almoner, Brompton Hospital (Miss Marx). Tuberculosis Almoner, St. George's Hospital (Miss Spencer). Lady Almoner, St. Thomas's Hospital (Miss C. Morris). Lady Almoner, Victoria Hospital (Miss E.W. White). Representative of the South London District Nursing Association (Miss A.M. Stanford). Representative of the British Red Cross Society (Mrs. E. Horn). 3 Staff of Public Health Department. (December, 1938). Deputy M.O.H. and Tuberculosis Officer Assistant Medical Officer (Maternity and Child Welfare) Assistant Medical Officer (Tuberculosis and M. & C.W.) Resident Medical Officer, Borough Maternity Hospital Consultant Gynecologist, Borough Maternity Hospital Consultant Obstetrician, Borough Maternity Hospital Consultant Medical Officer, Ante-Natal (V.D.) Clinic Medical Officer, Mundella Road Centre Medical Officer, Diphtheria Immunisation Clinic Dental Surgeon (by arrangement with British Dental Hospital) Public Analyst STANLEY KING, m.d., m.r.c.p., d.p.h. (Miss) M. L. HAMILTON, m.b., Ch.B., d.p.h. (MrV) M. J. O'FLYNN, b.a., m.b., B.Ch., B.A.O. (Miss) E. N. CHRISTIE, m.b. Ch.B. (Miss) ALICE BLOOMFIELD, m.d., f.r.c.s., f.r.c.o.g. F. W. ROQUES. m.d., m.c .. f.r.c.s., f.r.c.o.g. H. CORSI, f.r.c.s., m.a., m.b., b.Ch., l.r.c.p. (Miss) E. M. SAXTON, m.d. W. W. KING-BROWN, m.r.c.s., l.r.c.p. J. RHYS HERBERT, l.m.s.s.a., l.d.s., r.c.s. C. HACKMAN, f.i.c. Senior Sanitary Inspector F.H. CHUTER (a c). Sanitary Inspectors: District. 1. W.E. Selway (b c). 2. G. Weeks (b c). 3. A. Webb (b c). 4. P.D. O'Grady (b c). 5. J.R. Glover (b c). 6. C. Binding (a c). 7. (Senior Inspector). 8. J.R. Holloway (a c). Other. (Miss) B.L. Kaye (a d f). Also HealthVisitors. „ J. Round (a d). (Food) J.A.H. Brownlow (b c). (Workshops) I.R. Lewis (b c). (Housing) R.J. McCarthy (a c). „ S.W. Simpson-Scott (b c). Organising Rat Officer—A.E. Tubby. Health Visitors: (Miss) B. L. Kaye (a d f).Also Sanitary Inspectors. „ J. Round (a d). „ N. Playne (a f g). „ D. Heap (a e). „ F.B. Goodall (a d f g). „ A. Bannerman (d f). „ V. Ventris (e f g). (Miss) H. A. Blackburn (b e f g h). „ B.E. Prager (e f g h). „ I.M.J. Sweeney (e f g ). „ M.C.H. Wilkie (e f g). „ E.L. Flemons (e f g). I.B. Abbott (e f g). K.I. Brown (e f g). One temporary health visitor. (For notes see next page.) 4 Clerical Staff— Chief Clerk—F.E. WARD. J.W. Brown (Statistical). E. Cole. H.C. Godfrey (a). W. Halstead. R. Graham. F. Pedrick (b). P.Brocking. One Vacancy. (Miss) M.A. Weller (M. & C.W. Records). (Miss) K.M. Hone. Two temporary clerks. Two office youths. Maternity Home— Matron—(Miss) M. Fevyer (f g). Sister—(Miss) F.M. Cooper (f g) and 1 Staff Nurse. 3 Vacancies. 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). Clerks—(Miss) C. Turner. (Mrs.) M. E. Werrett. Laboratory technician—T.E. Noble. Disinfecting Station—Superintendent—T. Farrow. Mortuary—Keeper—W. Newman. Public Vaccinators and Vaccination Officer-See page 58. (a) 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 Battersea. 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 1938. A Summary of the principal vital statistics for the year is given on page 7. In my Annual Report for 1937 I drew attention to the high infantile mortality rate for that year, and I hazarded the opinion that the rate was an abnormal one and that it was unlikely to continue at so high a level. It is pleasing to note that the rate for the current year has fallen to 53 per 1,000 births as compared with 70.43 in 1937. The fall in the number of infant deaths in the Borough from 1901 to 1922 was rapid and continuous, but since that date the infant death rate has remained more or less stationary with only comparatively small fluctuations from year to year. The death rate from Tuberculosis is the lowest ever recorded in the Borough. The general work of the Public Health Department has been carried on under considerable difficulties during the latter part of the year, and I gratefully acknowledge the loyal service so readily rendered by the whole staff in carrying out duties which, in many cases, involved a new orientation of mind and practice. I wish to thank the Mayor and Members of the Borough Council, and more particularly the Chairman and Members of the Public Health, Maternity and Child Welfare and Housing Committees, for the continued support that I have received from them during the year. I am particularly mindful of the assistance always so readily given by the Chief Officers of the Council. 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, 1939. 6 CONTENTS. page General 1-6 Vital and Social Statistics 7-21 Maternity and Child Welfare 22-54 Infectious and Other Diseases 55-80 General Sanitary Administration 81-104 Food Supply 105-115 Factories and Homework 116-120 Housing 121-127 Appendices 128-149 (See Index at end.) 7 Summary of Statistics, 1938. 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 1938) 141,700 Structurally separate occupied dwellings on rate books at end of 1938 28,042 Rateable value (1938) £1,167,395 Sum represented by a penny rate £4,750 2. Extracts from Vital Statistics of the Year. Births— Males. Females. Total. Legitimate 1,012 1,014 2,026 Illegitimate 44 44 88 Live births 1,056 1,058 2,114 Still births 34 22 56 Live birth-rate (per 1,000 population) 14.92 Still-birth-rate (per 1,000 births live and still) 25.8 Deaths—Males, 845; females, 830 1,675 Death-rate (per 1,000 population) 11.82 Number of women dying in or in consequence of childbirth— From sepsis 5 Other puerperal causes 1 Maternal mortality rate (per 1,000 births live and still) 2.76 Deaths of infants under 1 year— Legitimate, 104; illegitimate, 9 113 Infant mortality rate (per 1,000 live births)— Legitimate, 51.33; illegitimate, 102.27. All deaths under 1 year 53.45 Deaths from Cancer (all ages) 274 „ Measles (all ages) 11 „ Whooping-cough (all ages) 3 „ Diarrhoea (under 2 years of age) 31 3. Census— Population. Private families. Inhabited 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 (1938) was 141,700, as compared with 143,500 in 1937. The population of Battersea at the Census taken in April, 1931, was 159,552, and the Registrar-General's estimate for 1938 therefore indicates a decrease of 17,852 (or 11 per cent.) since the Census, and 1,800 during 1937-8. The Registrar-General's estimate of the mid-year population of the Borough (141,700) 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, 1938. Males. Females. Total. Density per acre Wards. 1. Nine Elms 407 11,207 11,406 22,613 55.6 2. Park 316 7,074 7,933 15,007 47.5 3. Latchmere 182 7,786 8,549 16,335 89.8 5. Church 171 7,356 7,524 14,880 87.0 North Battersea 1,076 33,423 35,412 68,835 64.0 4. Shaftesbury 140 6,031 6,499 12,530 89.5 6. Winstanley 126 8,428 8,612 17,040 135.2 7. St. John 117 3,322 4,279 7,601 65.0 8. Bolingbroke 205 7,440 8,974 16,414 80.1 9. Broomwood 499 8,413 10,867 19 280 38.6 South Battersea 1,087 33,634 39,231 72,865 67.0 Borough 2,163 67,057 74,643 141,700 65.5 BIRTHS. The number of live births registered in the Borough during 1938 was 2,898 (1,457 male, 1,441 female), an excess of 16 males. Of this number 1,288 were transferred out, the permanent residence of the parents being outside the Borough, and 504, registered outside the Borough, were transferred in, giving on balance a total of 2,114 births (1,056 male, 1,058 female) relating to Battersea residents, and a corrected (live) birth-rate of 14.92 per 1,000 of the population. This is a decrease of 0.02 on that of 1937. The tables on the next two pages give the distribution of the births and the birth-rate per 1,000 of the population in the subdistricts and in the wards for the year 1938, and figures relating to the previous decennium 1928-37:— * 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, DEATHS AND INFANT MORTALITY, 1938. Area. Estimated Population 1938. BIRTHS. DEATHS (all Ages). INFANT DEATHS. Live. Still. Number. Rate. Number. *Rate Number. Rate. Number. *Rate. M. F. Total. M. F. Total. M. F. Total. M. F. Total. Sub-Districts. North Battersea 68,835 507 500 1,007 14.6 22 11 33 31.7 400 354 754 11.0 34 21 55 54.6 South Battersea 72,865 549 558 1,107 15.2 12 11 23 20.3 445 476 921 12.6 39 19 58 52.4 Wards. No. 1, Nine Elms 22,613 171 170 341 15.1 8 2 10 28.5 123 112 235 10.4 8 8 16 46.9 No. 2, Park 15,007 113 110 223 14.9 1 2 3 13.3 95 73 168 11.2 8 3 11 49.3 No. 3, Latchmere 16,335 111 108 219 13.4 6 5 11 47.8 99 93 192 11.8 8 3 11 50.2 No. 4, Shaftesbury 12,530 79 99 178 14.2 1 — 1 5.6 85 68 153 12.1 5 2 7 39.3 No. 5, Church 14,880 112 112 224 15.1 7 2 9 38.6 83 76 159 10.7 10 7 17 75.9 No. 6, Winstanley 17,040 123 146 269 15.8 4 2 6 21.8 102 92 194 11.4 12 10 22 81.8 No. 7, St. John 7,601 84 77 161 21.2 2 3 5 30.1 43 59 102 13.4 3 — 3 18.6 No. 8, Bolingbroke 16,414 140 122 262 16.0 1 2 3 11.3 90 100 190 11.6 10 2 12 45.8 No. 9, Broomwood 19,280 123 114 237 12.3 4 4 8 32.7 125 157 282 14.6 9 5 14 59.1 Borough 141,700 1,056 1,058 2,114 14.9 34 22 56 25.8 845 830 1,675 11.8 73 40 113 53.4 * Still birth rate per 1,000 births (live and still). Infant death rate per 1,000 live births. Other rates in this table per 1,000 estimated population. 10 Vital Statistics of Whole District during 1938 and Ten Previous Years. Year. 1 Population estimated to middle of each year. 2 Births. Total Deaths registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected number. 3 Nett. Number. 6 Rate.* 7 of nonresidents registered in the district. 8 of residents not registered in the district. 9 Under 1 year of age. At all ages. Number. 4 Rate.* 5 Number 10 Rate per 1,000 nett births. 11 Number. 12 Rate.* 13 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 1938 141,700 2,898 2,114 14.9 2,679 18.9 1,374 370 113 53 1,675 11.8 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 1931). *Rates calculated per 1,000 of estimated population. 11 Of the Battersea births (live and still) which occurred within the Borough, 680 were "domiciliary births." The birth-rate shows a decline in three Wards of the Borough and an increase in the six remaining Wards. The birth-rate in Battersea was 0.3 per 1,000 lower than the average for the previous decennium 1928-1937. Illegitimate births numbered 88 or 4.16 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 13.4 per 1,000 of the population, and for England and Wales the rate was 15.1. Still-births. The registration of still-births is made compulsory by the Births and Deaths Registration Act, 1926. During 1938 there were 69 still-births registered in Battersea, of which 38 were of Battersea parents. Eighteen still-births occurring outside the Borough were registered as belonging to Battersea, making 56 in all, representing a still-birth rate of 25.81 per 1,000 births (live and still) registered. Of the 56 still-births 2 (3.6 per cent.) were registered as illegitimate. The number of Battersea still-births registered, and the stillbirth rates, from 1928 to 1938, were as under:— No. Rate. No. Rate. 1928 90 31.8 1935 69 31.8 1929 71 26.4 1936 60 27.4 1930 103 37.4 1937 63 28.5 1931 66 26.0 1932 72 30.1 Mean 1933 65 27.9 1928-37 72 29.7 1934 65 29.3 1938 56 25.8 Notification of Births. During 1938 the number of notifications of live births received belonging to the Borough was 2,100. The corrected number of Battersea births registered during the year was 2,114. The proportion of notified to registered births was, therefore, 99.3 per cent. Notifications of 456 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 2,100 above. Fifty-two still-births were notified under the provisions of the Public Health (London) Act, 1936, during the year, including 14 cases occurring outside the Borough, the number notified being 92.9 per cent. of the total Battersea still-births registered. The homes from which births are notified are visited and revisited by the Council's official health visitors or the health visitor of the voluntary organisation 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 statutory requirements. 12 MARRIAGES. The marriages registered in Battersea during 1938 numbered 1,296. The marriage-rate (i.e., the number of persons married per 1,000 of the population) was 18.3. Year. Marriages. Marriage-Rate. 1933 1,376 17.9 1934 1,432 19.0 1935 1,446 19.5 1936 1,364 18.7 1937 1,409 19.6 Mean, 1933-37 1,405 18.9 1938 1,296 18.3 DEATHS. The number of deaths registered in the Borough during 1938 was 2,679. Of these 1,374 were deaths of non-residents and were transferred to the districts in which the persons ordinarily resided. There were on the other hand, 370 deaths of Battersea residents registered outside the Borough. The total (corrected) number of deaths belonging to the Borough was 1,675 (males 845, females 830). This gives a recorded death-rate of 11.82 compared with 11.8 for London, and 11.6 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 past year this factor is 0.99, and the adjusted death-rate for the purpose of such comparison is therefore 11.70. 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 1938:— Under 1 year. 1- 5 - 10 - 15 - 25 - 45 - 65 + Total. M 73 21 4 3 22 83 250 389 845 F 40 18 6 4 18 75 187 482 830 Ttls. 113 39 10 7 40 158 437 871 1675 %of Total 6.7 2.3 0.6 0.4 2.4 9.5 26.1 52.0 100 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, 1928-1938. 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 1938 58.9 The deaths of 871 residents of Battersea aged 65 years and upwards were registered. The distribution of these deaths, which constituted 52.0 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 100 80 71 87 13 43 184 210 394 South Battersea 94 114 89 113 22 45 205 272 477 Borough 194 194 160 200 35 88 389 482 871 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. 1 567 26.82 31 27.43 532 31.76 2 520 24.60 27 23.90 400 23.88 3 541 25.59 29 25.66 335 20.00 4 486 22.99 26 23.01 408 24.36 Total 2,114 100.0 113 100.0 1,675 100.0 The death-rate during 1938 was lowest in the Nine Elms Ward (10.4), and highest in Broomwood Ward (14.6). Decreased deathrates were recorded in seven wards of the Borough. The natural increase of population (that is excess of births over deaths) was 439, as compared with 294 in 1937. The causes of the 1,675 deaths occurring in 1938, classified in various age groups, are shown in the Appendix, pages 134-35. 14 Deaths in Public Institutions. During 1938 the deaths of Battersea residents occurring in hospitals or institutions numbered 1,076. Of this number 751 occurred within and 325 outside the Borough. Of the total Battersea deaths in institutions 798 occurred in the general hospitals of the London County Council. INFANT MORTALITY. During 1938 the deaths of 113 infants under 1 year of age were registered as belonging to Battersea. The total number of live births registered during the year was 2,114, giving an infant mortality rate of 53.45 per 1,000 live births, as compared with 70.43 in 1937, 59.21 in 1936, 65.11 in 1935, and 61.28 in 1934. The infant mortality rates in the County of London and in England and Wales during 1938 were 56 and 53 respectively. The distribution of the 113 infant deaths and the infant mortality-rates for the registration sub-districts and the wards, are shown in the table on page 9. It will be noted that in the sub-districts the rate was, as is usual, lower in South Battersea (52.4) than in North Battersea (54.6). In the wards, St. John showed the lowest rate (18.6) and Winstanley Ward the highest (81-8). The year shows a welcome reduction in the infant mortality rate, which in 1937 soared to a height it had not reached for some years previously. The rate for 1938 is in fact well below the average for the past decade, and taking 1937 and 1938 together the rate is only 62 per 1,000 births. Reference to the chart on page 20 will show that the fall in the infant mortality rate, which was so spectacular in the early years of this century, has not continued at such speed since the war. But if the twenty years which have passed since then be divided into two decades it will be seen that the reduction still continues. The table following enables the variations in the different wards of the borough to be compared. Infant Mortality Rates for 20 years. Area. 20 years 1919-1938. 10 years 1919-1928. 10 years 1929 1938. North Battersea 67.30 70.04 63.01 South Battersea 58.15 60.76 54.69 Wards. No. 1. Nine Elms 68.88 75.59 57.82 ,, 2. Park 68.08 68.72 67.06 ,, 3. Latchmere 62.27 63.22 60.87 ,, 4. Shaftesbury 64.40 65.24 63.16 „ 5. Church 69.24 69.48 68.89 „ 6. Winstanley 64.46 70.13 63.11 „ 7. St. John 54.90 62.02 47.10 ,, 8. Bolingbroke 49.60 49.82 49.34 ,, 9. Broomwood 48.94 50.40 47.29 Borough 63.14 65.98 59.02 15 The figures in this table are not averages, but the actual rates for the areas enumerated in the periods named. The rates, both for the Borough and the two sub-districts, each show a reduction of about 10 per cent. when the last decade (1929-38) is compared with that preceding it. In the wards, however, though a reduction is shown in every case it varies from as little as 0.85 per cent. (Church Ward) to 24.5 per cent. in Nine Elms Ward. Another large reduction— 24 per cent.—occurs in the case of St. John Ward, which shows the lowest rate for the last 10 years. In the 4 wards where the rate during 1919-1928 was heaviest (i.e., above the Borough rate), it was reduced by 11 per cent. in the following decade, whereas in the remaining 5 Wards the reduction was 7.25 per cent. only. The mortality rate in Battersea among female infants has, since the war, been roughly three-fourths of that for male infants, the actual figures being, females 55.2, males 70.4 per 1,000 births. There were 31 deaths of infants during the first four weeks of life (or 27.4 per cent. of the total infant deaths) as compared with 62 deaths (or 41.1 per cent.) in 1937 and a percentage for the quinquennium 1932-1937 of 44.6. As already shown the infant death rate in the last ten years has decreased by about 10 per cent., as compared with the previous decade. The ratio of the number of deaths in the first 4 weeks of life to those in the first twelve months has, however, actually increased (from 42.4 to 43.1 per cent.), thus illustrating the fact that the measures taken to reduce infant mortality have been less successful in the very early weeks of life than in a later stage. Indeed it is recognised that the saving of infant life in the neo-natal period can only be effected by ante-natal care and skilled treatment of the mother at confinement. The new municipal mid-wifery services, and the extension of ante.natal centres may, perhaps, succeed in the field where child welfare clinics have been least successful. Table showing Deaths of Infants under 1 day, under 1 week and under 4 weeks from 1933 to 1938. 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 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 1937 23 23 16 62 41.1 Mean 25.0 19.4 14.4 58.8 44.6 1938 10 12 9 31 27.4 16 The causes of the 113 infant deaths are shown in detail in the appendix, pages 136-8. 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 1938 was 102.27 per 1,000 births, as compared with 69.77 in 1937, 57.5 in 1936, 160.9 in 1935, and 134.8 in 1934. The corresponding deathrate of legitimate children in 1938 was 51.33, the ratio of mortality rate of illegitimate infants to that of legitimate being 199 to 100. For the 20 years 1919-38 this ratio was 209 to 100. 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 :— Insured persons residing in Battersea registered as unemployed:— 17th January, 1938 4,337 25th January, 1937 3,382 4th April, 4,112 19th April, 2,850 18th July, 3,910 26th July, 2,634 17th October, 4,165 18th October, 3,089 Domiciliary relief granted at various dates:— 1938 Cases Persons 1937 Cases Persons 26th March 1,491 2,405 27th March 1,560 2,721 25th June 1,457 2,349 26th June 1,451 2,368 24th Sept 1,472 2,353 25th Sept 1,412 2,260 31st Dec 1,508 2,482 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 an increase of 38, and the second a decline of 2 per cent. for the year 1938 compared with 1937. 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 285 children per month received free dinners in the elementary schools, and 975 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 9½ per cent. on those for 1937. 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 117, &c., as to factories, &c., and the numbers employed therein. 17 Routine Medical Inspection of Elementary School Children in Battersea, 1938. BOYS. GIRLS. Total. Percentage. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Batt. London. Number examined 813 708 691 685 893 759 855 692 6,096 - - Clothing and boots— Good 657 586 556 530 758 651 691 511 4,940 81.0 54.6 Fair 156 121 135 155 135 108 164 181 1,155 19.0 45.1 Poor — 1 — — — — — — 1 0.0 0.3 Nutrition— Good 75 42 64 51 88 105 80 82 587 9.6 16.2 Average 666 576 570 580 745 600 698 573 5,008 82.2 77.2 Below normal 72 90 57 54 60 54 75 37 499 8.2 6.6 Bad - - - - - - 2 - 2 Cleanliness of head— Clean 812 706 690 684 886 751 839 680 6,048 99.2 97.7 Nits 1 1 1 1 2 8 13 4 31 0.5 2.0 Pediculi — 1 — — 5 — 3 8 17 0.3 0.3 Cleanliness of body— Clean 813 708 691 684 893 759 855 691 6,094 100.0 98.7 Dirty — — — 1 — — — 1 2 0.0 1.2 Pediculi — — — — — — — — — 0.0 0.1 Teeth— All sound 453 438 502 485 499 494 623 493 3,987 65.4 70.2 Less than 4 decayed 269 210 178 186 300 216 213 183 1,755 28.8 26.3 Four or more decayed 91 60 11 14 94 49 19 16 354 5.8 3.5 Vision— 6/6 in both eyes — 530 503 494 — 582 572 498 3,179 72.6 67.8 6/9 in either or both eyes — 118 76 74 — 111 145 74 598 13.7 19.0 6/12 or worse in either or both eyes — 54 111 116 — 62 138 117 598 13.7 13.2 18 Examination of Elementary School Children in Battersea, 1938. boys. girls. Entrants Age 7 Age 11 Age 14 Entrants Age 7 Age 11 Age 14 Number examined 813 708 691 685 893 759 855 692 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 9 8 10 9 5 5 - - 7 7 2 2 9 9 3 3 Skin disease 6 6 6 4 2 2 2 2 15 11 6 6 6 4 12 12 Defective teeth — 344 — 262 — 183 — 199 — 382 — 254 — 229 — 178 Enlarged tonsils 110 57 60 29 9 4 9 4 121 58 67 42 37 19 20 11 Adenoids 2 1 1 1 — — — — 9 5 3 2 1 1 1 1 Enlarged tonsils and adenoids 12 10 6 5 1 — — — 12 11 4 3 1 1 — — Other nose and throat defects 5 3 9 7 5 4 2 2 10 8 5 5 4 2 2 1 Enlarged glands 6 3 -— — 1 1 — 4 2 7 3 3 2 — — Eye disease 15 11 14 10 9 7 5 4 15 14 15 8 14 10 4 3 Vision defect — — — 29 — 72 — 63 — — — 36 — 96 — 84 Otorrhoea 4 4 3 2 4 4 3 3 8 7 6 4 6 3 — — Other ear disease 4 2 1 1 — — — — 2 1 5 3 3 3 — — Defective hearing 1 1 3 2 1 1 3 1 — — 2 1 1 — — — Speech defects 2 — 3 1 2 1 2 1 — — 1 1 1 1 — — Heart defects 4 1 6 — 2 1 4 1 4 1 9 — 3 1 3 — Anaemia 3 — 1 1 3 2 — — — — — — 1 — 3 3 Lung defects 22 13 9 5 4 3 4 4 32 17 10 5 4 2 3 2 Nervous defects — — 6 3 2 — 2 — 1 — — — 2 2 1 — Phthisis — — — — — — — — — — — — — — — — Other Tb. disease — — — — — — — — — — — — — — — — Rickets 3 — 1 1 — — — — 4 1 — — — — — — Spinal deformities — — 1 — 1 — — — 1 — 2 2 7 6 3 3 Other deformities 3 1 3 1 6 2 2 — 6 1 2 1 8 6 3 1 Other defects 14 11 7 5 5 4 4 1 15 11 15 7 22 16 5 3 Number of children noted for treatment 410 324 267 253 460 323 346 284 *Defects however slight axe included under "cases"; those severe enough to require treatment are shown under * 19 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 21.1 164.7 1885 125,618 4,654 2,566 2,088 37.0 20.4 179.0 1886 129,937 5,140 2,477 2,663 39.5 19.0 162.1 1887 134,256 5,186 2,451 2,735 38.6 18.2 156.6 1888 138,565 5,061 2,187 2,874 36.5 15.7 146 .2 1889 142,884 5,161 2,240 2,921 36.1 15 .6 138.2 1890 147,203 5,105 2,854 2,251 34.6 19.3 174.1 1891 150,880 5,237 2,697 2,540 34.7 17 .9 143 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 D* 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 . 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 1938 141,700 2,114 1,675 439 14.9 11.8 53.4 Census years in heavy type * Population as estimated for purpose of (B) Birth-rate, (D) Death-rate, † Decrease 20 Birth, Death and Infantile Mortality Rates in Battersea from 1861. 21 Comparative Statistics, London Boroughs. (Compiled by the Medical Officer of Health of Popular and re-produced by his kind permission.) Cities and Boroughs. Estimated resident population (mid-1938) Live births, annual rate per 1,000 population. Deathrate per 1,000 population. Deaths of infants under one year to 1,000 births. LONDON 4,062,800 13.4 11.4 56 West Districts. Crude Adjusted Paddington 137,400 13.74 11.33 11.21 66 Kensington 174,100 12.8 11.7 10.9 78 Hammersmith 125,100 15.5 11.3 11.6 61 Fulham 137,700 14.2 11.6 11.7 51 Chelsea 56,050 10.2 13.5 11.5 80 City of Westminster 124,400 8.3 10.4 10.7 54.9 North Districts. St. Marylebone 90,680 8.84 11.12 11.0 60 Hampstead 90,480 11.7 11.4 10.7 57 St. Pancras 179,400 13.5 11.5 11.7 64 Islington 292,300 15.32 11.9 12.02 65 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central Districts. Holborn 34,350 7.28 10.51 11.25 84 Finsbury 56,960 13.0 12.9 14.1 73 City of London 8,780 6.6 10.7 11.8 51.8 East Districts. Shoreditch 80,360 14.7 11.4 12.5 64 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 60.7 Poplar 134,400 14.9 11.4 12.7 60 South Districts. Southwark 145,300 14 0 12 . 5 13.4 57 Bermondsey 97,420 14.8 11.0 12.54 45 Lambeth 272,800 14.09 11.9 11.7 51 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46 Camberwell 222,400 13.97 12.27 12.27 61 Deptford 95,460 14.4 11.8 12.3 54 Greenwich 95,770 13.64 10.89 111 42 Lewisham 229,000 13.9 10.49 10.5 47 Woolwich 150,900 13.6 10.4 11.0 50 Note.— The information relating to London supplied by the RegistrarGeneral and that for individual Boroughs by the Medical Officers of Health. 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. A memorandum from the Wandsworth Division of the British Medical Association setting out various proposals designed to secure better co-operation between private medical practitioners and the Council in the ante-natal and infant welfare services provided by the Council and also with regard to diphtheria immunisation was before the Council in May. A deputation from the Association had already attended before the Health Committee in support of the proposals. The Council decided to inform the Division that the services in question had been built up by the Council as a result of many years experience and on the advice and with the approval of the Ministry of Health, and that they were of opinion that no improvement was likely to be effected by the adoption of the proposals suggested. Maternity and Child Welfare Districts and Centres. For administrative purposes, the Borough is divided into fourteen districts, for each of which a health visitor is responsible. There were, at the end of the year, 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. At each of the municipal centres a clinic is held twice weekly with a woman Medical Officer in attendance, as shewn in the table on page 23. 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. Grants and Contributions. Ancillary services included in the scheme are :— (1) St. Mary's House, Macaulay Road, Clapham Common (vide page 44). (2) St. Margaret's Day Nursery and Resident Hostel, Cambridge Road (vide page 49). 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, are 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 1938-39 in connection with their Maternity and Child Welfare scheme, as under :— [continued on page 25 23 MATERNITY AND CHILD WELFARE CENTRES (at 31ST December, 1938.) 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.* — — — Post-natal, Maternity Hospital - 10.0 a.m. — — — Infant Welfare (Mother and Child)— Southlands, Shuttleworth Road 1.30 p.m. (a) — 1.30 p.m. — — 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.) — — 1.45 p.m. — 1.45 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, Shuttleworth Road - 2.0. p.m. — — — All Saints' Hall, Prince of Wales Drive - — — 9.30 a.m. — Plough Road Institution - — — — 1.30 p.m. Chatham Hall, Chatham Road 1.30 p.m. — — — — Gideon Road disused school — 1.30 p.m. — — — 55 Mundella Road — — — 1.30 p.m. — Dental, Southlands — 10.30 a.m.† 10.30 a.m. — 10.30 a.m. Diphtheria Immunisation (Schick test), Southlands — 2.0 p.m. 1.30 p.m. 2.0 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. (a) • Fortnightly. ** A Medical Officer attends fortnightly. f Children only. A Medical Officer attends each session except those marked (a). 24 Summarised Statistics Relating to Infant Welfare Centres, 1938. Municipal. Voluntary. Grand Total. Southlands. Plough Road. All Saints' Hall Chatham Road. Gideon Road. Mundella Road. Total. Chislehurst (St.James's) Mission. Women's League of Service. Total Municipal and Voluntary. Sessions held 99 99 100 100 100 101 599 51 76 127 726 Weights recorded 4,337 5,590 5,639 5,464 6,265 2,951 30,246 646 2,233 2,879 33,125 Advice only given 939 1,187 1,251 912 531 574 5,394 178 21 199 5,593 Total attendances 5,276 6,777 6,890 6,376 6,796 3,525 35,640 824 2,254 3,078 38,718 Average per session 53.3 68.5 68.9 63.8 68.0 34.9 59.5 16.2 29.7 24.2 53.3 „ „ week 101.5 130.3 132.5 122.6 130.7 67.8 685.4 15.8 43.3 59.2 744.6 First attendances 279 360 304 313 48 190 1,794 30 145 175 1,969 Children attended 444 648 626 562 637 344 3,261 71 293 364 3,625 Doctor's attendances 51 99 100 100 99 49 498 26 76 102 600 „ interviews 1,302 2,234 2,012 2,242 2,081 1,123 10,994 289 1,346 1,635 12,629 „ average per attendance 26 23 20 22 21 23 22 11 18 16 21 (Summary of the work carried out at other centres will be found as under:— Ante-natal Clinics, page 35; Dental Clinic, pages 31, 75; Light Treatment Centre, pages 48, 76; Anti-diphtheria Clinic, page 60; Massage Centre, page 49; Mothercraft classes, page 25; Toddlers' Clinic, page 52.) 25 Invalid Children's Aid Association {vide page 50) £50 National Baby Week Council £2 2s. St. Thomas's Babies' Hostel (vide page 47) £200 South London District Nursing Association (vide page 47) £300 Southwark Diocesan Association for Moral Welfare (vide page 44) £150 Victoria Hospital for Children £100 The Council is represented upon the governing bodies of the larger of these voluntary associations (except the two hospitals) as will be found set out on the pages cited. They are not directly represented upon the Chislehurst Mission, the South London District Nursing Association, or the Southwark Diocesan Association for Moral Welfare, but in the case of the last named the Medical Officer of Health is summoned to the meetings of the Committee. In the case of the National Baby Week Council Mrs. K. S. D. Baker and Mrs. M. J. Robinson were re-elected in March as the representatives of the Council. Mothercraft Classes. Instruction in mothercraft is given weekly at 6 centres, the average attendance during 1938 being respectively:- Southlands 61 55 Mundella Road 14.9 Gideon Road 18.0 Women's League of Service (Southlands) 14.4 Chatham Road 7.9 Plough Road 16.7 In total there were 304 meetings with a total attendance of 3,964, giving on average 13.0 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. 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. 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. Although provided mainly for residents in the League's district, mothers and children from other parts of the Borough are in suitable cases sent to the dining rooms and supplied with dinners at the cost of the Council. 26 Dr. A. Maud Swanson, Medical Officer in charge of the Clinic, reports:— Infant Clinics.—76 sessions were held with a total attendance of 2,254, average 29.7. Ante-natal Clinics.—27 sessions were held with a total attendance of 253, average 9.4. Cases referred to Hospital.— 6 children to the Children's Hospital, Tite Street. 1 child to St. George's. 1 child to Battersea General. Mothers attended the following Hospitals, &c., for their confinements:— 19 Battersea Maternity Home. 12 St. Stephen's Hospital. 11 Borough Midwife. 11 Private Midwife. 1 Hammersmith Hospital. 2 St. George's Hospital. 1 Private Doctor. Holidays.—10 mothers and 10 children were sent to the seaside for a week. 2 children had 3 months in the country sent by the Invalid Children's Aid Association. 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.—The Committee continued to make use of the surplus fund of the late Battersea School for Mothers, from which grants are made by the trustees towards the relief of necessitous cases nominated by the Council and living in the area formerly administered by the School. In all, grants amounting to £11 12s. 3d. were expended during 1938 among the deserving cases nominated. Battersea Fathers' Council. This Council was founded in 1930, and in 1938 had a membership of 56, and continued to meet monthly at the Mundella Road centre during the year, the average attendance being 17. A branch of the Council in the area served by the Southlands Centre was opened on 24th January and has met there monthly since, with an average attendance of 16. Though handicapped by the absence through illness of the Health Visitor by whom the meetings are usually organised (Miss Wilkie), the Council had a year of full activity, a number of well known speakers addressing the meetings. 27 The subjects discussed included—Dental care, Education, Local Government machinery, Blood transfusion, Hygiene. A cricket club was formed and arrangements made for winter practice in preparation for matches during the season. Though not an integral part of the Council's Maternity and Child Welfare scheme the work is of definite value and is looked on with approval by the Ministry of Health. Health Visitors. The Health Visiting Staff, the personnel of which is shown on page 3, consists of 14 Health Visitors, two of whom are partly employed as women Sanitary Inspectors. Facilities are granted by the Council to students of recognised training bodies for practical instruction and training as health visitors and women sanitary inspectors. During the year 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. The home visiting carried out during 1938 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 4,632 312 4,944 Notified births 10,755 674 11,429 Still-births 59 4 63 Children aged 1-5 years 7,386 738 8,124 Infant deaths 115 20 135 Notifiable infectious disease 4,572 209 4,781 Non-notifiable disease 181 34 215 Prevention of diphtheria 125 18 143 Dental cases 72 2 74 V.D. cases 2 — 2 Maternal deaths 6 — 6 Foster mothers and children 813 — 813 Other 1,062 127 1,189 Totals 29,780 2,138 31,918 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 47). 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 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 21 1 1 Belgrave 3 - 1 1 Bolingbroke 36 - — — Charing Cross — 13 — 13 Children's, Gt. Ormond St. 6 — 5 5 General Lying-in — 334 — 334 Hammersmith (L.C.C.) — 30 — 30 King's College — 7 — 7 Lambeth, Brook St. (L.C.C.) — 1 — 1 Middlesex — 4 — 4 National, Queens Square 1 — — — Paddington (L.C.C.) — 1 — 1 Royal Eye 1 — — — Royal Orthopaedic 1 — — — St. George's — 91 — . 91 St. James's (L.C.C.) 29 1,125 4 1,129 St. Luke's (L.C.C.) — — — — St. Mary Abbotts (L.C.C.) — 13 — 13 St. Stephen's (L.C.C.) 1 236 — 236 St. Thomas's 87 204 42 246 St. Thomas's, Babies 276 — — — South London, for Women 10 6 — 6 Victoria, Chelsea 616 — 263 263 Vincent Square 8 — 2 2 Westminster 5 24 — 24 Battersea Tuberculosis Dispensary - - - - Other Societies — — 17 17 L.C.C. ante-natal and midwifery services - 208 208 Private midwives' cases — 116 — 116 Totals 1,101 2,413 335 2,748 The London County Council, with a view to establishing a closer link between the Maternity and Child Welfare clinics of the borough councils and the general hospitals of the County Council, invited the Council to agree in principle to the association of the medical officers of the clinics in an honorary capacity with the maternity departments and ante-natal clinics at the hospitals. 29 The Council agreed, and later Dr. Hamilton, Assistant Medical Officer of Health (Maternity and Child Welfare) was appointed to act in such a capacity at St. James's and St. Stephen's L.C.C. hospitals. By arrangement with the County Council the treatment of minor ailments found in children attending the centres may also be carried out at the school clinics of the County Council, of which there are three serving Battersea. This service was only utilised in a few cases. 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. 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 present compared with the past five years:— A.—Number of Persons Supplied, 1933-8. Year. Mothers. Children. (Years.) Total Persons Exp. Nursing. 0— ¼- 1½- 3—5 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 Mean 1933-7 238 362 68 542 429 66 1,705 1938 372 328 98 662 445 166 2,071 [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.— Quantity and Cost of Milk Supplied. Year. Liquid (pints). Dried (lbs.) % Supplied. Cost to Council. Free At reduced price. 1933 237,629 3,642 90.7 9.3 £3,280 1934 153,906 2,483 90.0 100 £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 Mean 1933-7 179,098 3,311 85.7 14.3 £2,736 1938 242,661 5,946 81.3 18.7 £4,240 [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.] 30 It will be seen that the average number of persons who received milk for 1933-7 was increased by 21 per cent. during the past year, while the amount expended was 55 per cent. greater. These increases are mainly due to the revised scale of assessment adopted in September, 1937, and the increased amounts then permitted to be issued in various cases ; but the establishment of additional toddlers' clinics has resulted in many more children between 3 and 5 years of age receiving milk than formerly. Care is taken to see that there is no abuse of the facilities provided, and in 1938 the enquiries made of employers as to the wages stated by the applicants were largely increased in number. The form of application was also revised and re-printed in order to avoid some ambiguities which might possibly lead to misstatements, and a number of cautionary letters were addressed to persons who were found to have made erroneous statements. In one case a prosecution was instituted with the result shewn on page 87. 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 1938. During the year 150 persons in 118 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 13,572 pints of liquid, and 220 lbs. of dried milk. The cost involved was approximately £268, 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 1,159 pints of Tuberculin tested milk were supplied under this scheme, the number of mothers affected being 20. 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. 31 There is also a scheme by which vouchers issued by two manufacturers are distributed at the welfare centres in suitable cases entitling the holders to purchase dried milk at chemists' shops at reduced prices. During 1938 vouchers for 9,808 lbs. of dried milk were issued, and in addition 153 lbs. of milk 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 were:— Women's League of Service (women) 266 (children) 496 Invalid Kitchens Association (women) 344 ,, ,, „ (children) 1,819 a total of 2,925, the cost to the Council being £67 19s. 9d. 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. 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 75). 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 1938 is summarised as follows:— Women. Children. Total. Sessions held 203 49 252 No. of patients who attended 464 487 951 No. of new patients 340 377 717 Total attendances 2,339 1,121 3,460 Work carried out:— Extractions — Ordinary 1 - 1 With local anæsthetic 25 2 27 „ general anæsthetic 527 217 744 Totals 553 219 772 32  Women. Children. Total. No. of teeth extracted 1,500 570 2,070 Scaling and polishing 53 — 53 Fillings 132 31 163 Upper dentures 49 — 49 Lower dentures 35 — 35 Denture visits 389 — 389 Dressings and treatment to gums 120 7 127 Repairs to dentures 16 — 16 Advice 1,043 877 1,920 The number of children who attended the dental clinic during 1938 declined from 537 to 487. This was due to the fact that the toddler's clinic previously held only at Southlands was divided among five other centres, from which comparatively few children came to the dental clinic. 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 on behalf of the Society, during the financial year 1938-9 (exclusive of the cost of dentures, shewn below), amounted to £38 12s. Od. The cost of dentures supplied during the financial year amounted to £195 17s. 3d. and the sums received from various sources were as under:- £ s. d. Contributed by patients 108 14 9 Payments by Chelsea Health Society 24 13 0 Grants from British Dental Hospital 5 0 0 Grants from Saturday and Sunday Hospital Funds 25 7 6 Public Assistance 4 0 0 Contribution by the Council 28 2 0 £195 17 3 The net cost to the Council of this service during 1938-39 was £502 4s. 9d. Ante-Natal Clinics. The ante-natal clinics provided by the Council under their Maternity and Child Welfare scheme were under the direction and supervision of the consultant gynaecologist (Miss Alice Bloomfield, m.d., f.r.c.s., f.r.c.o.g.). These clinics were held throughout the year 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 was held at the Southlands centre on Fridays. Clinics were also held at the Plough Road and East Battersea (All Saints') centres, 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 held an ante-natal clinic at their Southlands premises. 33 Booklets of advice for expectant mothers were available free of charge at each infant welfare centre. Each mother who applied for admission to the Borough Maternity Hospital, or for attendance by the Borough district midwife in her own home, was required to attend the ante-natal clinic periodically before her confinement, and was seen at least once by the consultant gynaecologist. Doctors and private midwives practising in Battersea were 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 Gynæcologist) reports:— Wednesday and Thursday Clinics (Battersea Maternity Hospital). Sessions held 104 Total attendances 3,076 Average attendance per session 29•6 New cases (primiparæ, 215; multiparæ, 187) 402 Return cases—85 (i.e., 45•4 per cent.) Stage of pregnancy when first seen— 1-6 months, 364; 6-8 months, 28; over 8 months, 10. Arrangements for confinement— Borough Maternity Hospital 322 District midwife service 72 Private midwife 2 Other arrangements 6 Cases referred for dental treatment 167 Cases referred to St. James' Hospital for X-ray for diagnosis of presentation, multiple pregnancy, &c. 25 Abnormalities met with at the clinics included the following— High blood pressure 47 Albuminuria 6 Contracted pelvis 13 Cardiac disease 3 ? Tuberculosis 2 Severe varicose veins 4 Others 17 Friday Clinic (Southlands). Sessions held 52 Total attendances 842 Average attendance per session 16•2 New cases (primiparæ, 84; multiparæ, 192) 276 Return cases—91 or 47 per cent. approximately. 34 Stage of pregnancy when first seen— 1-6 months, 233 ; 6-8 months, 36; over 8 months, 6 ; not stated, 1. Arrangements for confinements— Borough Maternity Hospital 132 Borough midwife 102 Private „ 19 L.C.C. 12 L.C.C. hospital 3 Other arrangements 8 Cases referred for dental treatment 78 Cases referred to St. James'Hospital for X-ray 2 Abnormalities met with at the clinic included the following— High blood pressure 4 Albuminuria 1 Contracted pelvis 1 Cardiac disease 4 ? Tuberculosis 1 Severe varicose veins 1 Others 3 Tuesday Afternoon (Special) Clinic. Sessions held 52 Attendances 718 Average attendance per clinic 13.8 Bloods taken for Wassermann reaction—Negative, 670; Positive, 1; Doubtful, 4 675 Gynaecological cases included the following— For diagnosis of pregnancy 9 For diagnosis and treatment of vaginal discharge 3 Retroversion of the gravid uterus 2 Other cases, including prolapses, dermoid cyst of the ovary, urinary infections, etc 18 Ante-natal cases examined—new, 8; old, 6. Post-natal cases examined—new, 6; old, 3. Note.—At this clinic all external versions under anaesthesia and examinations under anaesthesia for diagnosis of presentation, etc., were carried out. 35 The subjoined table shows in summary the number of attendances, &c., during 1938, 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 104 52 52 49 257 Attendances 3,076 842 787 616 5,321 „ average 29•6 16•2 15•1 12•6 20•7 New cases 402 276 95 70 843 Interviews by doctor 3,076 814 751 595 5,236 Average per session seen by doctor 29•6 15•7 14•4 12•2 20•4 The work of the ante-natal clinic of the Women's League of Service is referred to on page 26. The number of new cases seen at the municipal clinics (except the Maternity Hospital) shewed in total an increase over the previous year of 78 per cent. This may be attributed directly to the operation of the new London County Council midwifery service, under which patients are persuaded to attend at definite intervals during the ante-natal period. 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 was fully equipped with the necessary requisites for diagnosis and treatment, and was under the direction and supervision of a specialist consultant (Mr. H. Corsi, f.r.c.s.). Mr. Corsi reports as follows :— " The number of patients examined during 1938 by Wassermann test was 675. Of these one only gave a positive result, though four others showed the probable presence of a mild degree of infection. The one case was fully treated, and, though the patient has not yet been confined, it can fairly safely be expected, that a healthy infant will be born. The other four cases received treatment considered adequate for their cases, and during the year there has been no difficulty in getting patients to come to the clinic. '* Three babies, whose mothers were treated in 1937 were also tested and found clear of all trace of blood infection. It was not possible to examine the blood of one further infant, but it has seemed healthy to ordinary medical examination. 36 BATTERSEA ANTE-NATAL (V.D.) CLINIC. Results 1922—1938. Year. Number of expectant mothers tested by W.R. Number giving positive W.R. Per cent. Number of expectant mothers with positive W.R. treated during pregnancy. Babies. Healthy Neg. W.R. Healthy looking. Not yet tested. Positive W.R. Still-born. 1922 - - - 1 1 0 0 0 1923 — — — 8 5 2 1 0 1924 517 18 3•5 15 11 3 0 1* 1925 653 14 2•1 8 7 1 0 0 1926 658 10 1•5 9 7 2 0 0 1927 674 12 1•7 12 6 4 2 0 1928 934 12 1•3 12 5 6 0 0 1929 804 13 1•6 13 10 3 0 0 1930 704 5 0•7 4 3 0 0 1* 1931 810 6 0•7 5 1 4 0 0 1932 832 11 1•3 11 5 6 0 0 1933 763 6 0•8 4 3 1 0 0 1934 727 5 0•7 3 3 0 0 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 1938 675 1 0•1 1 3 1 0 0 [W.R.—Wassermann reaction.] * Not syphilitic. 37 "It is notable that the percentage of positive tests found last year has shrunk almost to vanishing point. It would appear therefore that the V.D. clinic has now served its purpose, and that quite apart from any administrative difficulties the time is very suitable for ending it. "I would like to express my thanks to all who directly or indirectly have helped me during the ten years the clinic has been my charge, and I am particularly appreciative of the interest, assistance and courtesy of the health visitors." The clinic was closed down at the end of 1938, the last session being held on 14th December. It was started on 15th October, 1921, and a complete record of the results of the work is summarised on the preceding page. The reason for the closing of the clinic is explained on pages 42-3. 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 made full use of the facilities provided. Midwives. At the beginning of 1938 there was only one private midwife practising independently in the Borough, but the Borough Maternity Hospital, St. James's Hospital and a private nursing home employed midwives numbering in all about 14 in addition to the Borough District Midwife. There were, however, in addition the panel of London County Council midwives, numbering 12 for the five boroughs (Battersea, Bermondsey, Lambeth, Southwark and Wandsworth) comprised in Area D. Four or five only of these 12 normally practised in Battersea, and not till mid-year did any of them reside in Battersea. The district practice of St. Thomas's and the General Lying-in hospitals, as well as of one outside nursing home, also extended into Battersea. Compensation was paid to the one private midwife left practising in respect of two of her patients whose confinement took place in an institution on medical advice. Midwives Act, 1936. The inauguration of the salaried service of midwives established by the London County Council under this Act took place on 1st January, 1938, and the necessary co-operation between their midwives and the Council's social services has been successfully established. One immediate effect, already noted on page 35, was the increased attendance at the ante-natal clinics. Although for many years past these clinics have been open to any practitioner or midwife without charge, outside the Council's own maternity 38 services, very little use was made of them. It cannot but be to the good that so many more expectant mothers will now be brought under medical supervision at a period so important in their lives. The further development of the London County Council's midwifery scheme—the establishment of the emergency obstetrical service (popularly known as " the flying squad ")—was in the last stages of preparation at the end of the year. The Council on the enquiry of the London County Council had already in September agreed to pay £5 5s. for each Battersea case attended. The service is intended for acute obstetrical emergencies when patients cannot be moved to hospital without undue risk; and a doctor with special obstetric experience, a midwife, and appropriate equipment (including facilities for blood transfusion) are to be despatched immediately on receipt of a request from the medical practitioner attending the patient. On 1st November, 1938, an Order made by the Ministry of Health and entitled the County of London (Midwifery—Prohibition of Unqualified Persons) Order, 1938, came into operation. Its scope is as indicated by its title, and it may be regarded as the last nail in the coffin of that picturesque but otherwise undesirable character whom Dickens immortalised as Sairey Gamp. Training of Midwives. The new Rules proposed by the Central Midwives' Board which were briefly referred to in the last annual report came into force during 1938. A longer period of training—from six to twelve months in the case of trained nurses and from one to two years for others—became compulsory. The Council, whose maternity hospital had for 16 years been a recognised training school, were affected by the new Rules, and in 1937 they applied for their hospital (which could not under the rules be recognised as a first period training institution) to be approved for the second (or practical) period of training. Before this approval was received however, discussions were taking place with the authorities of the University College Hospital, Gower Street, W.C., with a view to co-operation for the purpose of first period training. These discussions resulted in the formulation of a scheme which received the approval of the Council in May and the sanction of the Central Midwives' Board later. The previous application in respect of the second period was therefore abandoned. Difficulty was however experienced in obtaining pupils, and the Council decided to abolish the training fee (£20 for a six-months pupil) formerly charged. To complete the Council's scheme, an arrangement was come to with the Gloucester District Nursing Society to receive for second period training, pupils who had been trained in the University College or the Council's hospital, but owing to the permanent closure of the Borough Maternity Hospital the scheme never materialised. District Midwifery Service. There were 173 cases attended in their own homes by the District Midwife as compared with 150 in the previous year. Particulars relating to this service are set out below:— Total number of completed cases attended in the district 173 (Booked in 1937, 45; booked in 1938, 128) Average number of visits to each case 16•5 Number of cases:— (a) Delivered by midwife (159 infants) 157 (b) ,, doctor Nil (c) Born before arrival (7 infants) 7 (d) Sent to hospital and confined there (10 infants) 9 (e) Referred to hospital for ante- or post-natal treatment 7 Total births (live, 174; still, 2) 176 Total number of bookings in 1938 201 Number thereof cancelled or transferred 32 „ confined during 1938 128 „ not confined in that year 41 201 Nine other cases were attended by the district midwife acting in the capacity of maternity nurse, a doctor having been engaged for the confinement. These cases are not included in the foregoing or following figures. Number of cases where medical assistance was summoned with reasons for requiring assistance :— (a) Ante-natal—6. (c) After labour—18. Ante-partum hæmorrhage 2 Post-partum hæmorrhage 7 Obstructed labour 2 Ruptured perineum 7 Delayed first stage 1 Do., with thrombosed varicose veins 1 Complicated breech 1 6 Pain in leg and groin 1 Collapse 1 Puerperal mania 1 (b) During labour—23. 18 Prolonged labour 16 Malpresentation 1 Diagnosis of presentation 1 Obstructed labour 1 (d) For infant—7. Fœtal distress 2 Sticky or watery eyes 4 Extended breech 1 Phimosis 2 Complicated breech 1 Other reasons 1 23 7 The consultant provided by the Council (vide page 46) was called to one case in the district service. 40 Number of cases of— Puerperal sepsis 1 Puerperal pyrexia Nil Maternal deaths 1 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, and, since January, 1938 the supply has been gratis. Forty-seven of the 173 cases attended during the year were dealt with by the relief midwife. It is recorded on page 42 et seq., that at the end of 1938 it became necessary to close the Council's maternity hospital permanently. The future of the district midwifery service which was directed from the hospital then became the subject of serious consideration. Though the Council in 1937 had felt unable to agree to the proposals of the London County Council for the absorption of the service, the new position resulting from the closure of the hospital, and the impossibility of providing additional relief for the midwife caused the Council to reconsider the matter, and on 21st December they decided to discontinue the district service and to ask the London County Council to take the midwife into their staff of domiciliary midwives. The service was actually closed down on 31st March, 1939. The County Council were prepared to adopt the Council's proposal but the midwife was unwilling. Like the maternity hospital the district service thus ceased to function after eighteen years of useful existence. It had its own important part in the Council's maternity services, and it may fairly be claimed that it was popular. Upwards of 2,600 confinements were conducted by the district midwife and only two maternal deaths occurred at the patients' homes. As in the case of the maternity hospital it is not possible to say that the loss of the service will be severely felt, since after the passing of the Midwives Act, 1936, the London County Council developed their service in such manner as to provide similar facilities available to all. Prior to this however the district service had held a unique place in the life of the Borough. BOROUGH MATERNITY HOSPITAL. The Borough Maternity Hospital was situate at 19 and 20 Bolingbroke Grove, overlooking Wandsworth Common. It was established soon after the war, and opened for the reception of maternity cases in February, 1921. There was accommodation for 30 patients at one time. The district midwifery service for the attendance of the district midwife on patients in their own homes was also directed from the hospital. 41 The fees for the hospital were fixed according to a scale adopted by the Council with provision for appeal against the assessments made. The nursing staff normally consisted of a matron, two sisters and 3 staff nurses, and usually there were 8 pupil midwives undergoing training, the hospital having been an approved training institution since 1922. The position of the hospital under the new rules of the Central Midwives' Board is referred to on page 38. In 1938, 16 pupils passed the qualifying examination of the Central Midwives' Board. The central ante-natal clinics and the special treatment clinic were held at the out-patient department of the hospital. A post-natal clinic was also held at the hospital. During 1938 there were 49 sessions held and 454 attendances were made. The average attendance per session was 9.3. Mr. F. W. Roques, m.ch., f.r.c.s., f.r.c.o.g., of the Middlesex Hospital, acted as consultant obstetrician, and it was found neces sary to call him to 38 patients during the year for the following reasons:— Albuminuria 2 Post-partum haemorrhage 2 Ante-partum hæmorrhage 1 Pyrexia 1 Caesarean section 13 Trial labour 1 Forceps deliveries 4 Version 3 Induction 6 Other reasons 5 Mr. Roques also paid routine supervisory visits to the hospital. During 1938 there were 468 cases admitted to the hospital as compared with 477 cases during 1937, 418 in 1936 (in which year the home was closed during a period of ten weeks), 489 in 1935, and 493 in 1934. Particulars relating to the cases dealt with during 1938 are as follows:— (a) Persons admitted— New cases (i.e., cases first admitted 1938) 467 1937 cases confined during 1938 1 Total persons admitted 468 (b) Number of admissions— For confinement 453 For ante-natal treatment (54 patients) 59 Total admissions 512 42 (c) Number of confinements— Admitted 1937, confined 1938 1 Admitted and confined 1938 452 Total confinements 453 Admitted but not yet confined at end of year 1 Received ante-natal treatment only 14 Number of deliveries— By midwives 413 „ doctors 40 453 Number born before arrival 2 Total births (including 9 pairs of twins) 462 Number of maternal deaths Nil* Number of cases notified as Ophthalmia Neonatorum with result of treatment (Unknown—nonBorough case) 1 Number of infants not entirely breast fed 40 Number of cases notified as puerperal sepsis 1 Number of cases notified as puerperal pyrexia 4 Number of infant deaths (7 still-born, 4 within 10 days of birth) and their causes 11 Still birth Died within 10 days— Foetus macerated 3 Prematurity 1 Ante-partum haemorrhage, Intercranial haemorrhage 1 (prolapsed chord) 1 Congenital haemorrhage, Premature 1 mongolism 1 Post-mature 1 Congenital microcephalic idiocy 1 Caesarean section 1 7 4 Closure of Hospital. During the past few years the Maternity Hospital, like other hospitals, but in greater degree than many, has suffered from that general shortage of nursing staff which has become such a disquieting feature. An institution such as the Council's hospital, with its small staff and consequent lack of social amenities could not expect to obtain nurses in competition with the larger London institutes. The difficulty of finding staff had already, in 1936, been the chief reason for the temporary closing of the hospital in that year, and in 1938 the difficulty recurred in more accentuated form. * 1 patient suffering from rheumatic endocarditis was transferred to St. James's Hospital and died there. 43 On the resignation of members of the nursing staff, it was found impossible to replace them, in spite of repeated advertisements, and it became necessary to employ nurses from private associations. The new regulations of the Central Midwives' Board with regard to the training of pupils added to the difficulties of the situation, since the number of pupils who could be trained had to be reduced to six instead of eight as previously. With little prospect of a permanent improvement therefore, it became incumbent upon me as Medical Officer of Health to consider anxiously the future of the institution. The building was over 50 years old, and I was aware that my colleague, the Borough Surveyor, held the opinion that to maintain the fabric in the condition desired by the Committee would prove very expensive. In consultation, therefore, we prepared reports upon the situation, and these were submitted to the Maternity Committee at its first meeting on 1st December. The reports are printed in the appendix, pages 128-33. The Committee gave to the reports the careful and detailed consideration which their importance warranted, and bearing in mind the altering circumstances of hospital accommodation in London, felt that they had no alternative but to recommend the Council to close the hospital, and as a concomitant to terminate the district midwifery service. The Council adopted the report on the 21st December, and arrangements were immediately put in hand to give effect to the decision. Actually no patients were admitted to the hospital after 31st January, and the last patient left the hospital on 9th February, 1939. The hospital was opened in 1921, and had therefore served the needs of the Borough for 18 years. Purchased, adapted and equipped at a cost of £18,851, it opened its doors to patients on 21st February, 1921. During its existence 8,842 patients were confined, while only 10 maternal deaths occurred therein. When it was opened, it filled a gap in the Maternity services available to Battersea residents. Even at its close it still fulfilled a useful function, and there was little evidence of any loss of popularity. There is no doubt, however, that, with the increased provision made by the London County Council, both for institutional and district midwifery, the necessity for such a hospital was not so marked as in its early years. It was one of the first municipal maternity hospitals to be established in London, and in proportion to the population served, it was the largest but one. In comparison with some other municipal hospitals, therefore, it is not surprising that a smaller proportion of beds was occupied throughout the year, but consistently year by year, the births occurring in it numbered approximately 21 per cent. of the Battersea births. 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, 1939 :— 44 Maternity Hospital, 1938—9. Total beds (excluding cots, labour and isolation beds), 30 : total cases admitted and discharged during year, 377 ; average number of beds occupied during such period, excluding cots, labour and isolation beds, 17.1 ; number of weeks spent in Institution by patients admitted and discharged during year, 758.9. A statement* showing expenditure for the year ended 31st March, 1939, in respect of the Maternity Hospital is given below. Item. Total. Per patientweek. £ £ s. d. Salaries - Medical 666 0 17 4 Nursing 885 1 3 1 Domestic and other 819 1 1 4 Superannuation (Council's contribution) 84 0 2 2 Fees to nursing homes re closing of hospital 278 0 7 3 Provisions 686 0 17 10 Drugs and other medical requisites 111 0 2 11 Fuel, lighting and water 371 0 9 8 Laundry 297 0 7 9 Repairs and Domestic 140 0 3 8 renewals Structural 383 0 10 0 Miscellaneous items— Telephones, stationery, etc., and sundries 169 0 4 5 Totals, excluding rates, insurance and loan charges 4,889 6 0 2 Rates and insurance 81 0 2 1 Loan charges 969 1 5 3 Gross cost 5,939 7 14 9 Income Pupil Midwives (including training grant) 175 0 4 7 Patients' payments 1,942 2 10 7 Other 71 0 1 10 Net cost £3,751 £4 17 9 * This statement does not take into account the Government Grant. Southwark Diocesan Homes. The Council make a grant of £150 per annum towards the cost of maintaining before, during and after confinement unmarried mothers and their children resident in the district, in St. Mary's 45 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. The grant is also intended to cover the cost of Battersea unmarried mothers who are sent into other approved homes by the Association. The number of Battersea mothers received in the Association's homes with their babies during 1938 was 13, and 2 admitted during 1937 remained for some part of 1938. These 15 mothers were maintained for 1,316 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. The mother herself is given the choice of a woman (subject, however, to approval by the Assistant Medical Officer), and details of the service to be rendered, times, &c., are arranged between them. The Committee then vote a grant, according to the necessities of the case. During the year grants totalling £9 16s. 0d. were made in nine cases. Maternal Mortality. During 1938, there were 6 deaths of women from diseases or accidents of child-birth which is equivalent to a fatality rate of 2.76 per 1,000 births (live and still), as compared with 4 deaths and a fatality rate of 1.81 in 1937. The certified cases of death were:— Sepsis following natural abortion 1 Puerperal septicæmia 1 Post puerperal pulmonary embolism and phlebitis 1 (a) Septicæmia, (b) osteomyelitis of ilium, (c) recent delivery 1 (a) Pulmonary embolism, (b) femoral thrombosis, (c) puerperal sepsis 1 Septic endometritis following cæsarean section 1 All these deaths occurred in hospital. In addition there were four maternal deaths in hospital not ascribed to causes directly associated with the puerperium. The rates for London and England and Wales in 1938 were 1.86 and 2.97 respectively. 46 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. 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 1937 — — 4 1•81 4 1•81 Mean, 1933-37 2•0 0•89 3•0 1•36 5•0 2•25 1938 5 2•30 1 0•46 6 2 •76 Following the usual procedure, and in accordance with the instructions of the Ministry of Health, the 6 deaths of Battersea mothers were 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. 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 1938. 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 in the past have failed to avail themselves of these facilities 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. The emergency obstetric service to be provided by the London County Council (referred to on page 38) had not yet come into being at the end of the year. Convalescent Homes. During 1938 accommodation was provided for 6 mothers and 6 children attending the Maternity and Child Welfare clinics at four approved convalescent homes. The cost incurred by the Council amounted to about £9 10s. 0d., and two of the families 47 concerned were charged with the balance of £3 2s. 0d. In one case the cost of maintaining a baby of 3 months in an open air home was borne by the Council from February to May, when the case was taken over by the London County Council. 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 1938 is as follows :— Test Feeds. Number of cases, 196, comprising : Mothers, 196 ; babies, 199. Number of attendances, 713. 15 of these cases received in-patient treatment. In-Patient Treatment. Battersea cases received— 19 mothers and 33 babies sent by Council. 3 babies sent from other sources. Period of stay. Cases sent by Council—19 mothers and 33 babies, 1,499 days; average, mothers 20 days, babies 34 days. Other cases—3 babies, 106 days (average 35 days). The contribution of £150 made by the Council annually in respect of the work carried out by the Hostel for Battersea mothers, was increased to £200 per annum from 1st April. 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. The total number of attendances made by the nurses of the District Nursing Association in connection with cases of infectious disease was :— 48 Nursing Service, 1938. Age. Name of Disease. Under 5 years. Over 5 years. Total. Cases. Visits. Cases. Visits. Cases. Visits. Ophthalmia neonatorum, &c 144 2,235 - - 144 2,235 Measles 26 210 7 83 33 293 Whooping cough 2 3 — — 2 3 Diarrhoea & vomiting 26 73 — — 26 73 Chicken pox 4 22 2 14 6 36 Impetigo 16 111 — — 16 111 Mumps - - - - - - Pemphigus neonatorum - - - - - - Puerperal pyrexia — — — — — — Pneumonia 9 112 26 548 35 660 Influenza — — 39 106 39 106 Erysipelas — — 1 11 1 11 Totals 227 2,766 75 762 302 3,528 Many of these cases were referred to the Association by medical practitioners. There were also 540 cases of minor diseases to which visits were made numbering 4,608. 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. ouches. During the year 138 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 58. The total attendances numbered 3,406, the average number per session being 24.7. A medical officer attended 16 of the sessions, at which she conducted 202 examinations. Five children were referred elsewhere for other treatment. The number of persons who received treatment during the year (excluding tuberculous children) was 136, including 16 who commenced treatment in previous years. 49 The ages of the 120 cases who attended first in 1938 were as follows:— Under 1 year 14 1 to 2 years 77 2 to 3 „ 29 The reasons for their treatment were:— Prevention of rickets 78 Debility 29 Retarded development 8 Recurring bronchitis (3) and anaemia (2) 5 Treatment in these cases was principally by the carbon arc 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 76. 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 1938, 149 massage sessions were held, at which the attendances numbered 1,385, an average per session of 9.3. The new patients numbered 61. 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 was represented during the year by Mrs. A. A. Burton, the Chairman of the Health Committee. There is accommodation for 27 children, and for 24 in a guest house which is attached for the reception of residents. During 1938 the attendances at the Nursery totalled 5,008, the number of children admitted being 50. In the case of the guest house 87 children were admitted, the average duration of their stay being 67.6 days. An annual grant of £500 is made by the Council under the Scheme made by the Ministry of Health (vide page 22). 50 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 arrangements. The Council undertook to store the shelter during the winter months, but accepted no responsibility therefor, and they bore the cost of erecting and dismantling it. 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 1938:— The Invalid Children's Aid Association is a voluntary organisation which works in close co-operation with statutory and voluntary bodies. Its aim is to give " Every Child a Chance " to become a self-supporting citizen in so far as his physical disabilities will allow. The work includes the provision of Convalescent Home treatment, the supplying and supervision of surgical appliances and the Association undertakes a considerable amount of home visiting at the request of hospitals, clinics, doctors, etc. The year 1938 was the busiest since the Branch was re-established in 1932, 399 new children (in addition to nearly 300 re-applications) were referred for help of various kinds. This is an increase of 43 new children over last year. Of the total of 399 new children, 63 came from Borough sources, 65 from School Medical Officers and Care Committees, and 223 from Hospitals. In 1938, 24 children were supplied with surgical appliances at a cost of £11 13s. 0d., and 191 children were sent to Convalescent Homes either at the seaside or in the country, for an average stay of 7½ weeks, at a total cost of £933 15s. 0d. This is an increase of £150 for an additional 26 children. The average cost of convalescence is 20s. a week for children under three, and 15s. a week over three years of age. 176 children under five years of age were referred to us by Infant Welfare Centres, Toddlers' Clinics, Hospitals, &c., for help of different kinds ; 76 children were provided with convalescence or surgical appliances, costing a total of £370 5s. 0d. During 1938, 25 children were sent to the Branch by the Tuberculosis Dispensary; 14 went for convalescence and 13 were boarded out under the Tuberculosis Contact Scheme. The cost of maintenance for the latter is borne by the London County Council, but a good deal of work has to be done by the Branch in placing these children in homes, buying outfits, providing escorts, &c., as frequently the mothers are too ill to make any arrangements themselves. Through the kindness of the Borough Council the Branch was able to hold a Jumble Sale in the Welfare Centre at Southlands, which realised £7 2s. 8d., and once again the Branch has to thank the Council for the use of the grounds at Southlands for their Summer Fête, which made a very welcome profit of £30 13s. 6d. 51 The Battersea Branch are very glad to have Councillor Mrs. A. A, Burton on their Committee as representative of the Health Committee of the Battersea Borough Council. The Branch Committee are much indebted to the Borough Council for allowing them the use of offices at Southlands and for making a grant of £50 a year for services rendered to children under five years of age. They are most grateful to the Council for their generous help, and are always very pleased to co-operate with them in any way that they can in the care of the invalid and cripple children of the Borough. Toddlers' Clinic. In the last Annual Report I recorded the decision of the Council to hold a weekly toddlers' clinic at each of the Council's six welfare centres, commencing with the financial year 1938-9. In the year 1938, therefore, there was throughout the year a weekly toddlers' clinic held at Southlands, and during the last nine months six weekly sessions held as under:— Monday (a.m.) Chatham Hall. Tuesday (p.m.) Southlands. „ Gideon Road. Thursday (a.m.) All Saints Hall. Thursday (p.m.) Mundella Road. Friday (p.m.) Plough Road Institution. To fill the appointment of medical officer made necessary by this extension of the clinics the Council, on 22nd March, appointed Dr. G. H. Newns, m.d., m.r.c.p., and he has since the beginning of April attended all these clinics except the original one held at Southlands, which remained in the charge of Dr. S. King, the deputy Medical Officer of Health. The defects found on medical inspection were as under, the table having been arranged as nearly as possible in the same order as that on page 18 relating to school children. Malnutrition 58 Lung defects 53 Skin disease 61 Nervous defects 9 Defective teeth 134 phthisis — Enlarged tonsils 35 Other Tb. disease — Adenoids 7 Evidence of past Rickets 30 Enlarged tonsils and adenoids 55 Spinal deformities 2 Other nose and throat defects 4 Other deformities (including knock knee, 72; flat foot, 19; bow legs, 18) 120 Enlarged glands 8 Eye disease 17 Vision defect 18 Other defects (including eneurisis 42 ; phimosis, 21; worms, 13; hernia., 15) 151 Otorrhoea 13 Other ear disease 1 Defective hearing — Speech defects 7 Total defects noted 809 Heart defects 19 Anaemia 7 Total children examined i ,224 The above table and that following show that of 1,224 children examined 569 showed defects to the number of 809, while 655 showed no defects, defective teeth not being counted for this purpose. 52 TODDLERS' CLINICS, 1938. Clinic held at Total. Southlands. Plough Road. All Saints Hall. Chatham Road. Gideon Road. Mundella Road. Children invited 708 412 442 266 308 273 2,409 Number who attended 288 200 252 195 230 121 1,286 On invitation 229 187 240 186 225 115 1,182 From 1937 38 5 9 2 4 4 62 Otherwise 21 8 3 7 1 2 42 Sessions held 48 38 39 35 37 39 236 Attendances— First 250 195 243 193 226 117 1,224 Other 347 248 400 246 291 138 1,670 Total 597 443 643 439 517 255 2,894 Average per session 12.4 11.7 16.5 12.5 14.0 6.5 12.3 Previously attended I.W.C. 212 1.43 211 163 196 69 994 Number showing no defects (except dental) 83 124 160 128 81 79 655 Referred to— Dental clinic 241 39 54 30 29 19 412 Schick clinic 177 5 11 3 13 3 212 Solarium 29 — — — — 1 30 Tuberculosis dispensary — 1 - — 1 — 2 School clinic 1 1 — 3 1 — 6 Hospital 50 30 25 23 20 9 157 Private doctor 4 -— — — — 2 6 Total 502 76 90 59 64 34 825 Recommended for milk supply 68 38 23 16 23 7 175 * Southlands Clinic open whole year; others from April to December. 53 Dr. Newns reports on the year's work as follows:— In November, 1936, a Toddlers' Clinic was started at Southlands for children age 3 years. The response was sufficiently encouraging to justify the extension of the clinics to the whole Borough. From April 1st, 1938, a Toddlers' Clinic was held weekly at each Infant Welfare Centre. This report covers the period from the above date to December 31st, 1938. (The figures also include those from the Southlands Clinic which was held throughout 1938.) All children from the ages of 2 to 5 years were eligible to attend the clinic, provided they were not attending school. On attaining the age of two years, children attending the Infant Welfare Centre were transferred to the Toddlers' Clinic. A circular was sent to the parents of all children in the Borough on or near their second, third and fourth birthdays, advising them to take their children to the clinic for examination. It should be noted that nearly 20 per cent. of the children had not previously attended an Infant Welfare Centre. The original intention was to see the children once a year and give them a complete medical examination. This was not entirely satisfactory as it did not provide adequate supervision or a sufficient check on the carrying out of advice or treatment. The children are now seen, therefore, at three-monthly intervals. Those who are underweight are usually seen more often. By this more frequent supervision, better contact is kept with the parents, and defects are detected at an early stage. The numbers at first were small, but they gradually increased, and are now fairly constant, the average being 12-13 per clinic. The numbers attending All Saints Clinic are higher because of the greater number of poorly nourished children who need more frequent supervision. Children who are found to be ill or suffering from defects are sent to private doctors or to local hospitals. Those with dental defects are referred to the Borough Dentist. Tuberculosis contacts are referred to the Tuberculosis Dispensary for investigation. The standard of nutrition varied considerably. In the Chatham Road and Gideon Road areas it was good, but in the Plough Road and All Saints districts many cases of malnutrition were met with. About 5 per cent. of the total cases seen were suffering from definite malnutrition, but there were many others who were considerably underweight. The proportion of children with defects was high, approximately 65 per cent. Many of the defects, however, were relatively slight, e.g., papular urticaria, bronchitis, &c. The commonest defects were dental ones, approximately 11 per cent. of the total. Enlarged tonsils and adenoids were frequently met with. Many of these cases were referred to hospital for operation. Genu Valgum was a common deformity, though generally mild in degree. Some cases of squint and otitis media were met with, and a few children having anaemia were discovered. No cases of clinical tuberculosis were found. It will be seen from the figures given that two out of three children presented some defect. While many of these were admittedly slight, such defects as dental caries, otitis media, enlarged tonsils and adenoids (especially the latter), if undetected, would result in very considerable disturbance to health. Other defects such as Genu Valgum and squint, if detected in the early stage can be corrected, whereas if they are left for several years are much more difficult to correct and may need operative treatment. The usefulness of these clinics seems therefore to be established. They close the hitherto open gap between the Infant Welfare Centre and the School Medical Service, and ensure that when the child reaches school age many of the defects so often found will have been detected and treated. 54 Child Life Protection. The statutory provisions relating to child 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 Child Life Protection visitors. The number of visits paid by them in 1938 to foster-mothers and children was 813. At the end of 1937 there were 114 Battersea foster-mothers known to the Council, 54 of whom had nurse children in their care to the number of 94. During 1938, 31 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 98 fostermothers, of whom 51 had nurse children in their care to the number of 80. The ages of the 80 children were as under:— Under 1 year 11 1 to 5 years 40 Over 5 and under 9 years 29 Twenty-three of the children were attending the welfare centres at the end of the year. No foster children died during the year, but there were 18 cases of infectious disease. Twenty-five foster-mothers were cautioned for failing to give prescribed notice of— Reception of nurse child 12 Removal of nurse child 10 Removal of foster-mother and child into Borough 2 Removal of foster-mother and child 1 In one case an unsuitable foster-mother was required to give up the care of a nurse child; in a second a prospective foster-mother was informed she should not receive children, but in no case during the year was it necessary to resort to legal action to enforce the requirements of the statute, nor was it necessary to exercise the power of fixing the maximum number of nurse children permitted to be kept by a registered foster-mother. The whole number of nurse children who were under observation during 1938 was 187. 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. 55 Notifiable Infectious Diseases. During 1938 under the notification clauses of the Public Health (London) Act, 1936, and the Orders and Regulations made thereunder, 3,356 cases of infectious diseases (excluding tuberculosis) were notified. In 1937 the total was 2,083. The increase in the number of cases notified during 1938 was chiefly due to the biennial outbreak of measles. The following is an alphabetical list of the diseases compulsorily notifiable in Battersea:— Anthrax. Cerebro-spinal fever. (meningococcal meningitis) Cholera. Continued fever. Diphtheria. Dysentery. Encephalitis lethargica, acute. Enteric (typhoid) fever. Erysipelas. Glanders. Hydrophobia. Malaria. Measles. Membranous croup. Ophthalmia neonatorum. Plague. Pneumonia, acute influenzal. „ acute primary. Polio-encephalitis, acute. Polio-myelitis, acute. Puerperal fever. „ pyrexia. Relapsing fever. Scarlet fever. Small pox. Tuberculosis. Typhus fever. Whooping cough. Excluding tuberculosis, measles and whooping cough, there were 843 infectious cases notified, which occurred in 748 houses. Of these cases 700, or 83.0 per cent., were removed to the isolation hospitals of the London County Council or to other institutions and 143, or 17.0 per cent., remained under treatment at home. Full particulars of all notifiable infectious diseases will be found in the form required by the Ministry of Health 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 57. Cases of "Contacts" which were reported to the Medical Officer of Health were kept under observation in connection with various diseases. 56 Cases of Infectious Disease (excluding Tuberculosis) notified during the Year 1938, 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 2 9 8 14 23 107 25 11 15 1 2 - 217 159 58 7 Erysipelas — — — 1 — 1 2 1 16 10 14 6 51 21 14 Scarlet fever- — 12 16 33 37 105 26 12 9 3 1 - 254 157 88 Enteric (typhoid) fever — — — — 1 — 1 — 2 — 4 1 2 Continued fever - - - - - - - - - - - - - - - - Puerperal fever — — — — — — —i 1 4 3 8 5 2 5 Puerperal pyrexia — — — — — — — — 15 6 21 11 6 Meningococcal meningitis - - - - - - - - - - - - 1 1 - Ophthalmia neonatorum 29 - - - - - - - - - - - 29 4 4 - Polio-myelitis, &c. — 1 1 2 5 1 - - - - - 10 3 7 1 Polio-encephalitis - - - - - - - - - 1 - ] - 1 1 Encephalitis lethargica - - - - - - - - - - - - - - - 3* Malaria — — — - — - Dysentery — 3 2 1 1 3 1 — 3 1 1 — 16 6 3 — Acute primary pneumonia. 14 15 10 11 11 24 12 7 25 14 48 22 213 79 57 77 Acute influenzal pneumonia — — 1 — — 1 — 1 5 2 4 4 18 7 4 5 Whooping-cough 35 42 35 47 67 98 1 - 325 27 21 3 Measles 99 218 214 379 387 802 53 18 18 — - — 2188 222 163 11 Totals 179 300 287 488 527 1147 121 51 112 40 72 32 3356 703 430 113 * No record of previous notification. 57 Notifications of Infectious Diseases, 1938, in Wards and Sub-Districts. Notifiable Disease. Wards. Districts.† Totals. 1 2 3 4 5 6 7 8 9 N S Small-pox - - - - - - - - Diphtheria 32 30 39 17 58 19 7 9 6 159 58 217 Erysipelas 5 6 8 1 9 6 4 7 5 28 23 51 Scarlet fever 36 29 49 24 46 21 12 15 22 160 94 254 Enteric (typhoid) fever — 1 1 — — — — — 2 2 2 4 Continued fever - - - - - - - - - - - - Puerperal fever 4 1 — — 1 1 — 1 — 6 8 Puerperal pyrexia 4 1 4 1 5 2 — 1 3 14 v 21 Meningococcal meningitis 1 — — — — — — — — 1 — 1 Ophthalmia neonatorum 4 2 4 1 3 5 4 5 1 13 16 29 Polio-myelitis, &c. — — 2 2 1 2 1 2 — 3 7 10 Polio-encephalitis - - - 1 - - - - - - 1 1 Encephalitis lethargica - - - - - - - - - - - - Malaria - - - - - - - - - - - - Dysentery 3 — 1 2 3 2 1 1 3 7 9 16 Acute primary pneumonia 35 28 33 16 22 35 10 17 17 118 95 213 Acute influenzal pneumonia 1 5 4 2 1 1 -— 2 2 11 7 18 *Whooping cough 25 38 21 4 34 88 26 18 71 118 207 325 *Measles 312 289 208 178 292 323 133 207 246 1,101 1,087 2,188 Tuberculosis (all forms) 36 25 23 15 14 18 12 49 28 98 122 220 Totals 498 455 397 264 489 523 210 334 406 1,839 1,737 3,576 * Notified from January to September under Local Order; then under General Order. †See footnote, page 8. 58 Small-Pox. No case of small-pox was notified in Battersea during 1938. During the year 18 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. T. Lasker, 435 Battersea Park Road, S.W.11. (Deputy—Dr. L.L. Heyman, 68 Lavender Hill, S.W. 11.) 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. 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 1938 was as under:— Primary vaccinations— Under 1 year 1,108 1 year and upwards 41 1,149 Re-vaccinations 28 1,177 Certificates issued, children under 14 (including children born in other districts) 1,840 Statutory declarations of conscientious objection received during the year 725 59 Full statistics for the year 1938 had not been prepared at the time this report went to print, the last figures available being for the year 1937, as under :— Children whose births were registered during the year ended 31st December, 1937— Number of births registered 2,773 Successfully vaccinated 1,480 Insusceptible of vaccination 9 Had small-pox — Statutory declarations of conscientious objection 719 Died unvaccinated 151 Postponement by medical certificate 39 Removed to other districts 281 Removals untraced, &c 77 Not yet accounted for 17 - 2,773 Scarlet Fever. The incidence of scarlet fever was higher in 1938, 254 cases being notified as compared with 215 in the previous year. No death was registered from the disease. Of the cases notified 245, or 96.5 per cent., were removed to hospital. Particulars of the incidence of scarlet fever during 1938 and the five 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 1 001 0.23 1937 215 1-50 200 1 001 0.47 Average 502 3.38 444 1.6 0.02 0.32 1938 254 1 79 227 0 — — The incidence of the disease was highest in Church, Latchmere and Park Wards. In 69 other notified cases (not included in the above totals), the diagnosis of scarlet fever was not confirmed. Diphtheria. There were 217 cases of diphtheria notified (excluding 61 other cases in which the diagnosis was not confirmed). There were 7 deaths registered as due to the disease. All the cases were removed to hospital. 60 Particulars of the incidence of this disease during 1938 and the five preceding years are shown in the following table :— Year. Cases. Deaths. Notified. Per 1,000 Population Houses Invaded. 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 1938... 217 1.53 191 7 0.05 3.23 The incidence of the disease was highest in the Church, Latchmere and Park 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 13 phials (approximately 68,000 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 was carried on under the supervision of Dr. F. Porter Smith, m.r.c.s., l.r.c.p., until his resignation in August, when it was placed as a temporary arrangement in charge of Dr. W. W. King Brown. The result of the year's work is summarised as follows:— Sessions held 51 Patients attending in 1938 (new 400) 594 Attendances 1,983 „ (average per session) 38.9 Number of tests for susceptibility (including 8 of old patients) 271 (Positive 221, negative on 1st test 38, on second 5, no reading 7) 61 62 Patients inoculated— Without test (new 125; old 5) 130 After positive test (old patients) 13 ,, ,, ,, (new „ ) 219 - 362 Inoculations— Old patients 23 New „ 959 - 982 Tests after inoculation— Old patients 196 New „ 169 - 365 (Readings—Negative, 316; positive, 6; no reading, 44), (including one of test made in 1937) Patients immune or immunised— On primary test (adults 2; school children 28; younger children 7) 37 After inoculation (new 143, old 174) (adults 2; school children 196; younger children 119) 317 - 354 Patients on register at end of year 290 Discontinued treatment 10 The total number of patients immunised or found by test to be immune was 354, out of a total of 594 patients who have attended during the year (59.7 per cent.). Since the opening of the clinic 2,806 patients have attended, and of these 2,073 have been immunised or found immune by test (73.9 per cent.). Acute Polio-myelitis and Polio-encephalitis. Ten cases of acute Polio-myelitis were notified during 1938, excluding one case in which the diagnosis was not confirmed. One death was recorded. Cases of Polio-myelitis are also kept under observation after they have passed the acute stage, and 37 cases were visited by the Council's female sanitary inspectors, who paid 135 visits during the year. At the end of the year there remained 33 cases on the register. One case of acute Polio-encephalitis, which proved fatal, was notified. Puerperal Fever and Puerperal Pyrexia. Eight cases of Puerperal Fever were notified in 1938, as compared with 3 in 1937, 3 in 1936, 4 in 1935, and 10 in 1934. Five deaths were registered as due to this disease. The number of notified cases per 1,000 births (live and still) was 3.69, as compared with 1.36 in 1937, 1.37 in 1936, 1.84 in 1935, and 4.5 in 1934. 63 There were 200 cases of Puerperal Fever notified in London. A comparison of the incidence of Puerperal Fever in London and Battersea will be found on page 139. The number of cases of Puerperal Pyrexia notified in Battersea was 21, and the incidence per 1,000 births (live and still) was 9.68. One of these cases was also notified as a case of Puerperal Fever and is included in the preceding figure. 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 1938. 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 3 other cases in which the original diagnosis was not confirmed. There were no deaths of Battersea residents from this disease. Cerebro-Spinal Fever. One case of Cerebro-Spinal Fever was notified in Battersea. The patient was removed to hospital. One other notification was subsequently cancelled. Encephalitis Lethargica. No notification of this disease was received during 1938, but three deaths were ascribed to post encephalitis lethargica. Ophthalmia Neonatorum. There were 29 cases of Ophthalmia Neonatorum notified in Battersea during 1938, as compared with 12 in 1937, 29 in 1936, 21 in 1935, and 23 in 1934. The rate per 1,000 live births was 13.7. There were 8 severe cases amongst the 29 notified, of which 6 were removed to St. Margaret's (L.C.C.) Hospital for treatment, and 2 received treatment in other hospitals. All cases notified during the year were reported to be cured without damage to sight. 64 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 was 2,235. All cases were kept under systematic supervision by the Health Visiting staff, and 121 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:— Ophthalmia Neonatorum, 1938. Sub-Districts. Wards. Cases. Births (live). Rate per 1000 Births. Year. Cases. Births (live). Rate per 1,000 Births. N. Battersea 13 1,007 12.9 1933 16 2,263 7.1 S. Battersea 16 1,107 14.5 1934 23 2,154 10.7 1. Nine Elms 4 341 11.7 2. Park 2 223 9.0 1935 21 2,104 10.0 3. Latchmere 4 219 18.3 4. Shaftesbury 1 178 5.6 1936 29 2,128 13.6 5. Church 3 224 13.4 6. Winstanley 5 269 18.6 1937 12 2,144 5.6 7. St. John 4 161 24.8 8. Bolingbroke 5 262 19.1 Mean 9. Broomwood 1 237 4.2 1933-37 20 2,159 9.4 Borough 29 2,114 13.7 1938 29 2,114 13.7 Erysipelas. There were 51 cases of Erysipelas notified, 35 of which were treated in hospital. No death was recorded from the disease. Measles. The London County Council made new Regulations—the County of London (Measles and Whooping Cough) Regulations— dated 9th September, 1938, which were approved by the Minister of Health and came into force on 1st October. A draft of the regulations had been previously submitted to the Council who made two suggestions thereon, one of which was adopted and embodied in the Regulations. Measles had previously been a notifiable disease in London from 1916 to 1919, but the regulations were then rescinded, and except in isolated boroughs (of which Battersea was one), notification was not required for a period of nearly 20 years. Battersea, however, obtained its own Order—the Battersea (Measles and Whooping Cough) Regulations, dated 8th April, 1922—but this was, of course, rescinded on the coming into force of the new regulations. 65 Notification remains as before limited to the first case occurring in a house within a period of two months, and the number of cases notified therefore does not correspond, even approximately, with the number of cases occurring. It is the practice, however, for the Council's Health Visiting or Inspectorial staff to visit all cases coming to their knowledge, and thus comparatively few cases pass unrecorded. In 1938, there were 2,188 cases of Measles notified, and 489 additional cases reported from schools and other sources, making a total of 2,677 cases, being 18.9 per 1,000 of the population; 11 deaths from the disease were recorded, or 0.08 per 1,000 of the population. The corresponding figures for 1937 were: cases 632, incidence per 1,000 population 4.4, deaths 3. Of the 2,677 cases, 405 were removed to hospital. The Health Visitors paid 3,794 visits to the cases notified, reported or suspected. The table below gives particulars in two-yearly periods of the biennial epidemics of measles which have occurred since 1921. Incidence and Mortality of Measles in Epidemic Periods, 1921-1938. Period. Cases. Deaths. 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 1937-8 3,309 11.602 14 .33 .049 0.42 Although the incidence of the disease in this epidemic is higher than in the previous one, it is lower than the average for the previous epidemics from 1921-1936 inclusive. Close co-operation with the school staff of the London County Council was maintained. A co-ordinated scheme, involving the earliest possible visiting of the home, effective isolation as far as practicable, and removal to hospital, was again put into effect; 15.6 per cent. of the cases notified or reported were removed to hospital. 66 A comparison of the death rates shown in the above table will indicate the steady progress that has been made in reducing the mortality from this disease. Particularly it will be noted that the last four epidemics together show a fatality rate per 100 cases of 0.7, as compared with 1.2 for the preceding four epidemics, while in the same groups the death rate per 1,000 population has been nearly halved. Whooping-Cough. The new Regulations referred to under the previous heading embraced this disease as well as Measles. The local Order of 1922, which was rescinded by the new Regulations, also applied to both diseases, so that Whooping-Cough has been compulsorily notifiable in Battersea for nearly seventeen years. During 1938 there were 325 cases of Whooping Cough notified to the Medical Officer of Health and 163 other cases were reported from the public elementary schools and other sources. The total number of cases notified or otherwise reported was 488, as compared with 917 in 1937, 783 in 1936, 1,065 in 1935, and 682 in 1934, the decrease in 1938 compared with 1937 being 46.8 per cent. Of the total cases, notified and reported, 56 were removed to hospital. There were 3 deaths registered from this disease, the deathrate being 0.02. Whooping-Cough, 1938, and Ten Previous Years. Year. Cases. Deaths. Notified or reported. Per 1,000 population. Registered. Per 1,000 population. Per 100 cases. 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 1937 917 6.39 9 0.063 0.98 Average 936 6.05 13 0.082 1.28 1938 488 3.44 3 0.021 0.61 TUBERCULOSIS. During the year ended 31st December, 1938, there were 220 cases of Tuberculosis (all forms) notified in Battersea as compared with 226 in 1937, 232 in 1936, 237 in 1935, and 236 in 1934. In addition 27 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 same number as in 1937. The following table (required by the Ministry of Health) shows the age and sex distribution of these 247 cases of Tuberculosis, and of the 101 deaths registered as due to the disease. 67 Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. Non- Respiratory. M. F. Total M. F. Total M. F. Total M. F. Total 0 — 1 1 2 - - - 1 - 1 - - - 1 — 1 1 2 3 7 10 - 1 1 - 1 1 5 — - 3 3 - 1 1 - - - 1 5 6 10 — 1 2 3 1 2 3 — - — - - - 15 — 13 15 28 3 4 7 2 2 4 2 - 2 20 — 14 19 33 2 2 4 4 8 12 - - - 25 — 28 25 53 2 3 5 13 10 23 1 2 3 35 — 25 11 36 — 1 1 9 5 14 — — — 45 — 10 6 16 — 1 1 7 4 11 — — — 55 — 21 5 26 1 1 2 13 5 18 1 — 1 65 and upwards 6 5 11 — — — 3 1 4 — — — Totals 120 93 213 12 22 34 52 36 88 5 8 13 Deaths from non-respiratory forms of tuberculosis formed 12.9 per cent. of the total deaths from the disease. In the tables on pages 140 to 142 is shown the information required by the Ministry of Health in regard to notifications. The localisation of the disease in the 247 new cases was as under:— Pulmonary 213 Non-Pulmonary— Bones and joints 14 Abdomen 2 Other organs 13 Peripheral glands 5 34 Non-Notification of Tuberculosis. The following table gives particulars in regard to non-notification of Tuberculosis for the 10 years 1929-1938. Year. Not notified (dead). Notified after Death. Notified on Form i. & ii. (Primary Notification not received). Reported from other sources Total. 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 1938 15 9 - 3 27 68 PERIOD 1st JANUARY TO 31ST DECEMBER, 1938. 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 101 deaths. SubDistrict. New Cases. Deaths. Respiratory Non-Respiratory Total Rate per 100,000 populn. Respiratory Non -Respiratory Total Rate per 100,000 populn. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. M. F. Total. North 60 39 99 3 6 9 63 45 108 157 25 15 40 1 1 2 26 16 42 61 South 60 54 114 9 16 25 69 70 139 191 27 21 48 4 7 11 31 28 59 81 Ward 1 26 13 39 1 — 1 27 13 40 177 6 9 15 1 — 1 7 9 16 71 2 12 10 22 1 3 4 13 13 26 173 6 3 9 6 3 9 60 3 12 11 23 1 1 2 13 12 25 153 8 1 9 - — — 8 1 9 55 4 7 5 12 2 2 4 9 7 16 128 6 2 8 1 1 2 7 3 10 80 5 10 5 15 — 2 2 10 7 17 114 5 2 7 - 1 1 5 3 8 54 6 7 12 19 1 4 5 8 16 24 141 7 3 10 1 1 2 8 4 12 70 7 5 4 9 — 6 6 5 10 15 197 2 3 5 — 4 4 2 7 9 118 8 26 21 47 4 2 6 30 23 53 323 5 9 14 2 - 2 7 9 16 97 9 l5 12 27 2 2 4 17 14 31 161 7 4 11 — 1 1 7 5 12 62 Borough 120 93 213 12 22 34 132 115 247 — 52 36 88 5 8 13 57 44 101 — Rate per 100,000 populn. 179 125 150 18 29 24 197 154 174 174 78 48 62 7 11 9 85 59 71.28 71.28 69 Deaths from Tuberculosis in Battersea, from 1901 (per 1,000 population). 70 In accordance with the suggestions of the Ministry of Health, 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 1938 in this connection. Deaths from Tuberculosis, 1938. Deaths from Tuberculosis registered as belonging to Battersea numbered 101, of which 88 (i.e. 87.1 per cent.) were due to pulmonary tuberculosis, 6 (i.e. 5.9 per cent.) to tubercular meningitis and 7 (i.e. 6.9 per cent.) to other forms of the disease. The death-rate from Tuberculosis was the lowest yet recorded in Battersea, being 71.28 per 100,000 population as compared with 85.71 in 1937, 100.34 in 1936, 85.02 in 1935, and 87.5 in 1934. The death-rate for the pulmonary form of the disease was also the lowest yet recorded. The allocation of the deaths according to age and sex, and in the Wards and Sub-Districts is shown on pages 67 and 68, while the chart on the following page shows the death-rates from tuberculosis since 1901. Of the fatal cases 12 were notified within one month before death; in 9 cases the notifications were received after death, and 15 cases were not formally notified. Of the 15 cases in respect of which no primary notification was received, 13 were patients who died in hospitals or other institutions, while 2 died at home. Of the 9 cases notified after death, 7 were in London County Council's General Hospitals, and 2 from other hospitals. The death-rates per 100,000 of the population during the past 38 years, in quinquennial averages and in each year since 1935, are given in the following table:— Tuberculosis Death-rates since 1901. 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 8.4 85.7 1938 62.1 9.2 71.3 71 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was found necessary 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 1938 the names of 24 patients were removed from the register as compared with 38 in 1937. The County of London (Tuberculosis) Regulations, 1930. Thirteen 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 1938. 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. The transfer of the tuberculosis wards from St. James's hospital to St. John's hospital (referred to in the previous annual report) became effective in August, 1938. The Tuberculosis Officer, who continues to act as honorary Tuberculosis Consultant to the London County Council, paid weekly visits in that capacity to the hospitals. After the transfer he continued to visit St. James's hospital when requested by the Medical Superintendent. 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 at present £1,084 per annum. The triennial revision of the amount of the grant, which will take effect in 1939 was commenced during the year. 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. 72 Patients and Attendances. In 1938, there were 887 additional names recorded at the dispensary, 24 more than in 1937. These related to 614 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; 243 who had been in contact with cases of tuberculosis; and 30 already notified in other districts who had come to reside in Battersea. Of these 887 cases 685 were discharged as non-tuberculous (including 240 of the contacts), 193 were found to be suffering from the disease, and 9 were kept under observation for diagnosis. Particulars of the 193 positive cases are given under the next heading, and also in form T.145 on page 143. Old patients to the number of 528 also attended during the year, and the total number of attendances at the Dispensary in 1938 was 5,275 (of which 4,388 were of old patients), as compared with 4.837 in 1937. Visits to the homes of dispensary patients were made by the Tuberculosis Officers in 352 instances, and 4,096 visits were made by the Dispensary nursing staff, including 271 to patients not on the Dispensary register. The number of deaths of Dispensary patients was 68 as compared with 89 in 1937. Twenty-four of the patients were discharged as "recovered" during the year, and 76 patients removed to other districts or ceased to attend. New Patients. The five following tables contain particulars of the 193 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. 73 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 4 — 2 20 10 6 - — — 42 Group T.B. plus Group I — — — 10 5 1 — 1 — 17 Group ii — — 3 29 27 21 12 9 3 104 Group iii - — — 2 — 2 2 1 — 7 Total 4 — 5 61 42 30 14 11 3 170 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 3 1 2 5 - — — 1 — 12 Abdominal — — — 1 — — 1 — — 2 Peripheral glands 1 - 1 1 — 2 — — — 5 Skin and other organs 1 — — 1 2 — — — — 4 Total 5 1 3 8 2 2 1 1 — 23 C.—Mode of Onset in Pulmonary Cases. Mode of Onset. Number of cases. Percentage. Cough 103 60.59 "Influenza" 3 1.76 Pleurisy 2 1.18 Pleurisy with effusion 4 2.35 Haemoptysis 39 22.94 Other modes 19 11.18 Totals 170 100.00 The large proportion of cases in which the first noticed symptom was haemoptysis (blood-spitting) is again to be noted. 74 D.—Occupations in the 170 cases of Pulmonary Tuberculosis. Occupation. No. of patients. Occupation. No. of patients. Accountants 2 Labourers, various 11 Butchers 2 Laundry worker 1 Billiards marker 1 Lift man 1 Carpenters 3 Needle workers 3 Cinema attendants 2 No occupation 4 Clerks, various 25 Painters and decorators 4 Cobblers 2 Porters 5 Domestic workers 12 Postman 1 Draughtsman 1 Printers 3 Drivers 6 School children 6 Engineers, various 9 Shop assistants 14 Factory workers, various 15 Street traders 3 Housewives 23 Waiters 5 Infants 2 Warehousemen 2 Insurance agents 2 E.—Family History of Tuberculosis in Pulmonary and Non-Pulmonary Cases. Near relative. Remote relative. No family history. Pulmonary 59 6 105 Non-Pulmonary 7 2 14 Totals 66 8 119 Of the 193 cases, therefore, a history of Tuberculosis in a near relative was elicited in 34.2 per cent. and in a remote relative in 4.1 per cent. In all 38.3 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 157, and the average length of stay was 92 days. The average period of waiting before admission was 9 days. Of these patients, 87 were discharged during the year, leaving 70 under treatment at the end of the year. Definite improvement as a result of institutional treatment was shown in 53 cases. Thirty-four patients discharged themselves while undergoing institutional treatment. 75 Ignoring 4 cases sent for observation, &c., the results of treatment in 83 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. 3 - 1 - 4 5 - - - 2 - - 1 B. i 1 - - 1 1 1 - - - - - - - B. ii 1 - 2 - 16 11 - 1 2 11 - - 8 B. iii - - - - - - - - - 2 - - 4 Non-Pulmonary 1 - - - 1 2 - - - - - - 1 T.C.=treatment completed. O.R.=own request. 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 1938 was 52, and 373 attendances were made, the average attendance per session being 7.2. The work carried out included:—Extractions, 113; scalings, 18; fillings, 71; dentures supplied—whole sets 12, partial sets 2; repairs to dentures, 5; dressings, 42; advice, 95 (average per session, 6.9); total, 358. The net cost to the Council during the financial year 1938-39 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 1938 the Tuberculosis Officer carried out 2,020 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. 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 and 1938, the Tuberculosis Officer carried out at that hospital the artificial pneumo-thorax treatment for which patients had previously to visit various institutions. Those patients who were already receiving this form of treatment, however, continued to visit the hospital they were already attending. 76 In all 74 patients were treated during the year (as compared with 55 in 1938 and 48 in 1937) and the refills given numbered 1,223 the numbers at each of the hospitals being as under:— Brompton Hospital 184 Colindale Hospital (L.C.C.) 2 St. Thomas's Hospital 82 St. James's Hospital 955 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 18 patients sent to hospitals other than St. James's amounted to £140 14s. 0d. as compared with £221 lis. 0d. in 1937. Examinations and Reports. Bacteriological examinations made during the year numbered 853, the specimens in 181 cases coming from medical practitioners. The number of positive results was 187, or 21.9 per cent. Reports to public bodies numbered 919. Consultations with medical practitioners at the homes of patients and reports made on patients sent to the Dispensary totalled 960, while reports received in respect of insured persons on forms G.P. 36 and G.P. 17 numbered 50. There were 23 patients referred to hospitals, other than for X-ray examination. Artificial Sunlight Treatment. During the year 8 Dispensary patients received treatment at the Council's artificial sunlight treatment centre at Southlands, making 199 attendances. In 4 cases treatment was completed, and in 6 cases definite improvement was reported. The usual period of treatment is from three to four months. The work is carried out by one of the Dispensary nurses under the direction of the Tuberculosis Medical Officer. Details of other patients dealt with at this Centre will be found on page 48. 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. 77 Extra Nourishment. The amount expended by the Council during the financial year ended 31st March, 1939, upon the provision of extra nourishment for 102 necessitous patients upon the Dispensary books was £439 12s. 6d. Dispensary Statistics. On pages 143 to 149 will be found a copy of Form T. 145, which contains the returns required by the Ministry of Health of the work of the Dispensary during the year 1938, and of Form T. 145a, which shows in a summarised form the condition of all patients whose case records were in possession of the Dispensary at the end of 1938, 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 1938:— Battersea Borough Council—extra nourishment, 172; dentures, 4; bed and bedding, 3 179 Public Assistance Committee—financial assistance, 28; clothing, 6; other assistance, 10 44 Charity Organisation Society—financial assistance, 5 5 British Legion—financial assistance, 7; clothing 11 18 Other Agencies—financial assistance, 18; dentures, 1; clothing, 3; other assistance, 1 23 Training and Employment—suitable agencies, 2 2 Handicraft Class. The Care Committee in February asked the Health Committee to consider again as to establishing a handicraft class for suitable patients attending the Dispensary, similar to classes established in various other Boroughs. The Health Committee were sympathetic but were faced with the difficulty that they had apparently no power to incur the necessary initial expenditure and that the Care Committee had not sufficient funds at their disposal for the purpose. Eventually, therefore, the matter was referred back to the Care Committee with a view to their raising funds from voluntary sources to enable the class to be started, and preliminary steps to this end were being taken at the end of the year. Non-Dispensary Cases. All the Tuberculosis visiting for the Borough is undertaken by the Dispensary staff. Of the 860 patients on the tuberculosis register at 31st December 114 were not on the dispensary register, i.e.. 13.25 per cent. of the total notified cases. Visits to the number of 271 were paid to these patients by the Dispensary nurses. 78 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 1938 numbered 52, as compared with 58 in 1937, a decrease of 10.3 per cent. There was a corresponding decrease in the zymotic death-rate from 0.404 in 1937 to 0.37 in 1938. The following table shows the zymotic death-rate (per 1,000 population) in Battersea for each year since 1933:— 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 1938 0.37 0.39 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 the 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 1938 there were 464 cases of chicken-pox reported, as compared with 547 in 1937, 426 in 1936, 178 in 1935, and 457 in 1934. Diarrhœa. The total number of deaths from diarrhœa of children under 2 years of age was 31, equivalent to a fatality-rate of 0.22 per 1,000 of the population. In 1937 there were 30 deaths and a fatality-rate of 0.21. Influenza. There were 10* deaths registered as being due to Influenza as against 43 in 1937, 20 in 1936, 18 in 1935, and 15 in 1934. The mortality-rate per 1,000 population was 0.07, as compared with 0.30 in 1937, 0.14 in 1936, 0.12 in 1935, and 0.10 in 1934. Influenzal Pneumonia was not so prevalent as in the previous year, 18 cases being notified as against 76 in 1937, 43 in 1936, 47 in 1935, and 41 in 1934. The death-rate was 0.04 per 1,000 of the population. * 5 of these deaths were ascribed to Influenzal Pneumonia. 79 Cancer. The number of deaths of Battersea residents from Cancer was 274 (males 134, females 140) as compared with 244 in 1937, 260 in 1936, 265 in 1935, and 240 in 1934. The death-rate from the disease per 1,000 of the population was 1.93. The deaths from cancer constitute 16.4 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, and for each year since 1935:— 1896-1900 0.52 1921-25 1.33 1901-5 0.88 1926-30 1.51 1906-10 0.95 1931-35 1.75 1911-15 1.11 1936 1.79 1916-20 1.28 1937 1.70 1938 1.93 The following table shews the localisation of the disease in the case of the 274 deaths recorded. Localisation. No. of deaths. Total. Percentage of total. Male Female Buccal cavity 15 1 16 5.84 Stomach, liver, peritoneum, intestines and rectum 66 67 133 48.54 Respiratory system 24 5 29 10.58 Female genital organs — 30 30 10.95 Breast — 27 27 9.85 Skin 5 1 6 2.19 Genito-urinary organs (male) 17 — 17 6.21 Other and unspecified organs 7 9 16 5.84 Total 134 140 274 100.00 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. Insulin was supplied to two such cases in 1938. Twenty deaths from this disease were registered in Battersea. 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 76) is carried out by the Clinical Research Association, of Watergate House, Strand. The number of bacteriological examinations of specimens sent in by medical practitioners practising in Battersea was 1,661 (exclusive of the specimens dealt with at the tuberculosis dispensary). 80 The following table gives particulars of the bacteriological examinations carried out during the year:— Suspected disease. Positive Results. Negative Results. Total. Diphtheria 137 1,515 1,652 Enteric fever — 6 6 Dysentery 1 1 2 Actinomycosis — 1 1 Total 138 1,523 1,661 The cost of these examinations is borne by the Council, and amounted to £214 18s. 10d., as compared with £237 4s. 6d. in 1937. 81 Sanitary Circumstances. SANITARY INSPECTION OF THE BOROUGH. Summary of Sanitary Operations for the Year 1938. (Public Health (London) Act, 1936, &c.) Complaints attended to 3 399 Water closets cleansed and repaired 836 Number of house inspections 37,801 House to house inspections 1,361 Cesspools abolished — Houses let in separate tenements on register 65 Urinals—inspections 56 Do. cleansed, altered, repaired or water laid on 40 No. of inspections of do. 275 Shops Act inspections 33 Dust receptacles provided 190 Premises improved, cleansed and repaired 2,636 Accumulations of manure and other obnoxious matter removed or proper receptacles provided 8 Underground rooms: Use discontinued 86 Rooms rendered fit 127 Keeping of animals in unfit state discontinued 4 Overcrowding abated 196 Leaky house-roofs and gutters repaired 744 Gipsy van inspections 20 Factories, &c., inspections 2,479 Yards and forecourts paved and repaired 555 Sanitary conveniences provided or improvements effected in Factories (Sec. 7) 23 Drains laid to new houses and tenements 114 Bakehouse inspections 92 Drains tested—Smoke tests 188 Bakehouse nuisances abated 37 Do. Water teste 1,446 Smoke observations 73 Drains relaid (wholly or partly) 67 Premises disinfected 2,397 Houses supplied with disinfectants 77 Drains cleansed and repaired 352 Frontage drains constructed or re-constructed 25 Certificates of disinfection granted 3,628 Mews and stables drained and paved - Intimation notices 3,031 Statutory Notices— Soil pipes and drains ventilated 174 Sections 197 & 200 3,159 Sink and rain-water pipes disconnected or repaired 565 Fifth schedule, &c. 1,262 Proceedings ordered by Council and Health Committee 3,086 Houses inspected and certificates granted (Sec. 95) 114 Summonses issued 83 Houses supplied with water and fittings repaired 37 Magisterial Orders obtained and enforced 61 Cisterns covered, cleansed or repaired 95 Samples taken under the Food and Drugs (Adulteration) Act 1,200 Additional water supplies to tenement houses 24 Miscellaneous 3,537 Total sanitary operations 73,231 Water closets provided, supplied with water or supply disconnected from drinking water cisterns 56 82 Legal Proceedings. Legal proceedings were taken by the Council during 1938 in respect of 83 contraventions of various Acts, by-laws, &c., administered by the Health Department, and for the recovery of expenses incurred by them in default of owners in one instance. 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 comply with a notice under the Act to abate a nuisance at No. 48 Winstead Street. 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. 40 Winstead Street. The drainage work having been repaired before hearing, summons dismissed under the Probation of Offenders Act, 1907. £1 1s. costs ordered to be paid to the Council within one month. The like at No. 42 Winstead Street. The like. The like at No. 48 Winstead Street. The like. 10s. 6d. costs ordered to be paid to the Council within one month. Failing to keep in proper repair the yard paving at No. 40 Winstead Street. The yard paving having been repaired before hearing, summons withdrawn. Failing to comply with notice under the Act to abate nuisance at No. 28 Wickersley Road. Notice having been complied with before hearing, summons withdrawn. Defendant paid 10s. 6d. costs to the Council. The like at No. 11 Woodgate Street. Order to abate nuisance within 28 days. 10s. 6d. costs ordered to be paid to the Council. Cost of repairing waste-pipe to sink at No. 93 Culvert Road in default of defendant after service of notice under the Act (£1 3s. 10d.). Judgment for claim and £1 1s. costs. Failing to comply with a notice under the Act to abate a nuisance at No. 71 Basnett Road. The notice having been complied with before hearing, summons withdrawn. Defendants paid 10s. 6d. costs to the Council. The like re No. 21 Abyssinia Road. Order to abate nuisance within 14 days. 10s. 6d. costs ordered to be paid to the Council. Failing to give notice of intention to carry out drainage work at No. 18 Tyneham Road. Fined £2. £1 1s. costs ordered to be paid to the Council. 83 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, (contd.). Fixing waste-pipe to sink at No. 18 Tyneham Road, so as to discharge on to yard paving. Fined £1. Failing to comply with a notice under the Act to abate a nuisance at No. 1 Sheepcote Lane. Order to abate the nuisance within 14 days. £1 1s. costs to be paid to the Council. Failing to comply with a notice under the Act to abate a smoke nuisance at Southampton Wharf, York Road. Order to abate the nuisance within twenty-eight days. £2 2s. costs ordered to be paid to the Council. Failing to comply with a notice under the Act to abate a nuisance at No. 8 Newcomen Road The notice having been complied with before the hearing, order made for £1 1s. costs to be paid to the Council. Repairing gully branch drain at No. 297 York Road so as to be a nuisance. Summons dismissed under Probation of Offenders Act, 1907. £1 1s. costs ordered to be paid to the Council. Repairing yard water closet at No. 297 York Road so as to be a nuisance. The like. Failing to give notice of intention to carry out drainage work at No. 297 York Road. Summons dismissed under Probation of Offenders Act, 1907. £1 1s. costs ordered to be paid to the Council. Laying sewage drain at No. 297 York Road without proper socket joint. The like. Application by Medical Officer of Health for an order for detention in an Infirmary for a period of three months. Order made for detention in an Infirmary for a period not exceeding three months. Failing to comply with a notice under the Act to abate a nuisance at No. 6 Orville Road. The nuisance having been abated, summons not separately dealt with. The like at No. 11 Orville Road. Order to abate the nuisance within 7 days. The like at No. 11 Orville Road (second notice). The nuisance having been abated, summons withdrawn. The like at No. 13 Orville Road. The like. Failing to comply with a notice under the Act to cleanse a room at No. 6 Orville Road infested with vermin. The work required having been carried out, summons not separately dealt with. Failing to comply with an Order of the Court to abate a nuisance at No. 21 Abyssinia Road. Summons adjourned sine die. 84 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, (contd.) Failing to comply with a notice under the Act to abate a nuisance at No. 122 Meyrick Road. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 61 Longhedge Street. Order to abate the nuisance within 21 days. £5 5s. costs ordered to be paid to the Council. The like at Nos. 41 /51 (odd Nos.), 57 and 59 Longhedge Street (eight summonses). Orders to abate the nuisances within 21 days. The like at Nos. 21, 23, 27, 29, 37 and 39 Longhedge Street (six summonses). The notices having been complied with before hearing, summonses withdrawn. Failing to comply with an Order of the Court to abate a smoke nuisance at Southampton Wharf, York Road. Summons adjourned sine die. Failing to comply with a notice under the Bylaws to repair or renew the defective yard paving at No. 5 Orville Road. The work required having been carried out, summons withdrawn. The like at No. 29 Longhedge Street. Fined £1. The like at No. 57 Longhedge Street. Fined £1. Failing to comply with a notice under the Bylaws to repair or renew defective seat of w.c. at No. 6 Orville Road. The work required having been carried out, summons not separately dealt with. Failing to comply with a notice under the Bylaws to repair or renew defective wastes to certain sinks at No. 6 Orville Road. Fined £2. £1 1s. costs ordered to be paid to the Council. Failing to comply with a notice under the Bylaws to repair or renew the fresh air inlet to a drain at No. 61 Longhedge Street. Fined £1. Failing to comply with a notice under the Act to abate a nuisance at No. 23 Orville Road. Orders made to abate and to prohibit the recurrence of the nuisance. The like at No. 7 Orville Road. Order made to abate the nuisance in seven days. 10s. 6d. costs ordered to be paid to the Council. The like at No. 151 Maysoule Road. The notice having been complied with summons dismissed. 10s. 6d. costs ordered to be paid to the Council. 85 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act, 1936, (contd.). Failing to give notice of intention to carry out drainage work at No. 156 Lavender Hill. Fined £2 with the alternative of one day's imprisonment. Failing to carry up a main waste-pipe at No. 156 Lavender Hill so as to afford a safe outlet for foul air. The like. Failing to ventilate the trap to a sink at No. 156 Lavender Hill so as to preserve its seal. The like. (The above sentences to run concurrently.) Constructing a main waste-pipe at No. 156 Lavender Hill so as to discharge into a hopper-head contrary to the by-laws. Summons withdrawn. Failure to comply with a notice under the Act to abate a nuisance at No. 36 Sarsfeld Road. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 15 Orville Road. Order made to abate the nuisance in 28 days. The like at No. 17 Orville Road. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 110 Winstanley Road. The notice having been complied with before hearing, summons withdrawn. The like at No. 94 Beaufoy Road. Order made to abate the nuisance in 28 days. Failure to comply with a notice under the By-laws in respect of defective w.c. pan and trap at No. 15 Orville Road. Fined £2. The like at No. 94 Beaufoy Road. Fined £2. Failure to comply with a notice under the Act to abate a nuisance at No. 89 Surrey Lane. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 68 Rawson Street. Order made to abate the nuisance in 14 days. The like at No. 137 Meyrick Road. The notice having been complied with before hearing, summonses withdrawn. 86 Nature of Offence or Claim. Result of Proceedings. Public Health (London) Act (contd.). Failure to comply with a notice under the Act to abate a nuisance at No. 9 Mundella Road. Order made to abate the nuisance in 28 days. 10s. 6d. costs ordered to be paid to the Council. The like at No. 13 Mundella Road. The like. The like at No. 23 Vicarage Crescent. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 23 Wayford Street. Order made to abate the nuisance in 10 days. 10s. 6d. costs ordered to be paid to the Council. The like at No. 87 Eccles Road. The notice having been complied with before hearing, summons dismissed. 10s. 6d. costs ordered to be paid to the Council. The like at No. 21 Roydon Street. Order made to abate the nuisance in 7 days. 10s. 6d. costs ordered to be paid to the Council. Failure to comply with By-law No. 10 in relation to the paving of the yard at No. 21 Roydon Street. By-law having been complied with, summons withdrawn. Failure to comply with the By-laws in relation to defective sink waste pipes at No. 21 Roydon Street. By-laws having been complied with summons withdrawn. Failure to comply with an Order of the Court to abate a nuisance at No. 1 Mundella Road. Fined £2. 10s. 6d. costs ordered to be paid to the Council. Housing Act, 1936. Failure to comply with a notice under Section 168 of the Act requiring him to supply the name and address of the freeholder of No. 73 Gonsalva Road. Fined £1. The like in respect of No. 75 Gonsalva Road. Fined £1. £3 3s. costs ordered to be paid to the Council. Food and Drugs (Adulteration) Act, 1928. Sale of Milk Regulations, 1901. Selling milk alleged to be adulterated with 9 per cent. extraneous water. Defendant having died since issue of summons, summons withdrawn. Selling milk deficient in fat to the extent of 24 per cent. below the permitted minimum. Defendant fined £5. £1 1s. costs ordered to be paid to the Council. Summons against employee withdrawn. 87 Nature of Offence or Claim. Result of Proceedings. Food & Drugs (Adulteration) Act (contd.). Selling milk deficient in fat to the extent of 3 per cent. below the permitted minimum. Summons dismissed under the Probation of Offenders Act, 1907. £1 1s. costs ordered to be paid to the Council. Selling milk alleged to be adulterated with 4 per cent. extraneous water. The like. London County Council (General Powers) Act, 1908, and By-laws made thereunder. While carrying on the business of a rag and bone dealer, distributed a toy. Fined 10s. The like. Fined. 15s. London Government Act, 1899. Contravention of Council's By-law as to fouling of footway by dogs. Fined 10s. 10s. costs ordered to be paid to the Council. County Courts Act, 1934. Recovery of cost of dried milk supplied under Maternity and Child Welfare Scheme (£1 16s.). Judgment for claim and 9s. 6d. costs to be paid at 8s. per month. Shops Act, 1934. Failing to comply with a notice under the Act to provide suitable and sufficient sanitary conveniences at No. 1a Clapham Junction Approach. A certificate of exemption in respect of these premises having been granted by the Council, 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 73 20 0 0 28 7 0 Housing Acts 2 2 0 0 3 3 0 Food and Drugs (Adulteration) Act, 1928 4 5 0 0 3 3 0 London County Council (General Powers) Act, 1908 2 1 5 0 — London Government Act, 1899 1 0 10 0 0 10 0 County Courts Act, 1934 1 — 0 9 6 Shops Act, 1934 1 — — Total 84 28 15 0 35 12 6 88 New Legislation, &c., 1938. The following new Acts and Orders affecting the work of the Public Health Department were passed or came into force:— (a) Acts of Parliament— Food and Drugs Act, 1938 (vide page 106). Increase of Rent and Mortgage Interest (Restrictions) Act, 1938 (vide page 123). London County Council (General Powers) Act, 1938, which contains provisions dealing inter alia with the provision by sanitary authorities of temporary shelter for occupants of houses undergoing cleansing from vermin, and the determination by the County Council of places for holding inquests. Population (Statistics) Act, 1938, which imposes upon Registrars of Births and Deaths the duty of obtaining certain further particulars on birth, still birth and death registration. Sea Fish Industry Act, 1938, under which all persons carrying on the business of (1) selling "white fish" by wholesale, (2) fishmonger, (3) fish frier, or curing, salting, &c., of "white fish" are required to register their businesses with the White Fish Commission. The Council are not directly concerned with this Act. (b) Orders and Regulations— Agricultural Produce (Grading and Marking). Three orders dealing with cauliflower and broccoli, cream cheese, and beef. Aircraft—Public Health (Aircraft) Regulations, 1938, for preventing the introduction of infectious diseases into the country by air-borne traffic. Disinfestation—Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. Factories— Local Authorities (Transfer of Enforcement) Order, 1938. Factories (Cleanliness of Walls and Ceilings) Order, 1938. Factories Act (Postponement of certain Requirements) Order, 1938. Sanitary Accommodation Regulations, 1938 (vide page 116). Measles and Whooping Cough—County of London (Measles and Whooping Cough) Regulations, 1938 (vide pages 64, 66) Midwives—County of London (Midwifery—Prohibition of Unqualified Persons) Order, 1938 (vide page 38). 89 Milk- Milk and Dairies Amendment Order, 1938 (vide page 112). Milk (Special Designations) Amendment Order, 1938 (vide page 113). Pharmacy and Poisons— Poisons List (Amendment) Order, 1938. Poisons (Amendment) Rules, 1938. Rent Restriction Regulations, 1938, which prescribe forms to be used in the execution of previous Acts and Orders. 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. 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 33, arising out of which 15 intimation notices were served. These related to defective, insufficient or unsuitable— Ventilation 1 Heating 14 Sanitary accommodation Nil Four statutory notices were served and were duly complied with. Since the passing of the Act 43 certificates of exemption from the requirements as to sanitary accommodation were granted by the Committee, of which, however, three were not issued, owing to change of circumstances occurring immediately. Three others were subsequently withdrawn. Owing to altered circumstances the Committee revoked another of such certificates in January, and took the prescribed action (including the institution of legal proceedings) to enforce the provision of additional accommodation. The owner, however, in view of structural difficulties, arranged instead for the conveniences at near-by premises to be made available for the occupants, and the certificate of exemption was then reissued and the summons withdrawn. There were 37 such certificates still in force at the end of 1938. The powers of sanitary authorities with regard to shops under the Shop Acts, and workshops of all kinds under the Factory Act are more or less clearly defined, but their powers in regard to offices is by no means so apparent. The Council therefore, on an enquiry by the Metropolitan Boroughs Standing Joint Committee, expressed the view that it would be advantageous if specific powers to deal with the sanitary conditions of offices could be obtained. 90 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). There were registered by the Council at 1st January, 1938, 71 traders occupying 88 shops. Four of these did not renew their licences, but three new applications were received in the year, so the number of traders registered at 31st December was 70, occupying 87 premises. Eight samples were taken but no infringement of the requirements of the Rules was reported. Amendments of the original rules were made by the Poisons (Amendment) Rules, 1938, and the Poisons List (Amendment) Order, 1938, made certain alterations in the Schedules to the Rules which determine by which persons the various poisons may be sold. 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 35 2 2 — Females— 67 Winstanley Rd. 66 13 — — — Total 133 48 2 2 — 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 17th February, when the number of beds occupied was found to be, men 32, women 13. 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. 91 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. The by-laws for the good rule and conduct of persons using the conveniences, which were previously made in 1901, were revised during the year, and having been approved by the Home Secretary in their new form, came into force on 1st June. By agreement with the owners of the "Old Swan" public house, Battersea Church Road, the public urinal adjoining those premises, which had been maintained by the local authority for many years, was removed to another site near at hand to permit alterations to be carried out to the licensed premises. The Council agreed with the London Passenger Transport Board to permit the Board's staff to use the public lavatories at Clapham Junction and the "Princes Head" under the terms of an arrangement made between the Board and certain other Metropolitan Borough Councils. Drainage Work. The by-laws made by the London County Council under the Metropolis Management Acts with regard to drainage, and also those under the Public Health (London) Act relating to waterclosets, &c., are enforced by the Council. During 1938 new drains were constructed to 254 new buildings, or additions to existing buildings, and the drains of 67 old buildings were partially or entirely reconstructed, under the supervision of the Officers of the Department. Seven 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 2 cases liability, wholly or in part, was admitted by the Council. The total expenditure incurred in these two cases amounted to £94 3s. 10d. In four cases liability was not admitted, and one remained under consideration at the end of the year. The total number of plans of proposed drainage work deposited during 1938, as compared with 1937, was as under:— 1938 1937 Re-construction or repair of existing drains 53 75 New buildings or additions to existing buildings 124 144 177 219 92 In 32 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 42 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 four cases where legal proceedings (the result of which is shown on pages 82, 83 and 85) were instituted. During the year drains were tested by smoke on 188 occasions and 65 cases were found defective. The water test was applied on 1,446 occasions, this being mainly applied to drains in course of construction or reconstruction. Soil pipes and drains were ventilated in 174 instances. Water closets were provided in 56 cases and existing closets repaired in 836 cases. The total number of drains relaid during the year was 67. Those cleansed and repaired numbered 352. 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 vehicle, and 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 1½ 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 street cleansing 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 vehicles, augmented as occasion requires by horse vans. 93 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, 1938, was :— Tons. Tons. House refuse 29,064 Trade refuse, stalls 1,813 Street refuse 2,651 do. shops 902 There are no earth closets, privies, or cesspools in the Borough. The somewhat cumbrous method of obtaining the repair or replacement of defective dust-bins by use of the nuisance procedure of the Public Health (London) Act was reviewed by the Council during the year, and acting on advice tendered by the Metropolitan Boroughs Standing Joint Committee they decided to adopt the more expeditious method of acting under the by-laws made by the London County Council under section 39 (1) of the Act of 1891. The Highways and Works Committee were therefore authorised to act on behalf of the Council in the execution of such by-laws so far as they related to defective dust-bins, and the Borough Surveyor assumed the duty of serving the necessary notices. 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. New by-laws made by the County Council were submitted to and approved by the Minister of Health, and came into force on 1st January, 1939. There are 65 premises in Battersea registered as houses let in separate tenements and 275 inspections of these premises were made in 1938. Sanitary Conveniences attached to Licensed Premises. The number of public-house urinals kept under inspection during the year was 119. In 66 instances the accommodation is accessible to the general public as well as the users of the houses, and in 53 cases the accommodation is accessible to the customers only. As a result of the annual inspection of these conveniences, 9 notices were served to remedy defects discovered, and were duly complied with. Local authorities outside the Metropolis have statutory power to require the provision in licensed premises of a reasonable number of sanitary conveniences for the use of the customers. On an enquiry by the Metropolitan Boroughs Standing Joint Committee the Council expressed themselves in favour of the extension of such powers to London. 94 Smoke Nuisances. During the year 73 observations were made and 5 complaints received. Nine notices (8 preliminary and 1 statutory) were served by the Council under the provisions of the Public Health (London) Act to abate smoke nuisances. In the case of one large firm it became necessary to institute proceedings, and an abatement order was made with two guineas costs against them. Subsequently, on further nuisance occurring proceedings were taken for non-compliance with the Court's Order, but in view of the explanation tendered the summons was adjourned sine die. At a Conference held in February a resolution was passed urging the formation of an Advisory Regional Smoke Abatement Committee for London and Greater London. Later the Council agreed to become a member of the proposed Committee, and appointed Mr. Councillor R. Moore and the Medical Officer of Health to represent them thereon. Effluvium, &c., Nuisances. No complaints were received of nuisance from effluvium during the year. 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 4 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 1938 certificates of water supply in respect of 114 houses or tenements were issued in accordance with Section 95 (2) of the Public Health (London) Act, 1936. In 24 cases the upper floors of tenement houses were provided with a water supply, on the requirement of the Council under the provisions of Section 95 (5) of the same Act. Notices were sent to the Metropolitan Water Board of waste of water observed at 26 premises during the course of inspection. 95 An application from the Co-operative Wholesale Society, Ltd., under Section 41 of the Factories Act, 1937, for permission to use the artesian well at their Milk Depot, Silverthorne Road, for the supply of drinking water to their employees was granted by the Council in October, upon a favourable report from the Medical Officer of Health as the result of an analysis of samples of the water. The Council's largest housing estate—the Latchmere Estate— comprising over 360 tenements is supplied with water chiefly from deep artesian wells. Frequent samples (in the latter months of the year at weekly intervals) were taken to test the purity of the supply, which, as shown by the Public Analyst's reports, reached a very high standard. 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. 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. One such case was taken before the Court (vide page 83) and an order obtained and enforced, and 37 other cases were dealt with. Sixteen of these were persuaded to enter a suitable institution, 9 (women) died during the year, and 12 were still under observation at the end of the year. Van Dwellings. The number of van dwellings in the Borough in 1938 was 55. 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 2 4 1 Mills' Yard, Culvert Road 18* 12 21 164 Falcon Road (rear of) 6 6 5 Manley's Yard, 45a Cabul Road 25 18 17 Van dwellings are frequently inspected. One van was unoccupied at the date of the last inspection. * Including Sheds. 96 Rag and Bone Dealers. Two 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 1938, the offenders in each case being itinerant traders. Legal proceedings were ordered in these cases, the result of which is shown on page 87. 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 1938. 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 1938 under the Council's Rat Repression scheme is summarised as follows:— Premises visited 1,810 Contracts made or renewed 8 Poison baits used 9,800 Dead rats found 1,173 Value of contracts £113 0 0 Cash for poison bait, &c. £3 11 0 Total expenditure (financial year 1938-39) £235 2 3 Income (financial year 1938-39) £112 12 0 Drains were tested at 68 premises in connection with this work, and in 55 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" (7th to 12th November). Bait was laid in the sewers, and was supplied to all applicants during the week free of charge. The co-operation of the public was invited by posters and advertisements, and 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. No action was taken under this section during the year. 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. 97 In regard to premises, the Council, wherever necessary, enforce their statutory powers to require the destruction of vermin, and they 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 1938, 358 premises were so disinfested, 96 of these being dwellings on the Council's own estates. The substances used for the purpose are sulphur dioxide and a proprietary preparation known as Solution D. With regard to goods it has been the custom for some years for verminous goods to be disinfested in situ while the rooms are being done, but when necessary they are removed and dealt with separately. The question of verminous furniture entering the Council's own estates was further considered by the responsible Committees, and it was decided that in the case of all families moving from clearance areas, disinfestation of the furniture should be carried out before it entered the new dwelling. This requirement was also to apply to other tenants whose furniture was known to be verminous. It became necessary, therefore, in the latter case, to inspect the home of the new tenant, and as a corollary the premises to which he was removing. From 23rd May, when this system came into force, 84 premises on the Council's estates became empty, and before re-letting were inspected. Twenty-two, or 26 per cent. of them were found to be verminous, 6 only slightly. Ten remained unoccupied at 31st December. The furniture of 74 incoming tenants was inspected—41 already living on the estates (of which 1 was verminous), and 33 elsewhere (of which 20 were verminous). In these 21 cases the furniture was disinfested. A building near the Disinfecting Station has been specially adapted for the purpose of the disinfestation of furniture, sulphur dioxide being the fumigant used. Bedding and household linen, however, are passed through the steam chamber at the disinfecting station. A contract was entered into with a local furniture remover to take the infested goods to the special chamber provided for the purpose, and on the following day, after it had been disinfested, to the new dwelling. The vans are themselves disinfested after delivery to the chamber. The London County Council made an enquiry as to the terms upon which the Council would undertake the disinfestation in transit of furniture of new tenants of their housing estates. They were informed that the Council would undertake the work provided the County Council bore the whole cost. After disinfestation of any of the Council's 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. 98 The attention of the Council was also drawn to a provision contained in the Liverpool Corporation Act, 1936, by which the sale or exposure for sale of secondhand furniture, mattresses, &c., infested with bed bugs is prohibited, and feeling that this was a valuable means of limiting the transmission of vermin, asked the Metropolitan Boroughs Standing Joint Committee to take the necessary steps to promote legislation for the purpose. 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 1938 there were 3,808 children and 432 adults cleansed and treated at the station. Of the children, 1,411 were suffering from scabies or itch, a contagious parasitic skin affection. The remainder were verminous. Of these children 3,723 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 number of persons cleansed and treated at the Personal Cleansing station and the expenditure incurred since 1906, the year in which the cleansing of verminous persons was begun :— Number of Baths, &c. Year. Adults. Children. *Expenditure *Amount Contributed. Verminous and Scabies. Verminous and Scabies. £ £ 1906-1915 10,443 6,430 1,037 303 1916-1925 3,269 39,117 5,007 3,155 1926 229 4,371 916 425 1927 256 4,360 960 418 1928 221 3,769 863 400 1929 278 4,335 927 400 1930 263 3,901 856 400 1931 283 3,898 875 400 1932 248 3,703 786 400 1933 223 3,385 821 400 1934 209 3,780 730 401 1935 194 3,791 787 401 1936 265 4,524 723 403 1937 389 4,256 729 403 1938 432 3,808 820 402 17,202 97,428 £16.837 £8,711 * Financial year ending 31st March. Other columns, calendar year. 99 Disinfecting Department. Summary of Work Carried out during 1938. Total premises disinfected 2,397 Rooms disinfected 2,502 Staircases disinfected 86 Schools disinfected 11 Number of articles laundered 19,113 „ ,, destroyed 271 ,, verminous, &c., persons (including 4,212 school children) 4,240 ,, infectious disease contacts dealt with 395 ,, library books collected 395 Articles. No. Weight. Tons cwts. qrs. lbs. Bedding, &c., disinfected 37,785 93 3 3 0 Ditto (articles from shelters and Cleansing Station, &c.) 9,037 (not weighed) Bedding, &c., lent 1,648 5 1 0 5 Verminous clothing, &c. 23,200 5 3 0 14 Articles from Welfare Centres 3,011 (not weighed) Total 74,681 103 7 3 19 Coroner's Court and Mortuary. The London County Council's lease of the Coroner's Court was renewed as from 1st April, 1938, on a yearly basis at an increased rent. Details as to the number of inquests held at the Coroner's Court, and bodies received into the Mortuary during 1938 are set out in the table on the following page. 100 Batter sea Mortuary, 1938. Details of bodies received. Usual place of residence. Total. Battersea. Wands -worth Elsewhere Residence unknown Inquest at Coroner's Court—Post-mortem at Mortuary 27 81 62 5 175 Post-mortem elsewhere 7 23* 11 2 43* No post-mortem 9 29 8 1 47 Post-mortem at Mortuary— No inquest (Coroner's certificate) 77 120 31 1 229 ,, (doctor's certificate) 1 - - - 1 Other bodies received— Sanitary and other reasons - 1 3 - 4 Total bodies received 121 253 115 9 498 Total inquests held 43 133 81 8 265 Total post-mortems held at Mortuary 105 201 93 6 405 VERDICTS AT INQUESTS HELD— Natural causes 1 12 22 5 40 War injuries 1 3 11 - 15 Accident and MisadventureAnaesthesia, operation, &c. 1 3 3 - 7 Asphyxia 4 3 1 - 8 Burns and scalds 4 2 - - 6 Drowning - - - - - Fall 7 38 15 - 60 Injuries (various) 2 2 2 - 6 Poisoning—Gas - 1 - - 1 Railway and street 6 24 10 - 40 Other accidents - 1 - - 1 Open verdictAbortion - 1 - - 1 Asphyxia - 1 - - 1 Neglect - 1 - - 1 Drowning - 1 9 - 10 Fall 1 1 1 - 3 Poisoning 1 2 - - 3 Burns 1 - - - 1 Still-born - - - 2 2 Sepsis of unknown origin 1 1 1 - 3 SuicideCutting 1 1 - - 2 Drowning 1 - 1 - 2 Hanging - 8 - - 8 Jump from high place - 3 - - 3 Poisoning—Coal gas 9 18 1 - 28 „ Drugs, &c. 1 4 1 - 6 Railway 1 - 2 - 3 Cause not stated - 1 1 - 2 HomicideManslaughter - - - - - Wilful murder - 1 - 1 2 Grand Total 43 133 81 8 265 * Body not received at Mortuary in one case. 101 Fouling of Footways by Dogs. One offence against the Council's by-law with regard to the fouling of footways by dogs was reported, and proceedings were instituted against the offender, who was fined 10s. with 10s. costs. The usefulness of the by-law in question is seriously impaired by its limitation to nuisances committed by dogs only while on lead, and the Council in September submitted a revised by-law to the Home Secretary (in a form already approved in another London Borough) by which this limitation was removed. The Home Secretary duly approved the by-law and fixed the date of its coming into operation as 1st January, 1939. In its new form the by-law is as follows :— (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this by-law, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this by-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this by-law shall be liable on summary conviction to a fine not exceeding forty shillings. (4) As from the date on which this by-law comes into force the by-law made by the Council on the 27th March, 1929, under Section 23 of the Municipal Corporations Act, 1882, as to the fouling of footways by dogs shall be and is hereby repealed. Propaganda. The national campaign inaugurated by the Government in the autumn of 1937 to advertise the health services provided and maintained by public bodies for the maintenance of the nation's health was continued during the first three months of 1938. Posters, leaflets, book-marks, &c., issued free by the Government through the agency of the Central Council for Health Education were distributed and displayed on public notice boards and on hoardings to the best advantage, the subjects dealt with in 1938 being 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. 102 The booklet enumerating the various activities of the Public Health Department was again issued during the year. 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, etc. The Council again 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 :— General subjects—convened by the Royal Sanitary Institute; held at Portsmouth 11th to 16th July; delegates, Mr. T. J. Hines and the Medical Officer of Health. Health Education—convened by the Central Council for Health Education for the 28th to 30th September, was postponed until early in 1939. Housing—convened by the National Housing and Town Planning Council; (1) held in London, 31st May; delegates, Mr. T. Pocock and Mr. W. J. Wye ; (2) held at Harrogate 25th to 28th November; delegates, Mr. I. O. Thomas (Chairman of the Housing Committee) and the Town Clerk ; (3) convened by the Institute of Housing and held at Norwich, 22nd to 24th September; delegates, Mr. T. Pocock and the Housing Superintendent. Maternity and Child Welfare—convened by the National Association for the Prevention of Infant Mortality; held in Bristol, 5th to 7th July; delegates, Mrs. A. A. Burton (Chairman of the Health Committee) and Mrs. E. Stone. Smoke abatement (2)—convened by the National Smoke Abatement Society ; both held in London, the first on 25th February and the second on 16th June, the delegates being respectively Mr. T. J. Hines and Mr. R. Moore, the Medical Officer of Health attending both. Public Health services—6th Congress and Exhibition, held in London 14th to 19th November; delegates, Mrs. A. A. Burton (Chairman of the Health Committee), and Mrs. M. J. Robinson. Sanitary Inspectors—convened by the Sanitary Inspectors Association; held at Edinburgh, 5th to 10th September; delegates, Mrs. M. J. Robinson and the Senior Inspector. 103 Tuberculosis—convened by the National Association for the Prevention of Tuberculosis ; held in London, 30th June to 2nd July; delegates, Mrs. E. S. Burton and the Tuberculosis Medical Officer. Changes in Staff, 1938. Medical Staff.—The decision of the Council to appoint a temporary medical officer whose duties should be partly concerned with the Public Health Department and partly with air raid precautions is referred to on page 104. Reference to the appointment of Dr. Newns as medical officer of the toddlers' clinics and the resignation of Dr. Porter Smith will be found on pages 51 and 60 respectively. Sanitary Inspectors.—In January the Council considered a report as to the necessity of increasing the staff of Sanitary Inspectors, which, despite the increase of their statutory duties, remained at the same number (11) as in 1914. Advertisements were therefore issued and Mr. S. W. Simpson-Scott was appointed on 23rd March. He commenced duty on 2nd May, and has since been engaged principally upon housing work. Health Vistors.—Owing to the prolonged illness of Miss M. C. H. Wilkie, and later to the absence on special leave of Miss D. Heap, it was necessary to appoint temporary Health Visitors. In addition to two short term appointments Miss M. W. Llewellyn was engaged on a temporary basis from 9th May, and still held the post at the end of the year. Clerical Staff.—Mr. H. N. Carter, grade A clerk, resigned his appointment in October, and his successor had not yet been appointed at the close of 1938. Maternity Hospital.—Dr. Bakewell, whose term of office as resident medical officer expired on 30th April, was permitted to retain the appointment until 30th June, when she was succeeded by Dr. E. N. Christie, m.b., ch.b. Miss R. Osborn, who held one of the appointments of sister at the hospital from October, 1937, left the service of the Council on 30th September. Miss Q. E. Yeomans, a staff nurse, resigned her appointment in June, and neither vacancy was filled. Tuberculosis Dispensary.—The retirement on superannuation of Miss E. F. Davies, dispenser at the Tuberculosis Dispensary, was referred to in the last Annual Report. The Council decided in filling the vacancy to appoint a laboratory technician, and Mr. T. E. Noble was appointed as such (with duties relating both to tuberculosis and maternity and child welfare), and took up the appointment on 25th April. 104 Air Raid Precautions. In common with other departments the Public Health Department took its share of the duties laid by the Government upon local authorities in connection with "A.R.P." schemes. In April and May the Sanitary Inspectors carried out an inspection of basements to ascertain those which might be utilised as shelters during air raids. At the time of the national crisis in September practically all members of the staff assisted in carrying out the scheme then improvised. The senior Inspector, Mr. Chuter, who had in the previous year received a course of training at the Civilian Anti-Gas School, and qualified as a First Class Instructor, was awarded a Special Certificate designating him as an Instructor (C.A.G.S.—Special). Later in the year Mr. Chuter undertook the instruction of a class of volunteers in anti-gas methods. The Council having before them a report of the Health Committee decided in October to appoint an additional Assistant Medical Officer whose duties should be equally divided between the air raid precautions service and the work of the Public Health Department. The appointment, although advertised, had not been filled at the close of the year. 105 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 :— Food. Quantity. Food. Quantity. Fish. Cod fillet 3 boxes. Fruit, etc. Crab 22 tins. Pears 11 bushels. Herrings 1 box. Walnuts 16 bags. Prawns 4 tins. Skate 1 box. Miscellaneous. Soles 17. Cheddar cheeses 16. Winkles 6 gals. 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. No such case was notified to the Medical Officer of Health during the year. Slaughterhouses and Knackers' Yards. The duty of licensing knackers and slaughterers of cattle and horses, and the premises used by them, was transferred to the Metropolitan Borough Councils in 1933. The only remaining slaughter-house in Battersea is at No. 345 Battersea Park Road, at which 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, 1937. This slaughter-house was kept under systematic inspection by the staff, and during the year 68 inspections were made by the Council's inspector. The carcases of 37 sheep were examined after slaughter. 106 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 was 96. Deducting 2, which were closed during the year, there remained 94 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, 1,424 inspections of these premises were carried out by the Council's Food Inspector. Public Health (Meat) Regulations, 1924. It was not found necessary to take action for any contravention of these Regulations. 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. This Act is the principal statute governing the purity of the food supply. During the year an amending and consolidating Act, the Food and Drugs Act, 1938, was passed into law. It will not, however, come into force until 1st October, 1939. The analysis of samples of food and drugs procured under the provisions of the 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 was 747, of which 8 or 1.1 per cent. (as in 1937) were certified by the Public Analyst to be adulterated. In addition to the foregoing, 453 informal samples were procured, none of which was reported against. 107 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 sample. (per cent.) Mean 1921—1925 6.4 7.4 „ 1926—1930 3.3 2.4 „ 1931—1935 1.8 2.1 1936 11 2.2 1937 11 0.9 1938 1.1 Nil The Public Analyst points out that the year under review yields results closely similar to those of the two preceding years with a marked improvement in the case of informal samples. The conclusion is confirmed that deliberate adulteration is almost non-existent in the borough. 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. ./ Bread - 4 4 - 0 0 Butter 3 46 49 0 0 0 Cheese - 12 12 - 0 0 Cocoa - 16 16 - 0 0 Coffee - 8 8 - 0 0 Confectionery - 14 14 - 0 0 Cream - 10 10 - 0 0 Cream, Tinned - 12 12 - 0 0 Flour - 4 4 - 0 0 Flour, self-raising - 8 8 - 0 0 Jam and marmalade - 4 4 - 0 0 Lard - 21 21 - 0 0 Margarine - 16 16 - 0 0 Milk 744 - 744 8 - 8 „ condensed (full cream) „ (machine - 8 8 - 0 0 skimmed) - 4 4 - 0 0 Mustard - 2 2 - 0 0 Sugar - 8 8 - 0 0 Tea - 32 32 - 0 0 Drugs - 44 44 - 0 0 Other articles - 180 180 - 0 0 Total 747 453 1,200 8 0 8 108 TABLE II. Drugs (all informal). Nature of sample. Examined. Adulterated. Acid, boric 4 0 tartaric 4 0 Camphorated oil 4 0 Epsom salts 8 0 Ointment, boric 6 0 zinc 10 0 Seidlitz powder 4 0 Tincture, ammoniated, of quinine 4 0 Total 44 0 TABLE III. Other Articles (all informal). Nature of sample. Examined. erated. Almonds, ground 4 0 Cakes, sponge 13 0 Cooking fat 1 0 Dripping 4 0 Fish, canned 8 0 „ paste 12 0 Fruits, dried 16 0 Honey 6 0 prepared 2 0 Jelly, table 30 0 Meat paste 4 0 Mustard compound 2 0 Olive oil 8 0 Peel, candied, mixed 4 0 Pepper 12 0 Pickles 4 0 Powder, blancmange 4 0 „ custard 14 0 Rice 12 0 Spice, mixed 4 0 Sponge mixture 4 0 Suet, shredded 4 0 Vegetables, tinned 4 0 Wines, non-alcoholic 4 0 Total 180 0 Adulterated Samples. The total number of samples certified by the Public Analyst to be adulterated, or not to comply with the requirements of the various Orders or Regulations, was 8, all of which were formal samples of milk. (See following pages.) 109 Milk. Of the 744 samples of milk (all were formal samples) 8, or 1.1 per cent. were reported as adulterated. Two were reported to be deficient in milk fat to the extent of 3 and 24 per cent, respectively, and six to contain extraneous water, in three cases not exceeding 3 per cent., in two cases 4 per cent., and in the remaining case 9 per cent. In the 5 years 1933-37, and in 1938, the percentage of adulterated (formal) samples of milk was as under :— Year. Samples taken. Adulterated. No. Percentage. 1933 768 6 0.8 1934 750 5 0.7 1935 738 6 0.8 1936 736 7 0.95 1937 740 8 1.1 Mean 746 6.4 0.87 1938 744 8 1.1 During recent years there has been a change in the method of delivery of milk into the borough. Road transport is used to a large extent instead of, as heretofore, rail. The average composition of the 736 samples of milk reported as genuine proved to be as under :— Total milk solids 12.38 per cent. Milk fat 3.61 Non-fatty solids 8.77 The Analyst reports that the content of milk fat in these 736 samples ranged as follows :— 4 per cent. and over 65 samples or 8.8 per cent. Between 3.9 and 4.0 per cent. 60 ,, ,, 8.2 ,, ,, 3.8 „ 3.9 ,, 67 „ „ 91 ,, ,,3.7 „ 3.8 ,, 100 „ „ 13.6 ,, ,,3.6 „ 3.7 ,, 118 „ „ 16.0 ,, ,, 3.5 ,, 3.6 ,, 124 „ 16.9 ,, ,, 3.4 „ 3.5 ,, 113 „ ,, 15.4 ,, ,, 3.3 „ 3.4 ,, 68 ,, ,, 9.2 ,, ,, 3.2 „ 3.3 ,, 15 „ „ 2.0 ,, ,,3.1 „ 3.2 ,, 3 ,, ,, 0,4 ,, ,, 3.0 „ 3.1 ,, 3 ,, ,, 0.4 ,, 736 100.0 All samples were systematically tested for the presence of preservatives and colouring matter but with negative results. 110 Milk sampling was carried out on 4 Sundays, and 30 samples were purchased for analysis on these occasions. Samples of milk in course of delivery by wholesale firms to the number of 11 were taken. Twenty-eight 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. Thirty samples of milk were taken for bacteriological examination. Of these 21 were of pasteurised milk and 9 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. Advantage was taken of these provisions by 7 Battersea milk purveyors in regard to 16 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 three instances, particulars relating to which will be found set out in the table on pages 86 and 87. In connection with the figures given yearly of the average composition of genuine samples of milk the Public Analyst writes that since his appointment in July, 1922, he has examined over 10,000 samples. He thinks that, having regard to this large number, these average figures should prove of value in court proceedings when questions arise as to the average composition of the milk supply of the Borough. The following tables concisely supply this information. The first shows the average monthly composition of all samples of milk, reported as genuine, examined during the period July 1st, 1922, to December 31st, 1938:— 111 Month. No. of Samples. Average Composition. % Total solids. % Milk fat. % Solids-notfat. January 1,048 12.49 3.66 8.83 February 903 12.41 3.58 8.83 March 1.080 12.33 3.53 8.80 April 846 12.28 3.49 8.79 May 1,033 12.27 3.44 8.83 June 990 12.26 3.45 8.81 July 1,107 12.25 3.53 8.72 August 809 12.28 3.58 8.70 September 1,014 12.46 3.67 8.79 October 1,069 12.62 3.76 8.86 November 1,080 12.78 3.87 8.91 December 747 12.66 3.80 8.86 Total 11,726 12.42 3.61 8.81 The next table shows the distribution of milk fat in the above 11,726 samples, expressed as a percentage figure :— Month 4 and over 3.9to 4.0 3.8to 3.9 3.7to 3.8 3.6to 3.7 3.5to 3.6 3.4 to 3.5 3.3to 3.4 3.2to 3.3 3.1 to 3.2 3.0to 3. Jan. 8.5 4.7 9.4 17.0 22.6 17.4 9.4 5.3 3.2 1.1 1.4 Feb. 6.5 2.9 5.3 10.3 19.3 23.1 16.3 8.4 3.5 2.9 1.5 March 5.7 1.9 2.0 5.8 13.0 22.3 23.4 14.2 6.8 3.1 1.8 April 4.0 2.2 4.2 4.6 10.2 18.8 24.6 19.3 7.8 3.0 1.3 May 4.0 1.4 1.8 4.4 9.0 13.4 22.6 22.4 11.9 6.5 2.6 June 4.2 2.1 3.4 3.8 7.2 14.8 20.1 22.4 13.1 6.3 2.6 July 4.6 3.6 4.5 8.1 14.8 21.0 21.1 14.5 4.4 2.3 1.1 August 6.9 2.8 6.1 10.0 15.7 25.4 18.3 6.6 4.6 2.1 1.5 Sept. 11.0 4.2 10.0 17.4 21.6 18.4 10.0 4.3 1.5 1.1 0.5 Oct. 15.7 9.3 17.4 22.2 15.8 10.2 4.3 1.8 1.8 1.0 0.5 Nov. 27.2 15.7 19.8 17.1 9.1 5.9 2.2 1.4 0.8 0.6 0.2 Dec. 20.9 13.9 17.4 18.6 11.8 8.8 4.0 2.7 1.4 0.5 0.0 Whole period 9.9 5.3 8.4 11.6 14.2 16.5 14.7 10.4 5.1 2.6 1.3 From the above table it will be seen that of every 100 samples of milk purchased in each month of the year, the percentage containing 3.5 per cent. of milk fat and over is likely to be approximately as follows:- January 79.6 May 34.0 September 82.6 February 67.4 June 35.5 October 90.6 March 50.7 July 56.6 November 94.8 April 44.0 August 66.9 December 91.4 Whole period 65.9 112 Around the months of May and June the fat-content of milk is at its lowest, and the solids-not-fat fall to the minimum round about July and August. This well-known seasonal variation in composition is sometimes pleaded in Court as an excuse for deficiencies in fat or solids-not-fat in those cases where either fall below the requirements of the Sale of Milk Regulations, 1901. Inspection of the first of the two foregoing tables very clearly shows that the standard required by the Regulations, namely, 3.0 per cent. for milk fat and 8.5 per cent. for solids-notfat, errs rather on the side of leniency than of severity, and demonstrates that when proceedings are instituted for small deficiencies below the above amounts these proceedings are well justified. The Sale of Milk Regulations allow a very generous margin of departure from average values, and the public have every right to demand that their milk should not fall below this lenient standard. 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. Two cases in which milk was being sold by unregistered purveyors-in one of the cases from unregistered premises—were reported to the Committee. In both cases the vendors were cautioned. An amending Order—the Milk and Dairies Amendment Order, 1938—made during the year revoked articles 8, 9 and 10 of the main Order, which related to the inspection of cattle. The Council, however, are not affected by the change. Milk (Special Designations) Order. The designations authorised by the Milk (Special Designations) Order, 1936, are "Tuberculin Tested," "Accredited," and "Pasteurised"; and the Metropolitan Borough Councils are the sole authorities within their respective areas for the issue of licences authorising the use of these designations. The number of licences valid during 1938 was as follows:- "Tuberculin Tested " milk Full. Supplemental. 46 3 Accredited milk - - Pasteurised milk 44 10 90 13 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 24 of the premises in respect 113 of which full licences were valid during the year were used for the purveyance of both "Tuberculin Tested" and "Pasteurised" milk. Of the remainder 22 were used for "Tuberculin Tested" milk only (one for bottling) and 20 for " Pasteurised " milk. It is worthy of note that since the term was first adopted in the Order of 1936 no application has been made to the Council for a licence to sell " Accredited " milk. A cautionary letter was by order of the Committee addressed to a vendor who was found to be dealing in designated milk without holding the necessary licence. The bacteriological examination of samples of milk is referred to on page 110. A new Order—the Milk (Special Designations) Amendment Order, 1938—came into force on 1st April. It is chiefly concerned with the changes resulting from the transfer to the Ministry of Agriculture of certain veterinary functions previously carried out by inspectors of some local authorities. The Council are not concerned with this aspect of the new Order, but as licensing authority they are given a new power of requiring the provision in a pasteurising apparatus of such number of indicating and recording thermometers as they consider requisite. Milk Shops. (a) Dairies within the meaning of the Milk and Dairies Acts, in respect of which both premises and occupier are registered. Retail. Wholesale. Total. On register at end of 1938 108 9 117 Added to register during year 4 - 4 Removed from register during year:- (i) Premises closed 2 1 3 (ii) Transferred to (b) below 4 - 4 Transferred on change of proprietorship 2 - 2 Registered for sale of cream only 8 - 8 (b) Premises from which milk is sold only in sealed containers (not dairies within the meaning of the Milk and Dairies Acts). On register at end of year 192 Added to register during year:- (i) New premises 12 (ii) Transferred from (a) above 4 16 Removed from register during year 5 Transferred on change of proprietorship 13 Inspections 581 Notices served—(Intimations 5, Statutory Nil) 5 114 The condition of premises in the Borough in which milk is sold or stored remains at a satisfactory sanitary standard. Twenty-nine vendors whose registered premises are without the Borough are registered as purveyors within Battersea, four being added during 1938. One such vendor who was found to be trading in the Borough without registration was cautioned by order of the Committee. Condensed Milk. During the year 12 informal samples of condensed milk were submitted for examination, of which 8 were described as "fullcream" and 4 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. One of the two shops registered under the provisions of this Act for the sale of artificial cream was removed from the register in February, the sale of artificial cream having been discontinued. Ice Cream. There were at the end of the year 243 premises (excluding street stalls) in the borough used for the manufacture, storage, or sale of ice cream, 12 more than at the end of 1937. All the premises, stalls, barrows, &c., from which the trade is carried on are kept under inspection during the season. During the year 343 inspections were made, and it was found necessary to serve 5 intimation notices. The conditions under which this commodity is now prepared and sold in Battersea are on the whole satisfactory. 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 were examined for the presence of preservatives and 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 1938, 2 new premises having been registered and 2 removed from the register. Sixteen inspections were made and one sanitary notice was served during the year in respect of this class of premises. 115 Agricultural Produce (Grading and Marking) Act, 1928. Amending Regulations relating to cream cheese, beef, and cauliflower and broccoli were made during the year. No legal action was found necessary 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 this Act. One offence was reported in regard to the labelling of imported meat, and the Committee directed that a cautionary letter should be addressed to the offender. 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 69, 1 having been removed from the register. All these premises are kept under systematic inspection. Inspections made during 1938 numbered 364, and 5 notices (3 intimation and 2 statutory) were served for various defects found on inspection. Restaurant Kitchens. The number of restaurant kitchens and eating houses on the register at the end of 1938 was 133, 7 having been added to the register and 4 removed during the year. The number of inspections carried out was 460. In 10 cases it was found necessary to serve intimation notices, and in 2 cases statutory notices, to remedy various defects. Street Stalls for Sale of Food. There are 162 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. Inspections numbering 200 were made of the premises used by street vendors for the storage of their stocks, and in 1 case defects were discovered calling for the service of an intimation notice by the Council. 116 Factories and Homework. Factories Act, 1937. This Act, which came 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 a definition laid down in 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. Orders were made by the Secretary of State on several matters connected with the Factories Act, the Council being concerned with four of these, namely: (1) the Local Authorities (Transfer of Enforcement) Order, 1938, by which in certain special cases local authorities were relieved of their duties under the Act; (2) the Factories (Cleanliness of Walls and Ceilings) Order, 1938; (3) the Home Work Orders Variation Order, 1938; (4) the Sanitary Accommodation Regulations, 1938, by which the Order of 1903 was revoked and new standards laid down. Administration of the Factory and Workshop Act, 1901, and the Factories Act, 1937. (1) Inspections for purposes of provisions as to health (including inspections made by the Sanitary Inspectors):— Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (with mechanical power) 1,092 38 - Factories (without mechanical power) 701 28 1 Other premises under the Act (including works of building and engineering construction, but not including outworkers' premises) 124 9 - Total 1,917 75 1 117 Factories. The following is a list of factories on the register at the end of 1938:- Trade. Where Mechanical Power is used. Where Mechanical Power is not used. No. of Premises on Register. Persons Employed. No. of Premises on Register. Persons Employed. Males. Females. Males. Females. Adults. Young Persons. Adults. Young Persons. Adults. Young Persons. Adults. Young Persons. Baker 44 239 26 - - 4 10 - - - Boot repairer 28 75 7 - - 6 15 2 - - Builder 4 91 12 - - 9 15 7 - - Carpenter and Joiner 4 20 6 - - 4 17 4 - - Chocolate maker and Confectioner 5 32 2 46 13 3 3 - 14 1 Coachbuilder 2 12 2 — - 4 27 3 - - Cycle repairer 1 2 — - - 8 30 6 - - Dressmaker 8 — — 18 2 8 - - 16 - Embroiderer — — - - - 1 - - 14 - Engineer—(a) general 26 1,227 145 51 39 - - - - - (b) motor 20 212 8 4 - 26 114 21 2 - Farrier and smith — — — 5 13 - - - Firewood cutter 9 45 6 13 5 1 2 1 3 - Florist — — — - 5 - - 18 - Foodstuff maker 11 399 29 126 56 1 2 - 2 - Laundries 15 78 11 527 165 3 2 - 6 - Masons 7 440 58 - - 1 3 1 - - Milliners — — - - - 5 - - 14 - Printers 20 185 29 55 19 - - - - - Rag sorter — — — — — 18 55 24 23 5 Sign writer — — — — - 7 30 4 1 - Tailor 2 3 1 4 - 39 71 2 63 7 Upholsterer — — — — — 6 17 3 7 - Other trades 88 4,110 599 1,798 468 57 175 24 108 16 Totals 294 7,170 941 2,642 767 221 601 102 291 29 118 (2) Defects Found. Particulars. Number of Defects Found on Inspection. Remedied. Referred to H.M. Inspector. Number of defects in respect of which Prosecutions were instituted. (1) (2) (3) (4) (5) Want of cleanliness (S.1) 36 36 - 1 Overcrowding (S.2) — — - — Unreasonable temperature (S.3) 1 1 - — Inadequate ventilation (S.4) 1 1 - — Ineffective drainage of floors (S.6) 1 1 - — Sanitary conveniences (S.7) :— Insufficient - - Unsuitable or defective 22 22 - — Not separate for the sexes 1 1 - — Other offences 10 10 - — Total 72 72 — 1 Ten new factories where mechanical power is used were added to the register, and 11 previously classified as workshops were transferred to mechanical factories, making 21 in all, viz.:— Baker 1 Firewood cutter 1 Chocolate maker 1 Printers 3 Dressmakers 8 Tailors 2 Engineer (general) 1 Other trades 3 „ (motor) 1 Sixteen mechanical factories were closed, the total number being therefore increased by five. Nineteen new factories where mechanical power is not used were added to the register dealing with the following trades:— Builders 3 Rag sorters 2 Dressmakers 2 Sign writer 1 Milliner 1 Tailors 3 Motor repairers 2 Other trades 5 Nine such factories were closed, and 11 transferred to mechanical factories, the total number of non-mechanical factories being therefore decreased by one. 119 In certain trades in which female labour is mainly used, the inspection of the factories is carried out by a female sanitary inspector, and during 1938 the number of her inspections amounted to 142, while those of the male inspector numbered 1,775. One intimation was served by the female inspector for defects found on inspection in a factory, which was complied with. Notice was given, in one instance, to H.M. Inspector relating to factory in which a " protected person " was employed. Outworkers. During 1938, 110 lists of outworkers were received, viz., 56 from Battersea employers, containing 155 names, and 54 from the Medical Officers of Health of other districts, containing 209 names. After eliminating outworkers not residing in Battersea (of whom 95 names were forwarded to the Medical Officers of the districts concerned) and duplicated entries there remained the names and addresses of 133 Battersea outworkers. The total number of registered outworkers in the Borough is 176, of whom 24 are "contractors," i.e., employers of labour for the purpose of the home-work received by them. The following table gives details of the outworkers' premises in the Borough, most of which are visited by the female sanitary inspector. The figures in brackets indicate the premises visited by the male inspector, which are included in the totals shown. Trade. Number on Register. Persons Employed Premises. Workrooms Blousemaker 1 1 1 Bootmaker 15 (15) 22 (22) 25 (25) Dressmaker 35 35 38 Embroiderer 22 22 26 Fancy goods 11 11 11 Fancy boxes 6 6 6 Fine needlework 2 2 2 Glovemaker 1 1 1 Knitting and crochet 6 6 6 Tailor 53 (43) 63 (53) 101 (90) Underclothing 1 1 1 Other trades 23 (2) 23 (2) 25 (4) Female Inspector 116 116 124 Male „ 60 77 119 Total 176 193 243 120 There were 29 new outworkers' premises added to the register and 34 were removed, there being thus a decrease of 5 in the number registered. There were 562 inspections of outworkers' premises, of which 401 were by the female inspector. It was not found necessary to serve any notice in regard to defects at these premises. Four cases of infectious disease occurred in these premises during 1938, and the usual precautionary measures were taken to prevent the spread of infection. Bakehouses. There were 51 bakehouses in Battersea at the end of 1938, at three of which no person other than the proprietor was employed. Of this total 44 make use of power in their business. Fourteen of the 51 are basement bakehouses. Changes in the register during 1938 were:— New bakehouses (mechanical) 1 Premises closed „ 4 „ „ (non-mechanical) 1 Inspections made numbered 92, of which 80 were to bakehouses where mechanical power is used. Nineteen intimation notices and one statutory notice were served, all of which were complied with. Warehouses and Wharves, &c. At the end of 1938 there were 63 premises on the register, including railway yards, mews and stables. These premises are systematically inspected, and during the year 93 inspections were made. It was not found necessary to serve any notice to remedy nuisances at these premises. 121 Housing. New Working Class Dwellings. Although progress was made by the Council in the erection of tenements on the site of the Mendip Road Clearance Area these dwellings were not completed during 1938. On the Savona Street Area, which had been acquired by the London County Council, the erection of the first block of dwellings was well in hand at the end of the year. In addition to the foregoing, 114 dwellings were erected by private enterprise. Included in this number is a block of 110 residential flats, situate in South Battersea. Overcrowding. Nineteen cases of overcrowding in such circumstances as to create an offence under the Act were reported, but in only eleven of these was it found necessary to serve notices upon both landlord and tenant requiring the abatement of the overcrowding; in six of the cases the overcrowding was abated when the attention of the offenders was drawn to the offence and in two cases, which were subsequently abated, having regard to special circumstances, no action was taken. It is satisfactory to note that, in addition to the two cases outstanding from 1937, all but two cases of overcrowding were abated without recourse to legal proceedings. In the two outstanding cases the notices served had not expired at the end of the year. Fifty-six cases of new overcrowding were reported, and in 196 instances overcrowding was abated. An application was received from an owner asking for a certificate that alternative accommodation offered was suitable within the meaning of the Act. The application was refused. An application was also made for a licence to increase the " permitted number " of a dwelling, but this was not granted. Certificates of "Permitted Numbers" were issued in respect of 783 houses containing 1,302 dwellings. Twelve 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 122 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:— 122  Referred in previous years but not then dealt with. Referred in 1938. Total. Families accommodated 33* 43 76 Offer declined or applicant otherwise suited 18 10 28 Recommendation not accepted by the London County Council 1 2 3 Still under consideration 82 67 149 Totals 134 122 256 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 275 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 17 other Battersea families. Clearance Areas. Sheepcote Lane Area.—Negotiations for the acquisition of the property comprised in this area, the Order in respect of which became operative during 1937, were proceeded with, but were not completed by the end of the year. Mendip Road Area.—The erection of dwellings, which will provide accommodation for 90 families, on the site of this area was commenced. Rush Hill Mews and Marmion Mews, Doddington Road, Culvert Road and Miles Cottages, Spicer Street Areas.—These four areas situate in different parts of the Borough together consist of 25 premises, occupied by 82 persons, and cover in the aggregate 455 of an acre. Clearance Orders were made by the Council in respect of these areas in February. Objections were made in respect of Rush Hill Mews and Marmion Mews Area and the Culvert Road Area. A local enquiry was held by the Minister of Health on 4th May and all the Orders were subsequently confirmed without modification and became operative on the 15th October. Savona Street Area.—This area, the subject of a Clearance Order made by the London County Council, was cleared by them and the work of erecting new dwellings was commenced. Hibbert Street (Nos. 1 and 2) Areas.—Reference was made to these areas—the Orders in respect of which were made by the London County Council—in the Report of the Medical Officer of Health for 1937. A local enquiry was held in connection therewith on 27th June and the Orders were confirmed in December. * Includes 3 cases previously included under "Recommendation not accepted." 123 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 will be found summarised on pages 125 to 127. 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. Appeals. No appeals were lodged against notices served under section 9 of the Housing Act, 1936. Demolition Orders. It was mentioned in last year's report that two houses had been represented with a view to demolition orders being made in respect thereof. These houses were, however, demolished by the owner prior to the making of the Orders. Another house, represented during 1938, was similarly dealt with. Closing Orders. Ninety-one Closing Orders, relating to rooms or parts of buildings in 47 houses in various parts of the Borough, were made by the Council. Of these Orders 86 (43 houses) were in connection with under ground rooms which did not comply with the Regulations of the Council in respect of such rooms. In addition, 127 basement rooms in 66 houses were rendered fit for habitation by the owners concerned. Increase of Rent, Etc., Acts. A new Increase of Rent and Mortgage Interest (Restrictions) Act came into force during the year. This Act decontrolled houses in London of a rateable value exceeding £35 and continued the provisions of previous Acts, with regard to controlled houses, until 1942. Provision was also made for the registration of decontrolled dwellings. Seven applications were received from tenants for the certificate, and 2 from owners for the report of the Sanitary Authority under the above mentioned statutes. The application for a certificate was granted in 6 cases and that for a report was granted in each case. The remaining application for the certificate was under consideration at the end of the year. Action under Section 4 of the Housing Act, 1936. In 35 cases (relating to 38 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 proceedings were considered necessary, but the Housing Committee directed that cautionary letters should be sent to the offenders. 124 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. In 49 cases (relating to 59 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 97 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 section 9 of the Housing Act, 1936, either informally or by the service of notice. Street. Houses dealt with. Street. Houses dealt with. Street. Houses dealt with. No. 1 District— No. 3 Dist. (cont.) No. 6 District— Chalmers Street 23 Octavia Street 39 Creek Street 2 Ruskin Street 1 Orbel Street 1 Darien Road l Silverthorne Road 23 Parkham Street 5 Lavender Road 45 Stewarts Road 2 Searle Street 1 Livingstone Road 1 Wadhurst Road 88 Surrey Lane 2 Meyrick Road 2 No. 2 District- Ursula Street 47 Newcomen Road l Austin Road 1 Worfield Street 1 Plough Road l Culvert Road 1 No. 4 District— No. 7 District- Dagnall Street 22 Afghan Road 1 Eccles Road l Landseer Street 1 Badric Road 2 Lavender Sweep l Latchmere Road 1 Benfield Street 2 Latchmere Street 2 Cabul Road 6 Nansen Road 1 Leitrim Grove 1 Ingrave Street 1 Stormont Road l Longhedge Street 29 Kerrison Road 3 Sugden Road 2 Millgrove Street 6 Lubeck Street 1 No. 8 District- Orkney Street 1 Mantua Street 22 Abyssinia Road l Ravenet Street 2 Orville Road 1 No. 3 District— Rowena Crescent 2 Almeric Road 2 Belleville Road 1 Ashurst Street 2 Stain forth Road 1 Bramfield Road l Battersea Bridge Road 3 Wayford Street 3 Burland Road l No. 5 District— Dents Road l Battersea Park Road 1 Beaufoy Road 1 Grandison Road l Dorothy Road 1 Leathwaite Road 3 Edna Street 27 Latchmere Road 1 Lindore Road 19 Elcho Street 1 Queens Road 1 Mallinson Road 28 Ethelburga Street 1 Tennyson Street 4 Northcote Road 1 Granfield Street 5 Wickersley Road 3 Salcott Road 1 Henning Street 6 Wycliffe Road 2 Sarsfeld Road 1 125 Summary No. 1 District 5 streets 137 houses. „ 2 „ „ *11 „ 67 „ „ 3 „ 15 „ 142 „ „ 4 „ 12 „ 45 „ „ 5 „ *7 „ 13 „ „ 6 ,, 7 „ 53 „ „ 7 ,, 5 „ 6 ,, „ 8 13 „ 61 „ Totals *74 „ 524 „ * One street included in both 2 and 5 Districts. Statistics for the Year ended 31st December, 1938. Number of New Houses or Tenements erected during the year:- (1) By the Local Authority Nil (2) By other Local Authorities Nil (3) By other bodies and persons 114 Number of Houses Demolished during the year:— (1) In pursuance of demolition orders Nil (2) In connection with clearance areas 166 (3) Voluntarily 24 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) 5,164 (b) Number of inspections made for the purpose 32,664 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,430 (b) Number of inspections made for the purpose 11,267 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,784 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 447 126 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 23 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 33 (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 2,260 (2,677 intimation notices) (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,180 (2,537 intimation notices complied with) (b) By Local Authority in default of owners 4 (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 Nil (3) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (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 91 (contained in 47 houses) (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 1,225 (ii) Number of families dwelling therein 1,225 (iii) Number of persons dwelling therein 6,410 127 (b) Number of new cases of overcrowding reported during the year 56 (c) (i) Number of cases of overcrowding relieved during the year 196 (ii) Number of persons concerned in such cases 1,040½ (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 128 APPENDIX. REPORTS OF THE MEDICAL OFFICER OF HEALTH AND OF THE BOROUGH SURVEYOR SUBMITTED TO THE COUNCIL ON 21st DECEMBER, 1938. (1) Report of the Medical Officer of Health. I beg to report on the present conditions obtaining at the Borough Council Maternity Home, Bolingbroke Grove, and on the District Midwifery service attached thereto. I have reported to the Health Committee from time to time on the very great difficulty experienced in the recruiting of nursing staff for the hospital during the past two years or more. Recently the position with regard to nursing staff has become more acute and has created serious difficulties in the running of the institution. The shortage of nurses, which is general, is, in my opinion, due to several causes— (i) The law of supply and demand—the demand for the services of nurses has increased considerably in recent years, and the demand has not been met by an increasing number of entrants to the profession. (ii) In many instances the working hours have been reduced in number, necessitating increased nursing staff. (iii) The profession of nursing has not yet been made ciently attractive to appeal to any large section of young women. (iv) The age on entry into the profession and the length of the period of training. The extension of the period of training for the certificate of the Central Midwives Board will undoubtedly result, for a time at least, in a further reduction in the number of qualified midwives. In view of the shortage of nursing staff it is, in my opinion, inevitable that a small institution such as the Borough Council's Maternity Hospital will suffer more acutely than larger institutions where the improved prospects of promotion and the added social amenities offer greater attractions, and it appears almost certain that for some considerable time the Council will be faced with even greater difficulty in securing nursing staff necessary for the efficient working of the hospital. The full complement of permanent nursing staff required for the hospital is:— Matron. Two Sisters. Four Staff Nurses. 129 At the present time there is a vacancy for one sister and two staff nurses, and, in addition, another staff nurse is off duty through illness and is likely to be away for some time. During the last three years the nursing staff has for lengthy periods been below strength and this has necessitated the requisition of private nurses at considerable expense to the Council. Moreover, the Committee will realise that this frequent change of staff is not conducive to efficiency and that the private nurses employed are in many cases unable to take the full duties of the permanent staff, e.g., they are unable to take personal responsibility for deliveries unless they have actually notified their intention to practise midwifery to the local supervising authority. Thus the responsibilities falling upon the remainder of the permanent staff are increased. The following are the particulars with regard to nurses supplied to the Maternity Hospital by various nursing associations for the past three years:— Year No. of Nurses Period Amount paid (inclusive of fares and expenses) Weeks Days Nights 1935/6 3 11 4 - £ s. d. 34 18 8 1936/7 6 7 - 1 25 9 9 1937/8 7 38 2 - 128 12 4 1938 (to 31st October) 4 11 6 - 36 13 6 The Committee will remember that in 1936 the hospital was closed for a period of ten weeks and arrangements were made whereby patients who had booked for admission during this period were admitted to other institutions. The necessity for the closure and the consequent considerable expense to the Council were very largely due to the shortage of staff. In order to illustrate the difficulty of securing nursing staff I should like to draw the attention of the Committee to the following facts. In April, 1936, advertisements were issued in the usual papers for the appointment of staff nurse. Those advertisements were repeated in May and June without producing a single response. The appointment was re-advertised on two occasions in July at an increased salary and four applications were received. In June, 1937, a further vacancy arose and no response was received until the advertisement had been issued four times when there were only two applicants. During this year the experience has been similar. Advertisements issued in June were unanswered. On re-issue two applications were received, but the applicants were unsuitable and were 130 not interviewed by the Committee. The appointment was readvertised in October without result. During recent years very many more maternity patients have been admitted to the general hospitals of the London County Council. The number of admissions to St. James's Hospital has been increasing rapidly, and in January of this year 23 beds for maternity patients were added to the existing 47—an increase of 50 per cent. I am given to understand that when the new London County Council hospital is opened at Tooting there will be accommodation in it for from 80 to 100 maternity patients. The needs for the district, therefore, as far as institutional treatment of maternity patients is concerned, are being increasingly met by the London County Council. I append hereto a table shewing the average number of beds occupied at the Borough Maternity Hospital during the past three years, together with the number of Battersea patients and patients from outside the Borough, who were admitted or discharged during those years:— Year Percentage of Beds Occupied Number of Patients Admitted and Discharged Battersea Patients Out of Borough Patients Total 1935/6 50·3 341 118 459 *1936/7 60·0 306 85 391 1937/8 61·0 349 118 467 * Hospital closed for ten weeks. The Borough Surveyor has furnished me with a report on the structural conditions of both Elmhurst and Westwood Tower, and I append this for the information of the Committee. In view of the undermentioned considerations, which are set out in detail in this report and in the report of the Borough Surveyor, viz.:— (i) The recurring shortage of nursing staff during the past three years which has rendered it difficult to provide that care and attention to which the patients are entitled ; (ii) The increasing provision made by the London County Council in its hospitals for maternity patients; and (iii) The indications that the structure of the hospital is unsound and will require considerable expense in maintenance in the near future, I recommend that, subject to the approval of the Ministry of Health, the Council's Maternity Hospital be closed down at as early a date as possible, and that the Committee take the necessary steps to secure this. 131 District Midwifery Service. Under the Midwives Act of 1936 the London County Council is the responsible authority for the provision of a domiciliary service of midwives in the County of London. When the County Council's scheme was inaugurated the Borough Council decided to retain the services of the District Midwife as an independent midwife and also the services of the private midwife who carried out relief duty. By letter dated the 27th October, 1937, the Minister of Health notified the Council that he would not be prepared to sanction the extension of this service and consequently an additional midwife could not be appointed by the Council. I have recently been notified by the relief midwife that she is not prepared to carry on indefinitely, and, indeed, is asking that she may be relieved of this work undertaken for the Council at an early date. There does not appear to be any possibility of finding adequate and suitable relief for the Council's own midwife and the relief required by her in the future will be greater than previously, because of the fact that, whatever decision is arrived at with regard to the Maternity Hospital, she will be deprived, under the Central Midwives Board's new rules, of the services of pupil midwives who carried out their district training under her supervision and gave her assistance in this work. It will be realised that without suitable relief it will be quite impossible for the district midwife to carry out her duties. I recommend, therefore, that this Council's district midwifery service be discontinued and that, subject to her consent, the London County Council be asked to take Miss M. L. Thompson on their staff of domiciliary midwives on the terms set out in their letter of the 3rd September, 1937. (Signed) G. MACDONALD, Medical Officer of Health. 17th November, 1938. (2) Report of the Borough Surveyor. The property is situated on the east side of Bolingbroke Grove, at the junction with Thurleigh Road, and has frontages of 211 feet to the former and 218 feet to the latter; the total area is 1.119 acres or thereabouts. The property comprises two buildings known as "Elmhurst" and "Westwood Tower," which were constructed about 60 or 70 years ago. When purchased by the Council in 1920 the buildings were converted from private dwelling houses into a Maternity Hospital and united by a communicating corridor at semi-basement level. In 1929 an extension was built at a cost of £4,182. 132 The present accommodation is as follows:— "Elmhurst." 2nd Floor 5 Rooms (Staff Bedrooms). Bathroom. W.C, and Lavatory. 1st Floor 6 Rooms—Nurses' Sitting Room. Doctor's Bedroom. Matron's Bedroom. Matron's Sitting Room. Staff Bedroom. Bedroom. Mezzanine Floor Bathroom and W.C. Ground Floor 4 Rooms—Two Wards. Bathroom. Doctor's Sitting Room. Entrance Hall. Semi-Basement Kitchen. Scullery. Larder. Heating Chamber. 2 Rooms—Nurses' Dining Room. Lecture Room. W.C. Corridor. Staircase serving all floors. "Westwood Tower." Tower Room at roof level in tower. 2nd Floor 6 Rooms. Bathroom and W.C. Tank Room. Corridor to Spiral Staircase. 1st Floor 6 Rooms—Isolation Ward. Duty Room. 3 Wards. Labour Ward. Bathroom, Lavatory and W.C. W.C. and Sluice Room. Ground Floor 6 Rooms—Night and Day Nursery. Waiting Room. Labour Ward. 2 Wards. Receiving Room. Pantry. 2 Store Rooms. Lavatory and W.C. Entrance Hall. 133 Semi-Basement 8 Rooms—Waiting Room (Clinic). Nurses' Room. Doctor's Room. Matron's Room. Dirty Linen Room. Linen Room. Maids' Dining Room. Store. Lavatory and W.C.s (Addition). Lavatory and W.C. Linen Cupboard. Stoker's Room. Coal Store. Heating Chamber. W.C. There is a main staircase between the Ground and First Floors and a service staircase on the north side of the building serving all floors. Cracks in various parts of the buildings have been under observation for some years and reports thereon submitted to the Health Committee from time to time. At present there are few rooms throughout both buildings without unsightly cracks, and whilst some appear to have stopped moving, several have recently increased in length and width and from their position and direction suggest that movement is still taking place in the foundations under the south-east corner and south wall of "Elmhurst." The east and south walls of this building bulge, and many of the window cills and arches are cracked externally. Test tallies placed in these walls in 1935 have cracked. The cracks in the east wall of the main staircase in "Westwood Tower" have increased in length and are probably part of the movement which caused a large crack to appear recently in Ward No. 4 on the Ground Floor. This crack occurred at night and was heard by the patients in this ward. The age and lay-out of the buildings do not, in my view, warrant heavy expenditure on underpinning foundations. If the present use of the properties is to be continued, it will be realised that further movement with accompanying cracks are bound to occur. Should this movement become dangerous at any time, shoring would have to be resorted to, followed by rebuilding of the portion affected. (Signed) H. BURLEIGH, Borough Engineer and, Surveyor. Town Hall, Battersea, S.W. 11. 17th November, 1938. 134 Causes of Death at different Periods of Life in Battersea, 1938. 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 845 73 9 12 7 22 33 50 78 172 194 195 F 830 40 4 14 10 18 37 38 62 125 194 288 1. Typhoid and paratyphoid fevers M. - - - - - - - - - - - - F. - - - - - - - - - - - - 2. Measles M. 7 2 3 2 - - - - - - - - F. 4 2 — — 2 — — — — — — — 3. Scarlet fever M. - - - - - - - - - - - - F. - - - - - - - - - - - - 4. Whooping cough M. 2 2 - - - - - - - - - - F. 1 1 - - - - - - - - - - 5. Diphtheria M. 2 - - 1 1 — - - - — — — F. 5 — 1 2 2 - - - - - - - 6. Influenza M 6 - - - - - - 3 1 - - 2 F. 4 - - - - - - - 1 1 — 2 7. Encephalitis lethargica M. 1 - - - - - - - - - - - F. 2 - - - - - - - 1 1 — — 8. Cerebro-spinal fever M. - - - - - - - - - - - - F. - - - - - - - - - - - - 9. Tuberculosis of respiratory system M 52 1 - - - 6 13 9 7 13 3 - F. 36 — 1 — — 10 10 5 4 5 1 — 10. Other tuberculous diseases M. 5 - - 1 - 2 1 - - 1 - - F. 8 — 1 5 — — 2 — — — — — 11. Syphilis M. 2 - - - - - - - 1 - 1 - F. - - - - - - - - - - - - 12. General paralysis of the insane, tabes dorsalis M. 5 - - - - - - 2 — 1 2 — F. 1 - - - - - - 1 - - - - 13. Cancer, malignant disease M. 134 - - - - 1 2 6 21 37 35 32 F. 140 - - - - - 2 10 19 37 43 29 14. Diabetes M. 5 - - - - - 1 1 - - 3 — F. 15 - - - - - - 1 2 2 6 4 15. Cerebral hæmorrhage, etc. M. 14 - - - - 1 - - - 1 9 3 F. 25 - - - - - 1 1 1 6 9 7 16. Heart disease M. 250 - - - - - 3 6 13 48 70 110 F. 313 — — — — 2 9 9 12 30 76 175 17. Aneurysm M. 6 - - - - - - - - 3 1 2 F. 9 - - - - - - - 1 3 3 2 135 Causes of Death, 1938 —(contd.). Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 18. Other circulatory diseases M. 32 - - - - - - - 1 7 13 11 F. 45 - - - - - - 1 2 11 11 20 19. Bronchitis M. 41 5 1 1 - 1 2 3 7 6 8 7 F. 34 2 — — — 1 — — 2 4 8 17 20. Pneumonia (all forms) M. 49 7 1 4 2 1 — 2 7 11 12 2 F. 28 9 — 1 — 1 — — 2 7 6 2 21. Other respiratory diseases M. 6 - - - - - - - 1 3 1 1 F. 2 1 - - - - - - - - - 1 22. Peptic ulcer M. 17 - - - - - 2 4 5 2 4 — F. 6 - - - - - - 1 1 1 2 1 23 Diarrhœa, &c. M 24 22 - 1 - - 1 - - - - - F. 10 9 - - 1 - - - - - - - 24. Appendicitis M. 5 1 - - 1 - - 2 - - 1 — F. 5 — — 2 — — — — 2 1 — — 25. Cirrhosis of liver M. 4 - - - - - - - - 3 1 — F. 1 - - - - - - 1 - - - - 26. Other diseases of liver, &c. M. - - - - - - - - - - - - F. 4 - - - - - - - 1 1 — 2 27. Other digestive diseases M. 14 1 - - - - 2 1 - 4 4 2 F. 10 — — 1 1 — — — 1 — 5 2 28. Acute and chronic nephritis M 37 1 - - 1 1 1 2 3 12 8 8 F. 20 — — — 1 — 2 — 1 3 8 5 29. Puerperal sepsis F. 5 — — — — 2 1 2 — — — — 30. Other puerperal causes F. 1 - - - - - 1 - - - - - 31. Congenital debility, premature birth, malformation, &c. M. 24 23 1 - - - - - - - - - F. 13 13 - - - - - - - - - - 32. Senility M 2 - - - - - - - - - - 2 F. 6 - - - - - - - - - - 6 33. Suicide M. 10 - - - - - 1 2 1 4 2 - F. 5 - - - - - 1 — 1 2 1 — 34. Other violence M. 23 4 2 1 1 5 - 3 - 3 1 3 F. 9 - - - - - - 1 - - 3 5 35. Other defined diseases M. 66 4 1 1 1 4 4 4 9 13 15 10 F. 62 3 1 3 3 2 8 5 7 10 12 8 36. Causes ill-defined, or unknown M. - - - - - - - - - - - - F. 1 - - - - - - - 1 - - - 136 North Battersea. Infant Mortality, 1938 Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 M. F. M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 2 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Diphtheria & croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 ... ... 2 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 1 1 1 ... 6 2 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 3 1 3 3 3 1 1 ... 10 5 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature birth ... 2 1 1 ... ... ... ... 1 ... 2 3 ... ... ... ... ... ... ... ... 2 3 Congenital malformation 1 ... ... 2 ... ... ... ... ... ... 1 2 ... 1 ... ... ... ... ... ... 1 3 Congenital debility ... ... ... ... 2 ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... 3 ... Icterus neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... Atelectasis and Asphyxia neonatorum 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pink disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Intussusception ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Other causes ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 3 2 2 3 2 ... ... ... 1 ... 8 5 8 3 8 5 5 4 5 4 34 21 Totals 5 5 2 — 1 13 11 13 9 9 55 Nett births in the year. Nett deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 963 44 1,007 52 3 55 137 South Battersea. Infant Mortality, 1938. Nett Deaths from stated causes at various ages under 1 year. CAUSES OF DEATH. AGE PERIODS. Under 24 hours. 1-7 days. Weeks. Total under 4 weeks. Months. Total deaths under 1 year 1-2 2-3 3-4 1-3 3-6 6-9 9-12 m. f. m. F. m. f. m. f. m. f. M. f. m. f. M. f m. . f. m. f. m. f. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 Diphtheria & croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... PulmonaryTuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 3 ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 ... 1 ... 2 1 7 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 3 1 7 2 1 1 1 ... 12 4 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l ... 1 ... Premature birth 2 2 1 1 ... ... ... ... ... ... 3 3 ... ... ... 1 ... ... ... ... 3 4 Congenital malformation 1 ... ... ... 1 ... ... 1 ... ... 2 1 ... ... ... ... ... ... ... ... 2 1 Congenital debility ... ... ... ... 1 1 ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 2 1 Icterus neonatorum Injury at birth ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... Atelectasis & Asphyxia neonatorum ... ... 2 1 1 ... ... ... 1 ... 4 1 ... ... ... ... ... ... ... ... 4 1 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pink disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... Intussusception ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... 4 ... 3 2 5 2 3 ... .. ... 1 ... 12 6 9 2 10 6 5 2 3 3 39 19 Totals 5 7 4 1 1 18 11 16 7 6 58 Nett births in the year. Nett deaths in the year (Infants under 1 year) Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1,063 44 1,107 52 6 58 138 Borough of Battersea. Infant Mortality, 1938. 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 3-6 6-9 9-12 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 2 3·54 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 2 1 2·65 Diphtheria and croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infuenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... MeningococcalMenin- gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tubercu- losis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0·89 Tuberculous Menin- gitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... 2 1 ... 5 2 6·20 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 4 1 2 1 2 7 9 14 ·16 Diarrhœa & Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 6 2 10 5 4 2 2 ... 22 9 27·43 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 0·88 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0·89 Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 0·89 Premature birth 2 4 2 2 ... ... ... ... 1 ... 5 6 ... ... ... 1 ... ... ... ... 5 7 10·62 Congenital malforma- tion 2 ... ... 2 1 ... ... 1 ... ... 3 3 ... 1 ... ... ... ... ... ... 3 4 6·19 Congenital debility ... ... ... ... 3 1 ... ... ... ... 3 1 2 ... ... ... ... ... ... ... 5 1 5·31 Icterus neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... 3 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 4 ... 3·54 Atelectasis & Asphyxia neonatorum 1 ... 2 1 1 ... ... ... 1 ... 5 1 1 ... ... ... ... ... ... ... 6 1 6·19 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pink disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 0·88 Fall ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 0·89 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asphyxia, accidental ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 ... 2·65 Intussusception ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 0·89 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 ... ... 1 4 2 5·31 6 4 7 5 5 1 ... 1 2 20 11 17 5 18 11 10 6 8 7 73 40 100·00 Totals 10 12 6 1 2 31 22 29 16 15 113 ... Percentage of Total 8·9 10·6 5·3 0·8 1·8 27·4 19·5 25·7 14·1 13·3 M.64·6 F.35·4 Nett births in the year. Nett deaths in the year (Infants under 1 year). Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. M 1,012 44 1,056 65 8 73 F 1,014 44 1,058 39 1 40 Totals 2,026 88 2,114 104 9 113 139 Maternal Mortality in the County of London and in Battersea, 1921-1938. 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 6·06 1932 1·33 1·66 2·99 0·86 0·86 1·72 1933 1·69 1·97 3·67 1·77 0·44 2·21 1934 1·34 1·46 2·80 1·39 1·86 3·25 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 1938 0·79 1·12 1·91 2·37 0·47 2·84 Puerperal Fever Notifications in the County of London and in Battersea, 1921-1938. Year. London. (Rate per 1,000 live births.) Battersea. (Rate per 1,000 live births.) Mean (1921-1925) 3·59 3·25 1926 4·24 4·04 1927 3·57 3·21 1928 4·09 2·55 1929 4·46 1·53 1930 4·15 3·39 Mean (1926-1930) 4·10 2·94 1931 4·44 2·42 1932 3·51 1·72 1933 4·51 1·33 1934 4·48 4·64 1935 4·32 1·90 Mean (1931-1935) 4·25 2·40 1936 3·19 1·41 1937 4·16 1·40 1938 3·66 3·78 140 Form T137 1938. Public Health (Tuberculosis) Regulations, 1930. Part I.—Summary of Notifications during the period from the 1st January, 1938, to the 31st December, 1938, 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 13 13 27 22 9 16 4 106 139 Females 1 — 3 2 15 18 24 11 5 3 5 87 110 Non-Pulmonary Males — 2 — 1 2 2 2 — — — — 9 10 „ Females — 3 1 2 4 2 3 1 1 1 — 18 19 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) NOTES—Part I. (a) 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. (b) Primary notifications for the purpose of columns (2)-(13) relate to patients who have never previously been formally notified in the area to which the Return relates. A patient who changes his residence from one Sanitary District to another in the same County may properly be the subject of Primary Notification in each such District. Only the first of such notifications, however, should be recorded in columns (2)-(13) of the Return for the County concerred, 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. 141 Supplemental Return. Part II.—New Cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55 65- Total Pulmonary Males 1 — — — — 1 1 3 1 4 2 13 „ Females — 1 — — — 1 1 — 1 2 — 6 Non-Pulmonary Males — 1 — — 1 — — — — 2 — 4 ,, Females - 4 - - - - - - - - - 4 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 7 — transferable deaths from Registrar-General 5 3 Posthumous notifications 4 5 "Transfers" from other areas (other than transferable deaths) 3 — Other sources if any (specify) — — NOTES.—Part II. (а) New cases of tuberculosis first coining to knowledge otherwise than by formal notification may, in some instances, afterwards be formally notified under the Regulations. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the Medical Officer of Health, it should be recorded as a "Primary Notification," and excluded from the Supplemental Return. If the formal notification is received in a subsequent year, such notification should be regarded as duplicate, as the case has already been included in the Supplemental Return for a previous year. (b) A formal notification which is not received until after the death of the patient should be included in the Supplemental Return as a "posthumous notification." (c) Particulars of cases coming to knowledge through the Death Returns, as well as of cases notified posthumously, are required by Article 10 (2) of the Regulations to be entered in the Notification Register. It follows that such cases will also be duly included in the number of cases removed from the Register during the year by reason of "death."—(cf. Head 3 of the second section of Part III. of the form overleaf.) (d) No case should be included both in the Summary of Notifications and in the Supplemental Return for the same year. (e) In Counties, the particulars for the purposes of this Return should be obtained by the procedure suggested in paragraph 2 of Part II. of Circular 549 142 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, 1938, on the Register of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 377 306 683 87 90 177 860 Number of cases removed from the Register during the year by reason of:— 1. Withdrawal of notification 1 2 3 — — — 3 2. Recovery from the disease 6 7 13 5 6 11 24 3. Death (all causes) 54 37 91 10 9 19 110 4. Otherwise 39 39 78 6 12 18 96 NOTES.—Part III. In Counties, the information should be compiled from the quarterly statements for the year 1938, 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. 143 Form T145 TREATMENT OF TUBERCULOSIS. BATTERSEA METROPOLITAN BOROUGH COUNCIL. Return for the Year 1938. (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 76 56 2 4 4 9 4 5 80 65 6 9 160 *(b) Diagnosis not completed - - - - - - - - 6 3 — — 9 (c) Non-tuberculous - - - - - - - - 186 164 53 42 445 B.—Contacts examined during the year:- (a) Definitely tuberculous 1 1 — 1 — — — — 1 1 — 1 3 *(b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 34 84 57 65 240 C.—Cases written off the Dispensary Register as— (a) Recovered 6 6 — 1 1 4 4 2 7 10 4 3 24 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 222 256 110 107 695 D.—Number of cases on Dispensary Register on 31st December:— (a) Definitely tuberculous 325 238 14 25 29 40 33 42 354 278 47 67 746 (b) Diagnosis not completed - - - - - - - - 6 6 - - 12 1. Number of cases on Dispensary Register on 1st January 724 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 40 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of" 76 4. Cases written off during the year as Dead (all causes) 68 5. Number of attendances at the Dispensary (including Contacts) 5,275 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 105 7. Number of consultations with medical practitioners:— (a) Personal † (b) Other 5 456 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) † 352 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,825 10. Number of (a) Specimens of sputum, &c., examined (b) X-ray examinations made in connection with Dispensary work 697 (+156 non-dis) 2,020 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 6 12. Number of "T.B. plus" cases on Dispensary Register on 31st Dec ember:— 414 (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 Nil * 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. 144 TUBERCULOSIS SCHEME OF THE BATTERSEA METROPOLITAN BOROUGH COUNCIL. Form T145a. pulmonary tuberculosis. Supplementary Annual Return showing in summary forn (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the Return relates Previous to 1921 1921—8 1929 1930 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus 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. 2 2 4 - 6 — — 4 - 4 — — — — — 1 2 1 — 3 F. 1 — — - - - — 2 - 2 1 - 1 - 1 — - — — — Children 1 - — - - 1 1 - - 1 - - - - - - - - - - Disease not arrested. Adults—M. - 3 - - 3 1 6 9 1 16 - 3 2 - 5 — 2 5 — 7 F. - 2 - - 2 1 1 6 - 7 1 - 2 - 2 3 1 3 — 4 Children - - - - - - - - - - - - - - - - - - - - Condition not ascertained during the year 3 2 2 — 4 9 5 5 4 14 5 — 2 — 2 3 — — — — Total on Dispensary Register at 31st December 7 9 6 - 15 12 13 26 5 44 7 3 7 - 10 8 5 9 - 14 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. - - - All - classes 69 16 12 12 24 7 2 2 - 4 3 2 - - 2 F. - - - - 73 24 3 8 - 11 5 3 1 - 4 1 - - — - Children — - - - 247 20 3 1 - 4 - - - - - 1 - - - - Lost sight of, or otherwise removed from Dispensary Register - - - - 589 152 69 168 51 288 14 17 22 5 44 23 10 27 5 42 DEAD. Adults—M. - - - - 253 36 36 209 197 442 5 8 36 29 73 10 5 28 18 51 F. - - - - 186 28 18 115 160 293 7 3 21 22 46 6 3 17 14 34 Children - - - - 44 10 1 9 6 16 1 — 1 1 2 1 — - 2 2 Total written off Dispensary Register — — — — 1461 286 142 522 414 1078 39 33 83 57 173 45 20 72 39 131 Grand Totals — — — — 1483 298 155 548 419 1122 46 36 90 57 183 53 25 81 39 145 145 PULMONARY TUBERCULOSIS—(Contd.). Form T145a—(Cond.). Condition at the time of the last record made during the year to which the Return relates 1931 1932 1933 1934 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 2 1 — — 1 — 2 1 — 3 2 1 — — 1 3 1 — — 1 F. 2 1 1 - 2 3 - - - — 2 - - - - 1 1 — — 1 Children 3 - - - - - - - - - - - - - - - - - - - Disease not arrested. Adults—M. - 2 5 - 7 1 3 — 1 4 2 2 7 1 10 1 5 14 — 19 F. 2 3 3 - 6 3 - 1 1 2 3 4 2 - 6 4 2 5 1 8 Children - - - - - - - - - - 2 1 - — 1 — — — — — Condition not ascertained during the year 2 3 — — 3 4 2 4 — 6 5 1 4 — 5 8 1 2 — 3 Total on Dispensary Register at 31st December 11 10 9 - 19 11 7 6 2 15 16 9 13 1 23 17 10 21 1 32 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. 1 1 1 - 2 2 - - - - - - - - - - - - - - F. 2 2 - - 2 1 - - - - 2 - - — — 2 — — — — Children 3 - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 8 14 20 4 38 21 8 19 1 28 21 10 25 - 35 20 8 30 - 38 DEAD Adults—M. 7 12 23 4 39 6 6 27 5 38 2 4 27 10 41 - 5 28 11 44 F. 7 12 11 7 30 3 8 11 6 25 4 1 19 6 26 2 — 12 8 20 Children 2 — - - - 1 - — - - - - — - — 1 1 1 2 4 Total written off Dispensary Register 30 41 55 15 111 34 22 57 12 91 29 15 71 16 102 25 14 71 21 106 Grand Totals 41 51 64 15 130 45 29 63 14 106 45 24 84 17 125 42 24 92 22 138 146 PULMONARY TUBERCULOSIS—(Contd.). Form T145a—(Contd.). Condition at the time of the last record made during the year to which the Return relates 1935 1936 1937 1938 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 1 - 1 - - - - - - - - - - - - - - - - - F. 3 - - - - - - - - - - - - - - - - - - - Children — — - - - - - - - - - - - — - — — — — - Disease not arrested. Adults—M. 6 3 12 - 15 11 1 30 - 31 8 2 28 1 31 12 10 42 2 54 F. 5 2 10 - 12 4 6 14 1 21 11 7 23 — 30 16 4 25 3 32 Children 2 - - — - 5 1 - - 1 3 — 2 — 2 5 — 2 — 2 Condition not ascertained during the year 2 1 4 — 5 3 1 1 — 2 2 1 2 — 3 - - - - - Total on Dispensary Register at 31st December 19 6 27 - 33 23 9 45 1 55 24 10 55 1 66 33 14 69 5 88 I (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults—M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 12 3 26 - 29 8 1 21 1 23 9 1 12 - 13 1 - 5 - 5 DEAD. Adults—M. 6 1 13 9 23 3 1 20 4 25 4 - 14 3 17 1 — 6 — 6 F. 4 — 12 7 19 1 - 18 6 24 3 - 7 2 9 1 — 3 2 5 Children - - 1 - 1 - — 1 — 1 — - 1 - 1 — — — — — Total written off Dispensary Register 22 4 52 16 72 12 2 60 11 73 16 1 34 5 40 3 - 14 2 16 Grand Totals 41 10 79 16 105 35 11 105 12 128 40 11 89 6 106 36 14 83 7 104 147 NON-PULMONARY TUBERCULOSIS. Form T145a-(Cond.). Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 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—8 1929 1930 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. - - - - - - 1 - 1 2 - - - - - - - - - - F. - - - - - - - 1 - 1 1 - - - 1 - 1 - - 1 Children - - - - - 1 2 - 4 7 - - — 1 1 1 1 - 1 3 Disease not arrested. Adults—M. - - - - - - - 1 1 2 1 - - - 1 - - - - - F. - - 1 - 1 - - 1 - 1 - - - - - — - - - - Children - - - 1 1 1 - 2 2 5 - - - - - - - - - - Condition not asceitained during the year 1 - — — 1 — — 1 1 2 1 — — 2 3 2 1 1 — 4 Total on Dispensary Register at 31st December 1 - 1 1 3 2 3 6 9 20 3 - - 3 6 3 3 1 1 8 Transferred to Pulmonary 2 — - — 2 2 1 1 1 5 - - - - - - - - - - (b) Not now on Dispensary Registe) and reasons for removal therefrom. Discharged as recovered. Adults—M. 1 — 1 1 3 7 2 2 4 15 — 1 — 3 4 1 1 — 1 3 F. - - - - - 2 2 1 6 11 1 - - 3 4 1 - - 3 4 Children 6 3 2 30 41 26 15 4 82 127 1 1 1 5 8 2 2 2 4 10 Lost sight of, or otherwise removed from Dispensary Register 21 7 15 50 93 36 11 20 79 146 4 1 1 5 11 2 2 1 8 13 DEAD. Adults—M. 1 - - - 1 7 - 2 - 9 - - - - - 2 — 1 - 3 F. 1 1 - 3 5 1 2 5 3 11 1 - - - 1 1 - - 1 2 Children 1 - - 8 9 6 1 2 3 12 - - - - - 1 - - - 1 Total written off Dispensary Register 31 11 18 92 152 85 33 36 177 331 7 3 2 16 28 10 5 4 17 36 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 32 11 19 93 155 87 36 42 186 351 10 3 2 19 34 13 8 5 18 44 148 NON-PULMONARY TUBERCULOSIS—(Contd.). Form T145a-(Contd.). Condition at the time of the last record made during the year to which the Return relates 1931 1932 1933 1934 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease arrested. Adults—M. 1 - - - 1 - - - - - - - - - - - - 1 — 1 F. 1 — — - 1 - - 1 1 2 1 — - 1 2 1 — — — 1 Children — — — 1 1 3 2 - 1 6 — — — 1 1 1 1 - 1 3 Disease not arrested. Adults-M. - - - - - - - - - - - - 1 — 1 1 - — — 1 F. - - - - - - - - - - - - - - - - - 2 1 3 Children 1 - - - 1 - — — - - 2 — - — 2 3 — - 1 4 Condition not ascertained during the year — — — 1 1 6 — — 2 8 — 1 - 2 3 - — - 1 1 Total on Dispensary Register at 31st December 3 - - 2 5 9 2 3 4 18 3 1 - 4 9 6 1 3 4 14 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adults-M. - - - - - - - - - - - - - - - - - - - - F. 2 - - 1 3 1 — 1 — 2 1 1 1 - 3 - - - - - Children 1 — - 1 2 - — - 2 2 1 - - - 1 - - - - - Lost sight of, or otherwise removed from Dispensary Register 8 1 3 5 17 6 1 5 4 16 4 1 2 5 12 3 - - 5 8 DEAD. Adults—M. - - - - - 4 - 3 1 8 2 - 1 - 3 — — 1 — 1 F. 2 2 - - 4 — — — 1 1 - - - - - - - - - - Children 1 - - - 1 - 1 — - 1 — - - 1 1 — — — - - Total written off Dispensary Register 14 3 3 7 27 11 2 9 8 30 9 2 5 6 22 3 - 1 5 9 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 17 3 3 9 32 20 4 12 12 48 12 3 6 10 31 9 1 4 9 23 149 NON-PULMONARY TUBERCULOSIS—(Contd.). Form T145a—(Contd.) Condition at the time of the last record made during the year to which the Return relates 1935 1936 1937 1938 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 Adult-M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - 1 3 4 - - - - - - - - - - - - - - - Disease not arrested. Adults—M. 1 - - - 1 - - — 1 1 2 - 4 1 7 4 - 1 — 5 F. 1 1 - 2 4 - - - — 1 2 2 1 1 6 3 1 2 2 8 Children 4 1 1 — 6 1 — — 5 6 2 — — 1 3 4 — - 2 6 Condition not ascertained during the year 2 — — 1 3 - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 8 2 2 6 18 2 - - 6 8 6 2 5 3 16 11 1 3 4 19 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - - (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered. Adult-M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 1 1 3 2 7 - - 2 2 4 - - 2 1 3 1 - i __ 2 DEAD. Adults—M. 1 - - - 1 — - - — — - - 1 — 1 - — - - - F. 1 — 1 2 Children — — 1 — 1 — — — — — — — — — — 1 — — - 1 Total written off Dispensary Register 2 1 4 2 9 2 2 4 — 1 3 2 6 2 — 1 — 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 10 3 6 8 27 2 - 2 8 12 6 3 8 5 22 13 1 4 4 22 150 INDEX. (Chief references in heavy type.) page Actinomycosis 80 Adulteration of food 86-87, 106—113 Aged and infirm persons 95 Agricultural Produce (Grading, &c.) Acts 88, 115 Aircraft (Public Health) Regulations 88 Air-raid precautions 104 All Saints' Hall centre 23-24, 32, 35, 51, 52 Ambulances 37 Analysis of food, &c 106-113 Analyst 3, 106 Animals 81, 106 Ante-natal clinics 23,26,32 37, 41, 46 Anti-toxin 60 Appeals (housing)123 Area of Borough, Wards, &c.7,8,10 Artificial Cream Act. 114 Artificial light treatment—see Solarium Bacteriological examinations 63,76,79-80, 106, 110, 143 Bakehouses 81, 117-118, 120 Basements123, 125 Baths (swimming) 95 Battersea General Hospital 26, 28 Battersea Park 50 Battersea Polytechnic 27 Battersea School for Mothers 26 Belgrave Hospital 28 Births 7, 8 11,13, 19-21, 27, 42, 136-138 Boarding out 50, 71 Bolingbroke Hospital 28 Breast feeding 47 British Dental Hospital 31-2 British Legion 77 British Medical Association 22 Brompton Hospital 76 Butchers 106 Butter 107 Cancer 7,79,134 Caravans—see Gipsy vans. Census 7, 8, 10, 19 Central Council for Health Education 101-102 Centres—see under subject heading. Cerebro-spinal fever 56-57,63,134 Charing Cross Hospital 28 Charity Organisation Society 77 Charts 20, 61, 69 Chatham Road centre 23-24, 25, 51, 52 Chelsea Health Society 32 Chicken pox 48, 78 Child Life Protection 27, 54 Children's Hospital, Great Ormond Street 28 Chislehurst (St. James's) Mission 22, 23-24, 25, 26 Clearance areas 122, 125 Clerical staff 4, 103 Closing orders 123, 126 Colindale Hospital 76 Combined drain claims 91 151 PAGE Common lodging houses 90 Complaints 81 Condensed milk 107, 114 Conferences 102-3 Consultants 3,32, 35, 39, 41, 46, 63, 71 Continued fever 56-57 Convalescence 26, 46, 50 Coroner's Court 99-100 Cream and artificial cream 107, 114 Crfche—see St. Margaret's Day Nursery. Culvert Road area 122 Dairymen112-113 Day Nursery—see St. Margaret's Day Nursery. Deaths 7, 9, 10, 12-16, 19-21, 45, 66-70, 75. 78, 79, 100, 134 138 Demolition orders 123, 126 Density of population 8 Dental treatment 3, 23, 27, 31, 52, 75 Deputy Medical Officer of Health 3 Diabetes 79, 134 Diarrhoea 7, 48, 78, 135-138 Dinners for mothers and children 16,25,31 Diphtheria 3, 22, 23, 27,56-7, 59 62, 80, 102, 134, 136-8 Disinfection and disinfestation 4, 81, 88, 96-99 District midwife 4, 26, 33, 39-40, 131 Doddington Road area 122 Dogs, nuisances by 87, 101 Domiciliary relief 16 Drains 81, 82-86, 91-2, 96 Drugs, analysis of 106-108 Dust, collection, &c 81, 92-3 Dysentery 56-7, 80 Effluvium nuisance 94 Encephalitis lethargica 56-7, 63, 134 Enteric (typhoid) fever 56-7, 63, 80, 134 Erysipelas 48, 56-7, 64 Eyesight 17, 18, 51 Factories 81, 88, 116-119 Families 7, 10 Fat melters 94 Fathers' Council 26 Fish shops 88,115 Food— By-laws 106 Poisoning 105 Preservatives in 109, 114 Protection of supply 81, 86-7, 105 115 Street stalls 93,115 Unsound 105 Food and Drugs Act, 1938 88, 106 Foster mothers and children 54 General Lying-in hospital 28 Gideon Road centre 23-24, 25, 51, 52 Gipsy vans 81, 95-6 Grants 22, 25, 47, 49, 71 Gynaecologist 3, 32—3 Hammersmith Hospital 26, 28 Handicraft Class 77 Health Committee 1 152 PAGE Health Visitors 3, 22, 25, 27, 103 Hibbert Street areas 122 Home helps 45 Home-work—see Outworkers Hospitals 26, 27-8, 52, 76, 92, 110 Houses erected and demolished 121, 125 Houses let in separate tenements 81,93,94 Houses, number of 7, 10 House to house inspections 81, 125 Houses, repair of 123, 124, 125-6 Housing 86, 102, 121 127 Housing accommodation 121-2 Housing Committee 1 Housing estates 95,97 Hydrogen Cyanide (Fumigation of Buildings) Regulations 88 IceCream 14 Illegitimate births and deaths 7, 11. 16, 136-8 Immunisation—Diphtheria 23, 52, 60 , 62 Impetigo 48 Increase of Rent, &c., Acts 88, 89, 123 Infant Life Protection—see Child life protection. Infant mortality 5, 7, 9, 10, 13, 14 16, 19, 20, 21, 27, 40, 42, 134-5, 136 8 Infant Welfare Centres 22, 23-4, 25, 26 Infectious disease 27, 47, 55 80, 88, 120 Influenza 48, 73, 78, 134 Inquests 100 Inspections (see also under subject) 81, 125 Institutional deaths 14 Insulin 79 Invalid Children's Aid Association 25, 26, 47, 50, 71 Invalid Kitchens Association 31 King's College Hospital 28 Kitchens 115 Knackers' yards 105-6 Lambeth Hospital 28 Latchmere Estate 95 Lavatories, public 91 Laundries 117 Legal proceedings 81, 82-87 Legislation 88 Light treatment—see Solarium. Licences 90, 105, 112-3 Licensed Premises 91, 93 Lodging Houses 90 London County Council estates 121-2 London County Council (General Powers) Act, 1938 88 London Passenger Transport Board 91 Longevity 13 Malaria 56-7 Marmion Mews area 122 Marriages 12 Massage 23, 49 Maternal mortality 7, 27, 40, 42, 45 46. 135, 139 Maternity and Child Welfare 3, 22 54. 102, 122, 128-133 Maternity and Child Welfare Committee 1 Maternity Centres and Districts 22-26,99 Maternity Hospital 3, 4, 23, 26, 32, 33, 35-37. 40 44, 103, 128-133 Maternity Hospital, closing of 42—43, 128-133 Maternity Outfits 40 153 PAGE Maternity—Specialist advice 46 Meals 16, 25, 31 Measles 7, 48, 56-7, 64 66, 88, 102, 134, 136-8 Meat 106 Medical Officer of Health 3, 5, 102 Mendip Road area 122 Meningitis 56-7, 63, 70, 134, 136-8 Merchandise Marks Act 115 Metropolitan Boroughs statistics 21 Middlesex Hospital 28 Midwifery (see also District Midwife) 28, 33, 35, 37, 38, 46, 88 County of London (Prohibition of Unqualified Persons) Order 88 Training 38, 41, 43 Midwives Act, 1936 37 Miles Cottages area 122 Milk Condensed 107, 114 Constitution of 109-112 Milk and Dairies Acts and Orders 89, 112-3 Sampling and Analysis 86-7,106-112 Scale of assessment for 30 Shops 113-4 Special designations 30,89, 112-3 Supply to schools and hospitals 16,110 mothers and children 16, 29-31, 52, 87 Tradesmen 112-3 Tuberculosis 71, 110 Mortuary 4, 99-100 Mothercraft classes 23, 25 Mumps 48 Mundella Road centre 3, 23-24, 25, 51, 52 Mustard 107 National Baby Week Council 25 National Hospital, Queens Square 28 National Society for Prevention of Cruelty to Children 54 Non-notifiable diseases 78-9 Notices, service of (see also under subject) 81, 126 Notification of Births 11 Nuisances—Proceedings re 82-86 Nurse children—see Child Life Protection. Nursing 25, 47-8, 64 Nutrition 17, 18,51, 53 Obstetrician 3, 41 Offensive matter, removal 94 Offensive trades 94 Offices 89 Old Swan P.H 91 Open Air School 71 Ophthalmia neonatorum 42, 48, 56-7, 63-4 Out relief 16 Outworkers 119-120 Overcrowding 81, 121-2, 124, 126-7 Paddington Hospital 28 Paving 81 Pemphigus neonatorum 48 Permitted numbers 121, 124 Personal Cleansing Station 98-99 Pharmacy and Poisons Act 89,90 Physicians, Royal College of 71 154 PAGE Pigeons 96 Plans, non-submission of 92 Plough Road centre 23-24, 25, 32, 35, 51, 52 Pneumonia 48, 56-7, 78, 135, 136-8 Poisons 89, 90 Polio-myelitis and -encephalitis 56-7, 62 Population 7, 8, 9, 10, 13, 19, 21 Population (Statistics) Act, 1938 88 Postmortem examinations 100 Post-natal clinic 23, 41 Preservatives in food 109, 114 Propaganda 101-2 Protected persons 119 Public Analyst 3, 106 Public Assistance 16, 30, 77 Public Cleansing 92-3 Public Conveniences 91 Public Health Regulations and Orders— Condensed milk 114 Meat 106 Preservatives, &c., in food 114 Public Houses 93 Public Institution deaths 14 Puerperal fever and pyrexia 7, 40, 42, 45-46, 48, 56-7, 62-3, 135, 139 Pupil health visitors 27 Pupil midwives 38, 41, 44 Rag and bone dealers 87, 96 Rag Flock Acts 96 Rateable value 7 Rats and mice 96 Refuse removal 92-3 Registration Sub-Districts 8, 9, 14, 15, 57, 64, 68, 136-8 Registration of Births 8, 11 Repair of unfit houses 123, 124, 125-6 Rent-books 123-4 Rent and Mortgage Restrictions Acts 88, 89, 123 Res taurant kitchens 115 Rickets 18, 49, 51 Royal College of Physicians 71 Royal Eye & Royal Orthopaedic Hospitals 28 Royal Sanitary Institute 102 Rush Hill Mews area 122 St. George's Hospital 26, 28 St. James's Hospital 8, 28, 29, 33, 34, 58, 71, 75 St. James's Mission 22, 23, 24, 26 St. John's Hospital 58, 71 St. Luke's (L.C.C.) Hospital 28 St. Margaret's Day Nursery, &c 22, 49 St. Margaret's (L.C.C.) Hospital 63 St. Mary Abbots Hospital 28 St. Mary's House 22, 44-5 St. Stephen's Hospital 26, 28, 29 St. Thomas's Babies' Hostel 25, 27, 28, 47 St. Thomas's Hospital 28, 76 Sampling of food 81, 106 112 Sanitary Inspectors 3, 27, 103 Savona Street area 121, 122 Scabies 98 Scarlet fever 56-7, 59, 61, 134 155 • PAGE Schick test clinic 23, 52, 60, 62 School children 16-18, 98-9 School treatment centres 29, 52 Schools 92,98,110 Sea Fish Industries Act 88 Senile mortality 13, 134-135 Sheepcote Lane area 122 Shops Act 81, 87, 89 Slaughter of Animals Act, 1933 105 Slaughter-houses and slaughtermen 105 Smallpox 56-8 Smoke nuisance 81, 94 Soap boilers 94 Social conditions 16-18 Solarium 23, 48, 52, 76 Southlands centres 23-24,25,32,33,35,51-52-71 South London District Nursing Association 25,47 South London Hospital for Women 28 Southwark Diocesan Association 25, 44 Specialists—see Consultants Springwell House School 71 Stables 81 Staff 3, 4, 5, 27, 41, 42, 103 Statistics—Summary of 7 Still-births 7,9,11,27,40,42 Street cleansing 92 Street stalls 93, 115 Structural defects124 Students 27, 38 Suicide 100, 135 Sunlight treatment—see Solarium Surgical appliances 50 Swimming baths 95 Tenement houses 81,93,94 Tents, vans, &c.—see Vans. Toddlers' clinic 23, 51-52, 103 Tuberculosis— 3, 4, 5, 18, 52, 57, 66 77, 79, 103, 134, 136-8, 141-9 Artificial light treatment 76 ,, pneumo-thorax 75-6 Bacteriological examinations 76, 79, 143 Beds 76 Boarding out 50, 71 Care Committee 2, 77 Clothing 77 Conference 103 Contacts 71, 74, 143 Deaths 5, 67-70, 72, 75, 134, 136-8, 141-9 Dental treatment 75 Dispensary 4, 28, 71-77 Extra nourishment 77 Grant 71 Handicraft class 77 Institutional treatment 74 Investigation by Royal College of Physicians 71 Localisation 67 Milk 71,110 New cases 52, 66-8, 72^1, 141, 143 Non-dispensary patients 72, 77 Notification 57, 66-68, 70, 140 Open-air School 71 Propaganda 101 156 PAGE Tuberculosis—contd. Recovery from disease 72, 142-9 Register of cases 71, 142-3, 144-9 Shelters 76 Staff 4, 103 Statistics 18, 57, 66-70, 140-9 Tuberculosis Officers 3, 71, 103 Tuberculosis Regulations 71 Visiting 72, 77, 143 X-ray examinations 75 Typhoid fever—see Enteric Fever Underground rooms 81, 123, 126 Unemployment 16 University College Hospital 38 Unmarried mothers—see Southwark Diocesan Association Unsound food 105 Urinals 81,91,93 Vaccination 58-9 Vans 81, 95-6 Venereal disease 3, 27, 35-7, 134 Vermin 17, 83, 88, 96-9 Victoria Hospital for Children 25,26,27,28 Vincent Square Hospital 28 Vital Statistics 7, 8-16, 19-21, 134-139 Voluntary Centres (Maternity and Child Welfare) 22-26 Wards 8, 9, 11, 13, 14, 15, 57, 58. 59, 64, 68 Warehouses 120 Water-closets 81,89,91,92 Water supply 81, 94 Wells 95 Westminster Hospital 28 Wharves 120 Whooping-cough 7, 48, 56-7, 66, 88, 134, 136-8 Women's League of Service 22-24, 25, 26, 31, 32, 47 Workshops and workplaces 81,116-120 X-ray examinations 46, 75 Zymotic diseases 78