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a3f9b17c-855b-4f6e-8803-ed78599c6a4f	If, as seems likely, there be a revival of interest in the question of improving Barnes High Street, we may perhaps see the disappearance of some of the old shops and cottages thereabouts which have long since ceased to be picturesque, and are rapidly becoming objectionable. 16 The order of the Local Government Board issued during 1910, and officially known as The Housing (Inspection of District) Regulations Order may here be conveniently alluded to. Consideration of this order was, in October last, referred to a special Sub-Committee under the chairmanship of Mr. Watson.
7cccf0a0-d4d2-4611-baba-72e87fdab3a6	I made some recommendations to this Committee, which, in November, reported to the Public Health Committee in the following terms:— " In The Housing (Inspection of District) Regulations, 1910, the Local Government Board draw attention that it is the Council's duty to cause to be made from time to time inspection of their district with a view to ascertaining whether any dwelling house therein is in a state so dangerous or injurious to health as to be unfit for human habitation, and for that purpose to comply with such regulations and to keep such records as may be prescribed by the Board. The Board's Order makes regulations with respect to the manner in which inspection of their district should be carried out, and with respect to the records to be kept of such inspection.
d1df52e9-14bd-4fe2-b9b1-bb323ca06d18	In order to comply with the Board's requirements we do not consider that it will be necessary for the Council to appoint an additional officer, as the work can be done by the existing staff in the Public Health Department, and we accordingly RECOMMEND the Council to adopt the following procedure:— (1) That the list or lists of dwelling houses, the early inspection of which is desirable, be prepared by the Medical Officer of Health. (2) That the inspections under the Order should be carried out by the Inspector of Nuisances acting under 17 the direction and supervision of the Medical Officer of Health. (3) That the records of the inspections should be prepared under the direction and supervision of the Medical Officer of Health, and Report by the Inspector of Nuisances with the clerical assistance of the Clerk in the Public Health Department; also such records be kept on the card system at present existing in that Department.
c9c6b24d-f872-4f28-b7ff-b6ce2c29bcb0	(4) That a report prepared by the Inspector of Nuisances be submitted to the ordinary meetings of the Public Health Committee by the Medical Officer of Health, who shall call the attention of the Committee to any action within their powers which may be necessary or desirable." The recommendations contained in this report were adopted by the Council without alteration, and are already put into actual working. It is not necessary for me to do more than draw attention to the extremely important character of the Board's regulations and to the very practical steps taken by the Council to give them due effect. In my Report for 1909 I mentioned that a card register of the district was then already in course of preparation, and it is to this register that the sub-committee alluded in their report. It required only the slightest modification to comply with the Local Government Board's requirements, and the work is therefore well in hand. The Water Supply of the district is quite satisfactory, though every year one or two old wells have to be closed.
44da27c1-318c-4cdc-99e3-ac5a4d99a73a	In my last report reference was made to the state of the Pale Well and 18 of Beverley Brook, its tributaries and ditches. In July, 1910, I reported at length on the condition of Palewell Common, and incidentally on the state of the well and the ditches. I recommended that the " well," or rather, the pond and contributing springs, should be properly cleansed, protected from contamination by a cattle fence, and maintained at a level by a properly arranged wear and sluice, with drainage through agricultural pipes into the ditch. I also recommended that the ditch (which drains into Beverley Brook) should be properly kept up by a hedger and ditcher. It does not seem likely that these very necessary things will be done unless the Common is taken over and managed by the Council under a scheme.
f0e7116f-e98a-439c-9b88-d65326526cab	That this should occur is, from every point of view, most desirable, but though the idea commands general assent, and has been seriously discussed, I am not aware that any definite steps have been taken. The Beverley Brook, and particularly its propensity to overflow its banks, is a topic of perennial interest. At the present moment some rather interesting legal questions are being discussed concerning the Authority really responsible for its care, and I understand that there is very good reason for holding that, having been a sewer, in a technical sense, under the old Metropolitan Board of Works, it is to the London County Council that we must look to find the body that now has it in charge. Be that as it may, a conference has been arranged to discuss the subject of flooding, &c., and at this conference representatives of the various riparian authorities will be present. Milk and Food Supply.
ae414499-b856-4fb6-b1d5-93a9c9d94018	It will be seen from the tables appended to this report that very many inspections have been made of the places where milk is sold in this district; and I am glad to say that I have again noticed in the course of my visitations, a marked improvement in their 19 general condition. We have for now some years pursued a settled policy, and we find that the purveyors are much more amenable than formerly. But I have still to deplore that it is not necessary for plans of new milk shops (and indeed of all new buildings intended for use by purveyors of perishable foods) to be submitted to the Local Sanitary Authority for a certificate of suitability. Nor should the process of registering milkshops be the solemn farce it at present is. It is illegal for a dairyman or milk-seller to carry on his business without first securing registration, but the Sanitary Authority cannot refuse to register, whatever be the state of the premises which it is proposed to use, without abuse of their statutory powers.
800cd263-363c-47c6-9f9a-2e1fc7d708be	The invasion of the neighbourhood by itinerant milk vendors who peddle a mixture of cow dung, water and skim milk, is a great nuisance, and as these gentry are particularly elusive it is difficult to bring them to book. Still, we do everything possible to demonstrate to them that Barnes is not the place for them, and last summer they were less in evidence than formerly. Although other factors have to be considered, it is, I believe, in the constant care that has been given to the supervision of the milk trade in this district that we may find one cause at least for the fact that our infantile death-rate has been in the last ten years reduced from 134 to 69 per 1,000 births. In 1898, the rate was 184 per 1,000, and in earlier years even higher. Places where food other than milk is prepared, stored, or exposed for sale and the articles of food therein, are kept under very careful observation.
6358a6db-79dc-4d75-8d04-c927e3965332	The number has lately increased, and at present there are ten eating-houses and eight fried fish shops in the district. 20 Late in the year, I was directed to report whether or no in this district, any offensive trades, other than those specifically named in Section 112 of the Public Health Act of 1875, which it might be desirable to deal with under Section 51 of the Act of 1907, are carried on. The new enactment just referred to makes it possible for bye-laws to be adopted dealing with the conduct of trades, not specifically named in the old statute, if now scheduled as " offensive trades" by the local authority. I therefore presented the following report, on November 17th, to the Law and Parliamentary Committee:— " I understand that I am to report whether in this district there are any offensive trades other than those specifically named in Section 112 of the Public Health Act 1875, which it is desirable to deal with under Section 51 of the Act of 1907.
cadfe657-f8ef-432a-9fab-1e1c20e5ed23	In my opinion the carrying on of a fried fish business may properly be considered, under certain circumstances, an offensive trade, and, as there are now several fried fish shops in the district I would recommend that this trade be so dealt with, and bye-laws for its regulation be framed. I have not heard recently of any nuisance arising from malting operations at the brewery; and the gas mantle factory in Fitzgerald Avenue is at present vacant. The recurrence of such nuisances is not however unlikely, but it would probably be difficult to secure assent, under the circumstances, to bye-laws designed to regulate such trade nuisances, in the absence of evidence as to their present existence."
a9cd3892-2c34-4d7d-9fbb-931a9d51400a	The Committee, being of opinion that the carrying on of a 2l fried fish business might, under certain circumstances be considered an offensive trade, requested me to furnish further information, and on January 2nd of this year (1911) I reported as follows:— " I have to report more fully the conditions under which the fried fish trade is carried on in this district, and the need, if any, for greater control being exercised over it. I would first premise that, so far as I understand the matter, no idea of prohibiting the perfectly legitimate trade in question has been mooted, either in this district or in any other in which better control has been sought. The plain fact is, however, that the fried fish business may not only be, if improperly carried on, an intolerable nuisance and source of detriment to a locality and its old established traders, but a source of danger and positive illness to those actually patronising it.
bd9a684e-75be-454a-9f25-56b456464f96	It may be fairly said that a business of this description which is a nuisance to neighbouring residents, is pretty sure to be a positive danger to its patrons, and that any regulations, designed to prevent a business where food is prepared being offensive, would be valuable safeguards to the working class customers of the establishment. It is true that lately complaints have not been made to me respecting the conduct of any of the fried fish shops in this district, but this is because we have hitherto been able by close supervision and moral suasion, to obtain compliance with our request. The district is, however, becoming more populous, and these places are increasing in number. The difficulty of control by purely personal authority therefore is ingravescent, 22 and the advantage of having a definite code embodying a definite policy is pretty obvious. At the present time there are eight fried fish shops in Barnes and Mortlake, distributed in even numbers between the two parishes. Formerly there were nine in activity, but one in Mortlake has recently been closed.
4f8ca687-423f-4c28-a45d-3315a001fc76	Most of those open at present are fairly well managed but one or two illustrate a point to which I would make particular reference. Small tradesmen take over premises which are barely suitable for the wet fish trade, and then, after an interval, commence frying fish for sale in a badly lighted and dirty back scullery, over a covered copper in which the family washing may or may not be done at week ends. Such a method of conducting the trade is not only fairly certain to be offensive, but is obviously dangerous. Without doubt, no premises ought to be used for the preparation of human food intended for sale, unless the Sanitary Authority is first satisfied of their fitness for the purpose, and in the case of the trade on which I am now reporting, this end can easily be obtained by placing it in the category of offensive trades.
9517ca97-1997-437d-9e68-3adef986545e	The fitness or otherwise of such premises would be determined by reference to the spaciousness, lighting, ventilation, etc , of the cooking room; and other points for consideration, during the carrying on of the business would be the character and description of the cooking range, the nature and quality of the oil employed, the means of disposal of the offal, the provision of storage room for uncooked fish, and general cleanliness. 23 It is perhaps not generally recognised that at present the statutory means of control over places where food is prepared for sale is very inadequate, and that your officers have to depend almost entirely on their personal influence in endeavouring to safeguard the public health in this respect. The proper conduct of the fried fish trade is of the greatest importance to the working classes, and I sincerely trust, therefore, that application will be made for the inclusion of this business in the category of offensive trades, and that then in due course the consequent steps will be taken to legalise bye-laws for its proper control in the interests of amenities."
506b3f22-6563-439e-9b5c-1044405c4207	The Committee, in view of their previous conclusion, have, I understand, considered a draft order in this matter, and have directed the Clerk to submit the same to the Local Government Board. The effect of this order, if confirmed, will be that the fried fish trade for this district will be scheduled under Section 51 of the Public Health Acts Amendment Act, 1907, and in due course byelaws for the regulation of the trade will be prepared and submitted to the Local Government Board in the usual way. Practically all the meat sold in Barnes and Mortlake comes from the Central Meat Market, but a little slaughtering is on occasion done by one or two of the local butchers. When any such slaughtering is done, Mr. Robinson, the Assistant Inspector of Nuisances, a most zealous and efficient officer, who has received special training in food inspection, is always present. In this connection I would draw attention to a serious flaw in our statutory armour. An officer such as Mr.
a8f011ab-f9a8-465f-b8a6-87036f402f80	Robinson, no matter how highly trained, has, unless he is an Inspector under the Public Health Act, no power to seize meat or other food, however rotten it may be. 24 The consequence of this is obvious. The Assistant Inspector, on finding unsound food, has to choose between persuading the vendor to instantly destroy the perilous stuff (and thus ablate all evidence of his own offence and the Inspector's alertness), and leaving it where it is whilst he seeks the Medical Officer of Health or Inspector of Nuisances, in the fond hope that the salesman will be stupid enough not to conceal it at once. Happily, very little positively unsound food is ever found in this district. Still, the law as it stands, in this as in many other respects, favours the wrongdoer and fails to protect the public in the shortest and most obvious way. The report of the County Inspector under the Food and Drugs Act (another weak statute) will be found on page 63.
8adbc2a6-df69-4317-9ea3-428717859194	Sewerage and Drainage. So far as the Council is concerned, all that has been done in respect of sewerage—and all that has been necessary—during 1910, has been the connection of new estates with the excellent and adequate main sewers. As is known, the sewers for this district join with those for Richmond, and the sewage from both places is dealt with at the Joint Sewerage Works, controlled by a joint Board composed of representatives from the two constituent authorities. During the year there has been a considerable increase in the plant laid down at these works, which now are doubtless adequate to any calls which may be made upon them for some time to come. In the course of the kerbing and channelling operations now in progress in White Hart Lane and other parts of the district, opportunity will be taken to improve the road gullies, and the disappearance of storm waters will naturally be accelerated.
2c0fc272-0413-4272-823a-ea84b534440a	25 The development of a building site in White Hart Lane hag led to the raising anew of the question of a relief surface water sewer down that street into the river, with the idea of avoiding one cause, at any rate, of overflow from the Beverley Brook. At the present time, and for years past, this brook has served as a surface water drain in respect of certain low-lying parts of the district which cannot drain into the available surface water sewers. A relief sewer would be costly, but is practically a necessity. For, whatever may be our opinion of the wisdom of those who built houses in the low levels of the district, and of those who subsequently bought the houses, the property is there, and producing rates, and doubtless anything that may properly be done in this direction for the advantage of a section of the community will prove ultimately to the advantage of the whole.
5b50e782-8be9-4d41-9cbf-e1d37a9816f2	For many years this district had to bear the reproach, no longer a just one, that epidemic diseases were far too prevalent ; and, for many years, medical men in London were in the habit of dissuading persons from taking up their residence herein. Those days are past, but it seems almost romantic that, within a few hundred yards of the Metropolitan cab radius, considerable numbers of staid and sober citizens should be from time to time held up by floods in the streets and inconvenienced by mediaeval conditions in their basements. Possibly, however, when the Beverley Brook has been taken in hand, and the relief sewer is an accomplished fact, something will be done to remedy the intolerable nuisance caused by the periodical flooding of The Terrace. This, though perhaps less frequent than formerly, owing to the rise of level contingent on the wood-paving, is really far more inconvenient than it was.
3ccbeafd-3a74-4df8-9d68-9041320dd980	For, owing to the necessity of now closing the road (in order to conserve the wood) whenever the water comes over, vehicles have, that they may get from White Hart Lane to High Street, Barnes, a distance of only a few hundred yards, to make 26 a detour of over two miles, involving delay at the level railway crossings for ten minutes at a time. In the course of my duties as Police Surgeon, I frequently have to pass from my house to the police station, a matter of three minutes' walk. In time of flood it may be half an hour's drive. I have laid stress, in referring to this matter, on the mere fact of physical inconvenience.
6ec07d4b-999d-4228-8081-660490a017e4	But there is no doubt at all that the tendency to, and, in fact, the actual incidence of, diphtheria and throat affections generally in this district is, at the present time, greatest in the low-lying parts, which are most subject to flooding and wherein the ground water is at all times relatively higher than in other parts of Barnes. This fact was singularly exemplified during 1910, in the course of the small outbreak alluded to in another section of this report. It is convenient here to refer briefly to one or two related matters. The Surveyor, and Inspector of Nuisances reported, early in the year, on the condition of the various urinals in the district belonging to public-houses and opening on public thoroughfares.
b222d4c3-f0cb-492e-8e68-632a0666d679	We had known for a long time that nearly all these places were in an unsatisfactory condition, but had found from experience that notices to the landlords were apt to result in closure, so that, in the upshot, there was no gain in the direction of either decency or inoffensiveness. As too the question of constructing public underground conveniences had been for many years under consideration, without progress being made, it had been thought wiser to wait before possibly aggravating the undesirable state of things known to exist. The Surveyor and Inspector, however, in their report, with which I was in complete agreement, pointed out that arrangements might be made with certain of the owners, the Council putting the structural conditions right and the lessees assuming responsibility for maintenance.
acc34216-62f2-4253-9604-c11e1c8a0c02	27 In the result notices were sent to the various owners, asking them to attend to certain matters and calling attention to the fact that, under Section 43 of the P.H.A.A.A., 1907, the local authority can under certain circumstances, insist on a urinal, opening on a street, being removed. Since the serving of these notices one or two of these places have been closed and others very much improved. The necessity for proper sanitary conveniences in the district is however not less imperative than before, and Barnes and Mortlake remain less provided with these accessories to health and convenience than, I suppose, any other populated areas hereabouts. There are still some cesspools at East Sheen in connection with houses that cannot be linked with any existing sewer, and sooner or later the question will have to be tackled. I am still of opinion that, in the meantime, cesspools within the district might well be cleansed periodically by the local authority. The disposal of house refuse is another subject of continued interest.
a33678cc-12a4-431a-a42e-3aae069ac289	Various discussions have been conducted during the past twelve months. Early in the year several reports were presented by the Surveyor as to a method of dealing with domestic refuse known as treatment by the Lighting Dust Manipulator; later on it was decided to discontinue the use of the shoot in Lonsdale Road, and for six months to barge all refuse away from the dock at the Council's depot in Mortlake. This plan however fell through, owing to resistance from the Port of London Authority, and at present things are going on as was formerly the case. No doubt next summer will bring with it a recrudescence of complaints from residents in the vicinity of the dust shoot, and further debate will occur. Apart from the nuisance that must 28 necessarily accompany the present plan, however carefully it be carried out, there is, in my opinion, a very real objection to it on sanitary grounds.
edbdbea0-2f68-41f6-9143-af4d5ae017dd	I refer to the opportunity it affords for the propagation of blow-flies in the area contiguous to the shoot—an area being rapidly covered with residences. It seems to be the detail of site that prevents the erection of a dust destructor. On this count it may be said that careful estimates appear to show that if a destructor were to be put up at Small Profit Dock (the site of the present shoot) there would be an actual saving of two or three hundreds a year, while to utilise either the Mortlake depot or a site near the Sewage Works would involve, because of the haulage, a loss as compared with the present arrangements. So far as the actual methods of collection are concerned, nothing could be more efficient than those arranged by the Surveyor, but the time is coming, I think, when more frequent calls should be made, at any rate, in some parts of the district. Here, however, the question of cost is a dominant factor.
d87457d5-d90c-4029-9efa-8122deb312a0	As Medical Officer of Health, I would like to see a destructor at Small Profit Dock, and the money saved allocated to defray the cost of more frequent collection from flats and some other places. During 1910 the Surveyor and I drew up, in collaboration, a form of notice requesting the tenants of flats, etc., to consume as much refuse as possible in their kitcheners, and we pointed out that the utilisation of such stuff for fuel is a matter of not only parochial but domestic economy. The point is, however, that in a great many households the use of the kitchener is being discontinued ; and, with fewer gardens of any size, stuff that formerly went to feed fowls and add to the manure heap, etc., is kept in the dustbin (too often of inadequate capacity) for days at a time. One thing might certainly be done.
de4597ea-f269-47fa-8b1c-36913c8c953d	Cinders and "dry core" should be kept in one bin, whilst garbage and "wet core" should be put in a separate small bin and removed, at any rate, from flats and 29 large houses, twice a week. Some such plan as this has been recently, I learn, instituted in New York with success. The Surveyor was instructed, in May last, to serve notices on the occupiers of certain premises abutting on passages at the rear of certain streets, requiring the same to be cleansed by them. In several instances of non-compliance, the passages were cleansed by the scavengers, and the cost apportioned between the defaulters. This seems on the whole the best course to pursue, but with the return of the suburban gardening season there will probably be a return of the causes of offence.
f8a2fc5a-7e48-4941-a9bc-be3a72889eca	The Bye-Law alluded to in my last report as having been framed by the Council with a view to preventing the construction of flats and double tenements with inordinate back additions, etc., has received formal confirmation from the Local Government Board. The principle is one which has been upheld in these reports from the first, and the bye-law which has been designed to give effect to it is, I think, a most admirable one, and likely to be widely adopted elsewhere. The question of bye-laws controlling the fried fish trade has already been referred to. No other trade that can fairly be called offensive is now carried on in the district. A sub-committee is at present sitting and considering the revision of our building bye-laws. I have communicated to the Surveyor my notion of several ways in which, from a sanitary point of view, these bye-laws might usefully be improved, and no doubt attention will be given to the various questions I would raise.
5e79f0b1-2081-45f3-a2bc-525cea854e40	As stated in my last report, the Council is now in possession of an excellent ambulance, provided for public use in cases of accident or emergency, by Dr. Mackintosh and some friends. But I am not sure that the conditions under which it is available are 30 fully appreciated by the public and the local medical men, if, indeed, they have been at any time defined. It would be of public service if they were to be laid down and sent, in a printed form, to all local practitioners when next occasion arises for some general communication to be made to them. The condition of the Public Elementary Schools in the district continues to exhibit progressive amelioration. During the past year, the new and excellent school in the Lonsdale Road has been opened, and the but lately erected schools in the Lower Richmond Road, are undergoing extension with a view to special provision being made for the feeble-minded amongst the scholars.
2990e390-b56d-4afe-a63e-aa20802892b5	The old National and Roman Catholic Schools in Mortlake have been considerably improved, and extensive works have been carried out, with great advantage, at the Green Schools, Barnes. I have continued to carry on, with the assistance of Dr. Cecil Johnson, the task of examining what are known as "School Attendance cases." In respect of these cases, some commentary may perhaps be permitted. It is a plain fact that a very large number (mostly girls), of the children, who attend Public Elementary Schools in England, are habitually sent by their parents in a verminous condition that would not be tolerated in a domestic animal. In consequence, it is as disgusting for the teachers to have to supervise these children as it is unpleasant and dangerous for the well-kept children of the more self-respecting working classes to mix with them.
15b50d5c-9ffc-4baf-b46d-54bfbac9855c	An enormous amount of trouble is given in turn to the teachers, to the school attendance officers, to the school attendance sub committees, to the education medical officer, to the medical officer of health, and finally to the Magistrates. And all this because there is, under exising statutes, no proper and direct 31 method of attaching responsibility to the parents for the condition of their children. In a logically governed state it would be recognized that, if a section of the public be allowed to enjoy the privileges of free education, it should be an essential part of the contract, made between the parents and the State, that the children should be sent to school in a condition that would not make it preferable for cleanly persons to forego the advantages of State education for their children in order that they may not become verminous.
9f9f55dd-e313-4c12-b507-4e6adbea2248	It is really ludicrous that a single contumacious or alcoholic mother in a slum should be able, thanks to our law, or absence of law, to defy and frustrate the persuasions and endeavours of all the highly trained officials and public spirited persons to whom I have just alluded, and to waste a great deal of public money and time, before her child's head can be freed from vermin. One thinks sometimes that the old dogma of the liberty of the subject has been degraded into a defence of the sacred right of the democracy to be dirty. A great part of the trouble is caused by the maternal notion that it is degrading for her child to be sent to school with hair cut short, or in a neat pigtail like a Swiss.
c14a49bb-b474-47dd-8d6e-be8a340c4820	The slum slattern prefers to send Gladys or Doris to school with her hair hanging in unwholesome and repulsive wisps, with one lock fatuously done up in a dirty ribbon, and the entire scheme completed, not by a neat cap or turban, but by a ludicrous "pitcher 'at." Thus vermin are propagated and "class distinctions" broken down. I would not for one moment, in writing these things, be thought to ignore the fact that very often, amongst the poor, one finds instances of families brought up to even fastidious personal cleanliness. It is in the interests of these that I would call attention to the dirtiness of others.
29f407a0-5772-4fb9-9a64-0eac1844abe8	It is however worth noting, and my real acquaintance with the homes of the working class is pretty considerable, that the good homes are nearly always those of persons bred in the country, and trained in service in families or on estates; while the bad homes 32 are those of the true Londoner who has never known any discipline other than that of the Board School. The report of Dr. Jones, the county Medical Officer of Health and Education Medical Officer, will contain other detailed information on these and other points. I will only add, that during 1910, it was necessary but twice to close a limited part of a school on account of interference of disease with the work of the teachers. In the main there has been no change in our manner of dealing with cases of infectious disease during the year. But the highly important order and circular of the Local Government Board, concerning the question of provision of antitoxin, must be mentioned.
d26d5fa9-afb1-41ee-9ea6-6bbf0b258ea7	Shortly after the receipt of this order and memorandum, a sub-committee was formed under the chairmanship of Mr. Watson, to whom the papers were referred. To this subcommittee it was my duty to make some recommendations, and after consideration, they were embodied in the following report, ultimately adopted by the Council: — "We have carefully considered this Order, and are of opinion that by the prompt and proper administration of antitoxin, considerable expenditure will be saved in the cost of maintenance at the Hospital. We accordingly recommend :— (1) That as at present a sufficient supply of antitoxin be kept at the Council's Hospital, and that arrangements be made for its supply at the Hospital at any time to any medical man, on payment of the capital cost, which is at present 4s. per bulb of 3,000 units.
93ea41a5-2e27-4623-b8c9-2abd1b8bad9a	(2) That the Medical Officer of Health be authorised to employ prophylactic injections in cases where he finds the same to be of advantage to the public health, 33 gratuitously, on condition that the injections are administered either by the Medical Officer of Health himself or under his immediate supervision. (3) That the Medical Officer of Heatth be authorised to make use of antitoxin for curative purposes, gratuitously, in cases where immediate removal to Hospital is impossible or inadvisable, on condition that the antitoxin is administered by him, and that subsequent removal to the Hospital of the patient first agreed to. (4) That in order to again call attention to these measures directed by the Council in this respect, the Medical Officer re-issue to medical men practising in the district, with the necessary modifications, the circular letter of June, 1909, with regard to the prevention of diphtheria.
79d7e9c5-7d74-45b9-9b71-00cc20720333	The adoption of these precautions will, in our opinion, save lives, and incidentally will avoid much unnecessary expense. As, however, these injections will involve extra work for the Medical Officer of Health, the Committee recommend that he be paid 10s. 6d. for each visit made by him after 6 p.m." The Order is a most useful and valuable one. It makes certain things that have in many places been done sub rosa, legal, and it is only to be hoped that the generality of the profession will recognise their obvious duty, and take advantage of its provisions in all cases of doubt and difficulty. I am not myself convinced of the advantages of the indiscriminate use of antitoxin as a prophylactic, and my own practice has been not to so use it except in the presence of definite enlargement or inflammation of the tonsils.
7521b9bf-9a7e-4c1b-92f1-0d6c10a21611	I firmly believe in the use of antitoxin in many cases of scarlet fever, notably those in which there is pseudo-membranous exudation on the tonsils, and I attribute 34 much of our late success at Mortlake in dealing with scarlet fever, to practical action based on a belief that the two infections are more frequently co-existent than is usually thought. At the Isolation Hospital no new works have been carried out during the year except those incidental to the improvement of the "old block," which is now in a very satisfactory condition. Minor repairs and cleansing operations have also been effected, and the whole institution is now, I trust, in a very fair condition of efficiency. Owing to the availability of the new block, opened in 1909, the management of the hospital has been of late relatively easy, as the difficulties that used to arise when several diseases, and patients of both sexes, had to be treated at once, are now overcome.
546f4f97-df3d-4691-97e4-c26c629e3e96	But there is one lesson, learnt during our former troubles, that perhaps deserves statement. It is that a system of bed isolation, such as I have described in a paper published in the "Transactions of the Royal Society of Medicine for 1910," may not only be of the greatest service in overcoming difficulty created by an insufficiency of wards, but is actually of the very greatest help in, at all times, preventing those secondary infections that have been the bane of a hospital superintendent's life; is of the very greatest importance to the patients; and conduces, in small hospitals, to considerable economy in the working of the nursing staff. This plan will, I believe, entirely supersede the system, now extensively used, of constructing separate cubicles, and may lead to not a little modification in the construction of isolation hospitals generally. I can honestly say that since we have adopted it at Mortlake we have had far greater confidence than formerly in dealing with doubtful cases, and cases of mixed infection.
b6afa0d6-a2e6-43a7-a7d7-7fd8605df238	The only disease, except variola, which I am not quite sure of controlling by this method is chicken-pox. The plan 35 of bed isolation is, however, certainly useful even in this instance, and I have some grounds for declaring that the spread of this disease can be checked if, in addition to the most rigorous bed isolation, general inunction with oil of eucalyptus is practised from the first. This plan has also been tried with great success by me in private practice. The treatment of scarlet fever by inunction is, however, quite another matter, and I have elsewhere given some reasons for not assenting to the claims of its advocates. It should not be forgotten, too, that Dr. Milne insists that, in addition to inunction, cases of scarlet fever should be subjected to throat swabbing with carbolic oil.
69b9256a-d42e-4632-afd5-247944aaec72	It appears to me, moreover, that such success as this practice of inunction has apparently met with has been in cases of what I have called " recessive infection," and I believe that in these cases the infective potency is very much less than in the initial, or "intensive" cases of an outbreak, or series of cases. We had during the year, I may mention, under our notice, one very clear instance in which a child, treated at home by inunction, apparently infected another with quite serious consequences. That inunction in scarlet fever may have some uses I do not deny, but that it will ever be a satisfactory substitute for isolation I hesitate even for one moment to consider likely. I would repeat what I have said in another place:—if the method has the value that its supporters declare, let it be shewn that its practice will check outbreaks. To shew that when inunction is practised after an outbreak has become well established the outbreak nevertheless comes to an end, proves nothing.
57b21e6c-02d3-43d6-a524-9a37c7589202	Outbreaks always do come to an apparent end, from attenuation of the poison. Under a satisfactory system outbreaks should not occur. I ought to mention how greatly I have been indebted to Miss Bellinger, the Matron of the Hospital, for her scrupulous care in carrying out the prescribed details of our practice at Mortlake, and 36 in what large measure any success we may have had has been due to her. The table on page 62 gives the case mortality year by year of the cases of scarlet fever and diphtheria actually treated in the Hospital, but does not include those cases in which the ultimate diagnosis, e.g., tonsillitis, was less serious than that originally notified. The rules and regulations of the Hospital, which had been for some long time obsolete, were considered in some detail, early in the the year, by the Hospital Sub-committee, under the chairmanship of Mr. Watson, and the subjoined rules, as drafted by the Committee, were ultimately adopted by the Council.
f01dcf51-2ff3-4727-b57d-53c24616d1ff	These rules settle very satisfactorily several points that had long given much trouble in administration, and have worked with complete smoothness. The old rules, which did not satisfactorily define the position of the medical superintendent in relation to the treatment of all patients, have disappeared, and there is no longer opportunity for vexatious disputations as to the cases which may be admitted. Similarly, the benefits of the Hospital are as they should be, offered without the necessity for further payment, to those who actually do pay the rates. It is one of the things hard to understand that ratepayers should have been, in the past, so anxious to exclude themselves from the benefits of what they do pay for; and even yet the middle class man, who grumbles most heartily at the burden of the rates, hardly realises how persistently, in the matter of hospitals, libraries, etc., he still stands in the light of his own interests. 37 The Urban District Council of Barnes.
d6886f24-6f9e-44e4-9a90-eb97f360a9ea	Isolation Hospital, South Worple Way Mortlake, S.W. Rules for the Admission of Patients. (1). The Hospital is provided for the use of those inhabitants of the Urban District of Barnes who may be suffering from any infectious disease except Smallpox. (2). No person, other than a member or authorised officer of the Council, shall be allowed to enter the grounds without a written permit from the Council or Medical Superintendent of the Hospital. (3). No person shall be admitted to the Wards of the Hospital without the permission of the Medical Superintendent, and every person so admitted shall conform to the regulations of the Hospital. (4). The Medical Superintendent may set apart any Ward, not for the time being required for ordinary patients, as a private ward at a charge of two guineas per bed per week. (5).
e9ed18a0-3395-4fa0-a011-32e27eebbb62	A charge for admission to the Hospital will be made in the case of persons not belonging to the district who may be temporarily resident therein, such person being admitted to a private Ward at the rate above prescribed, or (if admitted) to an ordinary Ward, at such rate as the Sanitary Committee shall, according to the circumstances, determine. (6). No charge will be made except in the case of persons admitted under rules 4 and 5, or on the request of the Guardians or their officers. 38 Regulations for Visits to Patients, Discharge from Hospital, &c. Patients may be visited on Wednesday and Sunday afternoons between the hours of 3 and 4 p.m. Not more than one person may visit each patient in an afternoon, and the duration of each visit shall not exceed 15 minutes. In no case may children be brought to the Hospital by visitors.
bf442ead-1a18-4e8c-8a85-2d6ec13b5f5b	Articles of food, sweets, fruit, etc., brought by relatives are to be left with the Porter at the gate, and will not be given to patients unless considered suitable. Visits of enquiry, and visits made for the purpose of bringing clothes, are to be made between the hours of 9 and 10 a.m. or 6 and 7 p.m. All clothes brought for the use of patients must be plainly marked with the name of the person for whom they are intended. Relatives who desire to see the Medical Superintendent should attend the Hospital at 1 p.m. In special circumstances only, relatives may be admitted to the Wards, on the order of the Medical Superintendent. Persons thus visiting the Wards, do so at their own risk. They are advised in all cases to partake of food before entering the Hospital, and must leave their hats and outer garments in the visitors' room at the Porter's Lodge.
192e59d2-dbae-46d8-8d65-d9407d3985f1	They will be provided with a gown to wear in the Wards, and are advised not to touch, or come in contact with the patients visited. They will be required, on leaving, to wash with disinfectant provided and are advised to change their clothes on returning home before mixing with other persons. 39 When a patient is about to be discharged from the Hospital one or two days' notice will be given. A complete change of clothes must be brought at the time stated on the notice sent. Patients are discharged between the hours of 1 and 3 p.m., unless special permission is given by the Medical Superintendent for discharge at any other time. The particular attention of relatives is drawn to the paper of advice given to each patient on his or her discharge. It was proposed by me that a code of regulations should be drawn up for the internal management of the Hospital, but, although the old rules have been withdrawn, it has not, for various reasons, been possible to make progress in new legislation.
b4eb25ef-0020-40d0-bb35-4deb7db7046c	It is one of the curious anomalies of our sanitary system that Isolation Hospitals are not under the direct control of the Local Government Board, and are not, like asylums and workhouses, subject to periodical inspection. They should be, and there have been Royal Commissions and departmental committees far more otiose than would be one on the provision and management of fever hospitals in this country The methods pursued in this district in respect of Tuberculosis have been fully detailed in past reports (q.v.) and there is no need to recapitulate them here. During the year ten cases were notified under the Tuberculosis Order of the Local Government Board (1909), some of them in duplicate or triplicate, and seven cases were notified under the old voluntary system, now applicable to non-pauper cases only. Twenty-two deaths due to pulmonary turberculosis, and nine due to other tuberculous diseases have to be recorded.
a9f9759c-feb1-4e5a-bf37-f61c9952603c	Many of 40 these occurred in institutions outside the district, such as London hospitals; others are deaths of persons long resident in asylums, etc. One death of a child under twelve months of age was certified as due to phthisis, and two deaths under twelve months were certified as due to tuberculous meningitis. Probably none of these three were really cases of tuberculosis. When all the facts are borne in mind, it would seem that our true tuberculosis death rate is really quite a low one. I would like to take this opportunity of drawing attention to the opportunities that now exist for the treatment of suitable cases of phthisis in Isolation Hospitals. Such an hospital as ours at Mortlake is admirably adapted for the temporary reception of these cases, and particularly for the application of the methods practised at the Frimley sanatorium. I trust that the subject will rcceive consideration, and, if so, perhaps some advantageous arrangements may be arrived at with the Board of Guardians.
6b10c008-97a8-4b5b-91b0-7649ce85096a	The cases of infectious disease occurring during 1910 were neither numerous nor important. There were forty cases of diphtheria, twenty-eight in Barnes and the remainder in Mortlake, Thirty-five were removed to Hospital, and two died, giving a case mortality of five per cent. During the early part of the year there seemed to be a certain amount of grouping amongst the Barnes cases, and it was popularly believed that conditions at the Green Schools were at fault. Enquiry shewed, however, that the disease was not confined to the scholars at this school, and that the chief common factor was undoubtedly residence in the lower lying part of the district, in which this school happens to be. After prolonged rainfall the ground water in this part of Barnes rises rapidly, and comes quite 41 near the surface. It invades those houses that have cellars, and is demonstrated by the brisk activity of the once famous spring on the Common near to Ranelagh Gardens.
ff39c9b7-ebec-405b-b216-0fe332abc3d5	It is hard to see what remedy there can be unless either improvement in the weather or a system of under drainage be arranged for. When, as at the moment of writing, there is such a rise following wet seasons, there are always many cases of simple tonsillitis, and the manner in which an outbreak of diphtheria may occur is obvious. Since the outbreak, or rather, series of cases, in the first part of 1910, the Green Schools have been thoroughly overhauled, and impervious floorings of wood on a concrete base have been laid down in certain classrooms formerly without them. Considerable alteration has been made in other respects, and no more cases have occurred. There were sixteen cases of erysipelas notified during 1910. Two proved fatal. Forty-nine cases of scarlet fever were notified, twenty-five from Barnes, and twenty-four from Mortlake. There were no deaths. Thirty-eight cases were treated in hospital.
d26e4e60-0fb2-4749-bbf9-bcb924c455b0	During 1910 it was found that two children living in Mortlake were in attendance at a public elementary school at Richmond whilst peeling from scarlet fever. The parent was prosecuted at Richmond for causing the children to be exposed whilst in an infective condition, and at Mortlake, for not having notified the fact that they were suffering from scarlet fever. Both prosecutions were successful, and penalties were imposed. One case of enteric fever, or typhoid, was notified and admitted to hospital. The sequel shewed the case to be clearly one of tuberculosis, although the diagnosis and admisson were fully warranted by the early clinical course, and the result of application of the Widal test. 42 One case of puerperal fever was notified, but subsequently the medical man in attendance informed me that in his opinion the patient had really died from malignant endocarditis.
3ccb801f-1eeb-4b81-9437-e8eb66bee168	It is clear, from the table given on page 61, that our position in respect of the three principal zymotic diseases, diphtheria, scarlet fever and typhoid, has, during the last decade, steadily improved, for the average number of cases notified annually has, in spite of increased alacrity in notification, rather diminished than increased. As the population has increased nearly one hundred per cent., it is obvious that the prevalence of these diseases has been halved at least. This would be a welcome achievement even if it had cost money. But the sanitary rate, i.e., the burden per pound of rateable value due to the cost of the hospital and public health department, has not increased during the period under review.
97109653-4922-47a5-8872-dc20d6b6a941	I mentioned in my last report that the actual inspection of the work of Midwives had been taken from the local medical officers of health, on what many considered most inadequate grounds, and transferred to a lady in other employment, who, it was proposed, should give part of her time to the task of inspection. It was anticipated that this plan would not be found so practicable or economical as the County Council hoped. I learn that the lady appointed has resigned her duties on the grounds of ill-health, and that the County Council now proposes to appoint two in her stead. There are several unfortunate aspects of the original changes, and although when the British Medical Association approached the Surrey County Council some months ago, the reply was that the matter was une chose jugée, it is regrettable that the County Council did not take the opportunity afforded by the resignation alluded to, to reconsider the whole matter. My report under the Factory and Workshops Act is 43 made in tabular form on pp, 65, 66, et seq.
4390a72f-82df-4bb0-b611-725c5bba024d	No difficulties that call for comment have arisen during the year, and some further information will be found on page 68. Our card system, commenced in 1909, and modified to meet the requirements of the Local Government Board under the Housing and Town Planning Act of 1910, has been arranged so as to show a complete account of all places coming under the purview of the Factory and Workshops Act. The number of complaints of Nuisances received during 1910 was but 72. Over four thousand visits of inspection were, however, made by Mr. Grylls and Mr. Robinson, and over 400 notices were served for abatement of defects. In every case these notices were complied with, and the nature and number of the defects remedied is best realized by reference to the table given on page 71. The Coroner's Court and Mortuary are now in excellent order internally, but considerable external repair will be needed soon. The Coroner for the Kingston division, Dr.
f9f8798c-b7b2-4c6e-88c1-41e53182eacf	M. Taylor, J.P., held 45 inquests at the court during 1910. The need for swimming baths in the district is hardly now a matter of dispute. But the actual provision of such baths, like that of a library, seems destined to be a subject of academical and debating interest only. Many of the facts illustrated by the statistical tables that follow this report have been already alluded to, but others may be mentioned. According to Table I, the birth rate for 1910 is the lowest recorded in eleven years. It is possible that the census may shew that I have over-estimated the population and therefore that the birth rate is too low. 44 But the actual number of births is lower than was the case last year, and returns shew that the rate is falling all over the country. The most striking feature of this table is however the fall shewn in the infantile death rate. Here we are on sure ground.
c9690648-73e3-45ba-bb57-b946c4b631f2	Again, it is a fall analogous to one occurring in many, though not all, parts of the country. But in this district the fall has been very marked indeed, from 134 per thousand births in 1900 to 69 per thousand in 1910. The Notifications of Births Act is not in force locally, nor have we any health visitors. I attribute the improvement, so far as it is attributable to local effort, to steady, persistent work on the lines of old-fashioned common sense sanitation ; especially to rigorous supervision of the milk trade, active attention to the condition of roads and streets, and insistence on the removal of dust and dirt from houses. Dirt in the milk shop, dirt in the street and on the footpaths, dirt in the house, dirt in the kitchens, dirt in the dustbins, and dirt in in the back yards—these are the causes of death in the nursery. Flies play an important part, no doubt, but cleanliness does away with flies.
2e2fb218-20b4-4f6d-9607-0bbd20da7fed	Soil temperature conditions no doubt are factors too, but these we cannot touch. Dirt we can remove. The number of deaths registered in the district during 1910 was 215. In 1901 and 1908 the numbers were 214 and 213 respectively. In all other years since 1899 the numbers have been higher, It is quite certain, then, that the death rate has fallen since 1900, when the number of deaths registered was 220, or five more than in 1910. I estimate the death rate for 1910 as 6.5 per thousand. In 1900 it was 12.7. 45 The deaths registered in public institutions beyond the district show on the whole an increase. This is because every year it is possible to more and more nearly make these returns complete. In 1900 they were quite imperfect, and so any comparison of the "corrected" death rates shewn in Table I, col.
86a21b94-8631-412a-bed3-095dd968aa12	13, gives an impression less favourable than is just. I estimate, however, the corrected death rate for 1910 as 7.9 per thousand, and believe this estimate to be a fair one. Table II. shews that, as might be expected, the infantile death rate is higher in Mortlake than in Barnes, and also that there are many more births in the former parish. Table III. shews how the cases of infectious disease were distributed between the two parishes, and Table IV. analyses the causes of, and ages at, death. Measles, whooping cough and diphtheria accounted for but five deaths, and diarrhoea and enteritis for but eight. Cancer accounted for but only twenty-two, a low figure, all things considered. Of the infantile deaths, shewn on Table V., seven, or one seventh of the total, were ascribed to premature birth, and six to such vague causes as atrophy, etc.
c2d736ee-a8e7-4c29-bc77-9a02a0f492ea	Status lymphaticus was reported once, and cerebro-spinal meningitis once. The table on page 60 giving, year by year, the number of houses in actual occupation each Midsummer, has already been commented on, but attention may be directed to the relatively enormous expansion in Mortlake. It will be interesting to see if the census shews whether or no the two parishes differ now in the number of persons per house. Probably the smaller households will be found to obtain in Mortlake. 46 The table on the succeeding page demonstrates what need not be further laboured :—the progressive diminution of cases of the grave infectious diseases in the district during the last decade, in spite of the urbanization of the locality, the increased facility of communication, and the growth of the population : that on the page following affords some estimate of the work of the Isolation Hospital, so far as it may be judged by the case mortality.
085bf933-a61b-43dc-8ce6-9fd6d93ffe78	The improvement in the results of the treatment of scarlet fever I attribute mainly to the routine use of salicylates, and to the recognition of the frequent coincidence of diphtheria as a secondary or symbiotic infection, before admission, in many cases commonly put down as septic scarlet fever. The very low case mortality from diphtheria shewn in 1901 is explained by the fact that in the early part of that year a number of cases were admitted, very properly no doubt, but of a very mild type. The cases tabulated for later years are cases passing both clinical and bacteriological investigation. The relative infrequency of diphtheria now-a-days is unfortunately a cause of hesitancy on the part of many medical men in dealing with the disease. A child is seen with croupy symptoms. The medical man in attendance recognises the danger, administers antitoxin, and within a few hours the child is apparently well again.
a7b9b338-3359-415d-b7c4-152ecfe0d786	The doctor, whose promptness has probably saved the child's life, bears the odium of being labelled an alarmist, and earns the undying hostility of the child's parents. In another case the medical man, less decisive in his methods, waits till death is impending before making a diagnosis. There are a few hours of confusion and anxiety, much futile administration of remedies, and perhaps death-bed tracheotomy. The relatives are quite happy, and complacently assure each other that "everything has been done." 47 Such is the attitude of the laity that helps to keep up the death rate from diphtheria—a disease that need never be fatal if medical aid be sought at once, and if antitoxin be confidently given as soon as possible. Mr. Houghton's table shews the work done in relation to the Food and Drugs Act, and the measure of its increase in proportion to the growth of the district and its needs. The return, kindly furnished to me by Mr.
7b1e8179-ff9d-4768-aee2-90a6b55a0182	Umney, Clerk to the Richmond Board of Guardians, shews how well vaccinated this district would be but for "conscientious objections." But it is not a whit the less advisable that our means of defence against smallpox should be as complete as possible, and it is to be hoped that very shortly some outstanding details in respect of the administrative arrangements at the County Smallpox Hospital will be satisfactorily settled. For the preparation of the succeeding tables I am indebted to Mr Grylls, who has for so many years acted, with such advantage to the district, as Inspector of Nuisances. I cannot write this, my last report, without expressing my very sincere thanks to him for the very loyal and efficient help he has afforded me during my term of office, and of saying what is but strictly true, that the district owes him much for his many years of judicious and thorough work. In Mr.
50d8b8ae-d0dd-4f13-b5c3-a7b73e89653b	Grylls' tables there is given but a hint of the really enormous amount of work now carried out in the Public Health Department. For the general policy the Medical Officer of Health is, of course, alone responsible, and this position is emphasised, definitely enough, by the recent order and memorandum of the Local Government Board. These documents, however, do not change the manner in which our work is carried on at Barnes; 48 and, whatever be the policy laid down by the head of the Department, without the subaltern co-operation of experienced and able inspectors, the fruition of that policy must necessarily be disappointing. The Public Health service is at present in a sadly inchoate condition.
f1231250-fe7b-4758-9874-faaacd22f946	Some lines of definition seem to be appearing, but, if in the future, as seems to be likely, district medical officers of health are to be so called whole-time officers, subsisting on a barely living wage, and if public health departments are to be staffed by inspectors who are merely clerks, I for one doubt if the quality of the work done will be always so high as has been the case with the medical officer in a less dependent position, and the inspector a man used to responsibility and the exercise of discretion. It is not however in machinery alone that change is occurring. Old-fashioned commonsense sanitation, the sanitation of the old officials and the civil engineers, responsible for the great amelioration of the public health in the sixties, seventies, and even the eighties, has been lately somewhat out of fashion.
1b98c1ed-deb3-42c0-b10b-028eb53e3d99	Bacteriology has been thought to inaugurate a new era, and the gratuitous distribution of tracts on hygienic subjects to bring about a sanitary millennium, whilst many medical officers of health have seemed to think that their duty lies in preaching the necessity for socialistic experiments, rather than in attending to the drains and milkshops of their districts. There are, I think, signs that already a wholesome reaction is in progress. Every day the latest discoveries of the laboratory seem, as has been recently pointed out, a propos of typhoid carriers, rather to justify confident insistence on the value of old methods, empirical though they were, than to point out short-cuts to the promised land of Hygeia. 49 But, in the mean time, the self reliance of the community has been greatly weakened. The parent conceives it the duty of the municipality to relieve him of unpleasant tasks, and the shiftless incapacity of the average town bred and school educated mother of the London suburbs is stupendous.
778396e8-2ae6-44bc-85c8-7708ddbbb366	The fact is that the State has been heaping benefits on certain classes of the community, and has exacted no service, and fixed no responsibility in return. If the public welfare is our real objective we should not fix our attention too exclusively on death rates. A drunken and idle person has, under present methods, his life prolonged by all the resources of science, whilst he gives no service in return. A shiftless mother sends her child to a school, devised and managed by the best intellects of the country, to learn drawing and "nature study," with a filthy body and a verminous head. Cajolery, diplomacy, and all the sanitary and clerical personnel of the district have to be brought into play before that child can be got decently clean. When domestic dirt has bred disease, and obstinacy has aggravated its spread, the unfortunate patient is removed to hospital and given advantages which are hardly within the grasp of an emperor's offspring.
38de89c6-58e8-49bc-a411-824eb3b57c60	Yet, under our existing statutes, nothing is exacted in return by way of service to the State, and in not the most trivial way can responsibility be attached to those who evade parental duties, cheerfully carried out by races that the Englishman looks on as barbarian and uncivilized. There is not one of the many sanitary boons which the State or municipality now affords that one would wish withheld; but surely the time is coming when, in the interests of economy, in the interests of the thrifty and industrious, in the interest of national character, and in the interests of public health, it should be seen to that, if there be giving there should be taking. 50 If State aids to health are to be enjoyed, there should be a corresponding penalty if the requirements of the administration are flouted, and the public resources wasted, through the neglect, supineness or wilfulness of the persons benefited.
ea3f0eb4-98af-424d-ab0f-30c92eb0e722	Unless some such change as 1 have indicated does occur in our methods, progress in national health and vigour must necessarily be arrested, by reason of the enormous cost of administering, or attempting to administer, without adequate powers of control. Signs of this are already obvious enough in relation to the schools and the work of medical inspection, even to the casual reader of the newspaper. But what is wanted is a leader of the masses, who will have the courage to insist on duty as a function of the people. To quote the now sufficiently hackneyed lines, then indeed we may see "Jerusalem, in England's green and pleasant land." 51 Statistical Cables. 53 TABLE I. Vital Statistics of whole District during 1910 and previous Years. Name of District—Barnes Urban. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District, Deaths of nonresidents registered in Public Institutions in the District.
ccbfceba-12ef-45fd-ac5a-71b25868bcf8	Deaths of residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 year of age. At all ages. Number. Rate per 1,000 births Number. Rate.* Number, Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1900. 17400 416 23.9 56 134 220 12.7 1 — 3 223 12.8 1901. 17900 420 23.5 56 133 214 12..5 3 — 24 237 13.2 1902. 19900 501 25.1 57 113 257 12.9 7 — 27 286 14.2 1903.
4205b07c-6ca7-4106-8e31-aa23e08c957f	21150 513 24.2 57 111 220 10.3 5 — 27 247 1.16 1904. 23200 618 26.6 83 134 237 10.2 — — 24 261 11.2 1905. 24250 600 24.7 73 120 254 10.4 3 — 35 289 11.9 1906. 25500 632 24.7 71 112 256 10.0 15 — 32 288 11.2 1907. 28000 684 24.4 63 92 267 9.5 5 — 33 300 10.7 1908. 28500 676 23 .7 63 93 213 7.4 2 — 34 247 8.6 1909.
e1e30635-bfa2-4689-8035-b8b0dfca7cf1	30500 703 230 62 88 277 9.0 6 — 44 321 10.5 Averages of years 1900-1909 23630 576 24.3 64 113 241 10.2 4.7 — 28 269 11.3 1910. 32500 682 20.1 47 69 215 6.5 3 — 44 259 7. 9 * Kates in columns 4, 8, and 13 calculated per l,000 of estimated population. Area of District in acres Total population at all ages 17.821 {exclusive of area 2,400 Number of inhabited houses 3.403 At Census of 1901. covered by water). ) Average number of persons per house .. 5'436 54 TABLE II. Vital Statistics of separate Localities in 1910 and previous years. Name of District—Barnes Urban.
cbbe9ca6-9dac-4f36-94bc-31d38024d835	Names of Localities. 1. WHOLE DISTRICT. 2. BARNES (Parish). 3. MORTLAKE (Parish). Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. a b c d a b c d a b c d 1900 17400 416 223 56 9750 230 107 26 7650 186 116 30 1901 17900 420 237 57 10100 258 127 27 7800 162 110 30 1902 19900 501 286 60 10700 259 140 32
3390f11a-dddc-4d42-969c-ef408d4e8dba	9200 242 146 28 1903 21150 513 247 59 11250 263 133 32 9900 250 114 27 1904 23200 618 261 86 12000 293 134 43 11200 325 127 43 1905 24250 600 289 74 12250 310 138 26 12000 290 151 48 1906 25500 632 288 75 12750 284 136 25 12750 348 152 50 1907 28000 884 300 65 13450 277 144 28 14550 407 156 37 1908 28500 676 247 67 13500 266 124 24 15000 410 123 43 1909 30500 703 321 66 14200 278 140 25 16300 425
838954b5-d343-44f5-b560-7a8528d44a30	181 41 Averages of years 1900 to 1909. 23630 576 269 66 11995 272 132 28 11635 304 137 37 1910 32500 682 259 49 15200 261 126 14 17300 421 133 35 55 TABLE III. Cases of Infectious Disease notified during the year 1910. Notifiable. Disease. Cases Notified in Whole District. Total Cases notified in each locality. Number of Cases removed to Hospital from each locality. At all ages. At ages—Years. 1 2 1 2 Total Cases removed to Hospital. Under 1. l.to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upw'ds. Barnes. M'rtl'ke Barnes. M'rtl'ke. Small pox — — —
b6371596-4c62-43bd-a8f9-e392013a4b57	— — - - — — — — — Cholera — - — - — - — — — — — — Diphtheria (including Membranous Croup) 40 - 8 29 2 1 - 26 14 23 12 35 Erysipelas 16 — 1 1 2 8 4 12 4 1 — 1 Scarlet Fever 49 - 10 31 6 2 — 25 24 19 19 38 Typhus Fever — - — — — — — — — — — — Enteric Fever 1 — — — — 1 — — 1 — 1 1 Relapsing Fever — — — — — — — — — — — - Continued Fever — — — — — — — — — — — — Puerperal Fever 1 - — — — 1 - 1 — — — — Cerebro-Spinal Meningitis 1 1 - - — - - —
2a969929-3423-43eb-85c2-9a635e4aab9e	1 - 1 1 Phthisis (1) Poor Law (2) Voluntary 10 7 - - - 4 12 1 7 10 4 5 9 Totals 125 1 19 61 14 25 5 71 54 47 38 85 Isolation Hospital, Mortlake. Total available beds, 40. Number of Diseases that can be concurrently treated, 4. Note.—One case of Scarlet Fever and the one of Cerebro-Spinal Meningitis were treated in London Hospitals Phthisis is treated in the Poor Law Infirmary at Richmond. 56 TABLE IV. Causes of, and Ages at, Death during year 1910. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District.
3d897bc9-ae38-4c29-8758-a647bacdc5a4	Total Deaths whether of Residents or Nonresidents in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards. Barnes. Mortlake.
d05b15dd-56b3-472c-a85b-74283f93d20a	Small-pox — - — — — — — — — — Measles 1 — 1 — — — — — 1 — Scarlet fever — — - — — - — — — — Whooping-cough 2 2 - - - - - 1 1 - Diphtheria (including Membranous croup) 2 — 1 1 — — — 1 1 2 Croup - — - — — — - — — — Fever Typhus - - - - - - - - - Enteric - - - - - - - - - - Other continued - — — — - — - — — — Epidemic influenza 6 — 1 - — 1 4 5 1 — Cholera - — - — — — — — — — Plague — - — — - — — — — — Diarrhœa.
f3e89102-a7de-42da-b076-a90ccf50394d	6 5 — — - 1 — 1 5 — Enteritis 2 2 — — — — - 1 1 — Gastritis — — — — — — — — — — Puerperal fever — — — — — — — — — — Erysipelas 2 — — - — 2 — 2 — 1 57 Phthisis (Pulmonary Tuberculosis) 22 1 1 1 4 13 2 10 12 — Other tubercular diseases 9 2 4 - 1 2 — 1 8 — Cancer, malignant disease 22 — — - — 12 10 13 9 — Bronchitis 17 — 3 — — 3 11 11 6 — Pneumonia 12 3 — — 2 3 4 7 5 — Pleurisy 1 - — — — — 1 — 1 — Other diseases of Respiratory organs - - - - -
26d7fcc1-c13a-49d3-85c8-02a38d9f814e	- - - - - Alcoholism Cirrhosis of liver 6 — — — — 6 — 4 2 — Venereal diseases — — — — — — - — — — Premature birth 7 7 - - - - - 1 6 — Diseases and accidents of parturition - — — — — — — - — — Heart diseases 23 — — — 1 11 11 12 11 - Accidents 9 2 1 1 — 5 - 5 4 - Suicides 2 — — — — 2 - 2 — — Other septic diseases 3 - - - - 3 - 2 1 — Cerebro-Spinal Meningitis 1 1 — — — — — — 1 — Syphilis 3 2 — — — 1 — — 3 — Found drowned 1 — — — — 1 — 1 - - Status Lymphaticus 1 1 — — — — — 1 — —
b872972d-6408-46d4-a3f6-589175b2363c	All other causes 99 21 1 — 1 25 51 45 54 — All causes 259 49 13 3 9 91 94 126 133 3 58 TABLE V. Infantile Mortality during the Year 1910. Deaths from stated causes in Weeks and Months under 1 Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 year.
74ae4c43-d7b8-4bee-a452-c836789060c0	All Causes (certified) 17 1 3 3 24 4 2 1 1 2 6 5 1 - 2 - 48 Common Infectious Diseases Small-pox - - - - - - - - - - - - - - - - - Chicken-pox — — — — — - — — - — — — - - - - - Measles - — — — - — — — — - - - - - - - - Scarlet Fever — — — - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) - - - - - - - - - - - - - - - - - Diarrhœal Diseases Whooping Cough - - - - - - 1 - - - 1 - - - - - 2 Diarrhœa, all forms - - - - - - 1 1 1 1 1 - - - - - 5 Enteritis.
72cf6f15-12ec-4e91-a16f-a4a570af31b0	Muco-enteritis Gastro-enteritis - - - - - 2 - - - - - - - - - — 2 Gastritis, Gastrointestinal Catarrh - - - - - - - - - - - - - - - - — Wasting Diseases Premature Birth 7 — — — 7 - — — — — — — — — — — 7 Congenital Defects - - - - - - - - - - - - - - - - - Injury at Birth - - - - - - - - - - - - - - - - - Want of Breast-milk, Starvation - - - - - - - - - - - - - - - - - Atrophy, Debility, Marasmus 4 - 1 1 6 1 - - - - - 1 - - - - 8 59 Tuberculous Diseases Tuberculous Meningitis - - - - - - - - - - 1 - - - 1 - 2
46920f71-8314-438a-aff8-ca2a73ee64cb	Tuberculous Peritonitis: Tabes Mesenterica - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - 1 - 1 Erysipelas - - - - - - - - - - - - - - - - - Syphilis — — — 1 1 — — — — — 1 — — — — — 2 Status Lymphaticus - - - - - - - - - - - - - - - - 1 Meningitis (not Tuberculous) - - — — — — — — — — — - 1 1 - — 2 Other Causes Convulsions 1 — — — 1 — — — — — — — — — — — 1 Bronchitis - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - -
2ce2cf67-35ce-496d-990b-70377c773dc5	- Pneumonia — — 1 — 1 — — — — 1 1 — - — — — 3 Suffocation, overlying - - - - - - - - - - - - - - - - - Other Causes 5 1 1 1 8 1 - - — — 1 3 — — — — 13 17 1 3 3 24 4 2 1 1 2 6 5 1 1 2 - 49 Sub-Division of Barnes and Mortlake. Population (estimated to middle of 1910), 32,500. Births in the year :—682 ; Deaths in the year of infants :—49 ; Deaths from all causes at all ages, 258. 60 TABLE Showing, year by year, since the last census, the number of houses in occupation each Midsummer. Date of Computation. Number of Inhabited Houses. Barnes.
eb6d09eb-41ea-47f3-bfdf-ab79e9a772da	Mortlake. Total. 1901 Census, March 1893 1510 3403 1902 Midsummer 2051 1763 3814 1903 „ 2167 1869 4036 1904 „ 2315 2120 4435 1905 „ 2377 2308 4685 1906 „ 2459 2464 4923 1907 „ 2576 2756 5332 1908 „ 2612 2942 5554 1909 „ 2745 3147 5892 1910 „ 3054 3433 6487 Increase, 1901-1910 1161 1923 3084 61 TABLE Showing the number of cases of Scarlet Fever, Diphtheria and Typhoid Fever notified annually since 1900, together with the estimated population for each year. Year. Estimated Population. Casks Notified.
39f92043-f663-4042-9094-630455d8159d	Cases per 1.000 estimated Population. Scarlet Fever. Diphtheria. Typhoid Fever. Totals. 1901 17,900 31 75 12 118 6.5 1902 19,900 75 61 8 144 7.2 1903 21,150 30 55 8 93 4.3 1904 23,250 31 14 7 52 2.2 1905 24,250 31 17 4 52 2.4 1906 25,500 38 115 8 161 6.2 1907 28,000 57 29 2 88 3.1 1908 28,500 36 29 5 70 2.4 1909 30,500 56 43 16 115 3.7 1910 32,
5a8cc57b-c84b-4332-bf66-6d491d345dd8	500 49 40 1 104 2.7 In the quinquennium 1896-1900 the number of cases notified averaged, each year, 6.1 per thousand of the estimated population. For the years 1901-1905 the figures were 4.3 per thousand, and for the five years 1906-1910 they are but 3.5 per thousand. 62 TABLE Showing the Case Mortality from Scarlet Fever and Diphtheria at the Isolation Hospital, Mortlake, during the years 1901-1910. Year. SCARLET FEVER. DIPHTHERIA. Cases. Deaths. Mortality per cent. Cases. Deaths. Mortality per cent. 1901 18 0 0.0 56 1 1.7 1902 56 1 1.7 46 6 1.30 1903 21 1 4.
954a5f20-9b04-469e-ac96-f4e6cfd5f880	7 45 3 6.5 1904 21 0 0.0 9 0 0.0 1905 24 1 4.1 14 2 14.2 1906 25 1 4.0 105 11 10.4 1907 50 1 2.0 17 2 11.7 1908 20 0 0.0 19 1 5.2 1909 46 0 0.0 35 4 11.4 1910 35 0 0.0 33 2 6.0 Totals 316 5 1.5 379 32 8.5 Altogether 74 cases were admitted during 1910.
521161fa-8f77-430d-9bc9-7e60df2db8ca	The diagnoses, as made in Hospital, were, Diphtheria 33, Scarlet Fever 35, Varicella 1, Erysipelas 1, Tonsillitis 2, Rubella 1, and Tuberculosis 1. There were 3 deaths, one from erysipelas and two from diphtheria. TABLE Showing the proceedings taken during 1910, under the Food and Drugs Act, by the County Inspector, Mr. R. A. Houghton. Articles Purchased. Samples taken. Found Genuine. Slightly Adulterated, etc. Crises in which proceedings taken. Convictions obtained. Fines Inflicted.
400546ed-c430-41ac-824e-5fda1d941ddd	Milk 61 52 5 4 3 £7 15 0 Butter 31 30 — 1 1 £2 4 0 Spirits 3 2 1 — — — Cocoa 1 1 — — — — Arrowroot 1 1 — - — — French Caper 1 1 - — — — Ground Oatmeal 1 1 — — — — Ground Almonds 1 1 — — — — Lard 1 1 — — — — Cheese 1 1 — — — — Totals 102 91 6 5 4 £9 19 0 64 TABLE Showing the administration of the Vaccination Acts in the Mortlake Registration Sub-District (which includes the parishes of Barnes and Mortlake) according to the return made by Mr. Umney, Clerk to the Richmond Guardians. Return for the period January 1st to December 31st , 1909.
6e7dc0bd-0e47-4fa0-9a0e-d48e4bbdeb7e	Registration Sub-District Comprised in the Vaccination Officer's District. No. of Births returned in the Birth List Sheets as registered. Number of these Births duly entered by 31st January, 1911, in Cols 1. 2,4, & 5 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which on 31st Jan., 1911 remained unentered in the Vaccination Register on account (as shown by Report book) of Number of these Births remaining on 31st jan., 1911, neither duly entered in the Vaccination Register (Cols. 3, 4. 5, 8, & 7 of this return) nor temporarily accounted for in the Report Book (Cols. 8, 9, & 10 of this Return).
b956cae9-5ecf-491d-89f5-dcd1335d4e90	Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of Birth of the Children to which they relate during the year 1910 Total number of Certificates of successful Primary Vaccination at all ages received during the calendaryear 1910. Col. 1. Column 2. Col. 4. Number in respect ofwhom Certificates or Statut'y Declarations of Conscientious Objection have been re- Col. 5. Postpone ment by Medical Certificate. Removalto Districts the Vaccination Officer of which has been duly apprised. Re"i moval to place unknown or which cannot be readier and cases not having been found. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead un vaccinated.
0c44bfa6-4d03-4a77-a3a2-e6ed967129e7	2 3 4 5 6 7 8 9 10 11 12 13 MORTLAKE 703 549 4 0 85 42 7 5 11 0 — 561 Return for the Period January-June, 1910. (Supplementary). MORTLAKE 333 268 2 0 38 11 8 2 4 0 74 — 65 Annual Report of the Medical Officer of Health for the year 1910 for the Urban District of Barnes on the administration of the Factory & Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES, and HOMEWORK. 1.- INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Prosecutions.
126d6128-3ca3-441c-9d8e-ab71abeddfd4	Factories (Including Factory Laundries) 34 2 — Workshops (Including Workshop Laundries) 317 11 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 68 - - Total 419 13 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Pound. Remedied. Referred to 11 M. Inspector Nuisances under the Public Health Acts :— Want of cleanliness 10 10 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 3 3 - - Sanitary ac- commodation insufficient - - - — unsuitable or defective — — — — not separate for sexes — — — — Offences under the Factory and Workshop Act- Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss.
c0cc39d2-88cc-4441-8d25-ecce81ab1b2c	97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report). - - - - Total 13 13 — — Sec. 22 of P.H.A.A.A., 1890, is in force, and 1 closet is required for 20 persons, or less, of each sex. 66 3.—HOME NATURE OF WORK. OUTWORKERS LISTS Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded Twice in the year. Once in the year. Lists. Outworkers. Lists. Outworkers. Wearing Apparel— (1) making, &c.
856f8283-7c0f-4afc-9862-9dcacb0b7e9f	- - 1 1 10 1 (2) cleaning & washing Lace, lace curtains & nets Furniture and Upholstery Fur pulling Umbrellas... Paper Bags and Boxes .. Brush making 1 Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Total — — 1 1 11 1 4—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Laundries 17 Dressmakers 22 Shoemakers 30 Bakehouses 15 Total number of workshops on Register 173 67 WORK. SECTION 107. Number of Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES (SEC. 108). OUTWORK IN INFECTED PREMISES (SECS. 109, 110).
7a78f762-fc70-49c2-89f5-fffb37060474	Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Failing to keep or perm 11 inspection of lists. Failing to send lists. — — 20 — — — - — — — 20 - — — - - - 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (S. 133) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S.5) Notified by H.M. Inspector - Reports (of action taken) sent to H.M. Inspector - Other — Underground bakehouses (S.
be576b72-5002-4e04-bd97-5044a4cdd87a	101)— Certificates granted during the year — In use at the end of the year 5 68 TABLE Showing the work done by the Sanitary Inspectors during 1910 with regard to places under the Factory and Workshops Act, 1901 BARNES. MORTI.AK??? TOTALS No. Visits. No. Visits. No. Visits. A.—FACTORIES— Brewer . . 1 1 1 1 Electric Lighting Works . . 1 1 1 1 Printers 1 1 2 4 3 5 Coachbuilders . . 1 2 1 2 Athletic Goods . . 1 2 1 2 Motor Works . . 1 4 1 4 Golf Club Maker . . 1 2 1 2 STEAM LAUNDRIES — Over 40 employees l 4 . .

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