Ful 8 Council of the Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health, J. CHARLES JACKSON. FOR THE YEAR 1915. Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Gentlemen, I have the honour to submit to you my twenty-fourth Annual Report on the vital statistics and the conditions affecting the health of the borough during the year 1915. The statistics of births, deaths and infectious diseases relate to the fifty-two weeks ended January 1st, 1916. POPULATION. The Registrar General has informed Medical Officers of Health that he proposes to exclude from his returns for local areas the deaths of all members of the armed forces of this and other countries and to calculate the death-rates on the estimated civil population. In the following memorandum the Registrar General has dealt with the method of framing these estimates and the reasons for its adoption Estimate of Civil Population, 1915. The war has made it impossible to adhere to the methods of estimation of local and national populations hitherto in use. Men of military age have been largely drafted to military training centres or sent abroad with the army, and the remainder of the 4 male adult population, as well as, to a lesser extent, the female popuation, has migrated on an unprecedented scale into areas other than those in which it was enumerated at the last census. Under these circumstances estimates of local populations based on the census returns were clearly inadmissible, and it became necessary to search for a substitute. Fortunately this was ready to hand in the shape of the National Register, which referred to a date only six weeks removed from that for which estimates were required, viz., the middle of the year 1915. No doubt this does not form a perfect record as it is known that a number of persons escaped registration. From investigations, however, which have been made in another connexion it appears that the defects in the register taken as a whole are not on such a scale as to affect seriously the estimates of population based upon it. By the method described below it was possible to derive from these returns estimates of the civil population only of each administrative area on August 15th. No attempt has been made to increase these by allowance for members of the fighting forces because, apart altogether from the difficulty of ascertaining the average military population of each district during the year, experience has shewn that under present circumstances only civilian deaths can be tabulated for local areas. If military deaths were to be included they would have either to be debited to the area in which they occurred, ai course which would render the death rates of districts containing large military hospitals meaningless, or to the area of residence. An attempt made to pursue the latter course has had to be abandoned owing to military authorities having been unable to furnish to the registrars the necessary information. It has been found necessary therefore to limit the tabulation of deaths by local areas to deaths of civilians, and under these circumstances the civilian population is obviously the proper one to use for the calculation of death rates. 5 An additional advantage in the use of the National Register populations is that these consist of habitual residents in each locality and not merely of the persons who happened to be present therein on a certain date. The deaths tabulated from the year 1911 onwards are also those of habitual residents only, and therefore the use hitherto of populations which in certain cases included very large institutional elements chiefly composed of non-residents introduced in these cases serious errors into the rates calculated from them, as pointed out in the Registrar General's Annual Reports. This source of error now of course disappears for the time being, and in such districts an unavoidable break in the continuity of the previously misleading rates will result. In any case, however, the maintenance of continuity is under present circumstances obviously impossible, and it is felt that the present estimates will furnish death rates calculated to indicate as nearly as may be the health conditions of the civil population. The method by which the estimates of civil population have been derived from the National Register returns may now be described. The ratio of the total population, less the males aged 15 to 65 years, to the number of females aged 15 to 65 years at the date of the census, was calculated for each administrative area, and this ratio was applied to the number of females on the National Register; the resulting product plus the number of males aged 15 to 65 years on the National Register was taken to be the number of the civil population of the district. A small adjustment was necessary in order to make the sum of the estimates for the several districts equal to the estimate for the country as a whole, made on the same basis. Further, the population in institutions was not registered and this (taken to be the same in the aggregate for England and Wales as at census date) together with a. number of persons of no fixed abode were distributed evenly over the whole country. 6 These two adjustments raised the original estimates by about one per cent. The question of the population to be used for the calculation of birth-rates has also required consideration. The births registered are not only those of the children of civilians, and the estimates of civil population therefore form an unsuitable basis for the calculation of birth-rates. It is impossible; to frame any estimate that would give reliable birth-rates, and it is suggested, therefore, that the birth-rates for 1915 be based upon the existing estimates of total population for 1914. These will sometimes be seriously in error owing to extensive migration having occurred. Although in such cases the Registrar General does not possess the local information necessary for applying any correction, it is not suggested that this fact need preclude Medical Officers of Health from making use of their opportunities in this direction. Difficulties, which will probably prove insoluble, remain as to estimation of populations in sex and age groups and the standardising factors dependent upon them. Moreover, the present method of estimation will obviously not apply to 1916 or subsequent years unless the National Register is effectively kept up to date or further enumeration made. Nothing can at present be decided as to these matters. The civil population of Fulham as estimated by the Registrar General on this method was, in the middle of 1915, 151,161, but in this estimate the refugees at Earl's Court were not included, and as the deaths occurring among them are not deducted, an addition of 2,000 has been made to the Registrar General's estimate, this being the average number of refugees housed at Earl's Court in 1915. 7 TABLE I. vital statistics of whole district during 1915 and previous years. Year. Population Estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable deaths.† Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of NonResidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1910 153,166 4,213 4,310 28.1 1,701 11.2 99 306 462 107 1,908 12.5 1911 153,284 4,012 4,122 26.9 2,019 13.2 169 378 517 125 2,228 14.5 1912 155,402 4,079 4,213 27.1 1,830 11.8 173 366 395 94 2,023 13.0 1913 157,117 4,234 4,302 26.9 1,833 11.3 212 407 412 96 2,028 12.7 1914 157,303 4,065 4,154 26.4 1,878 12.3 137 391 469 113 2,132 13.6 1915 a 153,161 3,736 3,870 24.3 1,787 11.7 130 677 446 115 2,334 15.2 (a) Estimated civil population. Notes.—This Table is arranged to show the gross births and deaths registered in the district during the year, and the births and deaths properly belonging to it with the corresponding rates. The death-rates are calculated per 1000 of the estimated civil population, and the birth-rates per 1000 of the estimated gross population. In Column 6 are included the whole of the deaths registered during the calendar year as having actually occurred within the district, but excluding the deaths of Soldiers and Sailors that have occurred in hospitals and institutions in the district. Information as to the number and causes of such deaths is given in the text of the report. In Column 12 is entered the number in Column 6. corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1. included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances under 3 (b) below. In Column 8 the number of transferable deaths of non-residents" which are deducted is stated, and in Column 9 the number of deaths of "residents" registered outside the district which are added in calculating the nett death-rate of the Borough. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) are regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement are referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where Total population at all ages 153,284 At Census of 1911 Area of District in acres (land and inland water), 1701. Total families or separate occupiers 36,430 8 MARRIAGES AND MARRIAGE-RATE. 2,043 marriages were registered during the year, or 593 above the highest number previously recorded. The marriage—rate, i.e., the number of persons married per 1,000 inhabitants, was 25.6, the average rate of the preceding ten years being 16.9. BIRTHS AND BIRTH-RATE. Excluding 22 births among non-residents, but including 1.56 children born of Fulham mothers in lying-in institutions situate in other boroughs, 3,870 births were registered, 2,004 of boys and 1866 of girls, representing a birth-rate of 24.3 per 1,000 of the total population estimated in the usual way, which is the lowest rate recorded in Fulham, being 3.9 per 1,000 below the average rate of the preceding ten years. The following table gives the number of births and the birth-rates in the various wards, corrected by the distribution of the births in Maternity Institutions to the wards in which the mothers resided:— TABLE II. Births in 1915. Ward, Males. Females. Total Births. Birth-rate. Barons Court 122 109 231 18.4 Lillie 311 323 634 24.0 Walham 177 148 325 25.8 Margravine 275 260 535 28.1 Munster 518 460 978 25.1 Hurlingham 92 89 181 19.1 Sands End 384 359 743 27.5 Town 125 118 243 18.5 The Borough 2,001 1,866 3,870 24.3 9 TABLE III. Causes of and Ages at Death during the Year 1915. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District (6) Nett Deaths at all ages of "Residents" in the Wards of the Borough whether occurring in or beyond the Wards. Causes of Death All Ages Under 1 Year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Barons Court Ward Lillie Ward Walham Ward Margravine Ward Munster Ward Hurlingham Ward Sands End Ward Town Ward 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 All Causes Certified (c) 2334 446 156 115 96 86 296 559 580 304 179 448 223 301 500 94 398 191 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1—Enteric Fever 4 ... ... ... ... ... 4 ... ... 4 ... 2 ... 1 1 ... ... ... 2—Small Pox 3 ... ... 1 ... ... ... 2 ... ... ... ... ... ... 3 ... ... ... 3—Measles 121 24 62 32 3 ... ... ... ... 30 2 16 14 18 25 3 42 1 4—Scarlet Fever 17 1 1 5 6 1 2 1 42 1 3 2 2 2 1 4 2 5 —Whooping Cough 51 26 13 9 3 ... ... ... ... 1 2 6 5 12 13 2 9 2 6—Diphtheria and Croup 27 1 5 7 14 ... ... ... ... ... 3 3 3 5 7 2 4 ... 7—Influenza 35 2 ... 1 1 1 6 7 17 ... 5 3 2 5 10 2 2 6 8—Erysipelas 7 2 ... ... ... ... ... 2 3 2 ... 5 ... 1 ... ... 1 ... 9—Phthisis (Pulmonary Tuberculosis) 198 ... 3 2 3 31 92 59 8 26 8 44 18 24 47 3 37 17 10—Tuberculous Meningitis 25 7 2 9 6 ... 1 ... 3 1 5 2 3 6 1 5 2 11—Other Tuberculous Diseases 26 6 2 2 5 3 5 3 1 2 5 2 4 7 1 3 2 12—Cancer, malignant disease 172 ... ... ... ... ... 22 86 64 11 20 29 23 14 21 10 30 25 13—Rheumatic Fever 6 ... ... ... 4 2 ... ... ... ... ... ... 1 1 3 ... 1 ... 14 - Meningitis. See note (d) 24 7 3 4 4 2 3 1 7 3 3 2 3 8 ... 5 ... 15—Organic Heart Disease 203 ... ... ... 10 5 25 74 89 7 20 42 15 19 50 11 27 19 16 - Bronchitis 215 27 5 8 ... 2 11 57 105 12 12 48 24 30 51 ... ... ... 17 — Pneumonia (all forms) 256 64 36 19 7 8 23 67 32 21 19 45 30 48 50 6 42 16 18 —Other diseases of Respiratory organs 32 ... 3 1 4 1 5 9 9 3 ... 9 5 3 8 ... 5 2 19—Diarrhoea and Enteritis 86 72 9 ... ... 1 ... 2 2 7 2 25 9 5 23 1 16 5 20—Appendicitis and Typhlitis 10 ... ... ... 1 1 5 2 1 2 1 1 1 2 1 1 1 21—Cirrhosis of Liver 20 ... ... ... ... ... 5 12 3 3 5 5 ... 2 4 ... 3 1 21 A-Alcoholism 7 ... ... ... ... ... 2 5 ... ... 1 1 1 ... ... 2 ... 2 22—Nephritis and Bright's Disease 73 ... ... ... 3 5 16 25 24 15 7 13 6 7 17 8 9 6 23—Puerperal Fever 5 ... ... ... ... ... 5 ... ... 5 ... 3 ... 1 1 ... ... ... 24—Other accidents and diseases of Pregnancy and Parturition 5 ... ... ... ... 1 4 ... ... ... 1 1 ... ... 2 1 ... ... 25— Congenital Debility and Malformation, including Premature Birth 149 149 ... ... ... ... ... ... ... 4 6 23 11 25 37 8 33 6 26—Violent Deaths, excluding Suicide 78 11 3 10 6 7 10 16 15 6 3 18 7 6 15 2 17 10 27—Suicide 15 ... ... ... ... 2 5 6 2 39 3 3 1 1 2 1 3 ... 28—Other Defined Diseases 463 46 9 5 16 13 45 123 200 ... 51 87 39 60 85 23 67 52 29—Diseases ill-defined or unknown 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2334 446 156 115 96 86 296 559 580 304 179 448 223 301 500 94 398 191 SubEntries included in above figures. 14 (a) Cerebro-spinal Meningitis 10 3 ... 2 1 2 2 ... ... 6 1 2 1 1 3 ... 2 ... 28 (a) Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (a) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2—10, and columns 12—19. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term "transferable deaths" see footnote to Table IX (b) All deaths occurring in institutions for the sick and infirm situated within the district. whether of residents or of non residents, are entered in column 11 of Table VI. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certi- fied" all other deaths are to be regarded as "Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10), but inclusive of Cerebro-Spinal Meningitis. Deaths of soldiers and sailors occurring in hospitals and institutions in the district are excluded from the total number of deaths registered in the district, and such deaths in like manner are excluded from column 11. 11 Illegitimacy. The illegitimates numbered 189 or 5 per cent. of the total births. Of these 142 were born within, and 47 outside the borough. Still-Born Children. 92 still-born children were buried in Fulham Cemetery, being in the proportion of one still-born child to every 42 living. Excess of Births over Deaths. The natural increase of the population by the excess of births over deaths was 1,536, compared with 2,190, 2,274 and 2,022 in the preceding three years. DEATHS AND DEATH-RATE. During 1915, 1,787 deaths of civilians were registered in the borough, but of these 130 were of persons not belonging to the borough, while G77 inhabitants of Fulham died outside the borough, chiefly in various public institutions. There were, therefore, including 61 deaths of Belgian refugees, 2,334 deaths of persons having their usual residence in Fulham, representing a death-rate of 15.2 per 1,000, which is 3.2 per 1,000 above the average rate of the preceding five years and is the highest recorded in Fulham since 1905. The death-rate of the County of London in 1915 was 16.1 per 1,000. and in the metropolitan boroughs the rates ranged from 12.4 in Hampstead to 20.2 in Bermondsey. 12 The death-rates in the several wards of the borough were as under:— TABLE IV. Ward. Death-rates 1915. Average Death-rates 1905-14. Ward. Death-rates 1915. Average Death-rates 1905-14. Barons Court 14.7 12.6 Munster 13.2 12.7 Lillie 17.6 14.2 Hurlingham 10.3 12.5 Walham 18.3 17.5 Sands End 15.5 13.9 Margravine 16.7 16.2 Town 15.1 12.1 Seasonal Mortality. The mortality in the four quarters of the year was as under:— Deaths. Death-rate. First quarter 739 19.3 Second quarter 559 14.6 Third quarter 467 12.1 Fourth quarter 569 14.9 Deaths of Soldiers and Sailors. The deaths of 38 men on military service, died in the borough, of whom 9 were Fulham residents, the causes of death being as under:— Wounds 8 Dysentery 6 Cerebro-Spinal Meningitis 4 Pulmonary Tuberculosis 4 Scarlet Fever 3 Cancer 3 Other Diseases 10 13 TABLE V. INFANT MORTALITY DURING THE YEAR 1915. Nett Deaths from stated causes at various Ages under One Year of Age. Nett Deaths wider One Year of residents in the Wards of the Borough whether occurring in or beyond the Wards. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. All causes Certified 105 13 11 15 144 85 83 71 63 446 18 89 41 67 107 14 96 14 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... J Measles ... ... ... ... ... ... 3 8 13 24 ... 4 3 1 4 1 11 ... Scarlet Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Whooping Cough ... ... ... ... ... 3 5 4 14 26 ... 2 2 9 6 ... 4 1 Diphtheria and Croup ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 2 3 ... 7 ... 2 1 2 2 ... ... ... Abdominal Tuberculosis (b) ... ... ... ... ... ... 3 3 ... 6 ... 1 ... ... 3 ... 2 ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) 1 ... ... 1 2 2 1 2 7 1 ... 1 ... 4 ... 1 ... Convulsions 2 ... ... ... 2 2 4 3 1 12 1 2 1 2 4 1 1 ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 1 2 ... ... 3 6 10 5 3 27 ... 11 1 2 9 ... 2 ... Pneumonia (all forms) ... ... ... 2 2 12 15 20 15 64 1 11 9 14 10 2 16 1 Diarrhoea ... ... ... ... ... 11 8 4 5 28 ] 4 6 3 5 1 4 3 Enteritis ... ... ... 2 2 10 14 14 5 45 1 19 1 2 14 ... 8 ... Gastritis ... ... ... ... ... 4 2 ... 2 8 1 2 1 1 1 ... 1 1 Syphilis 1 ... ... 1 2 3 ... ... 1 6 1 1 1 1 1 ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 6 ... ... 1 7 1 1 ... ... 9 ... 1 ... ... 1 1 6 ... Injury at Birth 5 1 1 ... 7 ... ... ... ... 7 1 ... 2 1 1 ... 2 ... Atelectasis 5 ... ... ... 5 ... ... ... ... 5 ... ... 1 1 2 ... 1 ... (CongenitalMalformations(c) 5 2 3 1 11 6 3 1 ... 21 ... 4 3 3 4 ... 3 3 Premature Birth 71 5 5 5 86 9 1 ... ... 96 4 16 7 15 25 5 21 3 Atrophy, Debility and Marasmus 6 2 1 1 10 13 6 1 ... 30 1 4 1 8 7 1 8 ... Other causes 2 ... 1 1 4 2 3 3 1 13 ... 3 ... 1 3 1 4 1 105 13 11 15 144 85 83 71 63 446 18 89 41 67 107 14 96 14 Nett Births in the year—Legitimate, 3,681; Illegitimate, 189. Nett Deaths in the year of—Legitimate infants, 393; Illegitimate infants, 53. (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenteries. Want of Breast Milk is included under Atrophy and Debility. 15 MORTALITY AT DIFFERENT AGES. Infantile Mortality. Of the 2,334 deaths, 446 or 19.2 per cent. were of infants under one year of age, and the rate of infant mortality measured by the proportion of deaths under one year to births registered was 115 per 1,000, being 8 per 1,000 above the average of the five preceding years. 25 of those who died under one year of age were children of Belgian refugees and if these deaths be deducted together with the births occurring among the refugees, the rate of infant mortality for the year was 110 per 1,000. The infantile death-rate of the County of London was 112 per 1,000 and in the metropolitan boroughs the rates ranged from 78 in Hampstead to 145 in Shoreditch. 105 or 23.5 per cent. of the deaths of infants under one year of age occurred in the first seven days of life, and 143 or 32 per cent. in the first four weeks, the mortality rate of infants in the first month of life being 37 per 1,000. The infantile death-rates of the several wards of the borough were as under: — TABLE VI. Ward. Deaths under one year per 1,000 births. Average 10 1915. years 1905-14. Ward. Deaths under one year per 1,000 births. Average 10 1915. years 1905-14. Barons Court 78 106 Munster 110 115 Lillie 140 118 Hurlingham 77 83 Walham 126 148 Sands End 129 119 Margravine 125 136 Town 58 75 16 Causes of Infantile Mortality. Table V gives the causes of the deaths at various periods under one year of age, and in the following table the mortality from certain groups of diseases will be found: — TABLE VII. Death-rates of Infants wider one year of age from certain groups of diseases. Diseases. Heaths per 1,000 births. 1915. Average of 10 years 1905-14. Infectious Diseases 13.7 9.0 Tuberculous Diseases 3.4 4.3 Diarrhœal Diseases 20.9 28.0 Respiratory Diseases 23.5 20.0 Premature Birth, Congenital Defects and Debility 38.0 34.3 Other Causes 15.5 21.4 115 117 Prevention of Infant Mortality—Notification of Births. 3,104 notifications of living and 73 of stillborn children were received under the Notification of Births Act, 84 per cent. of the births registered in Fulham being notified. Of these 74.5 per cent. were notified by midwives, 20.9 per cent. by medical practitioners, and 4.6 per cent. by relatives. Visits were paid to 560 babies by your Sanitary Inspector Mrs. Davies, and to 778 by the Superintendent of the Fulham School for Mothers or her assistant, and 4,100 re-visits were paid. 775 infants were brought to the consultations held by the three doctors on the staff of the School for Mothers, and their attendances totalled 8,074. The fact that 20 per cent. of the children born in Fulham during 17 the year were brought to the consultations and that the great majority attended regularly is satisfactory proof of the appreciation by Fulham mothers of the work of the School. Arrangements have now been made for securing the continued attendance of the children at the consultations until they enter school and for the treatment of certain ailments from which they are found to be suffering. Under this scheme, 163 children were examined on an average twice during the year by the doctors, and of these 28 received the necessary dental treatment at the Dental Department of the Fulham School Treatment Centre, and 19 were operated on at the same Institution for enlarged tonsils and adenoids, the fees of the operating doctors and dentists being paid by the Committee. The scheme, so far as it has gone, has been successful, and there is undoubted need for its further development, so that all the babies who have attended the consultations shall be kept under regular medical supervision, since medical inspection has brought to light all over the country the wide-spread suffering of young children. Many of the defects and ailments which beset the entrants to our elementary schools could with proper handling be prevented or remedied long before they reach 5 years of age. To bridge the gap between infancy and school age in the care of children is a pressing need, and one which Schools for Mothers seem particularly suited to meet. Ante-natal Clinic. In previous reports attention has been called to the fact that the decline of recent years in infant mortality has been mainly confined to the ages over one month, and that there has been comparatively but little diminution in the deaths among infants in the first month of life. These deaths have been called non-preventable, as being due to ante-natal causes, but if more attention were paid to the health of the mother during pregnancy, many of these deaths might be prevented, and the 18 number of still-born births, which occur in the proportion of one still-born to every 40 living, would also be lessened. In order that expectant mothers may be able to obtain medical guidance, two of the doctors on the staff, Miss Alice Benham, M. D., and Miss Mildred Burgess, M.D., have undertaken to hold an ante-natal clinic. The midwives practising in Fulham, have been invited to bring to the clinic any of their patients about whose health they are anxious, or who have previously had difficult or premature confinements, Appointment of Health Visitors. For some years past the need for the appointment of Health Visitors, whose chief duties would be to visit homes in which births have occurred and give advice to the mothers with regard to the feeding of the infant and its healthy upbringing, has been repeatedly urged upon the Council, and as the Local Government Board had in several circulars issued during 1914 and 1915 brought under the notice of the Council the necessity at the present time for taking all possible steps to secure the health of mothers and children, I again submitted a report on the question which will be found in the Appendix. The Council on consideration of the report decided to appoint two Health Visitors at salaries of £100 a year rising to £125, of which a moiety will be repaid to the Council by the Local Government Board. To these posts Mrs. Bryning and Miss Durnford were appointed and commenced their duties on April 1st, 1916. Deaths of Illegitimate Children. Of the 446 infants who died before attaining the age of one year, 53 or 12 per cent were illegitimate, the mortality among them being in the proportion of 280 deaths per 1,000 births, against 107 per 1,000 among children born in wedlock. 19 Insurance of Children. Certificates under the Friendly Societies Act were issued in respect of 370 children under the age of five years, 52 per cent of the children dying at this age period being insured. Deaths at other age periods. Table VIII. gives the number of deaths and the deathrates at certain other age periods above one year. TABLE VIII. Deaths over one year of age. Age Period. Number of Deaths. Percentage of Total Deaths. Death-rate per 1000 of estimated population living at age period. 1 and under 2 years 156 6.7 44.3 2 „ 5 „ 115 4.9 10.5 5 „ 15 „ 96 4.1 3.1 15 „ 25 „ 86 3.7 3.6 25 „ 45 „ 296 12.7 6.6 45 „ 65 „ 559 23.8 22.4 Over 65 „ 580 24.9 90.2 Deaths from Epidemic Diseases. To the seven principal epidemic diseases 304 deaths were ascribed, representing a death-rate of 2.0 per 1,000 which is 0.4 per 1,000 above the average of the preceding five years. 20 TABLE IX. Cases of Infections Diseases notified during the Year 1915. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total cases removed to Hospital. At all Ages. At Ages—Years. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward Sands End Ward. Town Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox 7 - 1 1 - 3 2 - - - - - 7 - - - 7 Cholera (C) Plague (P) — - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 271 6 94 131 22 16 1 1 17 48 12 28 90 25 37 14 256 Erysipelas 89 1 6 5 8 34 21 14 7 21 7 9 19 3 18 5 37 Scarlet Fever 621 4 156 376 42 41 1 1 25 100 47 67 171 54 126 31 585 Typhus Fever — — — — — - — — — — — —- — — — — — Enteric Fever 14 — — 3 3 4 4 — 2 5 — 2 3 2 — — 12 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - - Puerperal Fever 24 — — — 7 16 1 — — 7 1 4 9 — 1 2 24 Cerebro-spinal Meningitis 20 4 5 2 4 5 — — 2 3 2 1 6 2 4 — 18 Poliomyelitis - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 47 47 - - - - - - 1 12 6 5 8 4 11 — 2 Pulmonary Tuberculosis 433 2 14 59 87 190 70 11 16 89 42 66 112 13 60 35 — Other forms of Tuberculosis 88 8 18 41 13 6 2 - 6 15 7 15 19 5 14 7 — *Chicken Pox 147 10 60 69 6 2 - - 4 23 8 25 55 9 10 13 - Totals 1761 82* 354 687 192 317 102 27 80 323 132 222 499 117 281 107 941 * Notifiable from March 17th to June 30th, 1915. 21 SICKNESS FROM NOTIFIABLE INFECTIOUS DISEASES. Table IX gives the number of cases of infectious diseases notified during the year. Smallpox. On February 3rd, a woman aged fifty-six, residing in Estcourt Road, who had been employed for some three months as a bedmaker on the male side at the Belgian Refugee Camp, Earl's Court, was found to be suffering from hœmorrhagic smallpox and died the same day in the ambulance on the way to the hospital. Her illness commenced on January 28th, and her last attendance at Earl's Court was on the morning of January 29th. Living at her home in Estcourt Road, were her husband, a married daughter, her son and his wife, and their five children The four younger children were unvaccinated, the eldest child and the four adults had been vaccinated in infancy. Vaccination was strongly urged, but was obstinately declined. The contacts were kept under observation, and the four adults and two of the children were removed to hospital as soon as they showed any signs of the disease, where the husband of the first patient and one of the children died. When her husband was removed to hospital with smallpox on February 13th, the mother allowed all her children to be vaccinated, and was also vaccinated herself. This was, of course, of no avail in the case of those who were already infected, but her baby at the breast who accompanied her to the hospital to which she was removed on February 15th did not contract the disease. It should also be noted that as the illness of the child who died did not commence until February 14th, it is most probable that if she had been vaccinated on February 3rd, when the nature of the grandmother's illness was discovered, she would have escaped the disease, but even if that had not been the case, the disease would most certainly have been so modified that she would have recovered. 22 The women who had worked at Earl's Court with the first patient were all vaccinated and kept under observa tion but none of them contracted the disease. None of the refugees at Earl's Court showed any signs pointing to a recent attack of the disease and no subsequent case occurred among them. As there were some 1800 refugees, many unvaccinated or imperfectly vaccinated, living in close association at Earl's Court at the time, it does not seem possible that anyone of them could have been in an infectious condition without spreading the disease, and it is probable that the charwoman came in contact with some infected rag or article of clothing which was destroyed as soon as it left her hands. It may be mentioned that a stewardess on one of the boats plying between Flushing and Folkestone was infected by smallpox about seven days before the woman at Earl's Court, the rash appearing on January 24th. Primary Vaccination. The following table furnished by Mr. Davies, Vaccinator, gives the returns for 1914 :— TABLE X. Vaccination Return for 1914, for the Borough of Fulham. No. of Births Registered from Jan. 1st, 1914. to Dec. 31st, 1914. Successfully Vaccinated. Insusceptible of Vaccination. Dead Unvaccinated. Postponed by Medical Certificate. Certificates granted under Clause 2 ot Vaccination Act, 1898. Removed to Districts in which Vaccination Officer has been notified. Removed to places unknown. Outstanding. 4072 2314 5 320 97 857 66 360 53 There was a further increase in the numbers of unvaccinated children, 21 per cent, being exempted by statutory declaration of vaccination objection against. 20 per cent, in 1913, and 35 per cent, of those born in 1914 remain unvaccinated. 23 Scarlet Fever. There was a marked drop in 1915 in the prevalence of scarlet fever, 621 cases being notified, compared with 1,042 in 1914. The returns for the four quarters were :— Cases. Deaths. First Quarter 185 6 Second ,, 143 6 Third „ 140 4 Fourth „ 153 1 621 17 The seventeen deaths represent a case mortality of 2.7 per cent., the highest since 1905. Diphtheria. The cases of diphtheria notified in the four quarters of the year were :— Cases. Deaths. First Quarter 46 6 Second „ 60 6 Third „ 51 4 Fourth „ 114 11 271 27 The number of cases was practically the same as in 1914 and 1913, but the fatality was higher, the twentyseven deaths comparing with twenty-three in 1914 and fifteen in 1913. 220,000 units of antitoxic serum were supplied to medical practitioners during the year. Enteric Fever. Only fourteen cases of enteric fever were reported, the lowest number previously recorded being fifteen in 1910. There were four deaths from the disease, and as the diagnosis was not confirmed in three cases, the case mortality was 36.6 per cent. 24 Puerperal Fever. Twenty-four cases of puerperal fever were notified during the year, the decennial average being twentythree, and there were four deaths, or 1.06 per 1,000 births Erysipelas. Ninety cases of erysipelas or thirty-seven below the average in the preceding ten years were notified, and seven deaths were attributed to the disease. Cerebro-Spinal Meningitis. Nineteen persons were notified as suffering from cerebro-spinal fever three being soldiers, two of whom were billeted in Fulham, and one was removed to Fulham from his mother's home in Chelsea after the commencement of his illness. Of the sixteen notified civilian cases, nine proved fatal, and in addition, the death of a boy aged fourteen, who was not notified was due to this disease. This boy had been employed as page in a hotel in the Strand and his death which occurred within eighteen hours of the onset of the disease was attributed to food poisoning, until at a second post-mortem examination, made by Dr. Spilsbury, it was found to be due to cerebro-spinal fever. Three days before his illness he had slept in the same bed with his two soldier brothers, both of whom were home from camps where there had been cases of the disease. They were both bacteriogically examined twelve days after they slept with their brother, but at that time neither was found to be a carrier. In two other instances the father of the patient had been home from his regiment on leave within ten days of the onset of the illness. 25 Poliomyelitis. Two children were notified as suffering from poliomyelitis. Both recovered, but in each case with paralysis of some of the muscles of the left leg. Ophthalmia Neonatorum. 44 infants were notified as suffering from ophthalmia by medical practitioners and three by midwifes. With one exception all are reported to have recovered with unimpaired sight. Chickenpox. Chickenpox was a notifiable disease from March 17th to June 30th, and in that period 147 notifications were received. One death in August was attributed to chickenpox. Tuberculosis. The notifications received during the year numbered 1432. Under Form A.—Cases not previously notified 793 „ „ B.—By School Medical Officers 46 „ ,, C.—Cases admitted to Poor Law Institutions and Sanatoria 306 „ „ D.—Cases discharged from Poor Law Institutions and Sanatoria 287 Of the above 558 were notifications of new cases, 461 being of pulmonary and 97 of other forms of tuberculosis. The following table gives the sex and ages of the persons notified :— 26 TABLE XI. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of notifications during the period from 3rd January, 1915, to January 1st, 1916. Age periods. Number of Notifications on Form A. Number of Notifications on Form B. (by School Medical Officers) Number of Notifications on Form C of admission to Primary Notifications. Total Notifications on Form A Primary Notifications. Total Notifications on Form B Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total. Under 5. 5 to 10 10 to 15 Total. Pulmonary. Males 2 7 9 13 18 27 63 41 21 11 4 216 375 3 7 4 14 14 54 98 Females - 7 15 22 22 20 51 35 23 15 7 217 306 - 10 4 14 18 61 57 Non-pulmonary. Males 6 11 12 8 1 1 1 1 - - - 41 49 1 1 2 4 8 18 2 Females 2 7 12 9 5 6 1 3 2 - - 47 60 - 4 1 5 5 12 3 27 Mortality from Tuberculosis. 198 deaths (101 of males and 97 of females) were registered from pulmonary tuberculosis, representing a death-rate of 1.29 per 1,000, the average of the preceding ten years being 1.32. The distribution of the deaths was as under :— Males. Females. Deaths in Poor Law Institutions 36 25 Deaths in Hospitals and Sanatoria 18 5 Deaths in Asylums 2 8 Deaths at Home 45 59 101 97 To other tuberculous diseases 51 deaths were ascribed, the death-rate being 0.34 per 1,000 against a decennial average of 0.40. Treatment and Prevention of Tuberculosis. Fulham Tuberculosis Dispensary. The Council has entered into a further agreement with the Committee of Management of the Fulham Tuberculosis Dispensary, under which they contribute £700 a year to the maintenance of the Dispensary, and £50 a year to the Brompton Hospital for Consumption in respect of patients who may be sent by the Tuberculosis Officer to the hospital for diagnosis, or treatment as out-patients. Of these sums one-half is repaid to the Council by the Local Government Board, and one-third by the London County Council, the net contribution of the Council being, £187 10s. Work of the Tuberculosis Dispensary. The following table gives a summary of the work of the Dispensary during the year:- 28 TABLE XII. STATISTICS OF FULHAM TUBERCULOSIS DISPENSARY, 1915. New Patients. 1. Suffering from pulmonary tuberculosis 174 2. „ „ other forms „ 28 3. suspected cases „ 260 4. non-tuberculosis 323 Total 785 Number of Attendances at Dispensary. 1. Insured 1,171 2. Uninsured 5,568 Total 6,739 Doctor's home visits 1,910 Nurses' ,, 2,918 Contacts examined 307 Contacts found tuberculous 19 Contacts who have become patients 157 Number of patients examined at request of London Insurance Committee 111 Number of these found tuberculous 109 (Of these 111, 70 were recommended for sanatorium treatment, 23 for hospital treatment, 15 for domiciliary treatment, and 3 for dispensary treatment.) Number of insured patients (old and new) treated at Dispensary 201 Uninsured patients sent to Sanatoria 32 „ „ ,, Convalescent Homes 28 „ „ Infirmary 41 „ „ ,, Boarded out 13 Patients who have had Tuberculin treatment 40 Consultations with Medical Practitioners 46 29 Institutional Treatment. Under the tuberculosis scheme of the London County Council the following patients were sent to sanatoria or hospitals during the year:- Males. Females. Patients under 14 years of age 4 14 Patients over 14 years of age 5 14 9 28 96 residents in Fulham (64 men and 32 women) received treatment in sanatoria as patients of the London Insurance Committee, their average stay being 11 weeks. DEATHS FROM NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. A severe epidemic of measles prevailed throughout the borough in the first six months of 1915, there being 119 deaths in that period, but only two in the second half of the year. The mortality from measles was higher in Fulham than in any previous year with the exception of 1896, when 164. deaths were recorded. Compulsory Notification. By an Order of the Local Government Board, measles and German measles were made compulsorily notifiable from January 1st, 1916. Whooping Cough. The deaths from whooping cough in the four quarters of the year were:- 1st Quarter 11 2nd „ 23 3rd „ 9 4th „ 8 51 The death-rate from the disease was 0,34, the decennial average being 0.32. 30 Diarrhœa. 72 deaths under one year of age and nine between one and two years were ascribed to diarrhoea or to enteritis. This diarrhœal death-rate, measured by the proportion of deaths under two years to births registered, was 21 per 1000, the corresponding rate of the County of London being 25, and the average rate in Fulham of the preceding 10 years, 32 per 1000. Influenza 35 deaths were certified to be due to influenza, the numbers in the three preceding years being 16, 27 and 25. DEATHS FROM OTHER DISEASES. Cancer. From malignant growths there were 172 deaths, 71 of males and 101 of females, representing a death-rate of 1.12 per 1000, against a decennial average of 1.06. The parts primarily affected were :— Males. Females. Cancer of the Buccal Cavity 8 2 Cancer of the Stomach, Liver, &c. 26 26 Cancer of the Peritoneum, Intestines and Rectum 15 14 Cancer of the Female Genital Organs — 31 Cancer of the Breast — 23 Cancer of the Skin 3 1 Cancer of other or unspecified Organs 19 4 71 101 Diseases of the Respiratory System. 503 deaths were ascribed to diseases of the respiratory system, or 22.5% of the deaths from all causes, being 80 above the decennial average. 31 CERTIFICATION OF THE CAUSES OF DEATH. Of the 2334 deaths registered, 194 or 92 percent, were certified by registered medical practitioners, and the remainder by coroners after inquest, no death being uncertified. DEATHS IN PUBLIC INSTITUTIONS. Fulham Infirmary and Workhouse. On April 1st, 1915, the Infirmary and Workhouse were taken over by the Military Authorities for hospital purposes, and are now known as the Fulham Military Hospital. From January 1st to April 1st, the deaths of 145 civilians occurred in Fulham Infirmary and of 15 in the Workhouse. Of these 145 lived in Fulham and 15 in other districts. Western Fever Hospital. In the Western Fever Hospital there were 53 deaths of residents in Fulham, 91 of residents in other districts, and four of soldiers. Deaths occurring outside the Borough among persons belonging thereto. The deaths of Fulham residents in public institutions and elsewhere outside the borough numbered 677, and occurred in the following institutions :— St. George's Hospital 58 West London „ 32 Other General Hospitals (Metropolitan) 44 Victoria Hospital for Children 26 Other Hospitals for Children 16 32 Lying-in and other Hospitals for Women 5 Brompton Hospital 6 Cancer Hospital 10 Other Special Hospitals (Metropolitan) 7 Homes for Incurables 13 Fever Hospitals of Metropolitan Asylums Board 16 Other Hospitals of Metropolitan Asylums Board 12 Provincial Hospitals and Sanatoria 8 Lunatic Asylums 103 Workhouses and Poor Law Infirmaries 279 In Private Houses, Nursing Homes, etc. 42 677 Of the deaths registered, 836 or 36 per cent. took place in either Poor Law institutions, in hospitals, or in public lunatic asylums, the percentages in the various classes of institutions being as under : — Deaths in Workhouses or Workhouse Infirmaries 18.3 ,, Metropolitan Asylums Board Hospitals 3.5 ,, other Hospitals 9.7 „ Public Lunatic and Imbecile Asylums 4.5 In the County of London, 45.7 per cent, of the deaths occurred in public institutions. GENERAL SANITARY ADMINISTRATION. Disinfection. The following articles were disinfected at the Council's Disinfecting Station, Townmead Road, during the year:— Beds 1030 Mattresses 989 Palliasses 388 Box Spring Beds 27 Pillows 2473 Cushions 869 33 Bolsters 985 Blankets 2289 Sheets 1783 Curtains 1883 Covers and Counterpanes 2089 Carpets and Rugs 1257 Articles of Clothing 4668 Sundries 6020 26750 In addition to the above the following articles from the Belgian Refugees camp, Earl's Court, were disinfected:— Mattresses 739 Pillows 884 Blankets 2784 Sheets 1890 6297 The following were also disinfected for the military authorities :— Blankets 655 Horse Rugs 258 Uniforms 145 1258 The following rooms were disinfected and cleansed :— After Scarlet Fever 539 „ Diphtheria 260 „ Enteric Fever 13 „ Puerperal Fever 27 „ Erysipelas 73 „ Phthisis 313 „ Measles 418 „ Cerebro-Spinal Fever 24 ,, Chickenpox 41 ,, Small-pox 9 „ other diseases 17 Verminous rooms fumigated and cleansed 167 1901 34 PUBLIC MORTUARY. 232 bodies were removed to the mortuary during the year and were admitted as follows:- At Coroner's request 120 Brought by Police 25 At request of M.O.H. 10 ,, of Relieving Officer 9 For convenience till funeral 68 232 Inquest were held on 143, and post mortem examinations were made in 105 of the above cases. Bacteriological Examination. The following bacteriological examinations were made on behalf of the Council at the Pathological Laboratory of the West London Hospital, by Dr. Julius Burnford. Material from cases of suspected Diphtheria. Number of Specimens. True Diphtheria bacillus isolated 62 Hoffmann or Pseudo Diphtheria bacillus isolated 22 Negative result 330 - 414 Blood from cases of suspected Enteric Fever. Widal or Typhoid reaction obtained 4 Widal or Typhoid reaction not obtained 19 - 23 Sputa from cases of suspected Tuberculosis. Tubercle bacillus found 91 „ „ not found 401 - 492 Other Examinations 6 935 35 FOOD SUPPLY. The dairies and milkshops, the ice cream shops and kitchens of restaurants, etc., were kept under systematic observation by your Inspectors. The arrangements, made at the request of the Local Government Board, for the supervision of the premises of contractors engaged in the supply of food for the Army or Navy, in order to secure the proper sanitary conditions of the premises and the wholesomeness of the materials used, were continued. Four firms were notified as having contracts for the supply of His Majesty's Forces. The licenses of the slaughterhouses at 611, Fulham Road and 640, King's Road were renewed by the London County Council in October. Unsound Food. The following articles examined at the request of the owners were condemned and destroyed:— Bacon 2 cwt. Chestnuts 5 sacks. Brazil Nuts 4 sacks. Fish 6 boxes. Fruit 6 boxes. 36 Proceedings under the Sale of Food and Drugs Acts. The undermentioned samples were purchased for analysis in 1915:— Article. Number of Samples taken Officially. Number Adulterated. Number of Samples taken Unofficially. Number Adulterated. Total Samples. Total Adulterated. Percentage of Adulteration. Milk 416 15 3 ... 419 15 3.4 Separated Milk 10 ... ... ... 10 ... ... Cream 4 3 10 8 14 11 78.6 Preserved Cream ... ... 4 ... 4 ... ... Cheese ... ... 20 ... 20 ... ... Butter 56 1 252 17 308 18 5.9 Lard ... ... 24 ... 24 ... ... Coffee ... ... 35 5 35 5 14.3 Coffee and Chicory ... ... 1 ... 1 ... ... Cocoa ... ... 22 2 22 2 9.0 Chocolate ... ... 1 ... 1 ... ... Sugar ... ... 12 ... 12 ... ... Honey ... ... 1 ... 1 ... ... Flour ... ... 13 ... 13 ... ... Sausages 7 3 15 4 22 7 31.8 Jams ... ... 23 1 23 1 4.3 Pepper 2 ... 12 2 14 2 14.3 Mustard ... ... 6 ... 6 ... ... Olive Oil ... ... 1 ... 1 ... ... Anchovy Paste ... ... 1 ... 1 ... ... Preserved Peas 3 2 1 1 4 3 75.0 Brandy 2 ... ... ... 2 ... ... Gin ... ... 2 ... 2 ... ... Rum ... ... 6 1 6 1 16.6 Whiskey 5 ... 5 ... 10 ... ... Camphorated Oil 2 ... 10 2 12 2 16.6 Liquorice Powder ... ... 9 ... 9 ... ... Seidlitz Powders ... ... 2 ... 2 ... ... 507 24 491 43 998 67 6.7 The percentage of adulteration was the lowest recorded in Fulham. Of the milk samples 3.4 per cent, were reported as adulterated, compared with 7.0, 4.9 and 5.7 per cent, in the preceding three years. 37 The average composition of the samples purchased as new milk in each of the four quarters was as under :— Period. Number of Samples. Solids, not Fat. Fat. Water. First Quarter 125 8.90 3.45 87.65 Second ,, 104 8.75 3.61 87.64 Third ,, 83 8.93 3.69 87.38 Fourth ,, 107 8.94 3.86 88.20 Proceedings under the Sale of Food and Drugs Acts, were instituted in the following cases:— Defendant. Offence. Result. Penalty. Costs. Alfred Jones, 66, Waldemar Avenue. Selling milk adulterated with 4 per cent, of added water Dismissed (Warranty proved) £ s. d. £ s. d. James Frederick Timms, 25, Ewald Road. Selling milk 10 per cent, deficient in fat. Convicted. 1 0 0 12 6 Henry Horton Busby, 564, King's Road. Selling camphorated oil 20 per cent, deficient in camphor. Convicted. 1 0 0 12 6 Edward Ruse, 2a, Humbolt Road. Selling milk 9 per cent, deficient in fat Convicted. 1 0 0 10 6 William Pettit, 2, Haldane Road. Selling milk 6 per cent, deficient in fat. Defendant ordered to pay costs. — 1 2 0 Alfred Jones, 66, Waldemar Avenue. Selling margarine for butter Convicted. 20 0 0 — Edward Francis, 574, Fulham Road. Selling milk 14 per cent, deficient in fat. Convicted. 1 10 6 — James Gardner, 177, Munster Road. Selling milk adulterated with 7 per cent, of added water. Convicted. 1 10 6 — David Morgan, 51, Hartismere Road. Selling cream adulterated with 9.1 grains of boric acid per pound of cream. Defendant ordered to pay costs. — 10 6 James Gardner, 177, Munster Road. Selling cream 16.8 grains boric acid per pound of cream. Defendant ordered to pay costs. — 10 6 Henry Moss, 19, Chesson Road. Selling milk 8 per cent, deficient in fat. Convicted. 1 10 6 — £27 10 6 £3 18 6 38 Public Health (Milk and Cream) Regulations, 1912. The following particulars of proceedings taken in 1915, under the above regulations made in pursuance of the Public Health (Regulation of Food) Act, 1907, are given in the form suggested by the Local Government Board in their circular letter of October 27th, 1913 :— 1. Milk and Cream not sold as Preserved Cream. Articles. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was found to be present. Milk and separated Milk 433 None Cream 10 7 Nature of the preservative in each case in column (b) and action taken under Regulations in regard to it. Preservative. Amount present. Action taken. Boric Acid 0.21 per cent. Samples taken unofficially. „ „ 0.36 „ „ „ „ 0.01 „ „ Vendors cautioned, and further samples taken. „ „ 0.25 „ „ „ „ 0.27 „ „ „ „ 0.24 „ „ Vendors prosecuted; ordered to pay 10/- costs. „ „ 0.03 „ „ 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (1) Correct statements made 4 (2) Statements incorrect — Total 4 (b) The examination made of milk fat in cream sold as preserved cream. (1) Above 35 per cent. 4 (2) Below 35 per cent. — 4 39 (c) Instances where (apart from analysis) the requirements as to labelling of preserved cream in Article 5 (1) and None. the proviso in Article 5 (2) of the Regulations have not been observed. (d) Particulars of each case in which the Regulations have not been complied None. with and action taken. 3. Thickening substances. No evidence of their addition to cream or preserved cream. 4. Other observations. None. Belgian Refugee Camp. The premises of the Earl's Court Exhibition, which were taken over by the Managers of the Metropolitan Asylums Board in October, 1914, for the accommodation of refugees from Belgium, were used for the same purpose throughout the year, and 46,187 refugees— 21,998 men, 11,985 women and 12,204 children-were received during the year, and the numbers remaining on December 31st, 1915, were 1,078, viz.: 426 men, 292 women and 356 children. The following extracts from the report of Mr. Powell, the officer-in-charge, gives an interesting account of the admirable work done there by the Asylums Board. "(1) The Earl's Court Exhibition premises were taken over by the Government on 15th October, 1914, the day after the summer exhibition of 1914 was closed. A few of the halls were hastily cleared of the exhibition paraphernalia, and the first night some 1,377 refugees were received. After this there was a short lull, following the fall of Ostend, and pending new arrangements for the transport of refugees from Holland. This breathing space was utilised for taking in hand the fitting up of large numbers of buildings of all shapes and sizes, from the Empress Theatre, in which, under a single span roof, were placed dining-tables for nearly 4,000, and 1,400 beds, one thousand of them being on the great galleries from which the seats were removed, to little side-show halls into which 30 beds were squeezed with difficulty. These buildings were spread over some 30 40 acres intersected by two railways—the three island sites being connected by long covered bridges, one of which was, as a last resort, pressed into service to hold 300 beds. The various structures were largely added to by improvised extensions, colonnaded arcades were filled in, open bars and switchback railway stations were given fronts and sides, rifle ranges were floored and repaired, rooms were built in odd corners, and long corridors partitioned along their length, and by these means 4,000 beds were put down by the middle of January. (2) Early in November, 1914, admissions were again in full swing, and by the end of the year 15,024 persons had been dealt with. The first six weeks of 1915 proved exceptionally busy, another 12,000 refugees arriving during that time. Almost everything else was perforce put aside at this juncture, to meet the demand for beds, and the necessity for passing the largest number of refugees through the camp as quickly as possible, and apart from feeding, housing and clothing the population, not much could be attempted. A church was opened, with daily services, and a large ball-room was converted into a concert-hall, in which excellent concerts were given nightly to audiences of over 1,000. The opening of the submarine campaign in the North Sea led to temporary cessations of transport more or less coincident with its severity, and thereafter the demands upon the accommodation of Earl's Court Camp were never again so large or urgent. (3) Already the seeds of much good work on the social side had been sown in such out-of-the-way corners as could be spared, and largely by voluntary helpers at the outset. With the decrease in the population, this work was developed in all directions, and the camp was converted from a huge caravanserai to a small Belgian township with its residential quarters, halls, church, schools, clubs, hospital, creche, works, shops and offices. Education was made obligatory for all children between 5 and 14, and optional outside these limits, and a school staffed by Belgian teachers opened, in which at one time 41 over 600 children were receiving instruction daily. A night school for adults is also part of the educational machinery. (4) Later in the year the works were opened for the benefit of those for whom it proved difficult to find outside employment or accommodation. A large and well found power woodwork factory was started, with fitters' and blacksmiths' shops, and in these much useful work has been carried out, including the construction of army huts, packing crates, boxes, etc. Basket, toy, tinsmiths' and mattress making shops have been added. In the women's workrooms, most of the clothing required for this camp is made, and many outside orders are fulfilled. A considerable part of the large English staff required at the outset, for the ordinary work of the camp, has been replaced by the refugees themselves. The large resident population, for which separate cubicles were constructed, proved hardworking and thrifty, have been extremely happy and contented for the most part, and have set an excellent tone to the camp during the winter of 1915-1916. The Board of Trade maintain a Labour Exchange in the camp, through which a very large number of refugees have been found useful and remunerative work in the country for which English labour was not available. Some 5,000 volunteers for the Belgian army have been obtained from the camp. For many of those unable to work or fight, hospitality has been found in the country through the agency of the Aldwych Refugees Committee. The health of the refugees has been remarkably good, and this must be attributed to the close supervision of the medical and nursing staff. An excellent little hospital of 36 beds has enabled the medical staff to deal with all ordinary ailments as a general rule, and with the most serious in emergencies; while the out-patients' department, where as many as 200 persons have been seen daily, and a large creche for babies, coupled with the weekly medical inspection of children and the medical 42 inspection of departures, as soon as these two latter measures became practicable, and constant attention from the first day to the cleanliness of the buildings and the beds, form the chief part of the armoury against disease. Notwithstanding the conditions under which thousands of persons were poured into this camp, there has been nothing of the nature of an epidemic." During the year there were among the inmates 28 notified cases of scarlet fever, 5 of diphtheria, 1 of cerebro-spinal fever and 1 of enteric fever. The deaths of Belgian refugees registered in Fulham during the year totalled 61, of which 25 were of infants under one year of age. Housing and Town Planning Act, 1909— Closing Order. Representation was made that 8, Peterborough Road was in a state so dangerous or injurious to health as to be unfit for human habitation, and a Closing Order was made by the Council. Demolition Order. The question of the demolition of the dwelling houses Nos. 2, 4 and 6, Peterborough Road, was considered by the Council and as they were of the opinion that these dwelling houses had not been rendered fit for human habitation, and that the necessary steps were not being taken with all due diligence to render so fit, the demolition of the houses was ordered. Determination of Closing Orders. The dwelling houses Nos. 10, 11, 12 and 13, Hatfield Street, having in the opinion of the Council been rendered fit for human habitation, Orders determining the Closing Orders which had been made in respect of them were made by the Council. 43 Drainage of Buildings. During the year the following drainage plans were submitted to and approved by the Public Health Committee:- Plans of drainage of new houses - ,, „ „ workshops, etc. 11 „ „ ,, additions to existing buildings 15 ,, „ of the re-construction of the drainage of existing buildings 42 68 Combined Drainage. Three systems of combined drainage for the maintenance of which the Council was liable, were re-constructed by the Council's contractor at a cost of £40 9s. 0d. The sum of £15 14s. 10d. was paid to the owners of two houses in respect of work carried out by them in compliance with the Council's notice, in connection with the drains which were "sewers" as defined by the Metropolis Local Management Act, 1855. Certificates uuder the Revenue Acts. Applications were received for certificates under the Revenue Acts for exemption from or abatement of inhabited house duty, in respect of 262 tenements, and for the renewal of 319 certificates which had been previously granted for a limited period. Of these 411 were granted, 101 were given after the completion of certain specified repairs and 69 were refused. 44 Factory and Workshop Acts. The following tables, prepared at the request of the Secretary of State of the Home Department, give a summary of the work done in connection with the Factory and Workshop Act:— I.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors, or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 152 4 — Workshops (Including Workshop Laundries) 324 18 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 172 12 - Total 648 34 — 45 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.m. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 33 33 • • • ... Want of ventilation 2 2 ... ... Overcrowding 2 2 ... ... Want of drainage of floors ... ... ... ... Other nuisances 5 5 ... ... Sanitary accommodation— Insufficient 4 4 ... ... Unsuitable or defective 7 7 ... ... Not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 4 4 ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 58 58 ... ... * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 46 3.— Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109. 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Sending twice in the year. Sending once in the year Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions Instances. Orders made (Sec. 110). Prosecutions (Sec. 109, 110). Lists. Outworkers. Outworkers. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— (1) making, etc. 4 ... 16 9 4 18 ... ... ... 16 16 ... 2 ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, etc., boxes, paper bags 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 6 4 16 9 4 18 ... ... ... 16 16 ... 2 ... ... 47 4.—Registered Workshops. Class. Number. Workshops on the Register (s. 131) at the end of the year:- Bakehouses 70 Laundries 45 Dressmakers, Milliners, Blousemakers 75 Tailors, Outfitters, etc. 25 Bootmakers 44 Motor and Cycle Makers 30 Cabinet Makers, etc. 21 Other Trades 152 Total number of workshops on Register 462 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 3 Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101):- Certificates granted during the year — In use at the end of the year 47 Cleansing of Children. 762 children reported by School Nurses to be in a verminous condition were cleansed at the County Council's cleansing station, 44, Sedlescombe Road, and 38 were treated for scabies. The rooms occupied by the children were cleansed by the Council, and their bedding and clothing were disinfected at the Borough Council's disinfecting station. 48 Smoke Nuisances. Ninety-one complaints were received of smoke nuisances, many of which related to the Council's Electricity Works. Fifteen statutory notices were served and warning letters were written to some of the worst offenders, but having regard to the difficulties under which manufacturers laboured no proceedings under the Public Health Act were instituted. General Sanitary Work. 1,288 complaints of nuisances were received and dealt with by your Sanitary Inspectors. 1.180 intimation and and 397 statutory notices were served. Legal Proceedings. Fifteen summonses for failing to comply with the Council's notices were ordered by the Public Health Committee, but it was not found necessary to proceed with them as the work was in each case at once put in hand. Proceedings under the Public Health (London) Act were taken against a medical practitioner for failing to notify a case of scarlet fever occurring in his practice and he was ordered to pay one guinea costs. Sanitary Staff. Two of your Sanitary Inspectors, Mr. F. Manning and Mr. M. Canton are still serving with His Majesty's Forces in France. Mr. T. Robey, Junior Clerk, who joined his regiment, the 2nd London Sanitary Corps at the beginning of the War, has received a commission in the Royal Field Artillery. Mr. Castley, who took 49 Mr. Robey's place, joined the Royal Army Medical Corps in November, and his place has been filled by Miss E, M. Clarke. I am pleased to have the opportunity of testifying to the industry and fidelity with which all the members of the Staff of the department have discharged their duties. I am, Sir and Gentlemen, Your obedient Servant, J. CHARLES JACKSON, Medical Officer of Health. July, 1916. 50 APPENDIX. REPORT ON MATERNITY AND CHILD WELFARE. To the Chairman and Members of the Public Health Committee. Gentlemen, Maternity and Child Welfare. Notification of Births (Extension) Act, 1915. The Local Government Board in their recent circular respecting the Notification of Births (Extension) Act, 1915, have pointed out that Section 2 of the Act provides that for the purpose of following up the information obtained by the notification of births and for facilitating arrangements for the care of expectant mothers, nursing mothers and young children, all the powers which the Sanitary Authority has under the Public Health (London) Act may be exercised. It will be seen, therefore, that the Act definitely contemplates that the powers of Sanitary Authorities will be used to promote the care of mothers and young children, and having regard to the urgent need that exists at a time like the present for taking all possible steps to secure the health of mothers and children, and to diminish ante-natal and post-natal infant mortality, the Board state that they are confident that they can rely upon Local Authorities making the fullest use of the powers conferred upon them. In July, 1914, the Local Government Board drew the attention of local authorities to the financial assistance they were prepared to grant in aid of systematic measures undertaken for the reduction of infantile mortality, and in the following memorandum they outlined the matters needing consideration in the preparation of a comprehensive scheme, formed with the object of securing that medical advice , and where 51 necessary, treatment should be continuously and systematically available for expectant mothers and for children till they are entered in a school register, and that arrangements should be made for home visitation throughout this period. LOCAL GOVERNMENT BOARD MEMORANDUM. Maternity and Child Welfare. A complete scheme would comprise the following elements, each of which will, in this connection, be organised in its direct bearing on infantile health. 1. Arrangements for the local supervision of Midwives. 2. Arrangements for— ANTE-NATAL. (1) An Ante-natal Clinic for expectant mothers. (2) The home visiting of expectant mothers. (3) A Maternity Hospital or beds at a hospital, in 'which complicated cases of pregnancy can receive treatment. 3. Arrangements for— NATAL. (1) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (2) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant at a hospital 52 4- Arrangements for— POST-NATAL. (1) The treatment in a hospital of complications arising after parturition, whether in the mother or in the infant. (2) The provision of systematic advice and treatment for infants at a Baby Clinic or Infant Dispensary. (3) The continuance of these Clinics and Dispensaries, so as to be available for children up to the jage when they are entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Creche, Day Nursery, School for Mothers or 'other school. (4) The systematic home visitation of infants and of children not on a school register as above defined. It is not of course expected that a complete scheme can be initiated at once, but the Board are anxious that work should not be delayed until a complete scheme can be formulated, and point lout that the first step to be taken by the Council is to consider whether the existing arrangements for home visitation are adequate, and after the provision of health visitors the other steps indicated in the model scheme 'can be considered. As the Committee are aware, I have, for many years, constantly urged the Council to appoint Health Visitors in order that they could efficiently Carry out the duties they undertook when they adopted ithe Notification of Births Act in 1907. The Council, however, up to the present, has refused to follow the advice given, and though their neglect has to some extent been counterbalanced by voluntary effort, the need now for an adequate number of Health Visitors is acutely felt. 53 It is, I venture to think, unnecessary for me to adduce arguments in favour of their utility, as there is now but one opinion on this point, and it is generally admitted that the decline in infant mortality during recent years is mainly due to the preventive methods adopted by sanitary authorities, and (of these, home visitation of infants has been the most important. It must be remembered that, although during the latter half of last century there was in this country a steady decline in the general death-rate at all ages due to the improvement in sanitation and (in the standard of comfort of the people, infantile mortality remained stationary, and there was practically no decline till the last decade, when special measures to lessen the enormous loss of infant life began to be taken, and 1 may further point out that the reduction in infant mortality of recent years has, at any rate in Fulham, been confined to children over one month of age, that is, to those who; are reached by the preventive efforts which have been adopted, and that there has been no reduction in the mortality of infants under four weeks of age, whose deaths are mainly due to ante-natal causes, which are but little afifected by existing preventive methods. It is, however, unnecessary to labour this point, as I think that the Council, in view of the paramount importance of the problem, will be only too willing to adopt any measures which might promise success even if such a result had not actually been proved. The question, therefore, appears to me to be mainly with regard to the number of Health Visitors who should be appointed. I have discussed this 'matter with Dr. Mivart. one of the Inspectors of the Local Government Board who was sent by the Board to see the Town Clerk and myself in order to bring to our notice the very great importance which the Board attach to the work of home visitation. The Local Government Board, who are acquainted with the details of 54 various schemes in all parts of the country, are of opinion that there should be one Health Visitor to every 500 births, and as there are in Fulham 4,000 births a year, this would mean eight Health Visitors. This, however, may perhaps be regarded as a counsel of perfection, and I am of opinion that, taking into consideration the assistance we get from voluntary organisations, at present two might be found adequate. This, however, is certainly the minimum number commensurate with efficiency, and I have every confidence that the Council will agree to their appointment. As the Local Government Board say in their circular, that even though at the present time strict economy is required in the public bodies and private individuals, the importance of conserving the infant life of the population makes it desirable that steps should be taken in the direction indicated, especially as a large outlay will not be involved in the provision of the services mentioned. The salary of a properly qualified Health Visitor would be about £100 a year, rising say to £125, and as one half of the expenditure will be refunded to the Council by the Local Government Board, the net cost of two Health Visitors will be at first £100 a year. With regard to the other suggestions of the model scheme, as the Local Government Board are anxious that there should be close co-operation between the Sanitary Authority and the numerous voluntary agencies now at work, the hospitals and the medical practitioners, I will take the opportunity of briefly detailing the work which is now being done by voluntary associations, in order that the Committee may appreciate the large amount of useful work in connection with child welfare that is being done in Fulham, and may formulate a scheme for co-ordinating and extending it. The following are the organisations dealing solely with children:— 55 Fulham School for Mothers— Two Branches at 90 and 92, Greyhound Road, and 170, Wandsworth Bridge Road. Children up to school age are seen at the Consultations held three times a week by three salaried doctors, and are visited at their homes by the superintendent and her assistant, both of whom are trained nurses and are qualified as Health Visitors. In 1914, 621 children, who made 7,631 attendances, were seen by the doctors, and 3,371 visits were paid by the nurses. Formerly the children did not attend the Consultations after they were twelve months old, but the necessity for bridging over the interval between infancy and school age was so apparent that now arrangements have been made for bringing them up at intervals for medical inspection until they enter school, and those of the elder children, whose teeth require attention or who have enlarged tonsils or adenoids requiring operation are now treated at the Fulham School Treatment Centre. It will be seen that the children attending the Consultations now receive skilled supervision from infancy until they enter school, when they come under the charge of the School Doctors and the Care Committee. The total expenditure of the Fulham School for Mothers is now about £900 a year. Ante-Natal Clinic.—Arrangements have also lately been made for an Ante-natal Clinic to be held once a fortnight at 92, Greyhound Road, by two of the doctors attending the Consultations. There is every prospect of securing the co-operation of midwives practising in Fulham, and in that event the Clinic should meet a much-needed want. 56 Fulham Day Nursery.—At this Institution, which is supported by voluntary subscriptions, children up to 5 years of age, whose mothers are compelled to go out to work, are received for the day, fed and well looked after at a small charge. The average daily attendance is about 20. The cost of the Institution is between £400 and £500 a year. Fulham Invalid Childrens Aid Society.—By this Society ailing and convalescent children are sent to convalescent homes or boarded out. Surgical instruments are supplied and general supervision exercised over chronic cases referred to the Society by Hospitals, etc. The expenditure of the Society, exclusive of the contributions of the parents, is about £550. Fulham School Treatment Centre— 18 and 20, Bagley's Lane.—Under an arrangement made with me acting on behalf of the Fulham Medical Practitioners by the London County Council, who pay the salaries of the doctors and nurses and capitation fees in respect of the children treated, school children are treated at the various departments, viz., Dental, Throat and Nose, Eye, Ringworm and Minor Ailments of the School Clinic held at 18 and 20, Bagley's Lane. About 3,500 children are treated yearly and the total expenditure is about £1,000 a year. Fulham Tuberculosis Dispensary.— Although of course not dealing exclusively with children, mention may also be made of the above, as 40 per cent, of the patients attending are children under ten years of age. The scope of its work is, however, so well known to the Committee that it is only necessary for me to mention it. Babies' Nursing Home.—I am also very pleased to be able to state that it is proposed to establish in Fulham a nursing home for sick children under three years of age. 57 The experiences of the doctors at the Consultations held at the Fulham School for Mothers has been that many children are brought to them who aiie in the early stages of acute illnesses, such as Diarrhoea, Pneumonia, etc., and require in addition to active medical treatment the most skilled nursing. This they cannot get in their own homes, and it is often impossible to secure their prompt admission to hospitals, and the result is they die, but if they could receive skilled attention and nursing many of them would undoubtedly be saved. It is proposed to receive the following cases: (1) Cases Received for the Day.— Wasting and ailing babies requiring special care and feeding such as cannot be carried out at their own homes owing to the mother's incompetence, obligatory absence at work or any other cause, but who are not suffering from acute illness. (2) Resident Cases.—Babies suffering from an acute illness (other than surgical) who require prompt medical treatment and skilled nursing and whose immediate admission to hospital cannot be secured. Such case to be admitted immediately if there is a vacancy without preliminary formalities. Every effort will be made to secure that only cases to which the mother is absolutely unable to give proper care and attention are admitted, either as daily or resident cases, and no case will be admitted except on the recommendation of a doctor. It will be gathered from the above resume of child welfare work in Fulham that a beginning, at any rate, has been made in the majority of the elements specified in the Model Scheme of the Local Government Board, though, of course, in some instances only a beginning, and it is necessary to endeavour as far as possible to co-ordinate the work, so as to prevent overlapping, and also to ascertain in what directions and by what methods it can be extended. For 58 this purpose, it is, in my opinion, advisable that the powers of the Council shall be exercised as permitted by the Act, in such manner as the Council shall direct, by a Committee which shall include lady representatives of the organisations I have mentioned, a practising midwife, land members of the Public Health Committee. Such a Committee might consist of the following representatives:— Fulham School for Mothers 1 Invalid Children's Aid Society 1 Day Nursery 1 Babies' Nursing Home (when established) 1 Midwives 1 Public Health Committee 6 11 This Committee would not interfere with the details of the work of the several Institutions nominating representatives, but act as a Central Council, receive the reports, co-ordinate the work of them all, and generally direct the measures adopted to promote child and maternal welfare. It will be seen that the measures I have advocated resolve themselves into two divisions which may be considered independently. The first is the appointment of Health Visitors, which I trust the Council will at once adopt; the second, the formation of a Children's or Infants' Welfare Committee which I submit for your consideration. I am, Yours obediently, J. CHAS. JACKSON, Medical Officer of Health. December, 1915.