The Metropolitan Borough of Finsbury A.E.Thomas,M.A.,M.D,,D.P.H. Medical Officer of Health. Public Health Department. Telephone N?I637 Holborn. all communications to be addressed to the medical officer of health. Ful19 Concil of the Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health, J. CHARLES JACKSON. Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Gentlemen, I have the honour to submit my Annual Report for the year 1916, which, in accordance with the suggestion of the Local Government Board, is limited to a record of the most important facts and figures. Population.—For the calculation of the death-rate and birth-rate the following estimates of population have been adopted by the Registrar General. For the death-rate 149,428 ,, birth-rate 162,580 The former is an estimate of the civil population, the latter of the total population, based on the assumption that the ratio between the total and the civilian population is the same in the borough as in England and Wales as a whole. Marriages.—1918 marriages were registered during the year against 2,043 in 1915, but the marriages in that year were 593 above the highest number previously recorded. Births.—Excluding 29 births among non-residents but including 183 children born of Fulham mothers in lying-in institutions situated in other boroughs 3,754 births were registered, 1,946 of boys and 1,808 of girls, representing a birth-rate of 23.1 per 1,000 of the estimated total population. This is the lowest rate recorded in Fulham, and is 3.2 per 1,000 below the average rate of the preceding five years. 4 TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1916 AND PREVIOUS YEARS. Years. Population Estimated to Middle of each Years. Births. Total Deaths Registered in the District. Transferable Deaths.† Nett Deaths Belonging to the District. Uncorrected Number. Nett. Under 1 Year of Age. At all Ages. of NonResidents registered in the District. of Residents not registered in the District. Number. Rate Number. Rate. Number. Rate per 1.000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 158,284 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 1916 a 149,428 b162,580 36,00 3,754 e 23.1 1,324 8.9 131 789 330 88 1,982 13.3 (a) Estimated civil population. (b) Estimated total population. (c) Birth-rate calculated on estimated total population. Notes.—This Table is arranged to show the gross births and deaths registered in the district during the year, and the births and death properly belonging to it with the corresponding rates. The death-rates for 1916 and 1916 are calculated per 1000 of the estimated civil population, and the other rate 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. 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 nick 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 the body was found. Total population at all ages 1563,284 Area of District in acres (land and inland water), 1901. Total families or separate occupiers 36,430 At census of 1911. 5 TABLE II. Causes of, and Ages at Death during the Year 1916. Nett Deaths at the subjoined ages of "Residents " whether occurring within or without the District (a). 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 Total Deaths whether of "Residents" or " NonResidents" in Institutions in the District (b) 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) 1982 330 77 65 73 79 261 496 601 148 169 319 208 284 441 113 291 157 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1-Enteric Fever 1 ... ... ... ... ... 1 ... ... 6 ... 1 ... ... ... ... ... ... 2—Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3-Measles 18 5 8 3 2 ... ... ... ... 14 ... 11 ... 3 2 ... 2 ... 4—Scarlet Fever 5 ... 1 2 2 ... ... ... ... 15 ... 1 ... 2 1 ... 1 ... 5— Whooping Cough 32 14 9 9 ... ... ... ... ... 13 4 8 4 5 5 2 4 ... 6-Diphtheria and Croup 20 ... 2 7 10 ... 1 ... ... 77 1 1 4 5 6 1 2 ... 7—Influenza 32 ... ... 1 1 ... 2 15 13 ... 5 3 5 2 5 3 3 6 8-Erysipelas 3 ... ... ... ... ... ... 1 2 ... ... 1 ... ... 2 ... ... ... 9-Phthisis (Pulmonary Tuberculosis) 210 ... 2 2 6 41 99 52 8 ... 13 30 25 36 48 10 30 18 10—Tuberculous Meningitis 25 4 5 6 8 1 1 ... ... 3 4 4 3 2 4 2 5 1 11—Other Tuberculous Diseases 32 5 7 2 4 5 5 2 2 1 3 4 3 7 7 1 5 2 12—Cancer, malignant disease 178 ... ... ... ... 1 24 84 69 ... 22 24 17 15 41 10 30 19 13—Rheumatic Fever 5 ... ... ... 2 2 1 ... ... ... ... 1 ... 1 2 ... 1 ... 14 —Meningitis. See note (d) 15 ... 4 4 3 2 ... 2 ... 7 2 1 3 1 5 ... 3 ... 15—Organic Heart Disease 191 ... ... ... 3 7 21 65 95 ... 10 34 12 27 49 20 23 16 16 —Bronchitis 222 22 6 1 2 ... 5 46 140 ... 15 44 27 38 32 12 40 14 17—Pneumonia (all forms) 154 41 19 13 4 2 17 32 26 7 5 21 24 26 38 9 20 11 18 —Other diseases of Respiratory organs 26 2 1 ... ... 2 2 6 13 ... 4 3 2 4 6 ... 5 2 19—Diarrhœa and Enteritis 69 60 4 ... ... ... ... 1 4 ... 3 17 5 11 18 1 10 4 20—Appendicitis and Typhlitis 5 ... ... ... 3 ... 1 1 ... ... 1 ... ... ... 2 1 1 ... 21—Cirrhosis of Liver 18 ... ... ... ... ... 3 9 6 ... 1 5 1 ... 4 1 2 4 2lA-Alcoholism 5 ... ... ... ... ... 2 3 ... ... 1 ... ... 1 ... 1 1 1 22—Nephritis and Bright's Disease 48 ... ... 2 1 1 8 25 11 1 5 3 6 9 11 7 5 2 23—Puerperal Fever 5 ... ... ... ... 2 3 ... ... 2 ... ... 1 2 ... ... 2 ... 24—Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... 1 6 ... ... ... ... 2 ... 2 2 ... 1 ... 25—Congenital Debility and Malformation, cluding Premature Birth 119 117 1 1 ... ... ... ... ... ... 7 25 13 16 26 3 21 8 26—Violent Deaths, excluding Suicide 72 11 3 5 11 2 11 17 12 ... 7 11 12 4 16 2 15 5 27—Suicide 14 ... ... ... ... ... 6 6 2 ... 1 2 1 ... 7 ... 1 2 28 —Other Defined Diseases 449 48 5 7 11 10 42 128 198 3 55 61 40 65 102 27 58 41 29 — Diseases ill-defined or unknown 2 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 1982 330 77 65 73 79 261 496 601 149 169 319 208 284 441 113 291 157 SubEntries included in above figures. 14 (a) Cerebro-spinal Meningitis 4 ... ... 2 ... 1 ... 1 ... 7 ... ... 2 ... 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 Deaths of soldiers and sailors occurring in hospitals and institutions in the district are excluded from the total (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 fied," all other deaths are to be regarded as "Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10). but inclusive of Cerebro-Spinal Meningitis. lumber of deaths registered in the district, and such deaths in like manner are excluded from column 11. 7 Illegitimacy.—The illegitimates numbered 203, or 5.4 per cent. of the total births. Of these 130 were born within, and 73 outside the borough. Still-born Children.—75 still-born children were buried in Fulham Cemetery, being in the proportion of one still-born child to every 48 living. Excess of Births over Deaths.—The natural increase of the population by the excess of births over deaths was 1,772, compared with 2,274, 2,022 and 1,536 in the preceding three years. Deaths.—During 1916, 1,324 deaths of civilians were registered in the borough, but of these 131 were of persons not belonging to Fulham, while 789 inhabitants of Fulham died outside the borough, chiefly in various public institutions. There were therefore, including 26 deaths among Belgian Refugees, 1982 deaths of persons, 992 males and 990 females, having their usual residence in Fulham, representing a death-rate of 13.3 per 1,000 of the estimated civilian population, or 0.5 per 1,000 below the average rate of the preceding five years. The death rate of the County of London was 14.3 per 1,000, and in the metropolitan boroughs the rates ranged from 10.5 in Hampstead to 19.3 in Finsbury. Seasonal Mortality.—The mortality in the four quarters of the year was as under:— Deaths. Death-rate. First quarter 528 14.1 Second quarter 489 13.1 Third quarter 398 10.7 Fourth quarter 567 15.2 Distribution of Deaths.—The death rates in the several wards, calculated on the assumption that the ratio of the estimated civilian population to the census population was the same in each ward as in the whole borough, were as under:— 8 TABLE III. Ward. Death-rate 1916. Average Death-rate 1911-15. Ward. Death-rate 1916. Average Death-rate 1911-15. Barons Court 13.9 11.8 Munster 12.0 12.5 Lillie 13.4 15.1 Hurlingham 12.3 11.8 Walham 16.8 17.5 Sands End 11.4 13.3 Margravine 16.0 15.5 Town 12.3 12.2 Infantile Mortality.—Of the 1,982 deaths 330 or 16.7 per cent. were of children under one year of age, and the rate of infant mortality measured by the proportion of deaths under one year of age to births registered was 88 per 1,000, which is the lowest rate recorded in Fulham. The decline in infant mortality during recent years is show in the following table:- TABLE IV. Infant Mortality in Fulham. Deaths of Infants under one year of age per 1,000 births. Average of five years, 1886-1890 170 ” ” 1891-1895 168 ” ” 1896-1900 167 ” ” 1901-1905 144 ” ” 1906-1910 117 ” ” 1911-1915 109 ” ” 1916 88 The infantile death-rate of the County of London in 1916 was 89 per 1,000, and in the metropolitan boroughs the rates ranged from 62 in Hampstead to 124 in Finsbury and Shoreditch. 9 TABLE V. INFANT MORTALITY DURING THE YEAR 1916. Nett Deaths from stated causes at various Ages under One Year of Age. Nett Deaths under 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 84 21 19 6 130 56 59 51 34 330 16 71 37 47 71 9 56 23 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 4 1 5 ... 3 ... 1 ... ... 1 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 1 ... 1 1 1 4 7 14 3 3 ... 2 3 1 2 ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 1 1 1 4 ... 1 ... ... 3 ... ... ... Abdominal Tuberculosis (a) ... ... ... ... ... 1 2 1 1 5 ... 2 ... 1 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 2 ... 1 4 ... ... 1 1 6 ... 1 ... 2 1 1 ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 1 3 6 7 4 2 22 1 4 5 3 3 ... 6 ... Pneumonia (all forms) 1 ... 2 ... 3 6 14 7 11 41 ... 7 7 5 10 3 7 2 Diarrhœa ... ... ... ... ... 4 3 10 1 18 ... 2 1 5 4 ... 4 2 Enteritis ... 1 ... 1 2 10 12 13 5 42 2 14 4 6 11 ... 3 2 Gastritis ... ... ... ... ... 4 7 1 ... 12 1 ... 2 ... 5 ... 2 2 Syphilis ... ... 1 ... 1 2 2 ... ... 5 ... 2 ... 1 1 ... 1 ... Rickets ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... Suffocation, overlying 5 1 ... ... 6 2 ... ... ... 8 2 1 1 ... ... ... 4 ... Injury at Birth 9 ... ... ... 9 ... ... ... ... 9 ... 3 2 ... 1 ... 2 1 Atelectasis 3 ... 1 ... 4 1 ... ... ... 5 ... 1 ... 3 ... ... 1 ... Congenital Malformations(c) 5 1 2 ... 8 3 1 1 ... 13 2 3 2 1 2 ... 1 2 Premature Birth 52 7 5 1 65 4 1 ... ... 70 4 18 7 8 14 1 13 5 Atrophy, Debility and Marasmus 7 6 5 2 20 7 5 1 1 34 1 4 3 8 7 1 7 3 Other causes 1 2 1 ... 4 4 3 2 3 16 ... 1 3 1 5 2 2 2 84 21 19 6 130 56 59 51 34 330 16 71 37 47 71 9 56 23 Nett Births in the year—Legitimate, 3,551; Illegitimate, 203. (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Nett Deaths in the year of—Legitimate infants, 284 ; Peritonitis and Enteritis and from Tabes Mesenterica. Illegitimate infants, 46. Want of Breast Milk is included under Atrophy and Debility. 11 TABLE VI. The infantile death-rates of the several wards were as under:- Ward. Deaths under one year per 1,000 births. Averages 5 1916. years 1911-15. Ward. Deaths under oner year per 1,000 births. Averages 5 1916. years 1911-15. Barons Court 82 102 Munster 76 107 Lillie 107 110 Hurlingham 54 72 Walham 111 125 Sands End 77 116 Margravine 98 126 Town 90 65 84 or 25 per cent. of the deaths of infants under one year of age occurred in the first seven days of life and 130 on 39.3 per cent. in the first four weeks. The mortality rate of infants in the first month of life was 35 per 1,000 births compared with an average rate of 38 per 1,000 during the preceding five years, the fall in infant mortality in 1916 being mainly confined to infants over four weeks of age. 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 one year of age from certain groups of diseases. Diseases. Deaths per 1,000 births. 1916. Average of 5 years 1911-15. Infectious Diseases 5.1 9.1 Tuberculous Diseases 2.4 3.2 Diarrhœal Diseases 19.4 24.8 Respiratory Diseases 16.8 19.7 Premature Birth, Congenital Defects and Debility 31.1 35.9 Other Causes 13.2 16.3 88 109 12 Deaths of Illegitimate Children.—Of the 330 infants who died before attaining the age of one year 46 or 14 per cent. were illegitimate, the mortality among them being in the proportion of 227 deaths per 1,000 births against 80 per 1,000 among children born in wedlock. Prevention of Infant Mortality—Notification of Births.—3,021 notification of living and 73 of stillborn children were received under the Notification of Births Act, 83 per cent. of the births registered in Fulham being notified. Of these 76 per cent. were notified by midwives, 20 per cent. by medical practitioners and 4 per cent. by relatives. Weekly returns are now obtained from the Registrars of the births which have been registered but not notified, and these children are visited by the Health Visitors and the attention of those responsible for the failure to notify is drawn to their omission. With the appointment in April, 1916, of two Health Visitors infant visitation has been more energetically undertaken and 4,448 visits were paid to 1,755 infants during the year by the Council's Health Visitors, and their work has been effectively supplemented by the activities of the Fulham School for Mothers at its three Infant Welfare Centres, 90 and 92, Greyhound Road, 160, Wandsworth Bridge Road and Melmoth Hall, Eustace Road. To the consultations held by the three doctors on the staff of the School for Mothers, 790 babies were brought and their attendances totalled 8,350, while 4,907 visits were paid to the homes of the babies by the Superintendent or her assistant. In addition to these 164 children over two years of age were seen by the doctors on 388 occasions, and of these 12 were operated upon at the Treatment Centre, 18, Bagley's Lane for enlarged tonsils and adenoids and 16 for dental defects. The number of older children attending 13 the consultations has been below expectations, and further efforts are needed if we are to approximate to the ideal that children shall be under continuous medical supervision from birth till they leave school. Ante-Natal Clinic.—The attendances at the antenatal consultations which have been held by two of the doctors on the staff, Dr. Mildred Burgess and Dr. Alice Benham have been disappointing, as only 28 women consulted the doctors during the year. The results, however, obtained in several cases show the value of the clinic and have encouraged the Committee of the School to try to extend its operations. Dental Clinic.—A further development of the work of the School has been the establishment of a Dental Clinic for nursing and expectant mothers attending the Centres. An arrangement was made with the Committee of the Fulham School Treatment Centre for the use of the rooms used for the School Dental Clinic, at 18, Bagley's Lane on one evening weekly, and the services of Mr. T. Vernon, L.D.S., the School Dentist, were engaged. A nominal fee ranging from 2d. to 9d. is paid for extractions, fillings, etc., and dentures are paid for by small instalments extending over from nine to twelve months. The clinic was opened in November, and during the first four months 54 women were treated, all of whom were supplied with dentures. The clinic should meet an urgent want as the condition of the teeth of working class mothers is very often deplorable, and the need for adequate treatment is generally recognised. Fulham Babies Hospital.—In March, 1916, a Nursing Home for Children under three years of age, was opened at 706, Fulham Road, which had been adapted and equipped for the purpose by a voluntary committee. The special objects of the Institution were that it should serve as a hospital for sick Fulham babies and that the mothers should be encouraged to visit 14 their babies frequently in order that they may be shown what is done for them and taught the treatment necessary for their welfare, and it is this combination which makes the hospital a novelty. There are 16 cots, and from the opening to the end of the year 100 babies had been admitted, and the average number of visits paid by each mother was 14. Except in special cases a charge of 6d. a day is made for each child, and patients are only admitted on the recommendation of a doctor, who has the option of attending the child while in the Hospital if he wishes. The Hospital works in close co-operation with the Fulham School for Mothers, and babies sent from the School have a prior claim to admission. The value of the Hospital has been recognised by the Borough Council, who have agreed to contribute £300 a year towards its maintenance, of which one half will be repaid to the Council by the Local Government Board. Deaths from Epidemic Diseases.—To the seven principal infectious diseases 139 deaths were ascribed representing a death-rate of 0.90 per 1,000 which is 0.87 below the average of the preceding five years. Sickness from Notifiable Infectious Diseases. Smallpox.—A Belgian who was removed on May 2nd from Earl's Court Refugee Camp to the Western Hospital as suffering from Chicken Pox, was subsequently found to be suffering from Smallpox. The patient landed at Newcastle from Russia on April 24th, and was brought the same day to Earl's Court, so that the infection was contracted abroad. All precautions were taken at the camp and no further case occurred. Scarlet Fever.—There was again a notable fall in the prevalence of scarlet fever, 286 cases being notified against 766, 1,042 and 621 in the preceding three years, and there were five deaths against 17 in 1915. 15 TABLE VIII. Cases of Infections Diseases notified during the Year 1916. Notifiable Disease. Number of Cases Notified, Total Cases Notified in each Ward of the Borough. At all Ages. At Ages—Years. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward Sands End Ward. Town Ward. Total cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 312 4 102 167 24 15 - - 3 75 24 47 86 7 61 9 305 Erysipelas 73 2 1 4 6 22 28 10 3 17 4 9 24 2 9 5 - Scarlet Fever 286 - 77 174 20 14 1 - 9 55 22 29 62 23 68 18 264 Typhus Fever - - - - - - - - - - - - - - - - - Enteric Fever 5 - - 1 2 2 - -- - 3 - - 2 - - - 4 Relapsing Fever (R) Continued Fever (c) - - - - - - - - - - - - - - - - - Puerperal Fever 22 - - - 8 14 - - - 6 2 3 3 1 7 - 17 Cerebro-spinal Meningitis 12 - 3 3 3 2 1 - - 3 3 1 3 1 1 - 11 Poliomyelitis 3 - 3 - - - - - - - - - 2 1 - - 1 Ophthalmia Neonatorum 49 49 - - - - - - 1 8 5 13 10 1 11 - - Pulmonary Tuberculosis 496 1 12 107 99 205 68 4 21 75 39 90 120 26 78 47 - Other forms of Tuberculosis 97 11 16 39 13 11 7 - 9 11 6 15 26 2 19 9 - Measles 751 37 264 369 51 29 1 - 32 73 45 160 225 50 111 55 - German Measles 703 12 98 443 71 70 8 1 62 68 26 46 214 60 121 106 - Totals 2809 116 576 1307 297 384 114 15 140 394 176 413 777 174 486 249 602 16 Diphtheria—312 cases were notified, compared with 271 in 1915, but the deaths numbered only 20 against 27 in the previous year. Enteric Fever.—Only five cases with one death were reported, the lowest number previously recorded being 14 in 1915. Puerperal Fever.—Twenty-two cases of puerperal septacsemia were notified, and there were five deaths, or 1.4 per 1,000 births. Erysipelas.—Seventy-three cases with three deaths were notified against an average of 119 in the preceding five years. Cerebro-Spinal Meningitis.—Twelve persons were notified with this disease, of whom four died, the number of civilian cases in 1915 being 17 with 10 deaths. The various cases were in no way related and in only one could any connection with Army cases be traced. Poliomyelitis.—Three children were notified, all of whom recovered with but slight loss of muscular power. Ophthalmia Neonatorum.—Forty-nine infants were notified as suffering from ophthalmia, four by midwives and the remainder by doctors. Proceedings were taken against a midwife for failing to notify a case of ophthalmia which resulted in total blindness, but the summons was dismissed by the magistrate, on the ground that although evidence was given that a notice had been sent to the midwife respecting the order of the Local Government Board, requiring the notification by midwives of cases of ophthalmia occurring in their practice, it was not proved that she had received it. Although the decision was clearly wrong in law, the Council decided not to appeal against it, as the case was reported by the London County Council to the Central Midwives' Board, and the name of the midwife was 17 removed from the roll. Of the cases notified, in one the sight was very seriously injured, but the remainder were reported to have recovered with unimpaired sight. Measles and German Measles.—The regulations made by the Local Government Board requiring the notification of measles and German measles came into force on January 1st, 1916, and 751 cases of measles and 703 of German measles were notified during the year. Sixty cases of measles and 26 of German measles were notified by the parents, 26 of measles and six of German measles by school teachers and the remainder by medical practitioners. Eighteen deaths were due to measles, eight being of children of Belgian refugees. The case mortality was 2.4 per cent., and the disease as well as being less prevalent, was of a much milder type than in 1915, when there were 121 deaths. Tuberculosis.—The notifications received during the year numbered 1,291, viz.:— Under Form A.—Cases not previously notified 833 ,, ,, B.—By School Medical Officers 58 „ „ C.—Cases admitted to Sanatoria and Poor Law Institutions 233 ,, ,, D.—Cases discharged from Sanatoria and Poor Law Institutions 167 Of the above 594 were notifications of new cases, 496 being of pulmonary and 98 of other forms of tuberculosis. The following table gives the sex and ages of the persons notified:— 18 TABLE IX. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of notification during the period from 1st Januray, 1916, to December 31st, 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 tions on From A Primary Notifications. Total tions on From 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 1 9 7 18 16 21 52 55 29 8 2 218 325 - 10 8 18 22 35 79 Females - 3 19 33 35 27 61 37 17 14 2 248 410 - 6 6 12 16 31 71 Non-pulmonary. Males 8 8 12 4 1 2 1 2 4 1 - 43 45 - 2 1 3 8 6 1 Females 3 8 9 4 8 2 6 3 1 1 - 45 53 - 5 2 7 12 9 1 19 Mortality from Tuberculosis.—210 deaths (110 of males and 100 of females) were registered from pulmonary tuberculosis, representing a death-rate of 1.41 per 1,000, the average of the preceding five years being 1.30. To other tuberculous diseases 56 deaths were due, the mortality being at the rate of 4.38 per 1,000. The distribution of the deaths from tuberculosis was as under:— Males. Females. Deaths in Poor Law Institutions 35 41 Deaths in Hospitals and Sanatoria 25 17 Deaths in Asylums 10 5 Deaths at Home 71 62 141 125 Treatment and Orevention of Tuberculosis. Fulham Tuberculosis Dispensary.-the ing table gives a summary of the work of the sary:- New Patients, 1. Suffering from pulmonary tuberculosis 225 2. „ „ other forms „ 13 3. suspected cases ,, 311 4. non-tuberculous 200 Total 749 Total Cases notified during 1916 (including 15 cases admitted during previous years) 253 Number of Patients Treated (old and new) 1. Insured 309 2. Uninsured 1,096 Total 1,405 20 Number of Attendances at Dispensary. 1. Insured 852 2. Uninsured 5,954 Total 6,806 Doctor's home visits 1,079 Nurses' ,, 2,828 Persons specially examined as Contacts 303 Number of these found tuberculous 24 Contacts who became patients during the year 207 Insured patients examined for purposes (sanatorium treatment, etc.) of London Insurance Committee 100 Uninsured patients recommended for sanatorium treatment to London County Council 62 Patients sent to Infirmary 55 Referred to Invalid Children's Aid Association 19 ,, „ Charity Organization Committee 40 „ ,, Children's Country Holidays Fund 34 Patients who had Tuberculin treatment 16 Patients who had cutaneous Tuberculin tests 344 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 16 years of age 13 21 Patients over 16 years of age 8 18 21 39 62 residents in Fulham (40 men and 22 women) received treatment in sanatoria as patients of the London Insurance Committee. Tuberculosis Care Committee.—In accordance with the scheme approved by the London County Council an Interim Tuberculosis Care Committee has been formed composed of representatives of the Borough Council, the Dispensary Committee, the School Medical Service, and the various local agencies engaged in 21 fare work. The Committee make the necessary arrangements for the appropriate institutional treatment recommended, assess and collect the contributions to be made by the parents of children sent to sanatoria, supervise the home conditions, arrange for the provision of extra nourishment when necessary, and endeavour to obtain suitable employment for adult patients and for children on leaving school. DEATHS FROM OTHER DISEASES. Whooping Cough.—The deaths registered from whooping cough numbered 32, being 21 below the average number of the five preceding years. Diarrhcea.—62 deaths under one year and four between one and two years, were ascribed to diarrhcea or to enteritis, the quinquennial average being 109. Influenza.—Influenza was the cause of 42 deaths or three less than in 1915. Cancer.—From malignant growths there were 178 deaths, 70 of males and 108 of females, representing a death-rate of 1.19 per 1000, against a quinquennial average of 1.08. The parts primarily affected were:— Males. Females. Cancer of the Buccal Cavity 4 3 Cancer of the Stomach, Liver, etc. 27 25 Cancer of the Peritoneum, Intestines and Rectum 18 24 Cancer of the Female Genital Organs — 22 Cancer of the Breast — 22 Cancer of the Skin 1 3 Cancer of other or unspecified Organs 20 9 70 108 22 Diseases of the Respiratory System.—399 deaths were ascribed to diseases of the respiratory system, or 20 per cent. of the deaths from all causes, being 35 below the quinquennial average. Venereal Diseases.—Ten deaths were certified as due to venereal diseases including five of infants from congenital syphilis. Scheme for the Treatment of Venereal Diseases.—Consequent upon the report of the Royal Commission the Local Government Board issued in July, 1916, the Public Health (Venereal Diseases) Regulations, together with circulars setting forth the necessity in the national interest, for Public Health Authorities taking immediate steps to carry out the recommendations in the Report of the Royal Commission. As the outcome of this the London County Council have entered into arrangements with the governing bodies of 22 hospitals, under which the hospitals undertook to appoint a Committee of the hospital staff to draft a scheme for carrying out the special work at the hospital relating to the diagnosis and treatment of venereal disease; which should include the appointment of a competent staff, the treatment of out-patients at evening sessions and other suitable times, the provision of beds for patients, the supply by the hospital of Salversan or its substitutes to approved medical practitioners, the supply to practitioners of apparatus for taking samples of blood, etc., the furnishing of reports on specimens sent by practitioners, the supply of statistical information in the work done, the provision of free instruction for practitioners and students, opportunities for practitioners to act as clinical assistants at approved rates of remuneration, the employment of women doctors in clinics for women, and the issue of printed instructions for the guidance of patients and practitioners. The scheme was approved by the Local Government Board and came into operation on January 1st, 1917. 23 Certification of the Causes of Death. Of the deaths registered, 1,728 or 92 per cent. 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.—This Institution was taken over by the Military Authorities in 1915, and is now known as the Fulham Military Hospital. Western Fever Hospital.—In the Western Fever Hospital there were 149 deaths, including 50 of residents in Fulham. Deaths Occurring Outside the Borough.—The deaths of residents in Fulham in public institutions and elsewhere outside the borough numbered 789, and occurred in the following institutions:— St. George's Hospital 43 West London „ 36 Other General Hospitals 39 Victoria Hospital for Children 36 Other Special Hospitals 37 Fever Hospitals of Metropolitan Asylums Board 4 Provincial Hospitals and Sanatoria 10 Homes for Incurables 14 Lunatic Asylums 114 Poor Law Institutions 409 Private Houses, Nursing Homes, etc. 47 789 24 GENERAL SANITARY ADMINISTRATION. Disinfection.—21,871 articles were disinfected at the Council's Disinfecting Station, Townmead Road, of which 4,922 were sent from the Belgian Refugees' Camp, Earl's Court. The following rooms were disinfected and cleansed:— After Scarlet Fever 272 „ Diphtheria 291 „ Enteric Fever 2 „ Puerperal Fever 21 „ Erysipelas 55 „ Tuberculosis 323 „ Measles 330 ,, Cerebro-Spinal Meningitis 12 „ German Measles 95 „ Cancer 20 ,, Poliomyelitis 1 ,, Miscellaneous diseases 29 Verminous rooms fumigated and cleansed 128 1579 Bacteriological Examinations. — 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 64 Hoffmann or Pseudo Diphtheria bacillus isolated 21 Negative result 330 415 25 Blood from cases of suspected Enteric Fever. Widal or Typhoid reaction obtained Widal or Typhoid reaction not obtained 6 6 Sputa from cases of suspected Tuberculosis. Tubercle bacillus found 74 ,, „ not found 304 378 Other Examinations 6 Total 805 Public Mortuary.—186 bodies were removed to the mortuary during the year and were admitted as follows :— At Coroner's request 83 Brought by Police 20 At request of M.O.H. 4 For convenience till funeral 79 186 Inquests were held on 100, and post mortem examinations were made in 64 of the above cases. FOOD SUPPLY. The dairies and milkshops, the ice cream shops and kitchens of restaurants, etc., were kept under systematic observation by your Inspectors. 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:— Cherries 2 baskets. Whelks 1 bag. Grapes 4 boxes. Fish 10 boxes. Potatoes 15 cwt. 26 Proceedings under the Sale of Food and Drugs Acts. The undermentioned samples were purchased for analysis in 1916 :— Article. Number of Samples taken Officially. Number Adulterated. Number of Samples taken Unofficially. Number Adulterated. Total Samples. Total Adulterated. Percentage of Adulteration. Milk 486 55 3 ... 489 55 11.1 Separated Milk 27 2 ... ... 27 2 7.4 Butter 19 3 310 16 329 19 5.7 Cheese ... ... 10 ... 10 ... ... Lard ... ... 7 ... 7 ... Coffee ... ... 10 1 10 1 10.0 Coffee and Chicory ... ... 1 ... 1 ... ... Cocoa ... ... 13 1 13 1 7.7 Sugar 11 ... 12 l 23 l 4.3 Flour 9 ... 3 ... 12 ... ... Pepper ... ... 11 ... 11 ... ... Olive Oil ... ... 2 ... 2 ... ... Crushed Linseed ... ... 6 ... 6 ... ... Camphorated Oil ... ... 7 2 7 2 28.6 Brandy 3 1 ... ... 3 l 33.3 Tinned Spinach 1 ... 5 3 6 3 50.0 Preserved Peas 2 2 2 2 4 4 100.0 Ether ... ... 1 1 1 1 100.0 Ginger ... ... 10 ... 10 ... ... Cough Drops ... ... 1 ... 1 ... ... Baking Powder 10 ... ... ... 10 ... ... Egg Powder 1 ... 6 3 7 3 42.8 Tartaric Acid ... 8 1 8 1 12.5 Cream of Tartar ... ... 1 ... 1 ... .. 569 63 429 31 998 94 9.6 The percentage of adulteration was 9.6, against 6.7 in the previous year. Of the milk samples 11 per cent, were reported as adulterated, compared with 4.9, 5.7 and 3.4 per cent, in the preceding three years. 27 The average composition of the samples purchased as new milk in each of the four quarters was as under :— Period. First Quarter Number of Samples. 117 ... Solids, not Fat. . 8.64 Fat. ... 3.40 Water.[?###] ... 87.96 Second ,, 135 ... . 8.95 ... 3.18 ... 87.87 Third ,, 108 ... . 8.79 ... 3.50 ... 87.71 Fourth ,, 129 ... . 8.94 ... 3.74 ... 87.32 Proceedings under the Sale of Food and Drugs Acts, were instituted in the following cases :— Defendant. Offence. Result. Penalty. Costs. Morgan Davies, 62, New King's Road, Fulham. Selling milk adulterated with 8 per cent, of added water Convicted. £ s. 10 d. 0 £ s. 12 d. 6 William Graham, 469, Fulham Road, Fulham. Selling margarine for butter. Selling margarine otherwise than in a properly stamped Convicted. 2 0 0 10 6 Charles Wheeler, 56, Boscombe Road, Hammersmith. wrapper. Selling milk 11 percent, deficient in fat. Convicted. 5 0 0 10 6 Charles Wheeler, 56, Boscombe Road. Hammersmith. Selling milk adulterated with 5 per cent, of added water. Convicted. 3 0 0 2 2 0 Leonard George Death, 156, Wandsworth Bridge Road, Fulham. Selling butter adulterated with 55 per cent, of margarine. Convicted. 5 0 0 15 0 Leonard George Death, 156, Wandsworth Bridge Road, Fulham. Selling butter adulterated with 40 per cent, of margarine. Convicted. 5 0 0 15 6 Thomas Setchfield, 134, Estcourt Road, Fulham. Selling milk adulterated with 4 per cent, of added water. Convicted, 2 0 0 10 6 Thomas Setchfield, 134, Estcourt Road, Fulham. Selling "new milk and water" adulterated with 50 per cent of added water and 37 per cent, deficient in fat. Dismissed Glovers', Ltd., Registered Office, 15, Brook Green. Selling milk 8 per cent, deficient in fat. Withdrawn George Harris, 42, Southerton Road, Hammersmith. Selling milk adulterated with 24 per cent, of added water. Convicted. 10 0 0 12 6 28 Defendant. Offence. Result. Penalty. Costs. Frederick Andrews. 59. Brecon Road,Fulham. Selling milk adulterated with 4 per cent, of added water. Convicted. £ s. 7 d. 6 £ s. 12 d. 6 Philip Jenkins, 245, Munster Road, Fulham. Selling milk adulterated with 6 per cent, of added water. Withdrawn John Owen Evans, 297, Munster Road, Fulham. Selling milk adulterated with 6 per cent, of added water. Convicted. 1 0 0 0 12 6 Ann Jane Hayward, 37, Burlington Road, Fulham. Selling milk 12 per cent, deficient in fat. Dismissed (Warranty proved) — — J. Mepham, 197, Felsham Road, Putney. Selling milk 21 percent, deficient in fat. Dismissed (Warranty proved) — — Thomas Setchfield, 134, Estcourt Road. Fulham. Selling milk 9 per cent, deficient in fat Withdrawn — — Thomas Evans, 52, Upcerne Road, Chelsea. Selling milk 8 per cent, deficient in fat. Defendant ordered to pay costs. — • 12 6 Henry George Moss, 11, Jervis Road, Fulham. Selling milk 7 per cent, decient in fat. Withdrawn t — William Wattam, 22 & 24, Phoenix Place, Notting Hill, W. Selling milk from which 9 per cent, of fat had been abstracted. Convicted 1 0 0 12 6 William Wattam, 22 & 24, Phoenix Place, Notting Hill, W. Selling milk from a vehicle without having name and address inscribed thereon conspicuously. Convicted. 5 0 Thomas Setchfield, 134, Estcourt Road, Fulham. Selling milk adulterated with 4 per cent, of added water. Convicted. 2 0 0 10 6 / John Evans, 145, Dawes Road,Fulham Selling milk 10 per cent, deficient in fat. Convicted. 1 0 0 10 6 Evan David Morgan, 51, Hartismere Road, Fulham. Selling milk 14 per cent, deficient in fat. Dismissed (Warranty proved) — — James Hedges, 59. Langthorne Street, Fulham. Selling milk 17 per cent, deficient in fat, Dismissed (Warranty proved) — B. Jones, 62, North End Road, Fulham. Selling preserved spinach adulterated with 3.32 grains sulphate of copper per pound Dismissed. — 4 4 0 costs against Council. M. Petrelli, 513, Fulham Road. Selling preserved peas adulterated with 3.04 grains of sulphate of copper per pound Withdrawn — £38 2 6 £14 4 0 29 Factory and Workshop Acts.—The following is a summary of the work done in connection with the Factory and Workshop Acts :— Inspection. Premises, Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 86 2 — Workshops (Including Workshop Laundries) 364 10 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 220 12 ~~— Total ... 670 24 — 30 Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.m. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 28 28 ... ... Want of ventilation 1 1 ... ... Overcrowding • •• ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 7 7 ... ... Sanitary accommodation— Insufficient 10 10 ... ... Unsuitable or defective 8 8 ... ... Not separate for sexes 3 3 ... ... 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 61 61 ... ... * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. Home Work.—12 lists of outworkers were received with 30 names thereon. 10 notices were served in respect of insanitary conditions in outworkers premises. Housing and Town Planning Act.—No representations were made under the Housing and Town Planning Act. 31 Drainage of Buildings.—During the year the following drainage plans were submitted to and approved by the Public Health Committee :- Plan of drainage of 6 blocks of flats 1 Plans „ „ „ workshops, etc. 5 „ „ ,, „ additions to existing buildings 19 „ „ the re-construction of the drainage of existing buildings 37 • 62 Combined Drainage.—Five 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 £51 5s. 7d. The sum of £47 17s. 3d. was paid to the owners of four houses in respect of work carried out by them in compliance with the Council's notices in connection with the drains which were " sewers" as defined by the Metropolis Local Management Act, 1855. Certificates under the Revenue Acts.—Applications were received for certificates under the Revenue Acts for exemption from or abatement of inhabited house duty, in respect of 160 tenements, of which 98 were granted, 29 were given after certain specified sanitary requirements had been complied with, and 33 were refused. Certificates in respect of 654 dwellings, which had been granted for a limited period, were renewed. General Sanitary Work.—1,013 complaints of nuisances were received which were dealt with by your Sanitary Inspectors. 1,202 intimation and 293 statutory notices were served. Proceedings were instituted in eight cases against owners of houses for failing to comply with the Council's 32 notices. In one case an abatement order was made with £1 1s. 0d. cost, and the other summonses were with drawn as the nuisances had been abated. A summons was also issued against a builder for contravening the bye-laws relating to the construction of soil pipes and a penalty of 5s. with £2 2s. 0d. costs was imposed. Staff of Public Health Department.—Two of your Inspectors, Mr. F. Manning and Mr. M. Canton, and two of the Clerks in the Public Health Department are still serving in the Army, and the places of the latter two have been filled by Mr. Barnett and Mrs. Hart. For the willing and able assistance they have at all times given me, I have to thank most heartily the Sanitary Inspectors and the members of the clerical staff. I am, Sir and Gentlemen, Your obedient Servant, J. CHARLES JACKSON, Medical Officer of Health August, 1917.