Council of the Borough of Fulham. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH J. CHARLES JACKSON. FOR THE YEAR 1920. WIGHTMAN & Co., LTD. " Westminster Press," Regency Street, S W. 1 77.75 FUL Council of the Borough of fulham. I ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH J. CHARLES JACKSON. FOR THE YEAR 1920. Town Hall, Fulham, S.W. 6. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Fulham. Sir, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1920. Particulars of the natural, social and housing conditions of the borough were given in the Report for 1919, and this is limited to a record of the vital statistics and of the various activities of the Council in connection with public health. Population.—The Registrar-General has adopted the following estimates for the calculation of the deathrate and birth-rate of the borough :— For the birth-rate 158,989 For the death-rate 158,621 Marriages.—The number of marriages registered was 1,601, and the marriage-rate, i.e., the number of persons married per 1,000 of the population, was 20.2. In the three preceding years the numbers were 1,408, 1,471 and 1,659. Births.—The births, corrected by the distribution of those occurring in lying-in institutions in the borough to the districts in which the mothers resided, and the inclusion of children born to Fulham mothers in lyingin institutions outside the borough, numbered 4,328 of whom 2,223 were boys, and 2,105 girls. 4 The birth-rate was 27.2 per 1,000 inhabitants, being 8.6 per 1,000 above that of 1919, and the highest recorded since 1910. The births registered in the four quarters were:— 1st quarter 1,259 2nd ,, 1,138 3rd „ 1,040 4th ,, 891 Looking at the progressive decline since the first quarter it is evident that the high birth-rate of 1920 will not be maintained. The birth-rate of the County of London was 26.5, and in the several Metropolitan boroughs the rates ranged from 36.9 in Shoreditch to 16.1 in Westminster, and 14.9 in the City of London. Illegitimacy.—The illegitimates numbered 207, or 4.8 per cent. of the total births, against 7.5, 8.4 and 6.5 per cent. in the three preceding years. Natural Increase of the Population.—The natural increase of the population of the borough by excess of births over deaths was 2,501, against 927, 181, and 1,098 in the three preceding years. Deaths.—During the 52 weeks ended January 1st, 1921, 1888 deaths of civilians were registered in the borough. Of these 457 were of persons not belonging to the borough, while 396 inhabitants of Fulham died outside the borough, chiefly in various public institutions. There were, therefore, 1,827 deaths of persons, 942 males and 885 females, having their usual residence in Fulham, corresponding to an annual deathrate per 1,000 of the estimated population of 11.5, which is the lowest recorded in Fulham, and 2.5 below the average rate of the preceding ten years. 5 TABLE I.—Vital Statistics of Whole District during 1920 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. Under 1 Year of Age. At all Ages. Number. Rate. Number. * Rate. of Non- of ResiResidents dents not registered registered in the in the District District. 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 al53,161 3,736 3,870 c24.3 1,787 11.7 130 677 446 115 2,334 15.2 1916 (i 149,428 3,600 3,754 c23.1 1,324 8.9 131 789 330 88 1,982 13.3 6162,580 1917 a 145,186 2,852 2,971 cl8.4 1,251 8.6 139 882 323 109 1,994 13.7 6161,841 1918 al43,211 2,593 2,672 cl6.7 1,704 11.9 186 973 286 107 2,491 17.4 6160,463 1919 a 152,543 2,947 3,000 cl8.6 1,510 9.7 242 634 250 83 1,902 12.2 6155,904 1920 a 158,621 4,383 4,327 c27.2 1,888 11.9 457 396 320 74 1,827 11.5 6158,989 (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 deaths properly belonging to it with the corresponding rates. The death-rates from 1915-1919 are calculated per 1,000 of the estimated civil population, and the other rates per 1,000 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 Soldu-rs and Satlors 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. †" 1 ransferable 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. 1 he 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 tin- 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 .it tintime 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) 1 he 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 V iolence 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 districtwhere death occurred, if known ; and (d) failing this, to the district where the body was found. 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 6 The death-rate of England and Wales and of the County of London was 12.4, and among the Metropolitan boroughs the lowest rate was 9.4, in Hampstead, and the highest, 15.6, in Shoreditch. Compared with 1919 the chief decline was in the mortality from influenza, to which 28 deaths were attributed against 147 in 1919. The mortality from zymotic diseases was higher than in 1919, 134 deaths being due to the seven principal epidemic diseases against 101, but with this exception was the lowest recorded, and the death-rate from these diseases was 0.88 against a quinquennial average of 1.27. There was again a drop in the deaths from tuberculosis, and a slight increase in those from cancer, while respiratory diseases were, as in 1919, below the average. Suicide accounted for 20 deaths, the highest number recorded in Fulham. Seasonal Mortality.—The mortality in the four quarters of the year was as under:— Deaths. Death-rate. First Quarter 549 13.8 Second ,, 455 11.6 Third ,, 329 8.3 Fourth ,, 494 12.5 1,827 11.5 7 8 table ii. Causes of, and Ages at Death during Year 1920. Nett Deaths at the subjoined ages oj " Residents," whether occurring within or without the District [a). Nett Deaths at all ages oj " Residents " in the Wards oj the Borough, whether occurring in or beyond the Wards. Causes or Death. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 year,. 5 and under 15 15 and under 25 years. 25 and under 45 years 15 and under 65 years. 65 and upwards. Total Deaths '• Residents " for " nonResidhnts" in Institutions District (6). Barou&Couct-WardJ Lillie Ward. Walbaro Ward. Munstcr Ward. Hurlingham Ward. Sauds 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) 1,826 319 40 51 98 78 237 441 562 895 166 314 180 194 395 102 307 118 Uncertified 1 1 ... ... | ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1—Enteric Fever 4 ... ... ... ... 1 3 ... ... 1 ... ... ... 1 ... ... 1 1 2—Small Pox ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3—Measles 24 8 5 5 5 ... ... ... 1 34 ... 2 4 1 4 1 9 3 4—Scarlet Fever 9 ... 1 5 3 ... ... ... ... 22 ... 1 ... ... ... ... 3 ... 5—Whooping Cough 17 11 2 3 ... ... 1 ... ... 12 ... 3 1 3 3 ... 4 3 6—Diphtheria and Croup 44 ... 3 12 28 1 ... ... ... 129 2 7 3 4 13 4 10 1 7—Influenza 28 1 ... ... 3 1 11 8 4 ... 2 3 ... 2 7 4 7 3 8—Erysipelas 6 2 ... ... ... ... 1 1 2 6 1 1 1 ... ... ... 1 1 9—Phthisis (Pulmonary Tuberculosis) 142 1 '3 2 8 24 63 34 7 85 ... 24 14 14 23 11 22 18 10 Tubereuleus Meningitis 15 4 2 ... 6 1 1 ... ... 13 1 ... ... 1 6 ... 3 ... 11—Other Tuberculous Diseases 15 3 ... ... 4 3 4 ... ... 4 ... 3 ... 4 5 ... 2 1 12—Cancer, malignant disease 189 1 1 1 1 ... 21 109 55 78 23 33 13 13 41 18 28 20 13 Rheumatic Fever 6 ... ... ... 5 1 ... ... ... 1 2 ... ... ... 1 ... 4 ... 14 Menigitis. See note(d) 5 2 1 ... ... 1 1 ... ... 1 ... 1 ... ... ... 1 ... ... l5—Organic Heart Disease 197 ... ... ... 8 3 24 59 103 39 24 36 28 14 34 12 30 19 16—Bronchitis 142 26 3 ... ... ... 3 31 79 48 6 28 20 18 27 5 28 10 17—Pneumonia (all forms) 169 40 15 11 ... 13 25 33 31 56 13 33 14 26 39 5 23 16 18—Other Diseases of Respiratory Organs 17 4 ... 1 ... ... 1 3 7 1 ... 3 1 1 7 ... 4 1 19—Diarrhoea and Enteritis 36 36 ... ... ... ... ... ... ... 24 3 8 3 6 11 2 2 1 20—Appendicitis and Typhlitis 11 ... ... ... 1 3 ... 4 1 4 ... 2 1 ... 5 ... 2 1 21—Cirrhosis of Liver 7 ... ... ... ... ... ... 7 ... 3 3 ... 2 1 ... ... ... 1 21 a—Alcoholism 1 ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... 22—Nephritis and Bright's Disease 65 ... ... ... 4 3 9 24 25 50 2 13 6 8 17 3 12 4 23—Puerperal Fever 10 ... ... ... ... 3 6 1 ... 12 11 ... 1 1 3 ... 1 3 24—Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... 3 4 ... ... ... ... 2 1 1 1 ... 1 1 25—Congenital Debility and Malformation, including Premature Birth 120 119 ... 1 ... ... ... ... ... 36 9 22 13 17 23 5 21 10 26—Violent Deaths, excluding Suicide 55 7 2 4 9 5 8 7 13 14 5 6 4 7 16 2 13 2 27—Suicide ... 20 1 7 S 4 1 2 6 2 ... 5 1 1 3 28—Other defined diseases 459 53 2 5 10 11 40 110 228 212 51 70 47 *51 100 26 70 44 29-Diseases ill -defined or unknown 7 2 ... ... 1 ... 2 ... 2 2 ... 2 ... ... 1 1 3 ... 1,827 320 40 51 98 78 287 441 562 895 166 314 181 194 395 102 307 168 (a) All " Transferable deaths" of residents, i c., of persons resident in the District Who have died outsiedit are included with the other deaths in cloumns 2-10 and colmns 12-19 Transferaable death of are in like manner exeluded from these columns For the presie meaning of the rerm "transferable non residents, i.c., of persons resident elsewhere in England and Wales who have died in the District, Deaths of Soldeers and Sailors Occurring in Hospitals and instituions in the District are Excluded from the Total number of deaths registered in the district and such daths in like manner are excluded from column from Column11. (b) All deaths occurring in Institutions for sick and infirm Situated within be districct, Whether of residents or of non residents, are entered in column of Table iv (c)All deaths certified by regilstered Medical Pratitioners and all inquest cases are classed as " Certified," all other deaths are regaree as "Uncerified." (d) Exclusive of 'Tuberculus Menigitis (10)but inclusive of Cerebro Spinal Menigits. 9 Distribution of Deaths.—The number and the causes of the deaths in the several wards of the borough are given in Table II. The death rates in the 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 of the borough, were as under:— TABLE III. Death-rates in Wards of Borough. Ward. Deathrate, 1920. Mean Deathrate, 1915-19. Ward. Deathrate, 1920. Mean Death- rate, 1915-19. Baron'sCourt 12.9 14.4 Munster 10.1 12.6 Lillie 12.8 16.2 Hurlingham 10.5 12.3 Walham 14.0 16.8 Sands End 11.4 13.7 Margravine 10.4 16.3 Town 12.3 14.5 Certification of the Causes of Death.—Of the 1,827 deaths registered, 1,688, or 92 per cent., were certified by registered medical practitioners, and 138 by coroners after inquest, while one was uncertified. Deaths in Public Institutions. Fulham Infirmary.—The deaths of 650 persons occurred in the Fulham Infirmary, of whom 395 lived in Fulham and 255 in other districts. Western Fever Hospital.—In this institution there were 40 deaths of residents in Fulham and 190 of residents in other districts. Deaths occurring outside the borough among persons belonging thereto.—The deaths of Fulham residents 10 outside the borough numbered 396, and occurred in the following institutions:— St. George's Hospital 61 West London Hospital 26 Other General Hospitals 55 Children's Hospitals 33 Other Special Hospitals 47 Homes for advanced cases 20 Hospitals of Metropolitan Asylums Board 31 Poor Law Infirmaries 27 Lunatic Asylums 47 In Nursing Homes, Private Houses and elsewhere 49 396 Of the deaths registered, 794 or 43.5 per cent. took place either in 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 23.1 ,, Metropolitan Asylums Board Hospitals 3.8 ,, other Hospitals13.9 ,, Public Lunatic and Imbecile Asylums 2.7 43.5 In the County of London, 46.8 per cent. of the deaths occurred in public institutions. Infantile Mortality.—Of the 1,827 deaths, 320, or 17.3% were of infants under one year of age, and the rate of infant mortality measured by the proportion of deaths under one year to registered births was 74 per 1,000, which is the lowest rate recorded in Fulham. The infantile death-rate of England and Wales was 80, that of the County of London 75 per 1,000, and in the Metropolitan Boroughs the rates ranged from 48, in Hampstead, to 94, in Bethnal Green. 11 TABLE VI. Infant Mortality during the year 1920. Nell Deaths Jrom slated causes at various ages under One Year of Age. Nell Deaths under One Year 0] Residents in the Wards oj the Borough, whether occurring in or beyond the Wards. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3-4Weeks. Total under 4 Weeks. 4Weeks and under 3Month 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. LUlie Ward. Walham Ward. Margravine Ward. Margiavine Word Hurlingham Ward. Sands End Ward. Town Ward. All Causes Certified 81 21 20 13 135 60 56 41 27 319 15 68 31 53 66 9 54 23 Uncertified 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 6 8 ... ... 2 1 ... ... 2 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough. ... ... ... 1 1 ... 3 4 2 11 ... 3 ... ... ... ... 2 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 2 ... ... 2 ... ... ... 1 ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 4 ... 2 ... ... 1 ... 1 ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 2 ... 1 ... ... 1 ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... 1 ... ... ... Meningitis( not Tuberculous) ... ... ... ... ... ... 1 ... 1 2 ... 1 ... 1 ... ... ... ... Convulsions ... ... ... ... 5 ... 2 2 ... 11 ... 4 ... 3 1 ... l 2 Laryngiti 1 ... ... ... 1 ... 1 ... ... 2 ... 1 ... 1 ... ... ... ... Bronchitis ... ... ... ... ... 10 4 7 3 26 ... 6 4 2 ... 1 8 1 Pneumonia (all forms) ... ... 2 ... 8 8 7 10 7 40 1 8 ... 10 7 ... 6 3 Diarrhcea ... ... 1 1 2 3 ... 3 1 17 1 4 2 1 6 1 1 1 Enteritis ... 1 ... 1 2 6 8 3 ... 19 2 5 ... 6 ... 1 1 ... Gastritis ... ... 1 ... 1 ... 3 ... 1 7 ... 1 1 1 1 1 2 ... Syphilis ... 1 2 ... 4 4 2 1 ... 11 2 4 ... 1 ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... Suffocation, overlying . 3 ... ... ... 3 2 ... ... ... 5 ... l ... ... ... ... ... ... Injury at Birth 6 ... ... ... 6 ... ... ... ... 6 ... 2 ... 1 1 ... ... ... Atelectasis 6 1 ... ... 7 ... ... ... ... 7 ... 1 1 1 ... ... 1 1 CongenitalMalformations(c) 2 l 2 2 7 3 2 1 ... 13 1 ... 1 2 3 1 4 ... Premature Birth 45 14 8 2 69 6 1 ... ... 76 4 15 11 10 13 1 13 9 Atrophy, Debility and Marasmus 7 2 2 2 13 5 8 3 ... 29 3 4 2 6 6 3 3 2 Other Causes 3 1 ... 1 5 6 1 3 4 19 1 3 3 ... 2 ... 6 1 82 21 20 13 136 60 56 41 27 320 15 68 32 53 66 9 54 23 Nett Births in the year—Legitimate, 4,121 ; Illegitimate, 207. (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Nett Deaths in the year of—Legitimate infants, 298 ; . Peritonitis and Enteritis and from Tabes Mesenterica. Illegitimate infants, 22. Want of Breast Milk is included under Atrophy and Debility. 12 13 The following table gives the infantile mortality in Fulham since 1886, when the district was separated from Hammersmith:— TABLE IV. Infant Mortality in Fulham. Deaths of Infants under one year of age per 1,000 births. Fulham. London Average of five years, 1886-1890 170 154 „ „ 1891-1895 168 156 „ „1896-1900 167 162 „ „1901-1905 144 139 „ „1906-1910 117 114 „ „1911-1915 109 108 1916 88 90 1917 109 104 1918 107 108 1919 83 85 1920 74 75 The infantile death-rates of the several wards of the borough were as under:— TABLE V. Infantile Death-rates in Wards of Borough. Ward. Deaths under one year per 1,000 Births. Ward. Deaths under one year per 1,000 Births. Barons Court 67 Munster 60 Lillie 114 Hurlingham 49 Walham 100 Sands End 70 Margravine 78 Town 51 82 or 25.6 per cent, of the deaths of infants under one year of age occurred in the first seven days of life and 136 or 42.5 per cent, in the first four weeks, the mortality of infants under the age of four weeks being 32 per 1,000 births. TABLE VII. Death-rates of Infants under One Year of Age from certain groups of Diseases. Diseases. Deaths per 1000 Births. 1920. Average of 5 years 1915-19. Infectious Diseases 4.4 8.1 Tuberculous ,, 1.9 2.9 Respiratory„ l5.7 20.1 Diarrhoeal ,, 9.9 19.3 Developmental ,, 28.9 35.0 Other ,, 13.2 14.6 74.0 100 0 The most notable decline was in the diarrhoeal rate, which was 3.8 per 1,000 below that of 1919, the lowest recorded, and 9.4 per 1,000 below the quinquennial average, but it will be remembered that the cold unseasonable weather of last summer was very favourable to a low diarrhoeal mortality. There was also a substantial drop in the deaths from developmental diseases, which hitherto have not shared the reduction shown in other groups of infantile diseases. Deaths of Illegitimate Infants.—Of the 320 infants who died before attaining the age of one year 22 were illegitimate, the mortality among them being in the proportion of 106 deaths to 1,000 illegitimate births, against 72 per 1,000 among children born in wedlock. Before this the mortality of illegitimates has invariably been more than double that of legitimate children, and their lowest rate was 195 per 1,000 in 1919. 14 Causes of Infantile Mortality.—Table VI. gives the causes of the deaths at various periods under one year, and in the following table the mortality from certain groups of diseases is given:— 15 MATERNITY AND CHILD WELFARE. Details of the scheme adopted by the Council for extending and co-ordinating the Maternity and Child Welfare WTork carried on in the borough, were given in the report of 1919, and the work has been continued during the past year on the same lines. Notification of Births.—3,866 notifications of living and 93 of still-born children were received under the Notification of Births Act, 89 per cent. of the births being notified against 97 per cent. in 1919. Of these, 2,991, or 75.6 per cent., were notified by midwives, 805 by doctors, and 163 by the parents or others. Visitation of mothers and Babies by Health Visitors.— The Council resolved in October last to appoint an additional Health Visitor, and Miss Jones, who had been acting as locum tenens, was engaged as a permanent Health Visitor. The visits paid by the Health Visitors were:— First visits to Infants 3,784 Re-visits 5,521 Re-visits to children aged 1 to 5 years 1,886 Visits to cases of Ophthalmia Neonatorum 37 Visits to cases of Measles 1,230 Other visits 183 It will be seen from the above that practically all the notified births were visited, at least once, by your Health Visitors, but it has not been possible to pay a sufficient number of revisits even during the first 12 months of life, and but few can be kept under observation till they have reached school age, which is what should be aimed at. As has been previously pointed out, the Ministry of Health consider that if the various duties of a Health Visitor are to be fully performed, a district with about 400 births will be as much as one Health Visitor can undertake. That there will be a considerable drop in the number of births this year is certain, but even if there is a fall of 25 per cent., 2 additional Health Visitors are required to reach the Ministry of Health standard. 16 Welfare Centres.—Infant Consultations.—In the report for 1919 the need for additional consultations was pointed out, as it had been found that it was not always possible to deal with all the babies brought to the clinics, and many had to be sent away, and the Council arranged, as recommended, for an additional weekly clinic at 92, Greyhound Road, and at 170, Wandsworth Bridge Road, and Dr. Florence Wilson, M.B., Glasgow, was appointed as a part time Medical Officer to hold these consultations. The following is a summary of the working of the clinics:— Consultations held by Dr. Thomson :— First No. of Attend- Total Average Consulta- ances Attend- Attend- At 92, Greyhound tions. of Babies. ances. ance. Road 91 616 5,039 55 At 170, Wandsworth Bridge Road 45 318 2,411 56 At Melmoth Hall, Eustace Road 45 358 1,479 33 Consultations held by Dr. Wilson:— At 92, Greyhound Road 18 140 777 43 At 170, Wandswort Bridge Road ... 18 133 650 36 217 1,565 10,356 48 Compared with 1919 there were 3,858 more attendances at the infant consultations. In connection with the clinics the following children attended for treatment:— At 92, Greyhound Road:— Number Number of children of attend- attending. ances. For massage or treatment of minor ailments 290 1,143 At the School Treatment Centre, 18, Bagley's Lane:— For operative treatment for enlarged tonsils and adenoids 13 For dental treatment 6 17 Fulham Babies Hospital, Lindsay House, Broomhouse Road.—The following is a summary of the work of the hospital during 1920:— In hospital, January 1st, 1920 11 Numbers of Babies admitted 154 Average duration of stay 28 days. Number of cases discharged:— (a) In good health 97 (b) Improved 19 (c) No improvement 8 (d) On account of the development of infectious disease 16 Number of deaths 12 In hospital, December 31st, 192013 The cases discharged on account of infectious disease were:— Seven cases of measles, which developed after the admission of a case of broncho-pneumonia from the environment of measles. Eight cases in which the diphtheria bacillus was found in the nasal secretion, though only one showed clinical symptoms. One case of whooping cough. Three cases were removed to the West London Hospital for operation, who died in that hospital. One ward was reserved during the last fortnight of August and the whole of September for cases of epidemic diarrhoea. Seventeen cases were admitted, and there were three deaths. The use made of the Babies' Hospital has hardly fulfilled expectations, as the average daily number in the hospital was only 12, or less than two-thirds of the capacity of the hospital, which, with the child populaof Fulham, should be kept full. But little use has been made of the hospital by the majority of local doctors, although they have been written to more than once on the matter. The hospital is well equipped, but the provision of a roof over part of the verandah, in order that children could have permanent openair treatment, is desirable. 18 Fulham Day Nursery.—The attendances during the four quarters were:— 1st quarter 1,862 2nd „ 1,897 3rd ,, 1,959 4th „ 1,861 7,079 The babies nursery was fully occupied throughout the year, and many applicants could not be accommodated, but there have been, as a rule, some vacancies for "toddlers." The usefulness of this institution is beyond question, and it is to be regretted that a similar institution cannot be provided in North Fulham. Maternity Welfare.—Ante-Natal Clinic.—At the ante-natal clinic, which is now held weekly at 92, Greyhound Road by the Assistant Medical Officer of Health, 283 women were seen, and their attendances totalled 663, and 773 visits were paid by the Superintendent of the Welfare Centre to expectant mothers. Women's Dental Clinic.—At the Dental Clinic, held at 18, Bagley's Lane, 52 women attended, making 210 attendances, and 49 were provided with dentures. The number attending is disappointing, being 20 less than last year. A great deal of time and energy has been expended by Miss Williams, the Superintendent of the Welfare Centre, in trying to get women to have their teeth attended to, but it is very hard to convince them of the importance to their health of sound teeth and gums. Maternity Home, 706, Fulham Road.—The Council's Maternity Home at 706, Fulham Road, was opened on February 2nd, 1920, and the record of the cases admitted was as under:— Number of cases admitted 135 Number of cases notified as puerperal septicœmia — Number of maternal deaths — Number of stillbirths 6 Number of deaths of infants in Home 3 (triplets) Operations of circumcision 25 19 Milk (Mothers' & Children's) Orders, 1918-1919.— During the year grants of milk free or at a reduced price to expectant mothers and to children under five years were made in 950 cases, and the amount expended was, for dried milk, £1,061 15s. 6d., and for fresh milk, £107 19s., a total of £1,169 14s. 6d. The applications are considered by a Sub-Committee of the Maternity and Child Welfare Committee, who make the necessary enquiries as to the circumstances of the applicants, and each case is re-considered at least every four weeks The current retail prices of milk in London in 1920 were, per quart:— s. d. January1 0 February and March0 11 April 010 May to September 0 8 October and November 0 10 December 0 11 In addition to that given free, or at a reduced price, 14,243 lbs. of dried milk, value £1,584, were sold at cost price to persons recommended by the Health Visitors or the Welfare Centres. Incidence of Infectious Diseases of Parturient Women and Infants and Young Children. Puerperal Fever.—32 cases of puerperal septicaemia, or 7-3 per 1,000 births, were notified, and there were 10 The scale of income that is now in force under which grants are made is as under :— No. in Family. Nett Weekly Family Income after Payment of Rent. Free. Half-price. Husband and Wife after 6 months of £ s. d. £ s. d. pregnancy 1 5 0 1 10 0 Husband, Wife and 1 Child 1 10 0 1 16 6 „ ,,2 Children 1 18 0 2 2 0 „ „ 3 „ 2 4 0 2 10 0 „ „ 4 „ 2 10 0 2 16 0 „ „ 5 „ 2 15 0 3 1 0 „ „6 „ 3 0 0 3 6 0 „ „7 „ 3 5 0 3 11 0 „ „ 8 „ 3 10 0 3 16 0 20 deaths, including one occurring in a nursing home outside London. Of the cases notified, 30 were removed to an isolation hospital or to the Fulham Infirmary. The incidence of puerperal fever was again greater in Fulham than in any Metropolitan borough. In addition to those from septicaemia, 7 deaths were due to other accidents and diseases of pregnancy and parturition. Ophthalmia Neonatorum.—40 infants were notified as suffering from ophthalmia. Nine were treated in hospital or infirmary, and 7 who required special attention were referred to the Fulham District Nursing Association. The results of the notified cases were as under:— Sight unimpaired 30 No information available 6 Died from other causes 4 40 Diarrhoea.—There was again but little diarrhoea in the borough, and only 52 cases were notified against 83 in 1919, and there were 36 deaths against 44. Whooping Cough.—This disease, though below the average, was more prevalent than in 1919, and caused 17 deaths, against 4 in that year. Measles.—Measles was prevalent throughout the borough during the first six months of the year, and 942 cases were notified, with 24 deaths, 18 being of children under 5 years of age. Provision of Nursing Assistance.—An agreement has been entered into by the Council with the Fulham District Nursing Association under which the Association agrees to provide, when requested, the necessary nurses for those suffering from measles, whooping cough, diarrhoea, puerperal fever, pneumonia and influenza, and the Council has undertaken to pay to the Association 1s. for each visit paid. TABLE VIII. Cases of Infectious Diseases notified durtng the Year 1920. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total cases removed to Hospital. At Ages—Years. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Smallpox - - - - - - - - - - - - - - - - - Cholera (C), Plague (P) - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 623 9 129 384 51 41 9 - 28 79 53 94 182 27 125 35 561 Erysipelas 102 4 2 8 11 28 33 16 1 13 8 24 29 - 14 13 55 Scarlet Fever 930 4 141 651 91 39 4 - 61 165 47 149 256 43 149 60 856 Typhus Fever - - - - - - - - - - - - - - - - - Enteric Fever 25 - - 5 7 11 2 - 3 4 - 7 5 - 4 2 19 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - - Puerperal Fever 32 - - - 9 22 1 - - 7 2 2 13 - 6 2 30 Cerebro-Spinal Meningitis 5 3 - - 1 1 - - - 3 - - - 1 l - 5 Polio-myelitis 2 - - 2 - - -- - - - - - 1 - - 1 - Ophthalmia Neonatorum 40 40 - - - - - - 2 6 4 9 13 - 4 2 9 Pulmonary Tuberculosis 282 1 6 31 67 119 50 8 19 51 29 35 68 15 43 22 - Other forms of Tuberculosis 93 5 13 44 17 9 4 1 3 16 6 10 31 3 20 4 - Measles 942 53 438 429 13 7 2 - 38 52 55 153 277 33 285 49 26 German Measles - - - - - - - - - - - - - - - - - F.ncephaliti Lethargica 2 - - - - - 1 1 — - 1 - - - - 1 114 Pneumonia 198 7 22 32 30 64 35 8 11 31 14 31 53 3 49 15 18 Diarrhoea 51 36 15 — — - - - 1 12 3 11 19 - 1 4 - Malaria 20 - — - 6 12 2 — 2 5 2 - 8 - 2 1 - Dysentery - - - - - - - - - - - - - - - - - Trench Fever - - - - - - - - - - - - - - - - - Totals 3,347 162 766 1,586 303 353 143 34 169 444 224 525 955 125 694 211 1693 21 22 Prevalence of and Control over Infectious Disease. Table VIII gives the number of cases of infectious diseases notified to the Medical Officer of Health during the 52 weeks ended January 1st, 1921. Smallpox.—No case of smallpox has been notified in Fulham since 1916. 20 cases were notified in the County of London in 1920. Vaccination.—The following table, furnished by the Vaccination Officer, Mr. H. Davies, gives the vaccination returns for the year 1919, those for 1920 not being yet completed. TABLE IX. Vaccination Return. Year. Births. Successfully vaccinated. Insus. of Vaccination. Had Smallpox. Declarations of Conscien tious Objections. Dead (un- vac- cina- ted.) Postponed by Medical Certificate. Removal to District & Vaccination Officer notified. Removal to Places unknown No. of Births not accounted for in other columns. 1919 2,890 1,555 4 — 756 185 87 63 219 21 Scarlet Fever.—There was a great increase in the prevalence of this disease, 930 cases being notified, the highest number recorded, against 371 in 1919 and 228 in 1918. The figures for the four qnarters were:— 1st quarter 139 2nd „ 141 3rd „ 228 4th „ 422 Total 930 This disease was generally of a very mild type and there were only nine deaths, or less than 1 per cent. of the notified cases. 23 Diphtheria.—Diphtheria, which showed a sharp rise in the last three months of 1919, was also much above the average, and more cases were notified than in any year since 1901. The returns for the four quarters were:— Cases Notified. Deaths. 1st quarter 193 15 2nd „ 100 12 3rd „ 110 8 4th „ 220 9 623 44 561 patients, or 89 per cent. of those notified, were removed to hospital. The 44 deaths represent a case mortality of 7.1 per cent. against 9.5 per cent. in the previous year. 1,280,000 units of antitoxic serum were supplied to medical practitioners. Enteric Fever.—25 cases were notified as Enteric Fever, against 6 in 1919. Of the 4 deaths from Enteric Fever, one was of a Fulham woman who had been in Colney Hatch Asylum for some years. In five instances the patient was infected by a previous case, the nature of which was not at first recognised, and there is reason to believe that the death, attributed to influenza, of another member of a family in which two cases occurred was due to typhoid. Errors in Diagnosis.—Of the patients notified as suffering from scarlet fever, 18 ; from diphtheria, 21; and from enteric fever, 4 ; were subsequently found not to be suffering from those diseases. Cerebro-Spinal Meningitis.—Five cases were notified, all after admission to a hospital or infirmary. Four of the patients died, but in two cases death was certified as due to pneumococcal meningitis. Polio-Myelitis.—Two children, who were attending the West London Hospital as out-patients, were notified as suffering from polio-myelitis. 24 Encephalitis Lethargica.—Two patients were notified, both of whom died. Pneumonia.—193 cases of pneumonia were notified, 159 being certified as acute primary pneumonia, 5 as broncho-pneumonia, 4 as lobar pneumonia, and 30 as influenzal pneumonia. Of these, 99 were notified after admission to the Fulham Infirmary by the Medical Superintendent. Nursing assistance was provided in 29 cases by the Council. Malaria.—20 ex-Service men were notified as suffering from malaria, against 104 in 1919. No cases of dysentery or trench fever were reported. TABLE IX. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary oj notifications during the 52 weeks ended January 1st, 1921. 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 Notifiations. 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 9 6 15 16 37 31 25 11 4 156 264 - 1 — 1 1 8 121 Females 1 4 6 8 12 24 31 20 11 3 4 124 197 — — 1 1 1 9 55 Non pulmonary Males 2 9 14 8 2 3 1 3 - 3 - 45 55 - 2 - 2 1 1 7 Females 3 4 9 5 8 4 2 3 1 - 1 40 50 - 4 2 6 6 4 6 25 26 Tuberculosis.—The notifications received during the year numbered:— Under Form A.—Cases not previously notified 566 „ „ B.—By School Medical Officer 10 „ „ C.—Cases admitted to Poor Law Institutions and Sanatoria 211 „ „ D.—Cases discharged from Poor Law Institutions and Sanatoria 227 Of the above 375 were notifications of new cases, 282 being of pulmonary and 93 of other forms of tuberculosis. The sex and year of the notified cases is given in Table IX. The marked decline of the notifications will be seen on reference to the tuberculosis statistics, given in Table XIII. Mortality from Tuberculosis.—142 deaths, 66 of males and 76 of females, were registered from pulmonary tuberculosis corresponding to a death-rate of 0.89 per 1,000, which is the lowest recorded, and 0.4 per 1,000 below the average of the preceding five years. 30 deaths were due to other tuberculous diseases, giving a death-rate of 0.19 per 1,000. Of the 142 persons certified as having died from pulmonary tuberculosis, 26 had not been notified as suffering from the disease, of whom 3 were inmates of lunatic asylums, and 16 died in hospitals or poor law infirmaries. The following table gives the time that elapsed in notified cases between the first notification and death. TABLE X. Period between date of Primary Notification and Death. Under 1 month 26 1 to 3 months 11 3 to 6 „ 10 6 to 12 „ 19 1 to 2 years 28 Over 2 years 22 27 Fulham Tuberculosis Dispensary.—1,804 patients attended the Dispensary during the year, of whom 760, 392 males and 368 females, were new patients, and of these, 179, 114 males and 55 females, or 23.5 per cent., were notified. The number of ex-soldiers and sailors who attended was 218, of whom 145 were tuberculous. The following table gives the diagnosis at various age periods. TABLE XI. Diagnosis at various Age Periods. Age. Pulmonary Tuberculosis. Other Forms. Suspects. NonTuber cular. Percentage Tuberculous. Under 5 1 7 23 35 1212 „ 10 4 13 66 120 8 03 „ 15 3 7 37 43 11.11 „ 25 39 5 33 40 37.60 ,, 35 40 2 30 44 36.20 „ 45 34 3 35 36 34.25 45 and over 21 - 15 24 35.00 All ages 142 37 239 342 23.55 Institutional Treatment.—The following patients were sent to Institutions:— Adults. Children under 16. Male. Female. To Sanatoria (early cases)— By London Insurance Committee 42 18 — By London County Council — 10 15 To Hospitals (acute and advanced cases)— By London Insurance Committee 52 8 — By London County Council 1 7 16 To Infirmaries 12 14 13 To Convalescent Homes 1 1 23 To Farm Colonies by London Insurance Committee 3 - — 111 58 67 28 Home Visits.—2,004 visits were paid by the Medical Officers of the Dispensary and 4,989 by the nurses who visit at the request of the Medical Officer of Health, all notified cases in the borough in addition to those attending the dispensary. 97 houses reported to the Medical Officer of Health by the nurses as insanitary, were repaired or improved. Examination of Contacts.—249 contacts were examined, of whom 26 were found to be tuberculous. On April 1st, 1921, the dispensary will be taken over by the Council and its administration will become part of the work of the Public Health Committee. During the nine years the Dispensary has been open the total amount expended by the Committee on equipment and maintenance has been approximately £19,000, which has been contributed in the following proportions:— £ Central Fund for the promotion of Tuberculosis Dispensaries 5,120 Other voluntary sources 5,630 London Insurance Committee 2,240 Local Government Board and Ministry of Health 3,130 London County Council 1,450 Fulham Borough Council (nett contribution) 1,450 Total £19,020 The following table gives the statistics of attendances since 1913, when the Borough Council first agreed to contribute towards the maintenance of the Dispensary:— TABLE XIII. DISPENSARY STATISTICS. 1913-20. Year New Patients Attendances at Dispensary Doctors' Home Visits Nurses' Home Visits Suffering from Pulmonary Tuberculosis Suffering from other forms of Tuberculosis Doubtful Cases NonTuberculous Cases Insured Uninsured 1913 324 86 323 429 2,361 11,967 2,175 1,517 1914 203 45 261 361 2,276 8,084 2,385 2,547 1915 174 28 260 323 1,171 5,568 1,910 2,918 1916 225 13 311 200 852 5,954 1,079 2,828 1917 286 13 349 329 1,052 6,528 1,141 2,789 1918 235 14 201 478 1,223 8,465 1,435 2,317 1919 221 50 251 281 1,444 8,116 1,724 4,043 1920 142 37 239 342 1,850 6,713 2,004 4,989 Year. Notifications. Deaths. Death-Rate. Pulmonary Other forms of Tuberculosis Pulmonary Other forms of Tuberculosis Pulmonary Other forms of Tuberculosis 1913 765 289 215 49 1.34 0.31 1914 531 164 207 45 1.32 0.29 1915 461 97 198 51 1.29 0.34 1916 496 92 210 56 1.41 0.38 1917 582 118 191 49 1.32 0.34 1918 561 80 207 47 1.45 0.33 1919 433 145 168 42 1.01 0.27 1920 282 93 142 30 0.89 0.19 29 30 An inspection was made last year by Dr. Chapman, Medical Inspector of the Ministry of Health, and Dr. Menzies, Principal Assistant Medical Officer of the London County Council of the Tuberculosis Dispensaries in London, and, as the result, a circular was issued by the Ministry of which the following were the most important recommendations:— 1. Treatment at the dispensary as distinct from diagnosis, consultation and general supervision, should, as a rule, be limited to patients whose continued treatment requires special knowledge or technical skill, and to those who are unable to obtain other adequate medical attendance. Patients who require treatment which can, consistently in the best interests of the patient, be properly undertaken by a general practitioner, and who are either insured persons or can afford to pay for medical attendance, should not be encouraged to attend the dispensary for routine treatment. 2. The practice of treating patients at the dispensaries on a large scale and over prolonged periods with bottles of medicine, cod-liver oil, etc., and of giving medicines to ensure the attendance of patients, should be discouraged. Patients should rather be educated out of the belief in the efficacy of drugs, and be taught the value of personal advice and of instruction in a hygienic mode of life. 3. The fullest possible measure of co-operation should be developed between the dispensary vice, and the school medical service, and children attending the dispensary, who are probably not suffering from tuberculosis, and others suffering from ill-health not due to tuberculosis, should be transferred to the School Medical Department, arrangements being made for these children to be referred back to the dispensary for further examination whenever necessary. 4. It is desirable that at least one evening session in each week should be arranged at each dispensary, and the question should be considered of instituting a special session on Saturday mornings, or at some other suitable time out of school hours, for children attending schools. 31 5. Efforts should be made to introduce at the dispensaries a system by which patients would be seen, if practicable, by individual appointment, or other means should be adopted to reduce to a minimum the time during which patients are kept waiting at the dispensary. 6. More adequate arrangements than at present obtain should be made for the examination by the Tuberculosis Officer of the home "contacts" or newly notified cases, and for the "following up" of patients for whose failure to continue in attendance at the dispensary no satisfactory reason has been ascertained. 7. It is important that the Tuberculosis Officer should become personally acquainted, as far as possible, with all medical practitioners practising in the area served by his dispensary, in order that the fullest degree of co-operation may be secured. 8. The local arrangements should be such as will enable the Tuberculosis Officer to visit the homes of dispensary patients, in order to become familiar with the envirbnmental conditions of the patients in his district and to enable him to supervise adequately the work of the dispensary nurses. Bacteriological Work.—The following bacteriological examinations were made either by Dr. Burnet or at the laboratorv of the Tuberculosis Dispensary:— Number of Specimens. Material from Cases of Suspected Diphtheria. Diphtheria bacillus isolated 294 1,205 Negative result 911 Blood from cases of Suspected Enteric Fever. Widal or typhoid reaction obtained 3 37 Negative result 34 Sputa from cases of Suspected Tuberculosis. Tubercle bacillus found 225 1,286 Not found 1,061 Examinations for other organisms 34 Wasserman tests 4 Blood examinations 12 2,578 32 Disinfection.—2,236 rooms were disinfected and cleansed after infectious disease. The following articles were disinfected at the Council's Disinfecting Station: Beds 1,477 Covers & Counterpanes 2,344 Mattresses 1,638 Eiderdowns 549 Palliasses 1,038 Curtains 3,149 Box Springs 25 Carpets 1,073 Pillows 2,981 Hearth rugs 884 Cushions 1,092 Clothing 7,488 Bolsters 1,055 Sundries 5,698 Sheets 2,597 33,088 FOOD. Milk.—At the end of 1919 there were 119 dairies and milkshops on the register, and during 1920 15 were removed and 19 added. 643 samples of milk were purchased for analysis, of which 51, or 8 per cent., were certified to be below the standard adopted by the Board of Agriculture, against 14.3, 13 and 108 per cent. in the three preceding years. In 8 of the 13 cases in which proceedings were taken by the Council the summonses were dismissed on the ground that the vendor had purchased the milk under a warranty that it was of genuine quality, and had sold it in the same condition as they received it. Milk and Cream Regulations 1912 & 1917.—The following particulars of proceedings taken in 1920, 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 643 None. Cream 3 „ 33 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 2 (2) Statements incorrect — Total 2 (b) The examination made of milk fat in cream sold as preserved cream. (1) Above 35 per cent. 2 (2) Below 35 per cent. — 2 (c) Instances where (apart from analysis) the requirements as to labelling of preserved cream in Article 5(1) and the proviso in Article 5 (2) of the Regulations have not been observed. None. (d) Particulars of each case in which the Regulations have not been complied with and action taken. None. 3. Thickening substances. Evidence of their addition to cream or preserved cream. None. 4. Other observations. None. Slaughterhouses.—The licences of the undermentioned slaughterhouses were renewed by the London County Council in October, no objections to their renewal being offered by the Borough Council. Premises. 611, Fulham Road 640, King's Road Licences. T. S. Payne. E. Vaughan. Bakehouses.—There are 68 bakehouses on the register, of which 47 are underground. They were systematically inspected and 12 notices served in respect of breaches of the special requirements of bakehouses were complied with. Restaurant Kitchens, etc.—95 inspections of the kitchens were made by your Inspector, Mrs. Davies, and 19 notices were served on account of defects observed. Food Inspection.—The stalls in North End Road were kept under careful observation by the Inspector of the District, and 311 special inspections of places where food is sold or stored were made by the other District Inspectors. Proceedings were taken under the London County Council General Powers Act, 1908, against Mr. D. Schaffer, of 307, North End Road, for failing to observe due cleanliness in the manufacture of chocolates, and he was fined £1 and 2s. costs. 34 Unsound Food.—The following articles, examined at the request of the owners, were condemned and destroyed:— Rabbits (skinned) 71 Corned beef 314 lbs. „ „ 28½cases. Bacon 39 lbs. „ (furred) 7 „ Sausages 40 lbs. Herrings 3 „ Meat paste 8 pots. Haddocks 24 lbs. Sheep's tongue 1 tin. „ 8 boxes. Condensed milk 359 tins. Skate wings 1 box. Jam 8 „ Fillets 42 lbs. Honey 1 tin. Kippers 28 lbs. Syrup 7 tins. Salmon 6 tins. Pears 60 boxes. Crabs 1 barrel. Bottled fruit 4 bottles. Mackerel 2 boxes. Strawberries 18 baskets. Winkles 1 sack. Apples 53 boxes. Sardines 6 tins. Tomatoes 45 bundles. Beef ... 1 hindquarter. (tinned) 29 tins. Chestnuts 12 sacks. Action under the Sale of Food and Drugs Acts. The undermentioned samples wrere purchased for analysis in 1920:— Articles. No. of Samples taken Officially. No. Adulterated. No. of Samples taken Unofficially. No. Adulterated. Total Samples. Total Adulterated. Per cent. of Adulteration. Milk 626 49 9 2 635 51 8.04 „ separated 7 ... 1 ... 8 ... ... Milk and Water 1 1 ... ... 1 1 100 Peas ... ... 4 ... 4 ... ... Cheese ... ... 36 ... 36 ... ... Lard ... ... 23 ... 23 ... ... Cream of Tartar ... ... 6 ... 6 ... ... Ground Ginger ... ... 5 ... 5 ... ... Self-Raising Flour 2 ... 17 ... 19 ... ... Cocoa ... ... 34 ... 34 ... ... Saccharine ... ... 9 1 9 ... 12.4 Coffee ... 27 ... 27 ... ... Sausages, 4 ... 39 8 39 8 29.5 Camphorated Oil 2 ... 13 3 15 ... ... Cream ... ... 3 ... 3 ... ... „ Preserved ... ... 2 ... 2 ... ... Butter ... ... 58 ... 58 ... ... Dripping ... ... 10 ... 10 ... ... Olive Oil ... ... 8 ... 8 ... ... Cayenne Pepper ... ... 6 ... 6 ... ... Malt Vinegar ... 11 ... 11 ... ... Rum ... ... 1 ... 1 ... ... Pepper ... ... 11 ... 11 ... ... Mustard ... ... 14 1 14 ... ... Mustard Mixture 1 ... ... ... ... 1 ... Fish Paste . . . ... 10 ... 10 ... ... Aspirin ... ... 2 ... 2 ... ... Flour ... ... 1 1 ... ... Sugar 1 1 1 2 50 644 50 357 16 1001 53 5.2 35 Prosecutions in respect of adulterated samples were instituted in the following cases:— Defendant. Offence. Result. Penalty. Costs. £ s. d. £ s. d. Lord Rayleigh's Dairies,Ltd., Reg. Offices:— 12, Great Russell Street, Bedford Square Selling milk 8% deficient in fat Convicted 2 0 0 2 2 0 George Harris, 42, Southerton Road, Hammersmith, W. Selling milk adulterated with 13% of added water Bound over in the sum of £10; Defendant having given up business. - - F. A. Sadler, 59, Brecon Road Unlawfully adding water to milk intended for sale Convicted 28 days' Imprisonment - Ditto Unlawfully exposing for sale milk to which water had been added Not dealt with - - Ditto Selling milk adulterated with 19% of added water Ditto - - E. Ruse, 2, Marville Road, Fulham, S.W. Selling milk without certificate as a dealer - 1 0 0 W. J. Winter, 7, Delvino Road, Fulham, S.W. 6 Selling milk adulterated with 3% of added water Summons dismissed, Warranty proved - - W. H. Moss, 19, Chesson Road, Fulham, S.W. 6 Selling milk adulterated with 10% of added water Ditto - - Edward Francis, 574, Fulham Road, S.W. 6 Selling milk with 10% of fat abstracted Ditto - - Ditto Selling milk with 11 % of fat abstracted Ditto - — Evan Evans, 66, Colehill Lane, Fulham, S.W. Selling milk with 4% of fat abstracted Ditto - - W. J. Winter, 7, Delvino Road, Fulham, S.W. Selling milk with 6% of fat abstracted Ditto - - Ditto Selling milk with 10% of fat abstracted Ditto - — Beatrice Whitehead, 80, Townmead Road Selling milk with 14% of fat abstracted Convicted 0 18 0 0 2 0 J. A Tucker 160, Wandsworth Bridge Road Selling milk adulterated with 21 % of added water Withdrawn on payment of costs 2 2 0 Lord Rayleigh Dairies, 12, Great Russell Street, Bedford Square Selling milk with 5% fat abstracted Convicted 2 0 0 2 2 0 E. C. Gardner, 18, Sherbrooke Road, S.W. 6 Selling milk which contained 4% of added water Dismissed, Warranty proved - - 36 SANITARY CIRCUMSTANCES OF THE DISTRICT. Sanitary Inspection of District.—The following inspections of dwelling-houses were made during the year by the Sanitary Inspectors:— Premises inspected. *In consequence of complaints 1,625 In consequence of infectious disease 1,749 House to house inspection 330 • 2,704 * Inclusive of houses reported as insanitary by Tuberculosis Nurses, Health Visitors, etc. The following notices requiring the abatement of nuisances found were served:— Intimation Notices. Statutory Notices. Number served. Number complied with on Dec. 31st, 1920 Number served. Number complied with on Dec. 31st, 1920 2,217 1946 838 714 The following is a summary of the work carried out in compliance with the notices served:— Drains relaid 102 Drains repaired 346 Soilpipes renewed 54 Soilpipes repaired 98 Stackpipes repaired 428 Sinks renewed or repaired 228 W.C.'s repaired 567 Cisterns 290 Water supply from main provided 51 Yards and forecourts paved 380 Dustbins provided 531 Dampness of rooms remedied 695 Rooms cleansed 5,376 Other nuisances abated 3,501 Proceedings under the Public Health (London) Act for failing to comply with the Council's notice were instituted in 13 cases, and in 8 orders were made to 37 abate the nuisance. In one case a further summons was issued for failing to comply with the abatement order, and a penalty of 10s. a day for 58 days, or £29 in all, was imposed upon the owner. Housing and Town Planning Act, 1919.—In dealing with defects found on the inspection of dwelling houses it is the custom to secure the abatement of the specific nuisances that are enumerated in Section 2 of the Public Health (London) Act, such as defective W.C.'s, sinks, pipes, &c., by the service of notices under that Act; but where the premises have been found in a generally dilapidated condition, wanting in light or ventilation, or without adequate facilities for the cooking and storage of food, notices have been served under Section 28 of the above Act, which empowers the local authority to require that a house shall be made in all respects reasonably fit for human habitation. During 1920, 389 notices were served under Section 28, of which, at the end of the year, 212 had been fully and 89 partly complied with. As the only alternative provided by the Act in the event of the default of the owner is for the Council to do the work themselves, and recover the cost from the owner, a number of houses in which no steps had been taken to comply with the notices were reported to the Public Health Committee, who obtained from the Borough Surveyor estimates of the cost of the work necessary to comply with the notices. These were submitted to the Finance Committee with a recommendation that the necessary funds for carrying out the work should be provided. The Finance Committee at first resolved to take no action in the matter, but on its urgency being pointed out by the Public Health Committee, the Council determined to carry out the necessary work themselves in 10 houses, and this is now in hand. The position with regard to some of the houses dealt with under Section 28 is very difficult, as the cost of the necessary repairs is excessive in proportion to the 38 rental. For example, the cost of carrying out the Council's requirements at Nos. 1-7, Sotheron Road, was estimated by the Surveyor at £1,750, and as the present rents of the seven houses average only 13s. a week, the return to the Council, even if the rents were increased in accordance with the Rent Restriction Act, would barely suffice to pay interest on the money expended, and would leave no margin for redemption of capital. But for the shortage of house accommodation there would be no hesitation in representing these and some others as unfit for human habitation, and then taking the necessary steps to close and demolish them; but, as things are, this course is out of the question. In the case of five houses, 10-14, Sotheron Road, the owner gave notice of his intention to close the houses rather than carry out the necessary repairs on the ground that the houses are not capable, without reconstruction, of being rendered fit for human habitation; but the Minister of Health, who is the arbiter under the Act, decided in favour of the Council that reconstruction was not required; and the requirements of the Council having in accordance with the suggestion of the Minister been modified in some respects, the necessary work is now being carried out. Proceedings under Section 18, Housing and Town Planning Act, 1009.—Thirteen houses in Albert Mews were represented as unfit for habitation, and closing orders were made. It was hoped that the Council would be able to acquire the site of these houses, together with some adjoining land belonging to Queen's Club, and erect one or two blocks of tenements, which, in addition to housing the displaced occupiers, would provide some additional housing accommodation, but no arrangement could be reached with the Committee of the Club, and as the site value of the land occupied by the mews was excessive, the scheme was abandoned, and the closing orders were not enforced. Reviewing the work under the Housing Act, it must be admitted that, irrespective of the drawbacks mentioned above, the results have been disappointing, as the 39 houses dealt with have been too few when the number of those in the borough that require attention is considered. This is certainly not due to any want of energy on the part of your Sanitary Inspectors, who have worked assiduously to improve existing conditions; but, after the discharge of their ordinary routine duties they have not much time to give to the systematic house to house inspection of their districts, and it must be remembered that the time occupied in the preliminary inspection of a dilapidated house is but a small fraction of that spent in re-visits, interviewing owners and builders, and in carefully supervising the execution of work which otherwise would, in many cases, be badly scamped. Inspector Drake has recently been instructed to give his whole time to a house to house inspection of certain selected streets, but the Council should at once appoint two additional temporary inspectors for, say, two years, which would make it possible to deal, within a reasonable time, with the worst streets in the borough. But whatever the Sanitary Authority may do by vigorous exercise of their powers towards improving housing conditions, there still remains the problem of the confirmed slum dweller. In too many instances houses which were thoroughly renovated have, within a few months, owing to the negligence and unclean habits of the occupiers, reverted to their former condition, and been again brought under the notice of your officers. Something may, perhaps, be done to prevent this, by the rigid enforcement of the bylaws, which we are waiting for,"for houses occupied by more than one family," which deal with the responsibilities of the occupier; but more is to be hoped for from the skilled and sympathetic management of house property. There is abundant evidence of the improvements that have been effected in insanitary areas without any reconstruction scheme, by what is known as the Octavia Hill method, which has been continued by the members of the Women House Property Managers' Association. A good example of this, though on a small scale, may be seen in Heckfield Place. The attention of the Council was drawn in 1913 by a special 40 report to the unsatisfactory conditions, both social and hygienic, prevailing in that area. It was shown that the mortality and sickness rates were much in excess not merely of those of the borough, but even of other slum areas, and that the housing conditions, as regards overcrowding and dirt, were thoroughly bad. About that time some 50 houses in Heckfield Place were acquired by Dr. Ernest Schuster and placed under the management of Mrs. Rawlings, a trained member of the Women's Association mentioned above. The result has been satisfactory, as there has been a decided change for the better in the habits of the tenants, and there is a striking difference between the condition of Dr. Schuster's houses and the other houses in the area. The management is on business terms and business methods, and as the housing problem in Fulham is not a question of building new houses, but of improving the existing ones, the Council might well consider the possibility of acquiring an insanitary area, such as the Field Road area, improving the houses and managing them on the lines indicated. Drainage of Buildings.—4 he following drainage plans were submitted to and approved by the Public Health Committee Plans of Drainage of new houses 3 „ „ additions to existing buildings 59 „ the reconstruction of the drains of existing buildings 36 Combined Drainage.— Two systems of combined drainage, of 8 houses in Grove Terrace, and of 2 houses in North End Road, for the maintenance of which the Council were liable, as there was no evidence that the houses had been drained by a combined operation under an order or with the approval of the Council or their predecessors, were reconstructed at a cost respectively of £627 and £81. Certificates under the Revenue Acts. Applications were received for certificates under the Revenue Acts for exemption from or reduction of inhabited house duty in respect of 284 tenements, of which 24 were granted, and 260 were given after certain specified work had been completed. 41 Certificates of Water Supply. Certificates of water supply were given in respect of 20 new houses in Sulivan Road. Water Supplies to Tenement Houses. An additional water supply to the upper storeys was provided in 12 tenement houses. Houses let in Lodgings. Although the proposed by-laws made under Section 2(S of the Housing and Town Planning Act in respect of houses let in lodgings or occupied by members of more than one family, were submitted to the Borough Council by the London County Council in July last, they have not yet been confirmed by the Minister of Health. There is urgent need for suitable by-laws to enable the poorer class of tenement house to be kept in decent condition. Increases of Rent (Restriction) Act, 1920. Under Section 2 of this Act, a tenant is entitled at any time, not being less than three months after the date of an increase of rent permitted by the Act, to apply to the County Court for an Order suspending such increase, on the ground that the house is not in all respects reasonably fit for human habitation, or is otherwise not in a reasonable state of repair. Before he can succeed the tenant must satisfy the Court by the production of a certificate of the sanitary authority or otherwise that his application is well founded. Only 10 applications for certificates were received, which were granted. Inspection of Factories, Workshops and Workplaces. The following is a summary of the work of the Inspectors under the Factory and Workshops Act. 42 Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 246 6 — Workshops (Including Workshop Laundries) 348 41 - Workplaces 220 3 - Total 814 50 - 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 36 36 - - Want of ventilation - - - - Want of drainage of floors - - - - Other nuisances - - - - Sanitary accommodation- Insufficient 6 6 - - Unsuitable or defective 6 6 - - Not separate for sexes 2 2 - - 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) 12 12 - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 62 62 - - * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 43 Outworkers' Premises. The number of addresses of Outworkers received from other districts, was 293. No. of Inspections. Notices Served. 795 43 Cleansing of Children. The names and addresses of 18 school children who had been found in a verminous condition were forwarded to the Public Health Department, and their homes were visited by your Sanitary Inspectors, and cleansed under the powers given by the London County Council (General Powers) Act, 1904, their bedding, clothing, &c., being dealt with at the Council's disinfecting station. Public Mortuary. 119 bodies were removed to the Mortuary during the year and were admitted as follows:— By order of the Coroner 77 Brought by Police 8 At the request of the M.O.H. 2 At the request of medical practitioners 4 For convenience till funeral 28 119 Sixty-eight post-mortem examinations were conducted, and inquests were held in 84 cases. Destruction of Rats.—The Rats and Mice (Destruction) Act came into operation on January 1st, 1920. It provides that "Any person who shall fail to take such steps as may from time to time be necessary and reasonably practicable for the destruction of rats and mice on or in any land of which he is the occupier, or for preventing such land from becoming 44 infested with rats or mice, shall be liable, on summary conviction, to a fine not exceeding five pounds, or, where he has been served with a notice under this Act requiring him to take such steps, not exceeding twenty pounds." The Borough Council are the authority required to execute and enforce the Act. In the event of the occupier failing to take necessary action, the Council may serve notice requiring him to take steps for the purpose of destroying rats and mice and of preventing his land or premises becoming infested, or, after 24 hours' notice, they may enter the premises, carry out the work and recover any reasonable expenses from him. The Sanitary Inspectors attended to all complaints respecting premises said to be infested with rats, but were unable to give the necessary time for their systematic detection and destruction, and as the nuisance was found to be of a serious nature the Council has resolved to appoint a whole-time Rat Officer for so long a period as may be found to be necessary. Scavenging.—The service for the weekly collection of house refuse was well maintained, and but few complaints of omission were received. It is, however, much to be regretted that the bi-weekly collection from fiats, where the storage of refuse generally presents difficulties, has been discontinued. HOUSING. The general housing conditions in the borough were dealt with in the Report for 1919. 20 houses built by private enterprise were completed last year, but the Council have been unable to acquire any land suitable for building purposes. The Housing Committee have made full enquiries respecting 31 sites, comprising practically all the vacant land in the borough, but either the land could not be purchased or the estimated cost was too high, and any hope of the Council being able to formulate any building scheme must be abandoned.