Council of the Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health J. CHARLES JACKSON. FOR THE YEAR 1921. Phelp Bros., Printers, The Broadway, Walham Green, S.W. Council of the Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health J. CHARLES JACKSON. FOR THE YEAR 1921. Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Sir, Ladies and Gentlemen, I have the honour to submit my twenty-ninth Annual Report on the vital statistics and the conditions affecting the health of the borough in the year 1921. Population.—The Census of 1921, originally planned for the 24th April, was unavoidably postponed till the 19th June. The population of the borough as enumerated on that day was 157,944, males 73,312 and females 84,632. The Registrar-General has pointed out that although the date of the census avoided the recognised programme of industrial holidays,some holiday movement was, largely owing to the abnormally fine weather, already then in progress, and consequently it has been deemed necessary for statistical purposes to make an adjustment by measuring the extent of the non-resident population in certain areas and by effecting its redistribution throughout the country. After making this by means of the best data available the Registrar-General has estimated the mid-yearly population of the borough for 1921 to be 159,400 and on this figure the statistics in this report are based. Increase of Population.— The following tables shows the increase of the population since 1851:— 4 TABLE I. Year. Population. Increase per cent. during previous intercensal period. Persons to the Acre. Rateable Value. 1851 Census 11,166 - 7.0 47,422 1861 „ 15,539 30.9 9.1 55,916 1871 „ 23,878 50.5 13.7 96,661 1881 „ 42,900 83.5 25.2 149,899 1891 „ 91,640 113.6 53.8 385,407 1896 „ 113,781 24.4 66.8 560,965 1901 „ 137,289 20.6 80.6 677,332 1911 „ 153,284 11.7 90.1 902,640 1921 „ 157,944 3.0 92.9 959,235 Population of Registration Sub-Districts. — The following table gives the population of the three Registration Sub-districts:— Census of 1901. Census of 1911. Census of 1921. North-East District 46,405 48,797 50,538 (Barons Court, Lillie and Walham Wards and Western Fever Hospital). North-West District 45,178 55,738 56,732 (Margravine and Munster Wards and Fulham Infirmary and Workhouse). South District 45,706 48,749 50.674 (Hurlingham, Sands End and Town Wards). 137,289 153,284 157,944 During the intercensal period, the natural increase of the population by the excess of births over civilian deaths was 16,957, so the net loss by migration and deaths in His Majesty's forces was 12,303. The population as enumerated at the census corresponds closely with the estimated population in 1920, viz. 158,621, which was based on the rationing returns furnished by the Ministry of Food. It was thought that, judging from the complaints of overcrowding, the population was then under-estimated, as there were at the Census of 1911 2,112 empty tenements in the borough 5 which were practically all occupied in 1921, and in addition 300 new houses and 7 large blocks of tenements were built during the ten years. These would accommodate more than the additional population, so that although probably there are more cases of gross overcrowding than there were ten years ago, a certain proportion of the population must be living under better conditions as regards house accommodation than was formerly the case. Marriages.—The number of marriages registered was 1,477, and the marriage-rate, i.e., the number of persons married per 1,000 of the population, was 18.5. In the three preceding years the marriages numbered 1,471, 1,659 and 1,601. 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 institutions outside the borough, numbered 3,528, of whom 1,824 were boys and 1,704 were girls. The birth rate was 22.1 per 1,000 inhabitants, being 5 per 1,000 below that of 1920. Illegitimacy.—The illegitimates numbered 159 or 4.5 per cent, of the total births, against 8.4, 6.5 and 4.8 per cent. in the three preceding years. Natural Increase of the Population.— The natural increase of the population by excess of births over deaths was 1,662, against 181, 1,098 and 2,501 in the three preceding years. Deaths.—During the 52 weeks ended December 31st, 1,865 deaths were registered in the borough. Of these 381 were of persons not belonging to the borough, while 382 inhabitants of Fulham died outside the borough chiefly in various public institutions. There were, there fore, 1,864 deaths of persons, 904 males and 960 females, having their usual residence in Fulham, representing an 6 TABLE II.—Vital Statistics of Whole District during 1921 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. of NonResidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. * Rate. Number. * Rate per 1,000 Nett Births. Number. * Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 al49,428 3,600 3,754 c23.1 1,324 8.9 131 789 330 88 1,982 13.3 b162,580 1917 a145,186 2,852 2,971 cl8.4 1,251 8.6 139 882 323 109 1.994 13.7 b161,841 1918 al43,211 2,593 2,672 cl6.7 1,704 11.9 186 973 286 107 2,491 17.4 b160,463 1919 al52,543 2,947 3,000 cl8.6 1,510 9.7 242 634 250 83 1,902 12.2 b155,904 1920 al58,621 4,383 4,327 c27.2 1,888 11.9 457 396 320 74 1,827 11.5 b158.989 1921 159,400 3,546 3,528 22.1 1,865 11.7 381 382 291 83 1,866 11.7 (a) Estimated civil population. (b) .Estimated total population. (c) iiirtn-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 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" outside the district which are added in calculating the nett death-rate of the Borough. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses and nursing homes (but not almshouses) are regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement are referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are referred (a) to the district of residence, under the general rule; (6) 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 157,944 At Census of 1921. Area of District in acres (land and inland water), 1701. 7 annual rate of 11.7 per 1,000 of the estimated population, being 0 2 per 1,000 above that of 1920, which was the lowest recorded in Fulham. The death-rate of males was 12.1, of females 11.3. The death-rate of England and Wales was 12.1 and that of the County of London 12.4, and among the metropolitan boroughs the lowest rate was 10.5 in Lewisham and the highest i4.3 in Southwark. Compared with 1920 there was an increase in the mortality from tuberculosis and cancer, the deaths from the latter being the most numerous hitherto recorded and in excess of those from any other disease. The mortality from zymotic diseases was also higher than in 1920, 163 deaths being due to the seven principal epidemic diseases against 134. Seasonal Mortality.—The mortality in the four quarters of the year was as under:— Deaths. Death-rate. First Quarter 514 12.9 Second 425 10.7 Third ,, 401 10.1 Fourth ,, 524 13.1 864 11.7 8 Distribution of Deaths.—The number and the causes of the deaths in the several wards of the borough are given in Table III. Certification of the Causes of Death,—Of the 1,864 deaths registered, 1,722, or 92 per cent., were certified by registered medical practitioners, and 142 by coroners after inquest, no death being uncertified. Deaths in Public Institutions—Fulham Infirmary.— The deaths of 683 persons occurred in the Fulham Infirmary, of whom 474 lived in Fulham and 209 in other districts. Western Fever Hospital.—In this institution there were 49 deaths of residents in Fulham and 142 of residents in other districts. Deaths occurring outside the borough among persons belonging thereto.—The deaths of Fulham residents outside the borough numbered 382, and occurred in the following places:- St. George's Hospital 52 West London Hospital 35 Other General Hospitals 48 Children's Hospitals 28 Hospitals for Women 15 Other Special Hospitals 85 Homes for advanced cases 18 Hospitals of Metropolitan Asylums Board 25 Poor Law Infirmaries 24 Lunatic Asylums 52 Nursing Homes, Private Houses and elsewhere 50 382 Of the deaths registered, 875 or 47 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 26.8 „ Metropolitan Asylums Board Hospitals 4.0 „ other Hospitals 13.4 Public Lunatic and Imbecile Asylums 2.8 47.0 9 TABLE III. Causes of and Ages at Death during the Year 1921. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District [a). Total Deaths Whether Of "Residents" Or "Non- Residents" In Institutions District (6) Nett Deaths at all ages of " Residents " in the Wards of the Borough whether occurring in or beyond the Wards. Causes of Death All Ages Under 1 Year 1 and under 2 year. 2 and under 5 years 5 and under 15 years 15 and under 26 years J5 and under 46 years 45 and under 65 years 65 and upwards Barons Court Ward Lillie Ward Walham Ward Margravine Ward Munster Ward Hurlingham Ward Sands End Ward Town Ward 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 All Causes Certified (c) 1864 291 65 43 79 90 247 44 603 905 172 331 158 211 459 85 278 170 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1—Enteric Fever 1 ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 2—Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3—Measles 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 4—Scarlet Fever 15 1 3 1 8 2 ... ... ... 22 1 1 ... 1 9 ... 2 1 5 — Whooping Cough 30 12 13 5 ... ... ... ... ... 15 ... 6 ... 6 6 1 11 ... 6—Diphtheria and Croup 43 2 6 8 26 ... 1 ... ... 143 3 8 5 4 14 ... 7 2 7—Influenza 36 2 1 ... ... 1 6 10 16 ... 5 3 2 3 14 ... 1 8 8—Erysipelas 7 ... ... ... ... ... 1 5 1 9 ... 2 1 ... ... ... 4 ... 9—Phthisis (Pulmonary Tuberculosis) 153 l ... ... 5 37 56 39 15 75 5 26 14 18 41 8 28 13 10—Tuberculous Meningitis 20 4 3 2 7 2 2 ... ... 13 1 7 1 2 3 1 4 1 11—Other Tuberculous Diseases 14 ... 1 2 ... 4 2 3 2 5 2 2 1 1 4 ... 3 1 12—Cancer, malignant disease 210 ... ... ... ... 3 22 99 86 87 25 38 18 22 45 8 30 24 13—Rheumatic Fever 14 ... ... 2 4 2 3 3 ... 2 ... 2 1 1 8 1 1 ... 14—Meningitis. See note (d) 14 4 2 1 3 ... 1 3 ... 5 ... 1 3 2 6 ... 1 1 IS—Organic Heart Disease 172 ... ... ... 2 2 32 52 84 34 12 28 9 25 43 11 24 20 16—Bronchitis 142 12 2 1 ... ... 5 28 94 53 16 33 13 11 26 12 25 6 17—Pneumonia (all forms) 147 38 18 5 5 3 28 21 29 59 13 18 11 1 23 40 8 21 13 18—Other diseases of Respiratory organs 21 1 ... ... 2 3 4 8 3 3 1 3 6 4 2 ... 5 ... 19—Diarrhoea and Enteritis 72 62 9 1 ... ... ... ... ... 56 6 13 5 15 12 ... 14 7 20—Appendicitis and Typhlitis 13 ... ... 1 4 1 2 3 2 3 3 2 2 ... 2 ... 4 ... 21—Cirrhosis of Liver 8 ... ... ... ... ... ... 7 1 2 2 1 ... 1 2 ... 2 ... 2lA-Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22—Nephritis and Bright 's Disease 63 ... ... ... 1 2 6 20 34 50 5 11 8 4 18 2 7 8 23—Puerperal Fever 6 ... ... ... ... 1 5 ... ... 8 ... 2 ... 2 1 ... 1 ... 24—Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... 1 6 ... ... 4 ... 1 ... 1 2 ... ... 3 25—Congenital Debility and Malformation, including Premature Birth 114 113 1 ... ... ... ... ... ... 39 6 22 5 14 38 6 13 10 26—Violent Deaths, excluding Suicide 55 6 ... 7 5 9 8 9 11 19 6 12 7 4 11 1 11 3 27—Suicide 17 ... ... ... ... 1 5 8 3 ... 4 2 4 2 3 ... ... 2 28—Other Defined Diseases 465 32 6 5 7 16 51 128 220 196 56 86 41 45 108 25 57 47 29—Diseases ill-defined or unknown 3 1 ... ... ... ... 1 1 ... 1 ... ... 1 ... ... 1 1 ... 1864 291 65 43 79 90 247 447 602 905 172 331 158 ! 211 459 85 278 170 (a) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside (6) All deaths occurring in institutions for the sick and infirm situated within the district, whether of it are included with the other deaths in columns 2—10, and columns 12-19. Transferable deaths residents or of non-residents, are entered in column 11 of Tab|e IV. of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certi- Distnct, are in like manner excluded from these columns. For the precise meaning of the term tied ," all other deaths are regarded as Uncertified." . ,. 'transferable deathj"i« footnote to Table I - (d) Exclusive of" Tuberculous Meningitis" (10). but inclusive of Cerebro-Spinal Meningitis. Deaths of soldiers and sailors occurring in hospitals and i titutions in the district are excluded from the total number of deaths registered in the district and such deaths in like manner are excluded from column II 11 TABLE IV. INFANT MORTALITY DURING THE YEAR 1921. Nett Deaths from stated causes at various Ages wider 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 Week. 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 oner Year. Barons Court \Vard.| Lilttle Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. All causes Certified 64 8 12 9 93 46 58 45 44 286 16 61 34 45 65 8 35 22 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... 1 1 ... .. ... ... ... ... ... 1 Whooping Cough ... ... 1 ... 1 4 2 1 4 12 ... 2 ... 2 5 ... 3 ... Diphtheria and Croup ... ... ... ... ... 1 ... 1 ... 2 ... 1 1 ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 2 1 4 ... 3 ... ... ... ... ... 1 Abdominal Tuberculosis (a) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 2 1 1 4 ... ... 2 ... 2 ... ... ... Convulsions 1 1 1 ... 3 ... ... 1 ... 4 ... 2 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 2 ... 1 3 3 3 ... 3 12 2 4 4 ... ... I 1 ... Pneumonia (all forms) 1 1 ... 1 3 6 9 7 13 38 2 4 4 9 7 ... 9 3 Diarrhœa ... ... 1 1 2 11 10 6 30 5 4 8 6 ... 4 1 Enteritis ... 2 1 ... 3 9 11 6 3 32 1 7 2 6 5 ... 7 4 Gastritis ... ... ... ... ... 3 1 ... 1 5 ... 4 ... ... .. ... ... 1 Syphilis ... ... ... ... ... 3 3 ... ... 6 1 1 l ... 1 ... 2 ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... 1 1 ... ... ... 2 ... 2 ... ... ... ... ... ... Injury at Birth 1 ... ... 1 ... ... 1 ... 2 ... ... ... ... 2 ... ... ... Atelectasis 10 ... ... 10 ... ... ... ... 10 2 1 1 ... 5 ... 1 ... CongenitalMalformations 6 4 ... ... 10 3 1 2 16 ... 3 1 3 5 ... 1 3 Premature Birth 45 4 5 1 55 8 ... ... ... 63 4 14 4 6 19 2 7 7 Atrophy, Debility and Marasmus 4 4 ... 2 10 15 7 2 ... 34 1 5 ... 5 12 3 5 3 Other causes 3 ... 1 ... 4 2 2 3 2 13 1 2 2 2 3 ... 3 ... 72 18 10 6 106 69 52 34 30 291 19 59 24 41 73 6 43 26 Nctt Births in the year—Legitimate, 3,369 ; Illegitimate, 159. (a) Under Abdominal Tuberculosis arc included deaths from Tuberculous Nett Deaths in the year of—Legitimate infants, 249; Peritonitis and Enteritis and from Tabes Mesenterica. Illegitimate infants, 42. Want of Breast Milk is included under Atrophy and Debility 13 Infantile Mortality.—Of the 1,864 deaths, 291 or 15.6 per cent. were of infants under one year of age, and the rate of infant mortality measured by the proportion of deaths under one year to registered births was 83 per 1,000, being 9 per 1,000 above that of 1920, but 9 per 1,000 below the average rate of the preceding five years. The infantile death-rate of England and Wales was 83 per 1,000 and that of the County of London 80. In the metropolitan boroughs the rates ranged from 54 in Stoke Newington to 107 in Kensington and 111 in Shoreditch. Causes of Infantile Mortality.—Table IV. 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:— TABLE V. Death-rates of Infants under One Year of Age from certain groups of Diseases. Diseases. Deaths per 1,000 births. 1921, Average of 5 years 1916-20. Infectious Diseases 4.3 6.6 Tuberculous „ 1.5 2.7 Respiratory „ 14.2 19.1 Diarrhœal „ 19.0 17.0 Developmental „ 85.6 32.6 Other „ 8.3 14.0 82.9 92.0 Deaths of Illegitimate Children.— Of the 291 infants who died before attaining the age of one year, 42 were illegitimate, the mortality among them being in the proportion of 264 deaths per 1,000 births against 74 per 1,000 among children born in wedlock. It is regrettable that the reduction noted last year, when the illegitimate mortality was only 106 per 1,000 births, has not been maintained. 14 MATERNITY AND CHILD WELFARE. The following is a summary of the work carried out under the Council's Maternity and Child Welfare Scheme during the year. Notification of Births.—3,311 notifications of living and 87 of stillborn children were received during the year under the Notification of Births Act. 94 per cent. of the births registered being notified. Of these, 2,509, or 74 per cent. were notified by midwives, 827 by doctors, and 62 by the parents or others. Visitation of Mothers and Babies.—The visits paid by the Health Visitors were:— First visits to infants 3,524 Re-visits 7,426 Re-visits to children, aged 1 to 5 years 4,517 Visits to cases of Ophthalmia Neonatorum 50 Visits to cases of Measles 429 Other visits 279 Welfare Centres.—Infant Consultations.— Arrangements were made in May for an additional weekly consultation to be held by Dr. Florence Wilson at Melmoth Hall, Eustace Road. Seven consultations are now held weekly, viz., three at 92, Greyhound Road, two at 170, Wandsworth Bridge Road and two at Melmoth Hall. The attendances during the year were: No. of Consultations. First Attendances of Babies. Total Attendances. Average Attendance. 92, Greyhound Road 134 601 6,787 50 170, Wandsworth Bridge Road 92 442 4,546 49 Melmoth Hall 75 262 2,091 28 301 1,305 13,424 44 There were 3,068 more attendances at the clinics than in 1920. 15 In connection with the clinics the following children attended for treatment:— At 92, Greyhound Road:— Number of children citt tiding. Number of attendances. For massage or treatment of minor ailments 582 2,030 At the School Treatment Centre, 18, Bagley's Lane:— For operative treatment for enlarged tonsils and adenoids 12 36 For dental treatment 18 60 Fulham Babies' Hospital, Lindsay House, Broomhouse Road.—The following is a summary of the work of the hospital during 1921:— In hospital, January 1st, 1921 14 Number of babies admitted 188 Average duration of stay 22 days. Number of cases discharged:— (a) In good health 128 (b) Improved 22 (c) No improvement 10 (d) On account of the development of infectious disease, viz. Whooping Cough 7 Number of deaths 20 In hospital, December 31st, 1921 15 The hospital was closed for seven weeks in May and June owing to some of the floors having to be relaid on account of dry rot. 34 more children were admitted than in 1920, but the hospital was again not used to its full capacity,the averagedaily number in the wards during the 45 weeks it was open being only 12, while there are 2 1 cots. Fulham Day Nursery.—The attendances during the year were:— Whole day. Half-day. Over 8 years 1,370 54 Under 3 years 6,144 331 7,514 385 In February, 1921 the Council having taken into consideration the financial position of the Committee of the Day Nursery, resolved to increase their annual 16 contribution from £300 to £600 a year as from April 1st, 1921, but on submitting the proposal for the sanction of the Ministry of Health, the Ministry pointed out that this was a very large contribution to an Institution of this class, and stated that in view of the very urgent need of economy in all branches of expenditure the proposed increase should be reconsidered. The Ministry, however, intimated that they were prepared to sanction a temporary increase in the present payment to enable the Nursery Committee to deal with their immediate financial difficulties. The Council thereupon suggested to the Ministry that the proposed increase of £300 should be sanctioned for one year only, and to this the Ministry agreed. Maternity Welfare.—Ante-Natal Clinic.—At the antenatal clinic, held by the Assistant Medical Officer, Dr. Thomson, 366 women were seen whose attendances totalled 1,103. Owing to the increasing attendance arrangements have recently been made for two antenatal clinics to be held weekly. Maternity Home, 706, Fulham Road.—The following is a record of the cases admitted to the Council's Maternity Home:— 1. Cases admitted 175 2. Average duration of stay 14 days. 3. Number of cases delivered by— (a) Midwives 168 (b) Doctors 7 4. Number of cases notified as puerperal cæmia none 5. Number of cases in which temperature was above 100.4 for 24 hours none 6. Number of cases notified as ophthalmia neonatorum, with results none 7. Number of cases of "inflammation of the eyes," however slight 4 8. Number of infants not entirely breast fed while in the institution none 9. Number of maternal deaths none 10. Number of foetal deaths (stillborn or within ten days of birth) 4 stillbirth 17 Women's Dental Clinic.-—At the Dental Clinic, held at 18, Bagley's Lane, 110 women attended, making 375 attendances, and 90 were provided with dentures. There was a gratifying increase in the number of women availing themselves of this service, as in 1920 only 52 women were treated, Visual Defects.—25 women attending the Welfare Centres were treated by the Ophthalmic Surgeon attached to the School Treatment Centre for defective sight. Milk (Mothers' and 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 514 cases, and the amount expended was, for dried milk, £912 15s., and for fresh milk, £129, a total of £1,041 15s. The amount expended in 1920 was £1,169 14S. 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 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 1 0 1 6 0 Husband, Wife and 1 Child 1 5 0 1 9 6 ,, ,, 2 Children 1 10 0 1 14 0 ,, ,, 3 1 15 0 2 1 0 ,, ,, 4 1 18 0 2 4 0 ,, ,, 5 2 2 0 2 8 0 ,, ,, 6 2 5 0 2 11 0 ,, ,, 7 2 9 0 2 15 0 In addition to that given free, or at a reduced price, 26,085 lbs. of dried milk, value £2,90 15s., were sold at cost price to persons recommended by the Health Visitors or the Welfare Centres. 18 Incidence of Infectious Diseases of Parturient Women and Infants and Young Children. Puerperal Fever.—27 cases of puerperal septicaemia, or 8 per 1,000 births, were notified, and there were 6 deaths. Of the cases notified 24 were removed to an isolation hospital or the Fulham Infirmary. The proportion of notified cases was again higher in Fulham than in any other metropolitan borough. In addition to those from septicaemia 7 deaths were due to other accidents and diseases of pregnancy and parturition. Ophthalmia Neonatorum.—30 infants were notified as suffering from ophthalmia, of whom 5 were removed to hospital. The result of the cases was as under:— Recovered with sight unimpaired 26 Corneal opacity in both eyes 1 Died during year from other causes 3 30 Measles.—396 cases were notified, against 942 in 1920, and there were only two deaths, the fewest recorded in any year. Diarrhoea.—140 cases were notified, or 88 more than in the previous year and there were 72 deaths. The diarrhoeal mortality, though little above the quinquennial average, was nearly double that of 1920, but while the summer of that year was cold and wet, that of last year was exceptionally hot and dry. For similar climatic conditions to those of 1920 we must go back to 1911, and in that year 180 deaths or 45 per 1,000 births were due to diarrhoea, so that last years figures are a striking tribute to the success that has attended the efforts made to reduce infantile mortality. 19 Prevalence of and Control over Infectious Disease. Table V. gives the number of cases of infectious diseases notified to the Medical Officer of Health during the 52 weeks ended December 31st, 1921. Smallpox.—No cases of smallpox have been notified in Fulham since 1916. Only two cases occurred in London during 1921. Scarlet Fever.—The incidence of this disease was again much above the average, 961 cases being notified, the highest number hitherto recorded. The fatality was also higher than in 1920, the 15 deaths representing a case mortality of 1.6 per cent, against 1.o per cent. in that year. Diphtheria.-—The exceptional prevalence of diphtheria shown in 1920 continued in 1921, and 579 cases were notified against 623 in the previous year. The 43 deaths due to the disease represent a case mortality of 7.3 per cent., or the same as in 1920. Enteric Fever.—Only seven cases were notified against 25 in 1920, and there was one death. Cerebro-Spinal Meningitis.— Four cases were notified, and there was one death. Encephalitis Lethargica.—7 cases were notified and 2 deaths were attributed to the disease. Pneumonia.—215 cases of pneumonia were notified, and of these 85 were notified after admission to the Fulham Infirmary by the Medical Superintendent. As 146 deaths were ascribed to pneumonia, it is evident that a considerable proportion of the cases was not notified. Nursing assistance was provided by the Council when needed. Tuberculosis.—360 new cases, 286 of pulmonary tuberculosis and 74 of non-pulmonary tuberculosis, were notified, and a summary of all the notifications received is given in the subjoined table. 20 TABLE VA. Cases of Infectious Diseases notified during the Year, 1921. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total cases removed to Hospital. At all Ages. Tages—Years. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Smallpox - - - - - - - - - - - - - - - - - Cholera (C), Plague (P) - — — — — — — - — — - - - - - - - Diphtheria (including Membranous Croup) 579 6 130 349 53 35 6 - 18 102 31 84 162 16 129 37 554 Erysipelas 92 4 2 6 5 16 37 22 7 16 6 30 26 — 5 2 62 Scarlet Fever 961 7 155 674 83 38 4 — 34 130 40 145 332 35 177 68 876 Typhus fever - - - — — — — — — — — — - - - - - Enteric Fever 7 - - 2 2 2 - 1 — 2 — 2 1 1 1 - 6 Relapsing Fever (R) - - — — — — — — — — — - - - - - Continued Fever (C) - - - - — — — — — — — — - - — - - Puerperal Fever 27 - - — 3 24 — — 2 6 1 4 7 1 4 2 24 Cerebro-spinal Meningitis 4 1 - 3 - — — — — . — — — 3 - 1 - 4 Poliomyelitis 5 1 2 1 - - 1 — — 4 — — — — 1 - 3 Ophthalmia Neonatorum 30 30 - - - — — — 3 5 1 5 7 2 5 2 4 Pulmonary Tuberculosis 286 - 3 22 61 115 70 15 19 51 14 40 80 12 54 16 — Other forms of Tuberculosis 74 - 12 33 16 8 5 - 4 10 4 5 28 — 16 7 — Measles 396 21 125 247 2 1 — - 3 61 31 5 43 31 193 29 5 Encephalitis Lethargica 7 - 1 2 1 2 — 1 — 1 1 — 2 — 2 1 6 Pneumonia 215 13 32 35 1 29 57 36 13 5 48 19 30 68 3 25 17 130 Diarrhoea 140 91 49 — — — — — 10 32 13 35 32 2 13 3 96 Malaria 9 — — — 4 4 1 — — 3 1 — 1 1 1 2 1 Dysentery 2 - — — 1 — 1 — — 1 — — 1 — — - 1 Trench Fever - - - - - - - - - - - - - - - - - Totals 2834 174 511 1374 260 302 161 52 105 472 162 385 793 104 627 186 1772 TABLE VI. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of notifications during the period from 2nd January, 1921, to 81 st December, 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 Notifications. Total Notifications on Form B Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 I5 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary Notifications. Under 5. 5 to 10 10 to 15 Total Primary Notifications. Pulmonary. Males - 2 7 5 11 18 32 25 24 18 6 148 240 - — - - - 14 114 Females - 1 4 6 13 19 36 22 17 11 9 138 225 - — — - 1 11 79 Non-pulmonary. Males - 5 14 4 1 6 2 - - 1 - 33 43 - - - - 9 4 12 Females - 7 8 7 6 3 3 3 3 1 - 41 52 - - - - - 1 8 21 22 Mortality from Tuberculosis.—153 deaths, 75 of males and 78 of females were registered from pulmonary tuberculosis corresponding to a death-rate of 0.96 per 1,000, being slightly above that of last year, viz. 0.89, which was the lowest recorded. 31 deaths were due to other tuberculous diseases. giving a death-rate of 0.19 per 1,000. Of the 153 persons certified as having died from pulmonary tuberculosis, 17 had not been notified, of whom 7 died in public institutions. The following table gives the time that elapsed in notified cases of pulmonary tuberculosis between the first notification and death. TABLE VII. Period between date of Primary Notification and Death. Under 1 month 34 1 to 3 months 17 3 to 6 „ 18 6 to 12 „ 18 1 to 2 years 27 Over 2 years 32 Fulham Tuberculosis Dispensary.—On April 1st, 1921, the Council took over the Dispensary from the Committee of Management and engaged all the members of the staff on the terms of remuneration and conditions of service of their existing appointment. Statistics of Dispensary.—The following summary of the work of the Dispensary has been furnished by the Tuberculosis Officer, Dr. John Sullivan. During 1921, 1,662 persons, of whom 757 were notified cases of tuberculosis, attended the Dispensary. Of these, 556 were insured, 333 were uninsured adults and 773 were children. Of the insured patients, 281 were ex-service men, of whom 180 were notified as suffering from tuberculosis. 646 were new patients, and of these 139 were notified as suffering from tuberculosis (21.5 per cent.); the 23 fication of old patients who were under observation brought the number up to 164. The attendances at the Dispensary numbered 7,461, consisting of 2,074 attendances of insured persons, 1,566 of uninsured adults and 3,821 of children. 3,511 physical examinations were made at the Dispensary or in the patients' homes. 383 Contacts were examined, of whom 31 were made patients. 2,217 visits were paid by the Medical Officers, and 5,640 by the nurses. Reports. 214 reports were sent to Doctors. 131 „ v London Insurance Committee. 206 „ „ London County Council. 209 „ „ Ministry of Pensions. 203 „ „ War Pensions Committee. TABLE A. Showing who recommended the patients. 208 were recommended by private doctors. 35 „ „ the Medical Officer of Health. 28 „ „ by the School Medical Officer. 21 „ „ by the School Authorities. 5 „ „ Hospitals. 2 „ „ Sanatoria. 6 „ „ Other Dispensaries. 13 London Insurance Committee. 6 „ „ London County Council. 41 „ „ the Dispensary Staff. 16 „ „ War Pensions Committee. 50 „ „ Ministry of Pensions. 18 „ „ Friends. 79 „ „ Patients, 78 „ „ the door plate. 3 „ „ the Charity Organisation Society. 13 „ „ the Invalid Children's Aid Association. 1 was „ the Children's Country Holiday Fund' 2 were „ the Soldiers' and Sailors' Families. Association. 21 were Contacts. 646 24 TABLE B. Sex and age of New Patients for 1921. Under 5 10 15 25 35 45 45 and over Total. Males 24 87 46 40 58 44 41 340 Females 21 66 31 53 65 45 25 306 Both Sexes 45 153 77 93 123 89 66 646 TABLE C. Diagnosis in Males and Females. Total Cases. Pulmonary Tuberculosis. Other Forms. Suspects. Non-Tuberculous. PercentageTuberculous. 340 Males 70 13 86 171 24.4 306 Females 46 10 77 173 18.3 646, both Sexes 116 23 163 344 21.5 TABLE D. Diagnosis at various Age Periods. Pulmonary Tuberculosis. Other Forms. Suspects. Non-Tuberculous. Percentage Tuberculous. Under 5 years — 2 11 32 4.4 „ 10 „ 2 8 36 107 6.5 „ 15 „ 4 3 23 47 9.09 „ 25 „ 31 6 24 32 39.7 „ 35 „ 30 2 28 63 26.01 „ 45 „ 26 2 23 38 31.4 45 and over 23 — 18 25 34.8 All ages 116 23 163 344 21.5 TABLE E. Housing Conditions of 127 of the 139 tuberculous patients found in 1921:— 4 lived in the Basement. 35 lived on the Ground Floor. 45 „ „ First ,, 4 „ „ Second „ 3 „ „ Top ,, 12 „ on more than one Floor. 24 „ in the whole house. 127 25 TABLE F. Housing Accommodation. No. of Families Occupying 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6 rooms or over Patient living alone 4 1 1 — — — „ „ with 1 other 3 5 6 2 — — „ „ „ 2 others 3 5 13 5 2 1 „ „ „ 3 „ — 2 11 3 3 — „ „ „ 4 „ — 1 12 8 3 2 „ „ „ 5 „ — — 4 3 4 2 „ „ „ 6 „ — 1 1 2 1 2 „ „ „ 7 „ — — 1 2 — 2 „ „ „ 8 „ — — 1 1 1 2 „ „ „ 9 „ - - - - - 1 Total 10 15 50 26 14 12 TABLE G. Sleeping accommodation of 127 Tuberculosis Patients. The Patients slept:— In a separate room in 54 cases Alone in bed with 1 other in room in 7 „ „ „ 2 others „ in 7 „ „ „ 3 „ „ ... in 5 „ In bed with 1 person and no others in room in 33 „ „ „ 1 „ 1 other „ in 8 „ „ „ 1 „ 2 others „ in 7 „ „ „ 1 „ 3 „ „ in 1 „ „ „ 1 „ 4 „ „ in 1 „ „ „ 2 persons and no „ „ in 1 „ „ „ 2 „ 2 „ „ in 2 „ „ „ 1 person and 3 „ „ in 1 „ Total 127 cases Patients sent away during 1921.— By the London Insurance Committee— Hospital. Sanatorium. Farm Colony. Men 9 26 1 Women 2 14 — Total 11 40 1 26 By the London County Council— Hospital. Sanatorium. Men 18 41 Women 3 28 Children 4 2 Total 25 71 By the Guardians mostly to Infirmary— Men 1 Women 15 Children 12 Total 28 58 children were admitted to the Open Air School. 6 children were boarded out and 1 sent to a Training Home by the Charity Organisation Society. 12 children were sent away by the Invalid Children's Aid Association. 108 Homes were reported as insanitary and have been done up. FOOD. Milk.—At the end of 1920 there were 123 dairies and milkshops on the register, and during 1921 15 were removed and 19 added. 669 samples of milk were purchased for analysis, of which 30, or 4.5 per cent., were certified to be below the standard adopted by the Board of Agriculture, against 13, 10.8 and 8 per cent. in the three preceding years. Milk and Cream Regulations, 1912 and 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 669 None. Cream 3 „ 27 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 3 (2) Statements incorrect — Total 3 (b) The examination made of milk fat in cream sold as served cream. (1) Above 35 per cent. 3 (2) Below 35 per cent. — 3 (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. One. (d) Particulars of each case in which the Regulations have not been complied with and action taken. Proceedings taken. Defendant fined £2 with £1 costs. 3. Thickening substances. Evidence of their additions 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 bv the Borough Council. Premises. Licensees. 611. Fulham Road Dangerfield & Venn. 640, King's Road E. Vaughan. Bakehouses.—There are 68 bakehouses on the register, of which 47 are underground. They were systematically inspected and 4 notices served in respect of breaches of the special requirements of bakehouses were complied with. Restaurant Kitchens, etc.—129 inspections of the kitchens were made by your Inspector, Mrs. Davies, and 15 notices were served on account of defects observed. Unsound Food.—The following articles examined at the request of the owners, were condemned and destroyed:— 28 Condensed Milk 79 tins. Rabbits 242 Corned Beef 2 tins. Tomatoes 16 ,, „ 56 lbs. Pears 60 tins. „ 1 barrel. Raspberries 144 tins. Grapes 98 boxes. Apples 15 „ Chestnuts 23 bags. Cocoanuts 98 Fish Paste 2 tins. Sardines 1 tin. Salmon 1 tin. Winkles 2½ bushels. Whiting 2 cases. Roe 3 boxes. Codfish 3 cwt. „ 2 boxes. Kippers 34 „ Skate 63 lbs. Haddock 11 cases. Plaice 2 boxes. Herrings 1 barel. Mackerel 1 box. Crabs 2 cases. Mustard and Cress 84 baskets. Action under the Sale of Food and Drugs Acts. The undermentioned samples were purchased for analysis during 1921:— Article. Number of Samples taken Officially. Number Adulterated. Number of Samples taken Unofficially. Number Adulterated. Total Samples. Total Adulterated. Percentage of Adulteration. Milk 647 29 9 ... 656 29 4.4 Separated Milk 13 1 ... ... 13 1 71 Ground Ginger ... ... 4 ... 4 ... ... Milk Powder ... ... 1 ... 1 ... ... Cream 2 1 3 3 5 4 80.0 Preserved Cream 1 ... 4 ... 5 ... ... White Pepper ... ... 2 ... 2 ... ... Cayenne Pepper ... ... 2 ... 2 ... ... Mercury Ointment 1 1 5 ... 6 1 16.6 Self-Raising Flour ... ... 13 ... 13 ... ... Butter 2 ... 138 2 140 2 1.4 Coffee ... ... 5 ... 5 ... ... Dried Eggs ... ... 3 ... 3 ... ... Cheese ... ... 15 ... 15 ... ... Lard ... ... 18 ... 18 ... ... Sugar ... ... 6 1 6 1 16.6 Sausages 9 5 11 5 20 10 50.0 Cocoa ... ... 20 ... 20 ... ... Jam ... ... 2 ... 2 ... ... Malt Vinegar 2 ... 15 2 17 2 11.7 Brandy ... ... 1 ... 1 ... ... Glycerine ... ... 18 ... 18 ... ... Margarine ... ... 3 ... 3 ... ... Vi-Lactogen ... 1 ... 1 ... ... Beef Dripping ... ... 5 ... 5 ... ... Egg Powder ... ... 3 ... 3 ... ... Tinned Peas 7 7 5 5 12 12 100.0 684 44 312 18 996 62 6.2 29 Proceedings were instituted in the under-mentioned cases:— Defendant. Offence. Result. Penalty, Costs. £ s. d. £ s. d. London Wholesale Dairies Ltd., 9, Harrow Road Selling milk 23 per cent. deficient in fat Dismissed (Warranty proved) — — Isaac Jones, 275, Wandsworth Bridge Road Selling milk adulterated with 4 per cent. of added water. Dismissed (Warranty proved) — Ann J. Hayward, 37, Burlington Road Selling milk 5 per cent. deficient in fat Dismissed (Warranty proved) — — A. Waterfield, 6, Masbro Road, Hammersmith Selling milk 18 per cent. deficient in fat Convicted. 1 0 0 2 2 0 C. S. Spencer, 2, Everington Street Selling milk adulterated with 13 per cent. of added water. Convicted. 1 0 0 5 5 0 Buscot and N. Berks Dairy Co., The Factory, Station Rd., Farringdon. Selling milk 14 per cent. deficient in fat Ordered to pay costs 4 4 0 Evan Morgan, 51, Hartismere Road Selling milk 9 per cent. deficient in fat Dismissed (Warranty proved) — — Adrian Gold, 92, May Street Unlawfully delivering preserved cream not properly labelled Convicted. 2 0 0 1 0 0 Henry Denew, 358, North End Road Selling milk 5 per cent. deficient in fat Dismissed (Warranty proved) — — Albert George, 148, Dawes Road Selling vinegar 25 per cent. deficient in acetic acid Ordered to day costs — 1 1 0 Fredk. Edwards, 355, Fulham Palace Rd. Selling tinned peas containing 2.59 grains of copper Dismissed (Warranty proved) — — Albert E. Jupe, 22, St. Johns Road Selling tinned peas containing 0.7 grains of copper Dismissed — — Nathan Shimberg, 77-78, Chiswell Street, E.C. Selling tinned peas containing 0.44 grains of copper Dismissed — — Alex. Dunnett, 44, Bolingbroke Road, Wandsworth Common Selling tinned peas containing 0.42 grains of copper Dismissed — — Jas. Dunnett, 23. Churchfield Mans., S.W. 6 Selling tinned peas containing 0.42 grains of copper Dismissed — — 30 GENERAL SANITARY ADMINISTRATION. Disinfection— 2,017 rooms were disinfected and cleansed after infectious disease. The following articles were disinfected at the Council's Disinfecting Station:— Beds 1,498 Mattresses 1,678 Palliasses 1,050 Box Springs 19 Pillows 2,682 Cushions 965 Bolsters 2,612 Blankets 3,493 Sheets 2 568 Covers and Counterpanes 2,827 Eiderdowns 772 Curtains 2,842 Carpets 1,067 Hearthrugs 860 Clothing 7,440 Sundries 6,418 38,791 Bacteriological Work.—The following bacteriologica examinations were made either by Dr. Burnet, or at the Laboratory of the Tuberculosis Dispensary. Material from cases of suspected Diphtheria. Diphtheria bacillus isolated 182 1,002 Negative result 820 Blood from cases of suspected Enteric Fever. Widal or typhoid reaction obtained — 9 Negative result 9 Sputa from cases of suspected Tuberculosis. Tubercle bacillus found 248 1,313 „ „ not found 1,065 Examinations for other organisms 36 37 Blood examinations 1 2,361 Public Mortuary.—131 bodies were removed to the Mortuary during the year and were admitted as follows:— By order of the Coroner 93 Brought by Police 19 For convenience till funeral 19 131 69 post-mortem examinations were made, and inquests were held in 110 cases. 31 SANITARY CIRCUMSTANCES OF THE DISTRICT. Sanitary Inspection of District.—1 he following inspections of dwelling-houses were made during the vear bv the Sanitarv Inspectors:— Premises inspected. *In consequence of complaints 1,246 In consequence of infectious disease 1,640 House to house inspection 347 3,233 *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, 1921 Number served. Number complied with on Dec. 31st, 1921 2,488 2,330 700 588 Proceedings under the Public Health (London) Act for failing to comply with the Council's notice were instituted in 19 cases, and in 4 orders were made to abate the nuisances. Housing and Town Planning Act, 1919.—376 notices were served under Section 28 of the above Act requiring the owners to do certain works which in the opinion of the Council were necessary to make the houses in all respects reasonably fit for human habitation. In 20 houses in which the owners failed to do the work the necessary repairs were carried out by the Council's workmen at a cost of £1,355. Of this amount, £522 has been repaid to the Council. In respect of 5 houses, appeals have been lodged with the Minister of Health against the Council's claims for repayment of the money expended. 32 Houses Let in Lodgings.—The proposed by-laws under Section 26 of the Housing and Town Planning Act, in respect of houses let in lodgings or occupied by members of more than one family, have not yet been confirmed by the Minister of Health. Drainage of Buildings.—The following drainage plans were submitted to and approved by the Public Health Committee:— Plans of drainage of new houses 11 blocks of flats „ „ additions to existing buildings 41 „ the reconstruction of the drains of existing buildings 80 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 510 tenements, of which 480 were granted and 30 refused. Certificates of Water Supply.—Certificates of water supply were given in respect of 7 new houses. Increase 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. 110 applications were received and 83 certificates that their houses were not in a reasonable state of repair, were given In 27 cases the certificate was refused, In each case in which a certificate was given a notice under the Public Health (London) Act or the Housing and Town Planning Act was served upon the owner requiring the execution of the work necessary, to put the premises in a reasonable state of repair, and on this being complied with, a certificate was given that the Council's requirements had been completed, and that the premises were now in a reasonable condition pf repair. 33 Factory and Workshops Acts.— The following inspections were made under the provisions of the Factories and Workshops Acts:— Premises. Number of Inspections. Notices served. Notices complied with. Workshops 413 30 30 Workplaces 164 20 20 Homes of Outworkers 662 36 36 Destruction of Rats.—As the damage caused by rats in very many premises in the borough, and especially in the wharves and warehouses on the river front was of a serious nature, and the steps hitherto taken by the Council to check the nuisance had been ineffective, the Council resolved, in February, 1920, to appoint a special Rat Officer for the purpose of inspecting premises and destroying the rats when found. After consultation with the officials of the Board of Agriculture, Mr. J. Harvey was engaged for this work at a salary of £5 a week, in the first place, for a period of one month, and thereafter from week to week as necessary. The services of the Rat Officer were retained throughout the year and a large number of factories, shops, warehouses, private houses and open spaces, were inspected by him, of which 280, found to be infested with rats, were dealt with. Many letters of appreciation of this work of the Council were received from occupiers of infested premises, and the Ministry of Agriculture informed the Council that their Technical Officer had visited a number of premises in the south of the borough and reported that the efforts of the officer appointed by the Council, under the Rats and Mice Act, appeared to have been successful in effecting a clearance in these premises, and the Ministry were glad to notice that a very useful work had been accomplished in Fulham during the last six months in connection with the destruction of rats and mice. Poisoned baits were also laid in some of the Council's sewers, and a large number of dead rats were found, and this work is still proceeding. The sum of £85 has been paid to the Council by occupiers of infested premises, for the services of the Rat Officer. 34 Combined Drainage.— Three systems of combined drainage, 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 by the Council at a cost of £161 3s. 9d. and the sum of £25 was paid to an owner for the expense he had been put to in repairing a house drain which was a "sewer" within the meaning of the Metropolis Management Act. Flooding of Basements.—The attention of the London County Council has been repeatedly drawn to the grave nuisance caused by the flooding of basements in all parts of the borough with sewage after heavy rainfall, owing to the incapacity of County Council's main sewers to deal with even a moderately heavy rainfall, especially when occurring at high tide. A storm on September 11th again resulted in a large number of basements being flooded with sewage, which deposited after the subsidence of the water a quantity of filth on and beneath the floors. A deputation of the Borough Council with deputations from the Hammersmith and Kensington Councils waited on the Main Drainage Committee of the L.C.C., and urged the immediate carrying out of the proposed scheme of works, with the view to the prevention of flooding in the low-lying area of the west of London. The remedial measures proposed provide for the construction of a sewer about a mile in length having an outlet to the river near Hammersmith Bridge, together with a new pumping station near the outfall. A tender for the construction of the sewer was accepted by the L.C.C. in December, and the work is now in progress. It is anticipated that the sewer will be completed in about a year, but the building of the pumping station and the installation of the machinery will probably take from two to three years. This will doubtless reduce the number of floodings, but it is probable that after exceptionally heavy rains low-lying basements in Fulham will still suffer. 35 Retirement of Medical Officer of Health. As this is the last annual report I shall have the honour of submitting, I must express my keen regret at severing my connection with the borough after nearly thirty years service, during the whole of which my relations with the members of the Council present and past, my colleagues and others have been such as to add greatly to my sense of loss. The increasing duties and responsibilities, however, of a Medical Officer of Health, which unfortunately are not often recognised financially, demand the energies of a younger man. Of late years there has been a marked development in the scope of public health work, which from being mainly environmental, is now largely concerned with the individual, as shown in the provision of dispensaries, infant and school clinics, hospitals, maternity homes and other forms of social service. In this connection my sincere thanks,"and the thanks of the people of Fulham, are due to those social workers who have given their time and money in promoting objects, the value of which was but tardily recognised by the local authority, who are now reaping the benefit of the efforts of the pioneers. To the members of the staff of the Public Health Department I owe the deepest gratitude for faithful service always ungrudgingly given; many of them, having duties to perform which invite criticism and opposition, have fearlessly and zealously devoted themselves to their task. From my colleagues I have always received sympathetic consideration and encouragement, and we have worked in complete harmony. I am, Sir, Ladies, and Gentlemen, Your obedient Servant, J. CHARLES JACKSON. 36 APPENDIX. HOUSING CONDITIONS. Year ended 31st December, 1921. 1.—GENERAL. (1) Estimated population 159,400 (2) General death-rate 11.7 (3) Death-rate from tuberculosis 1.08 (4) Infantile mortality 83 (5) Number of dwelling-houses of all classes:— Undivided private houses 17,486 Structurally divided private houses 862 Blocks of flats, tenements, etc. 601 Shops with dwelling-house above 1,682 (6) Number of new working-class houses erected 7 2.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,233 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 347 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,488 37 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 72 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 376 (2) Number of dwelling-houses which were rendered fit:— (a) by owners 346 (b) by Local Anthority in default of owners 20 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close none B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,488 (2) Number of dwelling-houses in which defects were remedied:— (a) by owners 2,329 (c) by Local Authority in default of owners 1 C. Prooeedings under section 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders None (2) Number of dwelling-houses in respect of which Closing Orders were made „ 38 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit None (4) Number of dwelling-houses in respect of which Demolition Orders were made „ (5) Number of dwelling-houses demolished in suance of Demolition Orders „ 3,—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvements Schemes under (a), Part I., or (b), Part II., of the Act of 1890 None 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Sections 25 of the Housing, Town Planning, &c., Act, 1919 „ 5.—Staff engaged on housing work with, briefly, the duties of each officer One Sanitary Inspector engaged in house-to-house inspection. Six District Sanitary Inspectors. 39 ADDENDUM. Since the above report was written an instalment of the report of the Census of 1921 has been published, and the following statistics relating to Fulham have been extracted from it. The subjoined table gives the number of houses in the borough and of the families occupying them. TABLE A. Dwelling Rooms and Families in the Metropolitan Borough of Fulham. Structurally divided dwellings occupied by private families or vacant. ] 1— 3 rooms. 4-5 rooms. 6-8 rooms. 9 or more rooms. Total dwellings. Total rooms. Undivided Private Houses 512 2 332 11,887 1,799 17,430 112,186 Structurally Divided Private Houses 983 868 239 10 2,100 8,014 Blocks of Flats, Tenements, etc, 1,462 2,935 846 16 5,289 22,166 Shops 181 617 756 121 1,675 9,529 Others 83 51 26 6 166 865 3,221 7,703 13,754 1,952 26,630 152,558 Vacant on Census night 123 307 191 20 651 3,215 Dwellings occupied by one private family 3,044 6,240 4,388 762 14,434 71,852 Dwellings occupied by two private families 48 1,027 7,589 566 9,230 59,841 Dwellings occupied by three or more private families 6 129 1.586 594 2,315 17,600 Total dwellings occupied by private families 3,098 7,396 13,563 1,922 25,979 149,293 Per cent. 12 28 53 7 100 — Total private families therein 3,158 1,687 24,610 3,981 40,436 — 40 Overcrowding.—From the figures given in the tables of the report, information may be obtained as to the amount of overcrowding in the borough. The average number of rooms occupied per person was 0.96. The population in private families numbered 154,515, and of these, 20,312 or 13.2 per cent. were living under overcrowded conditions, i.e., more than two persons in a room, while in 1911, of a population of 149,702, in private families 21,784 or 14.6 per cent. were living two or more in a room. The subjoined table gives the number of persons living more than two in a room in 1911 and 1921, and it will be seen that although there is, as anticipated, an increase in the worst form of overcrowding, i.e., in those living four or more in a room, there is a substantial reduction in the total number of persons living under overcrowded conditions. No matter what vacant house accommodation there may be, there are always some who prefer to herd together rather than pay, even when they can well afford it, for more house room, but judging from the insistent demands there are for more house room, these people are becoming fewer, and the bulk of the population rightly claims that sufficient houses must be built to enable all to live under decent conditions. TABLE B. Number of persons living more than two in a room in 1911 and 1921. Number of persons per room. 1911. 1921. Total Persons. Percentage of population in private families. Total Persons. Percentage of population in private families. Four or more persons to a room 1,706 1.1 1,927 1.3 Three and under four persons to a room 6,225 4.2 5,823 3.8 Over two and under three persons to a room 13,853 9.3 12,563 8.1 21,784 14.6 20,313 13.2