Council of the Borough of Fulham. ANNUAL REPORT OF THE Medical Officer of Health, J. CHARLES JACKSON. FOR THE YEAR 1917. Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Gentlemen, I have the honour to submit my Annual Report for 1917, which, in accordance with the instructions of the Local Government Board, is limited to a brief record of the most important matters that have affected the public health during the year. Population.—For the calculation of the death-rate and birth-rate the following estimates of population have been adopted by the Registrar General:— For the death-rate 145,186 „ birth-rate 161,841 The former is an estimate of the civil population, the latter of the total population, based on the assumption that the ratio between the total and the civilian population is the same in the borough as in England and Wales as a whole. Looking at the crowded state of the borough, both are probably under estimated. Marriages.—1,403 marriages were registered during the year, against 1,450, 2,043 and 1,918 in the three previous years. Births. —Excluding 75 births among non-residents, but including 194 children born of Fulham mothers in lying-in institutions situated in other boroughs, 2,971 births were registered, 1,530 of boys and 1,441 of girls, representing a birth-rate of 184 per 1,000 of the estimated total population. This is the lowest birthrate recorded in Fulham, and is 6.4 per 1,000 below the average rate of the preceding five years. Illegitimacy.—The illegitimates numbered 224, or 7.5 per cent: of the total births, the highest proportion recorded in any year. Of these 137 were born within, and 87 outside the borough. VITAL STATISTICS OF WHOLE DISTRICT DURING 1917 AND PREVIOUS YEARS. Nett Deaths belonging to the District. 1 Population Estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths.† Uncorrected Number. 3 Nett. of Non- Residents registered in the District. 8 of Residents not registered in the District. 9 Under 1 Year of Age. At all Ages. Number. 4 Rate 5 Number. * 10 Rate per 1,000 Nett Births. 11 Rate. 13 Number. * 6 Rate. 7 Number. * 12 155,402 4,213 1,830 366 395 94 2,023 13.0 1912 4,079 27.1 11.8 173 1913 157,117 4,234 4,302 26.9 1,833 11.3 212 412 96 2,028 12.7 407 1914 157,303 4,065 4,154 26.4 1,878 12.3 137 391 469 113 2,132 13.6 1915 a153,161 3,870 e24.3 1,787 11.7 130 677 446 115 2,334 15.2 3,736 1916 a149,428 b 162,580 3,600 3,754 e23.1 1,324 8.9 131 789 330 88 1,982 13.3 e18.4 1,251 1917 2,852 2,971 8.6 882 323 1,994 13.7 a145,186 b161,841 139 109 (a) Estimated civil population. (b) Estimated total population. (e) 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 for 1915, 1916 and 1917 are calculated per 1000 of the estimated civil population, and the other rates per 1000 of the estimated gross population. * In Column 6 are included the whole of the deaths registered during the calendar year as having actually occurred within the district, but excluding the deaths of and Sailors that have occurred in hospitals and institutions in the district. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. †"Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g . casuals, are not included in Columns 8 or 9, except in certain instances under 3(b) below. In Column 8 the number of transferable deaths of "non residents" which are deducted is stated, and in Column 9 the number of deaths of "residents" registered outside the district which are added in calculating the nett death-rate of the Borough. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) are regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement are referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where 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 TABLE II. Causes of, and Ages at Death during the Year 1917. 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 Institution in the District (b) 11 Nett Deaths at all ages of “ sidents ” in the Wards of the Borough whether occurri in or beyond the Wards. Causes of Death 1 All Ages Under 1 Year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under45 years 45 and under 65 years 65 and upwards Barons Court Ward Lillie Ward Munster Ward Hurlingham Ward Sands End Ward Town Ward Walham Ward Margravine Ward All Causes Certified (c) 1994 323 96 255 594 374 117 ... 89 66 91 480 149 151 170 ... 262 ... 414 ... 333 ... 173 ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... 13 ... ... 1 ... 1-Enteric Fever ... 2 ... ... ... ... 2-Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3-Measles 75 26 28 16 5 ... ... 15 3 6 19 2 2 22 12 9 ... ... 4-Scarlet Fever 4 ... ... 2 1 ... 1 ... ... 23 ... ... 2 ... 2 ... ... ... 5-Whooping Cough 22 5 11 5 1 ... ... ... 6 2 6 1 3 4 6 ... ... ... 3 2 2 6-Diphtheria and Croup 16 2 10 1 ... ... ... 53 ... 4 5 3 ... ... ... 4 7-lnfluenza 32 1 ... ... ... 1 5 7 18 ... 3 4 ... 6 5 4 6 8-Erysipelas 2 ... ... 1 1 1 1 1 ... ... ... ... ... ... ... ... ... ... 9-Phthisis (Pulmonary Tuberculosis) 191 3 2 4 32 80 19 32 37 11 39 16 10 51 9 3 7 30 10-Tuberculous Meningitis 8 7 1 ... 25 3 5 1 ... 1 4 4 4 5 3 ... 5 ... 11-Other Tuberculous Diseases 24 5 ... 3 3 4 6 2 1 3 1 4 5 4 4 2 3 1 12-Cancer, malignant disease 178 2 1 1 12 70 31 17 ... 92 ... 19 15 35 17 23 21 13-Rheumatic Fever 5 ... ... ... 3 1 ... 1 ... ... 1 1 ... ... 1 1 1 ... ... 14-Meningitis. See note (d) 17 4 1 4 3 2 3 ... 10 3 1 2 3 5 1 2 ... ... 15-Organic Heart Disease 202 ... 1 2 7 20 74 98 2 14 37 20 24 44 7 33 23 ... 16-Bronchitis 180 15 2 2 3 1 11 30 116 1 11 40 16 26 31 7 23 26 17-Pneumonia (all forms) 179 47 31 17 6 4 18 34 22 7 14 39 13 26 39 8 32 8 18-Other diseases of Respiratory organs 16 ... 1 1 3 3 ... 1 8 2 ... 2 5 1 3 1 ... 1 19-Diarrhæa and Enteritis 85 63 4 8 1 ... 3 2 4 ... 1 24 13 10 17 2 16 2 20—Appendicitis and Typhlitis 8 ... 1 2 2 2 1 ... 1 ... ... ... 3 2 2 ... ... ... 21—Cirrhosis of Liver 12 ... 1 1 3 ... ... 3 4 ... 2 2 2 1 ... 1 4 ... 21A-Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22—Nephritis and Bright's Disease 75 ... 1 4 3 12 34 21 1 6 14 5 2 14 9 18 7 ... 23 Puerperal Fever 4 ... 2 3 1 ... 2 1 ... ... ... 2 ... ... ... ... ... ... 24—Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... ... ... 1 ... 1 2 ... ... ... ... 2 2 ... ... 25—Congenital Debility and Malformation, including Premature Birth 92 ... 1 ... ... ... 6 10 8 11 28 21 93 ... ... 1 8 ... 26—Violent Deaths, excluding Suicide 54 5 2 5 8 3 6 11 14 2 1 10 4 7 8 8 10 6 27—Suicide 6 ... ... 1 ... ... 1 1 ... 1 1 1 1 ... ... ... 5 ... 28 —Other Defined Diseases 478 45 4 7 23 57 212 3 127 5 46 81 29 65 105 32 74 46 29—Diseases ill-defined or unknown 5 ... 1 ... 1 2 1 ... 2 1 1 ... 1 ... ... ... ... ... 1994 323 96 89 66 91 255 480 594 149 151 374 170 262 414 117 333 173 Sub- Entries included in above figures. 14 (a) Cerebro spinal Meningitis 11 1 3 1 1 2 ... ... 9 ... 2 1 3 4 ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (a) Poliomyelltis ... ... ... ... ... ... (a) All “Transferable Deaths” of residents, i.e., of persons resident in the District who have died outside it, are included with the other deaths in columns 2—10, and columns 12-19. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. For the precise meaning of the term “transferable deaths” see footnote to Table IX (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, are entered in column 11 of Table VI. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as “Certi- fied," all other deaths are regarded as “Uncertified.” (d) Exclusive of “Tuberculous Meningitis” (10). but inclusive of Cerebro-Spinal Meningitis Deaths of soldiers and sailors occurring in hospitals and institutions in the district are excluded from the total number of deaths registered in the district, and such deaths in like manner are excluded from column 11. DEATHS. —During 1917 1,251 deaths of civilians were registered in the borough, but of these 139 were of persons not belonging to Fulham, while 882 inhabitants of Fulham died outside the borough, chiefly in various public institutions. There were, therefore, including 19 deaths among Belgian Refugees, 1,994 deaths of persons, 998 males and 996 females, having their usual residence in Fulham, representing a death-rate of 13˙7 per 1,000 of the estimated civilian population, which is 0˙2 above the average rate of the preceding five years. The death-rate of the County of London was 150 per 1,000, and in the Metropolitan boroughs the rates ranged from 10˙6 in Woolwich to 22˙5 in Shoreditch. Excess OF BIRTHS OVER DEATHS. —The natural increase of the population by the excess of births over deaths was 977, compared with 2,022, 1,536 and 1,772 in the preceding three years. Seasonal Mortality.—The mortality in the four quarters of the year was as under: — Deaths. Death-rate. First quarter 713 19.6 Second quarter 504 13.9 Third quarter 367 10.1 Fourth quarter 410 11.3 DISTRIBUTION OF DEATHS.— The death rates in the several wards, calculated on the assumption that the ratio of the estimated civilian population to the census population was the same in each ward as in the whole borough, were as under :- TABLE III. Average Death-rate 1912 - 16. Death-rate 1917. Average Death-rate 1912 - 16. Death-rate 1917. Ward. Ward. Munster Barons Court 12.9 11.7 11.8 12.2 Hurlingham Lillie 14.6 16.6 13.0 11.7 Walham 14.3 17.2 Sands End 13.4 13.1 Margravine. 15.3 15.3 13.8 Town 12.5 INFANTILE MORTALITY. —Of the 1,994 deaths, 323 or 16˙2 percent, were of children under one year of age, and the rate of infant mortality measured by the pro-portion of deaths under one year to births registered was 109 per 1,000. This is 21 per 1,000 above that of 1916, which was the lowest recorded in Fulham. The infantile death-rate of the County of London in 1917 was 103 per 1,000, and in the metropolitan boroughs the rates ranged from 75 in Lambeth to 158 in Shoreditch. TABLE IV. The infantile death-rates of the several wards were as under:— Ward. Deaths under one year per 1,000 births. Average of 5 1917. years 1912 - 16. Ward. Deaths under one year per 1,000 births. Average of 5 1917. years 1912 - 16. Barons Court 95 105 Munster 98 101 Lillie 148 106 Hurlingham 54 75 Sands End Walham 100 123 113 112 Town Margravine 123 115 85 68 CAUSES OF INFANTILE MORTALITY.— Table V gives the causes of the deaths at various periods under one year of age, and in the following table the mortality from certain groups of diseases will be found: — TABLE VI. Death-rates of InfantS under one year of age from certain groups of diseases. Diseases. Deaths per 1,000 births. 1917. Average of 5 years 1912 - 16. Infectious Diseases 11.5 8.7 Tuberculous Diseases 2.7 5.5 Diarrhœal Diseases 20.9 19.5 Respiratory Diseases 22.9 20.1 Premature Birth, Congenital Defects and Debility 31.0 34.6 Other Causes 17.2 15.4 109.0 101.0 TABLE V. INFANT MORTALITY DURING THE YEAR 1917. Nett Deaths from stated causes at various Ages under One Year of Age. Nett Deaths under One Year of residents in the Wards of the Borough whether occurring in or beyond the Wards. CAUSE OF DEATH. Under 1 Week. 1 - 2 Weeks. 2 - 3 Weeks. 3 - 4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Month and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Barons Court Ward. Lillie Word. Walham Ward. Margravine Ward. Munster Ward Hurlingham Ward. Sands End Ward. Town Ward. 66 15 9 8 98 61 53 42 69 323 17 68 45 76 7 20 Certified 24 66 All causes Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... 5 19 26 6 3 2 6 1 6 1 Measles ... ... ... ... ... 2 1 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 1 1 1 2 5 2 ... 2 ... 1 ... ... ... ... ... Diphtheria and Croup ... ... ... 1 ... 1 2 ... 1 1 ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... 2 ... 3 3 8 1 3 2 1 ... 1 ... ... ... Abdominal Tuberculosis (a) ... ... 3 ... ... 3 ... ... ... 1 1 ... 1 ... ... ... ... 1 1 1 1 5 2 ... Other Tuberculous Diseases 1 ... 1 ... ... 1 ... ... 1 ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis ... ... ... ... ... 2 1 3 1 ... 1 1 ... ... ... ... ... ... Convulsions 1 ... 1 2 9 ... 1 2 4 ... ... 1 2 3 1 1 ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 1 1 8 3 3 15 ... 4 ... 5 1 2 3 ... ... ... ... ... Pneumonia (all forms) 3 3 10 17 7 2 7 12 3 10 2 1 1 ... 5 12 47 4 Diarrhœa ... 1 1 4 7 ... ... 12 ... 3 3 2 1 3 ... ... ... ... Enteritis 2 1 ... 1 4 16 15 8 8 51 1 14 7 4 12 1 10 2 Gastritis 1 2 ... 1 1 ... 1 1 1 1 1 5 ... 1 ... ... ... ... Syphilis ... 1 ... 1 6 ... ... 7 1 4 1 ... 1 ... ... ... ... ... ... ... 1 1 ... 2 1 ... 1 ... Rickets ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... 1 ... ... 2 3 ... 1 ... 1 ... 1 ... ... ... ... Injury at Birth 8 ... ... 8 ... ... ... 8 ... 1 1 3 1 1 1 ... ... ... Atelectasis 6 ... ... 6 ... ... ... 6 ... 4 ... 1 ... ... 1 ... ... ... CongenitalMalformations(c) 5 1 8 1 2 4 3 2 ... 2 ... ... 2 12 1 ... ... 1 Premature Birth 33 4 4 3 44 3 ... ... ... 47 ... 8 4 16 1 10 4 4 Atrophy, Debility and Marasmus 6 4 4 15 10 4 2 2 2 5 8 ... 8 1 5 2 3 33 Other causes 2 ... ... ... 2 1 2 1 6 12 1 2 ... 2 4 ... 3 1 66 15 9 8 98 61 53 42 69 323 17 68 24 45 76 7 66 20 Nett Births in the year—Legitimate, 2,747 ; Illegitimate, 224. Nett Deaths in the year of—Legitimate infants, 268; Illegitimate infants, 55. (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. Want of Breast Milk is included under Atrophy and Debility. DEATHS OF ILLEGITIMATE INFANTS.- Of the 323 infants who died before attaining the age of one year 55 or 17 percent, were illegitimate, the mortality among them being in the proportion of 246 deaths per 1,000 births against 98 per 1,000 among children born in wedlock. PREVENTION OF INFANT MORTALITY. — Notification OF BIRTHS. — 2,633 notifications of living and 67 of still- of Born, children were received under the Notification of Births Act, 92 per cent, of the births registered in Fulham being notified. Of these 70 per cent, were notified by midwives, 27.5 per cent, by medical practitioners and 25 per cent, by relatives. 2.442 babies were visited by your Health Visitors, who paid 4,419 visits, and in addition 3,010 visits were paid by the Superintendent and the nurses of the Fulham Maternity and Child Welfare Centre. 664 babies were brought to the consultations held at 92, Greyhound Road, 170, Wandsworth Bridge Road and Melmoth Hall, Eustace Road, by the doctors attached to the Welfare Centres. Sickness From Notifiable Infectious Diseases. Scarlet Fever. — 234 cases were notified, being fewer than in any year since 1891, and there were 4 deaths. Diphtheria.— 237 cases were notified, with 16 deaths, against 312 with 20 deaths in 1915. ' Enteric Fever. — Eleven cases were notified, with two deaths. Puerperal Fever. — Fifteen cases were notified, and there were four deaths, or 1˙3 per 1,000 births. ERYSIPELAS. — There were 50 cases of erysipelas, with two deaths. Cerebro - Spinal Meningitis.— Twenty cases were notified, against 17 and 12 in the two preceding years, and there were eleven deaths. TABLE VII. Cases of Infectious Diseases notified during the Year 1917 Notifiable Disease. Number Of Cases Notified. Total Cases Notified in each Ward of the Borough. Total cases removed to Hospital. At all Ages. At Ages—Years. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards Small-pox - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 237 88 21 5 - 10 20 55 8 233 110 13 41 37 8 58 - 10 2 20 3 Erysipelas 50 3 2 5 7 16 12 5 1 3 2 9 - Scarlet Fever 234 63 136 23 11 1 - 11 41 17 24 42 17 74 8 221 - - Typhus Fever - - - - - - - - - - - - - - - - 1 - 3 - Enteric Fever 11 - 2 3 5 1 2 2 2 1 11 - - - - — Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - 3 12 Puerperal Fever 15 - - - 4 10 1 - - 4 1 5 2 - - 20 5 7 3 3 2 - - 1 3 2 4 5 1 4 - 16 Cerebro-spinal Meningitis 5 1 4 - - - - - 1 - 4 Poliomyelitis - - 4 - - - 17 4 9 Ophthalmia Neonatorum 57 57 - - - - 4 5 6 8 1 12 - 67 Pulmonary Tuberculosis 582 3 17 145 115 224 67 11 29 90 51 88 142 34 96 52 - Other forms of Tuberculosis 118 10 52 18 13 2 3 10 15 11 17 32 3 20 10 - 10 Measles 82 809 1009 80 - - 2021 38 3 104 360 136 216 518 96 415 176 German Measles 361 8 52 144 90 61 6 - 96 36 17 29 92 24 25 42 - 267 930 188 717 306 Totals 3711 175 1063 1607 362 393 92 19 612 263 428 506 Poliomyelitis.— Five cases were reported, but in one the diagnosis was not confirmed. All recovered with slight paresis. Ophthalmia Neonatorum. Fifty-seven babies were notified as suffering from ophthalmia, 18 being reported by midwives, and the remainder by doctors. Seven cases were removed to hospital. With one exception all recovered with unimpaired sight. Measles was epidemic throughout the borough during the first half of the year, and 2,021 cases were notified, of which 1,967 occurred between January and July. Of these, 1,889 were reported by doctors, and 121 by relatives. Fatality. Seventy-five deaths were ascribed to measles, giving a case mortality of 3˙7 per cent. Provision of Nursing for Measles. — In March the Borough Council made arrangements with the Fulham and Hammersmith District Nursing Association for the services of nurses in cases reported to them by the Medical Officer of Health as requiring nursing assistance. German Measles. — 361 cases of German Measles were notified, which was most prevalent in Baron's Court Ward. No death was attributed to the disease. Tuberculosis. — The notifications received during the year numbered 1,483, viz.:— Under Form A.—Cases not previously notified 912 „ B.-By School Medical Officers 98 „ „ C.-Cases admitted to Sanatoria and Poor Law Institutions 252 „ „ D. —Cases discharged from Sanatoria and Poor Law Institutions 221 Of the above 700 were notifications of new cases, 582 being of pulmonary and 118 of other forms of tuberculosis. The following table gives the age and sex distribution of the cases :— TABLE VIII. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of notifications during the period from 31st December, 1916, to 29th December , 1917. Age periods. Number of Notifications on Form B. (by School Medical Officers) Number of Notifications on Form C. of admission to Number of Notifications on Form A. Primary Notifications. Primary Notifications. Poor Law Institutions. 65 and upwards Total. Total Notifications on Form A Total Notifications on Form B Sanatoria. 1 to 5 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 5 to 10 10 to 15 5 to 10 under 5 0 to 1 Total. Pulmonary. Males 1 8 33 18 18 29 66 68 31 13 284 430 14 4 19 35 35 67 7 1 Females 2 7 27 28 24 44 62 36 14 9 4 257 367 1 17 4 22 40 47 68 Non-pulmonary. Males - 8 9 18 2 7 2 6 2 - - 3 57 61 - 4 4 13 9 3 Females 4 1 - - 4 10 13 12 7 2 1 1 54 54 - 3 3 10 19 4 Mortality from Tuberculosis. - I9I deaths (99 of males and 92 of females) were registered from pulmonary tuberculosis, representing a death-rate of 1˙32 per 1,000, the average of the preceding five years being I˙33. To other tuberculous diseases 49 deaths were due, the mortality being at the rate of 0˙34 per 1,000. Prevention and Treatment of Tuberculosis. Fulham Tuberculosis Dispensary. —The following table gives a summary of the work of the Dispensar— New Patients. 1. Suffering from pulmonary tuberculosis 286 2. „ „ other forms „ 13 3. suspected cases „ 349 4. non-tuberculous 329 Total 977 Total Cases notified during 1917 (including 32 cases admitted during previous years) 331 Number of Patients Treated (old and new). - 1. Insured 471 2. Uninsured 1,317 Total 1,788 Number of Attendances at Dispensary. 1. Insured 1,052 2. Uninsured 6,528 Total 7,580 Doctor's home visits 1,141 Nurses' „ 2,789 Persons specially examined as Contacts 492 Number of these found tuberculous 21 Contacts who became patients during the year 197 Insured patients examined for purposes (sanatorium treatment, etc.) of London Insurance Committee 112 Uninsured patients recommended for sanatorium treatment to London County Council 61 Patients sent to Infirmary 45 Referred to Invalid Children's Aid Association 29 „ „ Charity Organization Committee 27 „ „ Children's Country Holidays Fund 47 Patients who had Tuberculin treatment 351 General Sanitary Administration. Disinfection. —25,302 articles of bedding, clothing, &c., were disinfected at the Council's Disinfecting Station. 2,II6 rooms were disinfected and cleansed after infectious illness. Bacteriological Examinations. — The following bacteriological examinations were made on behalf of Dr. Burnet. Number of Specimens. 46 True Diphtheria bacillus isolated Hoffmann or Pseudo Diphtheria bacillus isolated 2 Negative result 220 268 Blood from cases of suspected Enteric Fever. Widal or Typhoid reaction obtained 6 Widal or Typhoid reaction not obtained 5 11 Sputa from cases of suspected Tuberculosis. Tubercle bacillus found 79 „ „ not found 342 11 -7 420 Other Examinations 11 710 Total Public Mortuary.—2l8 bodies were removed to the mortuary during the year. Food Supply.— The dairies, slaughterhouses, bakehouses, restaurants, &c, were kept under observation by your Inspectors and a large amount of work was carried out by them in connection with the numerous Orders of the Food Controller, the duty of seeing that these were observed being imposed on them. Unsound Food. —Proceedings under the Public Health (London) Act were instituted in the following cases: — Defendant. Offence. Result. Penalty. Costs H. Humphries, 32, Braithwaite Rd, Exposing unsound fish for sale. Convicted. 0 10 6 2 0 0 Depositing unsound fish for the purpose of sale Convicted. 2 0 0 C. White, 0 10 6 The following articles examined at the request of the owners were condemned and destroyed: — Mutton 30 lb. Kippers 6 boxes. Fish 3 bags. 2 cases. Mussels Fish 3½ stones. Winkles 2 baskets. Fish I sack. Apples 8 bushels. 7 bags. Dates 1 Case. Greens Action under the Sale of Food and Drugs Acts. The undermentioned samples were purchased for analysis in 1917: — Article. Number of Samples. Percentage of Adulteration. Number Adulterated. Milk 562 80 14˙3 Separated Milk 4 ... 0˙0 Dried Milk 1 ... 0˙0 Condensed Milk 1 1 100˙0 Cream 4 100˙0 4 Butter 6˙0 215 13 Margarine 1 0˙0 ... Cheese 10 ... 0˙0 Cream Cheese 2 2 100˙0 Lard 33 I 33˙3 Coffee 28 ... 0˙0 Cocoa 75 7 9.5 Sausages 6 1 16.7 Flour 9 ... 0˙0 Self-raising Flour 9 ... 0˙0 Baking Powder 5 ... 0˙0 Cayenne Pepper 10 ... 0˙0 White Pepper 9 0˙0 ... Mustard 9 ... 0˙0 Preserved Peas 3 2 66˙6 Tinned Beans 1 1 100˙0 Olive Oil 1 ... 0˙0 Ice Cream Powder 1 ... 0˙0 Camphorated Oil 1 0˙0 ... Tartaric Acid 1 ... 0˙0 Syrup 1 0˙0 ... 1,002 112 11˙2 There was a marked increase in the adulteration of milk, the samples certified during the last five years to be below the standard of the Board of Agriculture being as under : — 1913 4˙9 per cent. 5˙7 „ 1914 1 9 1 5 3˙4 „ 1916 9˙6 „ 1917 14˙3 „ Proceedings under the Sale of Food and Drugs Acts, were instituted in the following cases : — Defendant. Offence. Result. Penalty, £ s. d. £ W. Cooper, 14, Ewald Road Selling milk adulterated with 7 per cent. of added water. Dismissed (Warranty proved) - Convicted. H. Maynard, 54, Mablethorpe Road Selling milk 20 per cent, deficient in fat. 10 0 W. Williams, 114, Lillie Road Selling margarine for butter. Convicted. 6 0 0 Ditto Ditto Convicted. 6 0 0 E. Morgan Selling milk 6 per cent, deficient in fat Dismissed (Warranty proved) - Convicted. T. Setchfield, 134. Estcourt Road Selling milk 57 per cent, deficient in fat. 3 0 0 1 Selling butter adulterated with 95 per cent, of margarine. C. Lockington, 6, Hazlebury Road Convicted. 1 0 0 Selling milk adulterated with 7 per cent, of added water. Convicted. 2 0 0 W. Winter, 7, Delvino Road Ditto Selling milk adulterated with 33 per cent, of added water. Convicted. 2 0 0 W. Langham, 117, Stephendale Road Selling milk adulterated with 12 per cent, of added water. Convicted. 10 6 Selling milk adulterated with 26 per cent, of added water. Convicted. 1 0 0 H. Barrett, 8, Hogarth Place Selling milk 26 per cent, deficient in fat. Convicted. 2 0 0 E. Jones, 24, Filmer Road A. Floyd, 6, Charleville Road Selling milk 10 per cent, deficient in fat. Convicted. 2 0 0 Defendant. Offence. Result. Penalty. £ s. d. £ Ditto Selling milk containing 42 grains of boric acid to the gallon. Selling milk 10 percent, de-cient in fat. Convicted, 10 0 0 2 2 0 Ditto Convicted. 0 2 0 1 J. Ely. 11.Rylston Road Selling milk 67 per cent, deficient in fat. Convicted. 0 Selling milk 4 per cent, deficient in fat. Dismissed (Warranty proved) Dismissed (Warranty proved) - T. Davies, 2, Everington Street W. Wattam, 24, Phoenix Place, Notting Hill Selling milk 5 per cent, deficient in fat. - No penalty Selling milk 9 per cent, deficient in fat. - 2 D. Cairs, 142, New King's Road - Selling milk adulterated with 8 per cent, of added water. Dismissed (Warranty proved) Dismissed (Warranty proved) Dismissed (Warranty proved) Convicted. J. Hickman, 309, Fulham Palace Road Selling milk 5 per cent, deficient in fat. - F. Lake, 101, Bishop's Road Selling milk 7 per cent, deficient in fat. - H. Denew, 358, North End Road 7 Selling milk 13 per cent, deficient in fat. 0 0 H. Moss, 11, Jervis Road 3 1 West London Dairy Co. 1, Spring St., Paddington Selling milk adulterated with 5 per cent, of added water Convicted. 0 0 2 Selling cream containing 15.4 grains of boric acid to the pound. Convicted 0 0 J. Walters, 797, Fulham Road £52 6 £11 0 The following prosecutions were instituted under the Public Health (Milk and Cream) Regulations, 1912 :— Defendant. Offence. Result. Penalty. £ d. s. £ J, Walters, 797, Fulham Road Selling preserved cream in a receptacle not properly labelled. Convicted, 1 0 0 Ditto Depositing preserved cream in a receptacle not properly labelled. Convicted 1 0 0 Selling preserved cream in a receptacle not properly labelled. West London Dairy Co., 6, Spring St., Paddington Convicted. 5 0 0 1 J. Hickman, 245, Munster Road Ditto Convicted 2 0 0 1 L. Duncan, 72, North End Road Ditto Convicted. 2 0 0 1 £11 0 0 £3 Factories, Workshops and Workplaces have been frequently inspected. Many have undertaken Govern- ment work, which has necessitated considerable additions and alterations. Certificates under the Revenue Acts. — Certi- ficates for exemption from or reduction of ' inhabited house duty were granted in respect of 135 tenements, and 193 certificates which had been granted for a limited period were renewed. Drainage of Buildings.— During the year the following drainage plans were submitted to and approved by the Public Health Committee :- Plans of drainage of additions to existing buildings 40 Plans of the reconstruction of the drainage of existing buildings 27 67 Combined Drainage.— One system of combined drainage, for the maintenance of which the Council were liable, was reconstructed, at a cost of £19. 15s. 6d. General Sanitary Work. —1,811 complaints of nuisances were received and dealt with by your Inspectors. 1,145 intimation and 278 statutory notices were served. Owing to the great difficulty experienced in getting work done, in consequence of the scarcity of labour and materials, the attention of the Inspectors has been mainly confined to securing the abatement of the more acute nuisances, and works of a less urgent nature have been postponed till more normal times. Sanitary Staff. —Two of your Sanitary Inspectors, Mr. F. Manning and Mr. M. Canton, are still serving with His Majesty's Forces in France. Mr. A. Carter, who had been acting as temporary Sanitary Inspector since October, 1914, resigned in March, and Mr. T. Yorke was appointed in his place. Mr. Yorke resigned in September, and his place was filled by Mr. Edgar Drake. To all the members of the staff of the Depart- ment I have to tender my heartiest thanks for the faithful assistance they have at all times given me. I am, Sir and Gentlemen, Your obedient Servant, J. CHARLES JACKSON, Medical Officer of Health. August, 1918.