AC 4346 M Ful 29 Metropolitan Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health for the Year 1935. Metropolitan Borough of Fulham. ANNUAL REPORT of the Medical Officer of Health for the Year 1935. JOHN ALEXANDER SCOTT, M.D., M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. t. w. PEGG & SONS, Ltd, Printers (t.u.) EFFIE ROAD. WALHAM GREEN. LONDON. S.W 6, 3 Public Health Department, Town Hall, FULHAM, S.W.6. July, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health and sanitary conditions of the Borough for the year 1935. The year has been a reasonably healthy one with no outstanding conditions affecting the health and well-being of the population. The death rate shows a diminution from 12.7 to 11.7, the decrease being mainly due to the non-occurrence of the bi-ennial measles epidemic. The Infant Mortality rate, possibly owing to the absence of the same factor, has also shown a satisfactory drop from 59 to 51. Whilst no Ministry of Health Housing Enquiries have been held, the Department has been active in house-to-house inspections and in the Survey of the district with a view to the future demolition of insanitary property. In particular, the survey of all the working-class houses in the district to determine the extent of overcrowding in accordance with the provisions of the Housing Act, 1935, has led to the accumulation of valuable information which will help in the determination of future needs. Staff Changes. Dr. J. Sullivan, who had been Tuberculosis Officer since November, 1912, and Medical Officer of Health since June, 1926, resigned his appointment in July, 1935, after 23 years of devoted service, on the grounds of ill-health. The Council appointed an additional Housing Inspector in February, 1935, bringing the number of Housing Inspectors to three. In order to facilitate the work of the Sanitary Inspectors two additional Junior Clerks were appointed during the year. The growth of the Maternity and Child Welfare Department's work also led to the appointment of an additional Maternity and Child Welfare Clerk in March, 1935. I regret to record the death of Mr. S. Webb, the driver of the Disinfecting Van, in December, 1935. The report this year contains an unusually large number of tables and will furnish correspondingly hard reading. No more concise method of presenting the facts bearing on the health and well-being of the inhabitants of the Borough is, however, available. I have much pleasure in being able to record at the end of such a short period my appreciation of the efficient work of an enthusiastic staff. I am, Mr. Mayor, Ladies and Gentlemen, Yours faithfully, J. A. SCOTT. Medical Officer of Health. 4 Fulham Borough Council. PUBLIC HEALTH COMMITTEE, 1935-36. His Worship the Mayor (Councillor S. Vanderhook, M.R.S.T., J.P.) Ex-Officio. Chairman: Councillor Miss A. Gilliatt. Vice-Chairman: Councillor J. H. Ward. Alderman R. M. Gentry, J.P. Councillor T. Harper. Councillor S. F. J. Ballantyne. „ Mrs. E. E. Hollingbery. „ R. A. Bender. „ Mrs. F. Laski. „ Dr. T. J. Bokenham. „ Mrs. J. Marsh. „ P. E. Coleman. „ Mrs. E. M. Rankin. „ L. F. Dew. „ H. Dodimead. Councillor Miss C. J. Sketchley. MATERNITY AND CHILD WELFARE COMMITTEE, 1935-36. His Worship the Mayor (Councillor S. Vanderhook, M.R.S.T., J.P.) Ex-Officio. Chairman: Councillor Mrs. J. Marsh. Vice-Chairman: Councillor Mrs. E. M. Rankin. Councillor H. Dodimead. Councillor Miss C. J. Sketchley. „ Mrs. E. E. Hollingbery. „ G. A. Thesiger. „ Mrs. F. Laski. * Miss S. Baber. „ Mrs. N. M. Phillips. * Mrs. R. M. French. „ Miss K. I. Pottle. * Mrs. E. M. Rae. „ W. Rankin. * Mrs. E. N. Vanderhook. * Miss C. M. L. Wickham. * Co-opted Members. 5 STAFF. Medical Officer of Health : *John Sullivan, M.B., Ch.B. (Edin.), D.P.H. (Lond.). (Resigned. 10th July, 1935.) *John Alexander Scott, M.D., M.R.C.S., L.R.C.P., D.P.H. (Liverpool). (Appointed 1st October, 1935.) Deputy Medical Officer of Health. *P. L. T. Bennett, M.C., M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.), T.D.D. (Wales). (Clinical Tuberculosis Officer and Medical Officer Borough Bacteriological Laboratory). Assistant Medical Officers of Health: *Ruby Thomson, M.B., Ch.B. (Edin.), D.P.H. (Edin. and Glas.), (Senior Medical Officer for Maternity and Child Welfare). *Helena E. Barrett, B.A., M.B., Ch.B., B.A.O. (N.U.I.). D.P.H. (Edin. and Glas.) Consulting Obstetrician: Alex. Galletly, M.C., M.B., Ch.B. (Edin.), F.R.C.S.E. Medical Officer, Diphtheria Immunisation Clinic: Guy W. J. Bousfield, M.D., (Lond.), M.B., B.S. (part-time). Public Vaccinators: North District: A. G. Wells, M.R.C.S. (Eng.), L.R.C.P. (Lond.), L.S.A. (part-time). South District: T. Duff Miller, M.D. (Glas.), Ch.B. (Glas.), F.R.F.P.S. (part-time). Dental Surgeon: *W. E. Dodd, L.D.S. (part-time). Public Analyst: Thomas McLachlan, A.C.G.F.C., F.I.C. (part-time). Vaccination Officer: Hugh Davies. Clerical Staff: A. T. Hurford, Chief Clerk. O. A. Trendell, D.P.A. (Lond.). E. Thompson. W. Swinson. A. E. R. Scott. L. Burrows. E. J. Sharp (Appointed 28th January, 1935). S. Firsht (Appointed 22nd July, 1935). 1 temporary shorthand-typist. 6 Maternity and. Child Welfare: *Miss A. Drury. *Miss E. G. Goodrum. *Miss I. M. Buckingham *Miss R. Barter (Appointed 25th March, 1935). Senior Sanitary Inspector: 1 *Albert E. Clutterbuck. Sanitary Inspectors: 1 *Edgar Drake. 12 *Frederick C. Payne. 12 *Thomas Henry Robey. 12 *Wilfred C. Turner. 12 *Alex. W. Gammack 1210 *Charles J. Price. (Sampling Officer). 1239 *Joseph H. R. Crabtree 12 *Frederick E. Walsh. 12 *L. G. Brooks (Appointed 12 *Arthur S. Jones. 25th February, 1935). 12 *Henry Hutchinson. 1456 * Mis Ellen H. Sexton. Health Visitors: 456 * Mrs. J. Bryning. 45678 *Miss E. V. Thomas 4568 *Miss E. Beckett. 4568 *Miss. N. Milburn 4567 *Miss. D. M. Hayward. 146 *Miss A. Perrett 456 *Miss G. Leach. (Infant Life Protection Visitor). 468 *Miss P. Kaye. Tuberculosis Dispensary Staff: Nurses: 4 *Miss E. E. Walker. 456 *Miss. E. C. Carmichael. 456 *Miss E. M. Pretty. *Miss M. C. Robinson, Bacteriological Assistant and Dispenser. *Miss M. E. Sargent, Clerk and Secretary of the Care Committee. *Miss W. Wright, Clerk (part-time). (Resigned 4th May, 1935). *Miss Grimstone, „ „ „ (Appointed 4th May, 1935.) *Mr. and Mrs. Roberts, Caretakers. Maternity Home: Matron: 46 *Miss M. Bustard. Assistant Matron: 46 *Miss M. Denman. 7 Disinfecting Station: Superintendent: A. V. Williams. Disinfectors: E. J. Eyles, W. Leaton, T. G. Martin. Van Driver: S. Webb. (Died 18th December, 1935). Mortuary Keeper: S. Churchill. Rat Officer: J. Gigner. Housekeepers Infant Welfare Centres: Greyhound Road: *Mrs. B. Gregory. Wandsworth Bridge Road: *Mrs. M. B. Sexton. *The Council receives Exchequer grants towards the salaries of these Officers. 1 Certified Sanitary Inspector. 6 Certificate of Central Midwives Board 2 Food Inspector's Certificate. 7 Fever Trained. 3 Registered Plumber. 8 Queen's Nurse. 4 Trained Nurse. 9 Member of Royal Sanitary Institute. 5 Health Visitor's Certificate. 10 Associate Member of Institute of Sanitary Engineers. Section I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 10 GENERAL STATISTICS. Area (Acres) 1,706 Population (Census 1931) 150,928 Population (mid 1935) 143,600 Number of inhabited houses (Census 1931) 26,245 Rateable Value at 31st December, 1935 £1,169,222 Sum represented by a penny rate £4,656 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. LIVE BIRTHS:— Total. Males. Females. Legitimate 1,886 982 904 Birth rate per 1,000 of the estimated population, 13.8 Illegitimate 103 49 54 STILLBIRTHS:— Legitimate 58 34 24 Rate per 1,000 total (live and stillbirths) births, 31.6 Illegitimate 7 4 3 DEATHS:— 1,662 829 833 Death rate per 1,000 of the estimated population, crude rate 11.6 adjusted rate 11.7 Percentage of deaths occurring in Public Institutions 56.5 Deaths. Rate per 1,000 total (live and stillbirths) births. Deaths from disease and accidents of pregnancy and childbirth From sepsis 3 1.46 From other causes 3 1.46 Total 6 2.92 Death rate of Infants under One Year of Age:— All infants per 1,000 live births 51 Legitimate infants per 1,000 live births 48 Illegitimate infants per 1,000 illegitimate live births 87 Deaths from:— Measles (all ages) - Whooping Cough (all ages) 5 Diarrhœa (under 2 years of age) 19 11 SOCIAL CONDITIONS. UNEMPLOYMENT. The Manager of the local Employment Exchange has kindly supplied me with the following particulars relating to the number of persons registered as unemployed:— October, 1935. January, 1936. Adult males 2,386 2,718 Adult females 555 920 Juvenile males 34 55 Juvenile females 25 86 LOCAL INDUSTRIES. The main local industries are the borough electrical power station, the gas works, a distillery, a sugar refinery, printing works, oil and petrol depots, transport and other distributive trades. The following table shows the various occupations of the inhabitants of the borough at the 1931 Census:— TABLE 1. Males. Occupation. Females. 70,476 Total Population. 80,452 2 I. Fishermen 215 II. Agricultural Occupations 2 13 III. Mining and Quarrying — 82 IV. Workers in treatment of Non-Metalliferous Mine and Quarry Products - 80 V. Makers of Bricks, Pottery and Glass 12 90 VI. Workers in Chemical Processes; Makers of Paint, etc. 4 4,024 VII. Metal Workers 190 103 VIII. Workers in Precious Metals and Electro-plate 9 1,292 IX. Electrical Apparatus Makers and Fitters and Electricians 250 110 X. Makers of Watches, Clocks and Scientific Instruments 2 100 XI. Workers in Skins, Leather and Makers of Leather Goods 68 36 XII. Textile Workers 34 739 XIII. Makers of Textile Goods and Articles of Dress 2,654 827 XIV. Makers of Food, Drinks and Tobacco 455 2,270 XV. Workers in Wood and Furniture 151 118 XVI. Makers of and Workers in Paper and Cardboard, etc. 251 659 XVII. Printers and Photographers 169 2,651 XVIII. Builders, Bricklayers; Contractors 4 2,174 XIX. Painters and Decorators 35 59 XX. Workers in other Materials 36 343 XXI. Workers in Mixed or Undefined Materials 76 8,501 XXII. Transport and Communications 457 7,658 XXIII. Commercial, Finance and Insurance (Not Clerks) 3,360 779 XXIV. Public Administration and Defence (Not Professional Men, Clerks and Typists) 22 1,497 XXV. Professional Occupations (Not Clerks) 1,489 762 XXVI. Entertainment and Sport 272 3,380 XXVII. Personal Service (Clubs, Hotels, etc.) 10,303 5,103 XXVIII. Clerks, Draughtsmen and Typists 5,232 1,199 XXIX. Warehousemen, Storekeepers and Packers 919 494 XXX. Stationary Engine Drivers, Dynamo and Motor Attendants 3 5,812 XXXI. Other and Undefined Workers 1,049 4,566 XXXII. Retired or not gainfully occupied 38,478 51,172 Total occupied, I-XXXI 27,508 12 COMMENTS ON THE VITAL STATISTICS. POPULATION. The Census taken during 1931 showed that the population of the borough was 150,928 but the Registrar-General's estimate of the population for the year 1935 was 143,600. This latter figure has been used for the compilation of the various rates mentioned in this report. The natural increase of the population (excess of births over deaths) varies from 200—300 each year so that the drop of apparently 7,000 in the population since the Census of 1931 is due to migration to the outer belt of London. Within limits this tendency is desirable and there is no doubt that Fulham's 1,700 acres will always be fully inhabited. It will be remembered that despite higher estimates in intervening years the actual Census enumeration of 1931 and 1921 showed a decline of 7,000 in the population during the ten years. There are still eighty-eight persons per acre in Fulham, only nine of the twenty-eight other London boroughs having a higher density. The natural increase in 1935 was 327 compared with 164 during 1934. MARRIAGES. The number of marriages during 1935 was 1,479 and the marriage rate (the number of marriages per 1,000 of the population) was 10.29. In the previous year the number of marriages was 1,336 and the rate was 9.39. BIRTHS. During the year the live births, corrected by the distribution of those occurring in lying-in institutions in the borough to those districts in which the mothers resided, and the inclusion of children born to Fulham mothers in institutions outside the borough, numbered 1,989, of whom 1,031 were males and 958 were females. The birth rate (the number of live births per 1,000 of the population) was 13.8, an increase of 0.1 compared with 1934. The birth rate for the whole of London was 13.3 and for England and Wales 14.7. STILLBIRTHS. The number of stillbirths during 1935 was 65 compared with 57 during the previous year. The stillbirths amounted to 31.6 per 1,000 of the total births (live and stillbirths). The corresponding rate for England and Wales was 32.17. On the basis of stillbirths per 1,000 of the population the local rate is 0.45 as against 0.62 nationally and 0.52 in the administrative county. ILLEGITIMACY. The illegitimate live births numbered 103 (49 males and 54 females) during 1935 compared with 110 for the previous year, and constituted 5.2 per cent, of the total live births. DEATHS. During the year ended December 31st, 1935, 1,353 deaths were registered as having occurred in the borough. Of these 129 were of persons not belonging to the borough while 438 inhabitants of Fulham died outside the borough, chiefly in public institutions. There were, therefore, 1,662 deaths of persons, 829 males and 833 females, having their usual residence in Fulham, representing an annual crude death rate of 11.6 per 1,000 of the population. This rate is 1.0 below that of the previous year and 1.4 above that of 1933. The death rate for England and Wales was 11.7 and for London 11.4. 13 According to the Registrar-General's summary of the deaths belonging to the borough there were 1,665, 3 more than calculated locally. Careful search has failed to show that the local figures are wrong and accordingly they have been used in compiling the various rates in this report. In any case a difference in total of 3 deaths only varies the death rate by 0.02 per 1,000 of the population. The Registrar-General supplies what is known as "a Comparability Factor" (based on the 1931 Census) for adjusting the local death rate so as to make it really comparable with the national crude rate or with rates of other districts which have been similarly adjusted. This factor takes into account variations in population both as regards sex and age-groups and enables more accurate comparisons to be made than is possible when using crude rates. The factor for Fulham is 1.01, and the adjusted death rate is, therefore, 11.7. Certain inferences from the birth rate and death rate tendencies year by year are of importance and are true locally as well as generally. The birth rate has shown a steady decline year by year for the last 50 years and has now probably reached its nadir. Thus the local rate in 1922 was 20.3; in 1925, 16.9; in 1928, 15.4. and in 1931, 15.08. The death rate of recent years on the other hand, remains reasonably stable and for the years quoted in the last sentence was 12.1, 10.7, 11.5, and 13.3. The highest incidence of mortality is in the first quinquennium of life and in old age. It will be obvious, therefore, that with a diminishing birth rate and a stationary death rate the proportions of the population in each age-group are changing each year in the direction of a relative preponderance of the old and a relative diminution of the young. This is well illustrated by the Census figures for London for the years 1921 and 1931. In these 10 years the number of children under 5 in the County area decreased by nearly 79,000, and the children between 5 and 10 by 72,000, whilst the number of persons over 10 increased by 64,000. In 1881, 24 per cent. of the population of London consisted of children under the age of 10 years; in 1921 the proportion was 17.3 per cent., and in 1931 it had dropped to 14.2 per cent.; from one quarter to one seventh in 50 years. These figures are the more striking when it is realised that during this period the infant mortality rate had been more than halved and the death rate of children under 5, proportionately reduced. Thus, in due time, should there be no change in the present conditions affecting health, the death rate will rise because there will be more of the existing population in the older groups in which death is a natural event. Should present tendencies continue it is estimated that the population of the country will become stationary by 1940 and subsequently begin to decline. These facts have obvious and wide implications apart from their bearing on the vital statistics of the community. Nothing further need be said here beyond recording the estimate that for the maintenance of the population at its present level, a birth rate of 19—20 per 1,000 is needed. CERTIFICATION OF CAUSES OF DEATH. Of the 1,662 deaths belonging to the borough, 1,484 or 89.29 per cent, were certified by registered medical practitioners; 109 or 6.56 per cent, by coroners after inquests; 67 or 4.03 per cent, by coroners without inquests, while 2 cases or 0.12 per cent, were uncertified. DEATHS IN PUBLIC INSTITUTIONS. Of the deaths of Fulham persons, 56.5 per cent. took place in Public Institutions The distribution of these was as follows:- per cent.  679 in Public Assistance Hospitals or Institutions 72.16 20 in Infectious Disease Hospitals 2.13 189 in Other Hospitals 20.08 53 in Mental Hospitals 5.63 14 FULHAM HOSPITAL. In this institution belonging to the London County Council, there were 587 deaths of which 533 were of Fulham residents and 54 of persons residing in other districts. WESTERN HOSPITAL. This hospital, the only London County Council Infectious Disease Hospital in the borough, had 73 deaths during the year, and of this number 16 were Fulham residents, while the remaining 57 were patients admitted from other districts. DEATHS OF FULHAM RESIDENTS OUTSIDE THE BOROUGH. The deaths of Fulham residents outside the borough numbered 438 and occurred in the following places:— St. George's Hospital 23 West London Hospital 23 Princess Beatrice Hospital 29 Other General Hospitals 53 Children's Hospitals 11 Women's Hospitals 5 Other Special Hospitals 34 L.C.C. Infectious Disease Hospitals 4 L.C.C. Hospitals and Institutions 146 Mental Hospitals 53 Sanatoria 11 Nursing Homes and elsewhere 46 438 ZYMOTIC DEATHS. The Zymotic death rate is that from the principal zymotic or infectious diseases, viz., smallpox, scarlet fever, diphtheria, measles, whooping cough, epidemic diarrhœa and fevers (typhus, enteric, other or doubtful fevers). The mortality from these diseases was lower than in 1934, 36 deaths being due to them as against 88. The death rate per 1,000 of the population was 0.25 compared with 0.6 for 1934. The decrease is due to the fall in the number of deaths from diphtheria and measles (a decrease respectively of 18 and 31). SEASONAL MORTALITY. The number of deaths in each of the four quarters of the year was as follows:— 1935 1934 First quarter 462 623 Second quarter 413 458 Third quarter 384 321 Fourth quarter 403 430 1,662 1,832 15 CAUSES OF DEATH. These are classified in Table 6 pages 21/22. The following table shows the number of deaths from the six commonest causes. Disease No. of Persons Males. Females. Percentage of total deaths Death Rate per 1,000 inhabitants Heart Disease 479 215 264 28.82 3.34 Cancer 218 103 115 13.12 1.52 Respiratory diseases 148 78 70 8.97 1.04 Tuberculosis (all forms) 129 73 56 7.76 0.89 Cerebral hæmorrhage 72 36 36 4.33 0.50 Chronic and acute nephritis 49 26 23 2.95 034 TOTALS 1,095 531 564 65.95 7.63 It will be seen that heart disease, as in the last 6 years, heads the list; 479 deaths were due to this cause compared with 498 in 1934. The sex distribution of these deaths was 215 males and 264 females. Of the total no less than 420 occurred in persons over the age of 55 years. Cancer came next as in the last 2 years with 218 deaths, a decrease of 52 on the previous year. 166 of these deaths were in persons over 55. Pneumonia, bronchitis and other respiratory diseases together caused 148 deaths. The age distribution is less marked in this disease, deaths taking place in every age group, though with a preponderance in the groups aged 45 and over. Tuberculosis caused 129 deaths of which 112 (67 males and 45 females) were from pulmonary tuberculosis. The death rate from pulmonary tuberculosis is 0.78 as against the national rate of 0.61. The prevention of this disease depends in the main upon good nutrition and good environmental conditions, the cure upon early diagnosis. The steady year by year fall in mortality from this cause is one of the most satisfactory achievements of public health and social work. Cerebral hæmorrhage is again a disease of the elderly, only 4 of the 72 deaths occurring under the age of 55. Influenza caused 24 deaths compared with 17 in 1934. 16 INFANTILE MORTALITY. Of 1,662 deaths of persons of all ages belonging to Fulham, 100 or 6.02 per cent. occurred in infants under 1 year of age. The Infantile Mortality Rate (the number of deaths of infants under 1 year of age per 1,000 live births) was 51 as compared with 59 during 1934. The actual number of deaths was 100 as compared with 118. The rate is the lowest recorded in the history of the borough. The Infantile Mortality Rate for England and Wales was 57 and for London 58. INFANTILE MORTALITY RATE IN FULHAM SINCE 1891. Average for 5 years. Actual rate for the last 8 years 1891-1895 168 1928 77 1896-1900 167 1929 69 1901-1905 144 1930 57 1906-1910 117 1931 67 1911-1915 109 1932 58 1916-1920 92 1933 65 1921-1925 73 1934 59 1926-1930 67 1935 51 1931-1935 60 The following table shows the births, infantile mortality, and death rates during the last 2 years for the various wards in the borough. TABLE 2. Wards Births Birth Rates Infantile deaths Infantile Mortality Rates General Death Rates 1935 1934 1935 1934 1935 1934 1935 1934 1935 1934 Baron's Court 185 96 12.9 6.5 9 10 49 104 130.9 12.8 Lillie 308 164 14.1 7.3 21 20 68 122 9.9 14.2 Walham 269 176 20.2 12.7 16 24 59 136 13.7 15.4 Margravine 198 565 12.2 34.8 11 15 56 26 11.5 12.4 Munster 431 427 12.9 12.9 20 18 46 42 10.9 11.6 Hurlingham 105 49 12.3 5.7 4 5 38 102 11.7 13.4 Sands End 314 181 13.8 7.8 9 13 29 72 10.2 12.5 Town 179 338 13.4 25.4 10 13 56 38 13.9 10.9 BOROUGH 1989 1996 13.8 13.7 100 118 51 59 11.6 12.6 17 The principal causes of infantile mortality were as follows:— Prematurity 22 deaths compared with 27 in 1934. Diarrhœa and Enteritis 13 deaths compared with 15 in 1934. Pneumonia (all forms) 13 deaths compared with 25 in 1934. Forty-two deaths (42 per cent. of all deaths under 1 year of age) occurred in infants under 4 weeks of age as compared with 46 in 1934, and 48 in 1933. MATERNAL MORTALITY. During the year investigations were made into the causes of death in 6 cases of maternal mortality and the reports were transmitted to the Maternal Mortality Committee. The following is a list of the cases with the causes of death:— Occupation. Age. Date and Place of Death. Cause of Death. Spinster—Music Hall artist. 19 March 2nd— in hospital. Septicæmia following abortion; insufficient evidence whether natural or due to interference. Open Verdict. Wife of a Cafe Bar Attendant. 17 June 1st— in hospital. 1. (a) Broncho-pneumonia. (b) Pyelonephritis (puerperal). 2. Cæsarian section. Wife of a General Labourer. 27 July 17th— in hospital. 1. (a) Puerperal septicæmia. (b) Delayed labour and forceps delivery (full time). 2. Albuminuria of pregnancy. Wife of a General Labourer. 37 July 27th— in hospital. Syncope due to loss of blood consequent upon injury to uterus and miscarriage (insufficient evidence to show how injury sustained). Open verdict. Wife of a Carpenter. 26 September 11th— at home. 1. (a) Post Partum Hæmorrhage, (b) Detachment of Placenta (8 months pregnancy). Wife of an A.B. Royal Navy. 24 September 14th— in hospital. 1. (a) General Peritonitis, (b) Puerperal sepsis. 18 Table 3.—Vital Statistics of the Whole Borough during 1935 and Ten preceding Years. Year. Population Estimated to Middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths. Nett Deaths Belonging to the Borough. Nett Deaths under One Year. Nett Deaths under Five Years. Zymotic Death Rate (Influenza included). Occurring in the Borough. Nett. Of NonResi dents registered in the Borough. Of Residents not registered in the Borough. At all Ages. Under 1 Year of Age. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Percentage of Total Nett Deaths. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1925 163,700 2,780 2,771 16.9 1,620 209 343 1,754 10.7 211 76 12.03 17.1 0.81 1926 164,300 2,691 2,670 16.2 1,578 168 373 1,783 10.8 173 64 9.7 15.8 0.71 1927 161,900 2,356 2,444 15.1 1,588 121 366 1,833 11.3 162 66 8.8 12.3 0.54 1928 155,300 2,319 2,388 15.4 1,548 128 360 1,780 11.5 185 77 10.4 14.4 0.73 1929 153,700 2,328 2,502 16.2 1,882 157 394 2,119 13.7 173 69 8.2 13.5 0.78 1930 153,700 2,226 2,366 15.3 1,473 143 343 1,673 10.8 136 57 8.1 13.4 0.68 1931 151,200 2,103 2,281 15.08 1,532 107 432 1,857 13.3 154 67 8.3 10.7 0.48 1932 149,600 1,842 2,137 14.3 1,569 202 481 1,848 12.4 124 58 6.7 10.7 0.69 1933 148,200 1,579 1,938 13.08 1,531 143 538 1,926 13.00 126 65 6.5 8.9 0.89 1934 145,400 1,592 1,996 13.7 1,531 206 507 1,832 12.6 118 59 6.4 10.9 0.74 1935 143,600 1,653 1,989 13.8 1,353 129 438 1,662 11.6 100 51 6.02 7.6 0.42 19 • TABLE 4. STATISTICS 1901—1935. Year. Population. Structurally separate Dwellings (Census). Number of Private Families (Census). Average size of Family (Census). Birth Rate. Death Rate. Infant Mortality Rate. Pulmonary Tuberculosis Rate. 1901 137,289 (Census) 19,667 32,137 4.27 33.2 15.8 152 1.35 1902 143,102 ..- - - 32.9 17.1 148 1.38 1903 147,780 - - - 32.5 13.9 127 1.34 1904 152,482 - - - 32.2 15.4 153 1.43 1905 156,210 - - - 30.5 15.1 145 1.23 1906 149,520 - - - 31.9 14.8 136 1.14 1907 150,670 - - - 30.6 14.6 122 1.23 1908 151,659 - - - 31.1 14.2 115 1.22 1909 152,501 - - - 28.2 13.9 108 1.30 1910 153,166 - - - 28.1 12.5 107 1.07 1911 153,284 (Census) 20,737 36,432 4.13 26.9 14.5 126 1.45 1912 155,402 - - - 27.1 13.0 94 1.36 1913 157,117 - - - 26.9 12.7 96 1.34 1914 157,303 - - - 26.4 13.6 113 1.32 1915 153,161 - - — 24.3 15.2 115 1.29 1916 149,428 - - - 23.1 13.3 88 1.41 1917 145,186 - - - 18.4 13.7 109 1.32 1918 143,211 - - - 16.7 17.4 107 1.45 1919 152,543 - - - 18.6 12.2 83 1.01 1920 158,621 - - - 27.2 11.5 74 0.89 1921 157,944 (Census) 26,630 40,436 3.82 22.1 11.7 83 0.96 1922 159,500 - - - 20.3 12.1 69 1.02 1923 161,600 - - ' - 19.3 10.5 64 0.92 1924 163,100 - - - 18.2 11.1 72 0.80 1925 163,700 - - - 16.9 10.7 76 0.92 1926 164,300 - - - 16.2 10.8 64 0.98 1927 161,900 - - - 15.1 11.3 66 0.77 1928 155,300 - - - 15.4 11.5 77 0.73 1929 153,700 - - - 16.2 13.7 69 0.96 1930 153,700 - - - 15.3 10.8 57 0.76 1931 150,928 (Census) 26,738 43,153 3.38 15.08 13.3 67 0.97 1932 149,600 - - - 14.3 12.4 58 0.91 1933 148,200 - - - 13.08 13.0 65 0.85 1934 145,400 - - - 13.7 12.6 59 0.77 1935 143,600 - - 13.8 11.6 51 0.78 20 TABLE 5.—VITAL STATISTICS OF LONDON BOROUGHS, 1935. • Borough. Estimated Resident Population (mid-1935). Live Births Rate per 1,000 Population. Death Rate per 1,000 Population. Infantile Mortality Rate per 1,000 Live Births. Crude. Adjusted. WEST DISTRICTS. Paddington 138,600 14.17 12.08 11.95 71.0 Kensington 178,300 12.4 12.1 11.3 79.0 Hammersmith 128,100 14.7 11.9 12.3 70.0 FULHAM 143,600 13.8 1.-6 11.7 51.0 Chelsea 57,320 10.2 12.6 10.7 59.6 Westminster 124,400 8.3 11.5 11.8 72.0 NORTH DISTRICTS. St. Marylebone 92,200 9.72 11.8 11.7 56.0 Hampstead 90,600 11.02 11.2 10.5 49.0 St. Pancras 185,300 13.3 11.97 12.2 62.8 Islington. 308,170 14.85 - 10.99 52.0 Stoke Newington 50,210 13.9 1l.l 10.6 51.0 Hackney 210,600 14.0 10.6 11.1 47.6 CENTRAL DISTRICTS. Holborn 35,400 7.65 11.9 12.7 89.0 Finsbury 63,100 14.7 12.6 13.7 59.0 City of London 9,360 7.6 11.0 12.2 113.0 EAST DISTRICTS. Shoreditch 88,400 14.6 11.3 12.4 52.0 Bethnal Green 99,910 14.4 10.3 11.6 51.0 Stepney 211,500 14.3 11.3 12.8 63.0 Poplar 143,700 15.4 11.0 12.3 46.0 SOUTH DISTRICTS. South wark 156,100 14.8 - 12.4 66.0 Bermondsey 102,700 14.5 11.7 13.3 69.0 Lambeth 279,900 13.65 12.15 12.02 59.0 Battersea 148,200 14.2 12.0 11.9 65.11 Wandsworth 343,300 11.03 11.00 10.23 55.0 Camberwell 234,400 13.4 11.8 11.8 60.0 Deptford 99,500 14.4 11.1 11.5 52.0 Greenwich 96,600 13.87 10.83 11.04 59.0 Lewisham 223,000 12.5 9.9 10.0 43.0 Woolwich 146,400 14.0 10.2 10.8 44.0 LONDON, Administrative County 4,185,200 13.3 11.4 - 58.0 ENGLAND AND WALES 40,645,000 14.7 11.7 -— 57.0 22 21 Table 6. Causes of and Ages at Death during the Year 1935. Nett deaths at the subjoined, ages of " Residents," whether occurring within or without the District. Total Deaths, whether of "Residents " or " Nonresidents " in Institutions in the District. Nett deaths at all ages of " Residents " in the Wards of the Borough, wherever occurring. Causes of Death. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years 75 years and upwards. Baron's Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingbam Ward. Sands End Ward Town Ward. 1 2 3 4 5 6 7 8 9 10 ii 12 13 14 15 16 17 18 19 20 21 22 All Causes {Certified 1660 100 7 19 28 64 73 85 180 297 393 414 768 197 217 182 186 360 100 232 186 {Uncertified 2 .. — — — — — — — — 1 1 — — .. .. .. 2 .. .. .. 1. Typhoid and paratyphoid fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2. Measles .. .. .. .. .. .. .. .. .. .. .. .. 1 — .. .. .. .. .. .. 3.Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. 5 ..—.. .. .. .. .. .. 4. Whooping Cough 5 1 1 1 .. .. .. .. .. .. .. .. 6 .. 1 1 1 .. 1 1 5. Diphtheria 12 1 .. 2 9 — — — — — — — 47 3 1 2 .. .. .. .. .. 6. Influenza 24 1 .... .. ... .. — 2 6 7 6 2 4 4 1 4 2 6 1 2 4 7. Encephalitis Lethargica 2 — — — 1 — — 1 — — — — 1 — — — 1 .. .. 1 8. Cerebro-spinal fever 1 — 1 — — — .. — — — — — — — — 1 .. .. .. .. .. 9. Tuberculosis of respiratory system 112 — — — 1 27 22 19 20 13 8 2 40 10 17 10 10 24 5 23 13 10. Other Tuberculous diseases 17 2 1 5 1 1 3 .. 1 1 2 .. 8 1 2 4 1 5 1 3 .. 11. Syphilis 6 1 1 — 2 2 — — 4 — 1 2 — 1 1 1 .. 12 General paralysis of the insane 12 .. .. .. .. .. — 1 2 5 4 — 7 1 2 — 2 1 .. 3 3 13. Cancer, malignant disease 218 — — — — 1 3 17 31 71 69 26 69 32 34 18 24 53 .. .. .. 14. Diabetes 27 — — — — — — — 2 3 14 8 13 1 4 4 3 4 3 3 5 15. Cerebral Haemorrhage, etc. 72 .. .. .. .. .. .. 1 3 14 32 22 37 8 9 5 12 14 5 9 10 16. Heart Disease 479 — — 3 5 7 7 37 78 129 213 193 56 62 42 57 106 24 73 59 17. Aneurysm 3 — — — 1 — — — — 2 — 2 1 — — 1 — 1 .. .. 18. Other circulatory diseases 74 — — — — — — 1 4 10 25 34 41 11 6 11 11 14 4 10 7 19. Bronchitis 52 4 — — 2 1 3 6 5 8 23 17 2 6 9 4 13 3 7 8 20. Pneumonia (all forms) 86 13 3 2 1 3 2 6 1 8 12 15 46 12 16 8 16 11 4 11 8 21. Other respiratory diseases 10 .. .. .. .. .. 1 — 2 4 3 — 2 1 1 2 .. 1 .. 4 1 22. Peptic ulcer 29 .. .. .. .. .. 3 4 8 6 6 2 16 4 7 4 3 7 1 2 1 23. Diarrhœa, etc. 22 19 — — — — — 1 1 — 1 — 20 2 3 6 2 3 1 2 3 24. Appendicitis 14 .. — 1 .. .. 2 .. 3 4 3 1 24 1 1 3 3 4 1 2 1 25. Cirrhosis of Liver 5 — .. 2 2 1 1 .. — — — 3 1 .. 1 26. Other diseases of liver, etc. 4 1 1 2 2 — 1 — — 1 1 1 — 27. Other digestive diseases 34 2 1 1 1 2 1 6 8 6 6 13 2 6 4 1 10 3 2 6 28 Acute and chronic nephritis 49 .. — —, 2 1 3 5 12 15 11 23 8 8 5 4 10 4 7 3 29. Puerperal Sepsis 3 — — — — 2 1 — — — — ! ] — — 2 — 1 .. .. .. 30 Other puerperal causes 3 — — — — 1 1 1 — — — 3 1 — — .. .. .. 1 1 31. Congenital debility, premature birth, malformations, etc 53 51 .. 1 .. 1 .. .. .. .. .. .. 29 8 12 5 4 10 2 7 5 32. Senility 19 — — — — — — — — — 3 16- 4 — 1 3 5 2 2 3 3 33. Suicide 25 — — — — 1 3 5 3 6 3 2 4 4 2 4 3 6 .. 2 2 34. Other violence 72 2 1 3 5 8 8 6 7 11 9 12 22 8 8 13 5 17 4 12 5 35. Other defined causes 119 3 — 1 6 8 11 6 19 17 29 19 63 16 5 12 13 30 12 15 16 36. Causes ill-defined or unknown 1 — — — — — — — — — 1 .. — .. .. .. .. .. .. .. Total 1662 100 7 19 28 64 73 85 180 297 394 415 768 197 217 182 186 362 100 232 186 23 24 Table 7. Infant Mortality during Year 1935. Nett Deaths from stated causes at various ages under One Year of Age. Nett Deaths under One Year in Wards. Cause of Death. Under i Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Baron's Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. All Causes {Certified 35 3 2 2 42 18 19 13 8 100 9 21 16 11 20 4 9 10 {Uncertified — — — — — — — — — — — — — — — — — — 1.Small-pox - - - - - - - - - - - - - - - - - - 2. Chicken-pox - - - - - - - - - - - - - - - - - - 3. Measles - - - - - - - - - - - - - - - - - - 4. Scarlet Fever - - - - - - - - - - - - - - - - - - 5. Whooping Cough — — — — — — — 1 1 - 1 - — — — — — C. Diphtheria and Croup - - - - - - - - 1 1 - - 1 -— — — — — 7. Erysipelas — 1 1 - - - - - - - - - - - - 1 8. Tuberculous Meningitis - - - - - - 1 - - 1 - - - 1 - - - 9. Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - 10. Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - 11. Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - 12. Convulsions 1 - - - 1 — 1 — — — 13. Laryngitis - - - - - - - - - - - - - - - - - - 14. Bronchitis and Pneumonia - - i 1 5 4 4 3 17 1 3 3 4 3 1 1 1 15. Influenza - - - 1 - - 1 - - - 1 — — — If!. Gastro-Enteritis and Diarrhœa - - - - - 4 6 4 3 17 2 3 4 1 3 1 3 17. Syphilis - - - - - - 1 - - 1 - 1 - - - 18. Rickets - - - - - - - - - - - - - - - - - 19. Suffocation, overlaying - - - - - - - - - - - - - - - 20. Injury by Birth 5 - - - 5 - - - 5 1 - - - 3 1 21. Atelectasis 8 - 1 - 9 - - - - - 1 2 1 2 3 - 22. Congenital Malformations 6 - 1 - - 1 2 - - 10 3 3 1 - 1 1 - 1 23. Premature Birth, Debility and Marasmus, etc. 16 3 - - 19 5 4 1 - 29 1 7 4 4 4 2 4 3 24. Other Causes — - — — — 2 - 1 1 4 - 1 2 1 — — — — Total 35 3 2 2 42 18 19 13 8 100 9 21 16 11 20 4 9 10 Section II. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 26 STAFF. A full list of the staff of the Health Department appears at the beginning of this Report. LABORATORY FACILITIES. The Council's labaratory is situated at the Dispensary, 114, New King's Road. It is equipped for all routine bacteriological work and during the year 2,920 specimens were examined. Arrangements have also been made with the Clinical Research Association for the examination of specimens during week-ends, holidays and emergencies, 841 specimens being reported on during the year. The following classification details the specimens examined:— Material from cases of suspected Diphtheria:— Diphtheria isolated 202 Negative result 2,032 Blood from cases of suspected Enteric Fever:— Agglutination reaction for Typhoid or Para- Typhoid obtained 1 Negative result 4 Pathological specimens for Enteric Organisms:— Positive result - Negative result 4 Sputa from cases of suspected Tuberculosis:— Tubercle bacilli found 288 Tubercle bacilli not found ... 1,015 Swabs from cases of suspected Gonorrhoea:— Gonococcus found 7 Gonococcus not found 74 Examinations of Urine 64 Blood Counts 3 Throat Swabs, Hæmolytic Streps, etc. 32 Examination of Ice Cream, Water and Meat, etc. 9 Other Examinations 5 Special Examinations of:— Sputa 11 Urine 10 Total Number of Examinations 3,761 AMBULANCE FACILITIES. This service is under the control of the London County Council, a depot being situated in the borough at the Western Hospital, Seagrave Road. 27 NURSING IN THE HOME. Certain types of cases requiring home nursing treatment are visited on behalf of the Council by the Fulham District Nursing Association, at a cost of one shilling per visit. A table showing the number and type of visits paid is given below. The District Nursing Association employs twelve full-time nurses, and besides nursing cases in their own homes, provides attendance and home visits in connection with the School Treatment Centres at Bagley's Lane and Bishop Creighton House. A treatment room is also available at the headquarters of the local Association. TABLE 8. HOME NURSING BY THE DISTRICT NURSING ASSOCIATION ON BEHALF OP THE FULHAM BOROUGH COUNCIL. Jan. to Mar. April to June July to Sept. Oct. to Dec. TOTALS Cases Visits Cases Visits Cases Visits Cases Visits Cases Visits Ophthalmia Neonatorum - - - - 1 34 1 2 2 36 Mammary Abcess and Inflamed Breasts 5 128 9 81 5 50 7 40 26 299 Ante Natal 13 120 3 40 2 32 2 19 20 211 Discharging Eyes 11 168 15 108 11 161 18 260 55 697 Mastisis - - - - - - 2 46 2 46 Wet Cord - - 8 52 11 78 11 85 30 215 Pneumonia 12 213 3 26 2 28 9 126 26 393 Broncho-Pneumonia 16 274 7 107 - - 7 101 30 482 Influenza 4 53 10 74 3 22 8 70 25 219 Mumps 1 10 2 10 - - 1 4 4 24 Septic Spots - - 2 9 - - 2 17 4 26 Diarrhœa 1 8 - - - - 2 42 3 50 Constipation 2 9 2 4 2 4 5 18 11 35 Septic Cord 1 51 - - - - - - 1 51 Chicken Pox 1 12 - - - - - - 1 12 Diphtheria 1 8 - - - - - - 1 8 Puerperal Pyrexia 1 19 - - - - 1 5 2 24 Debility 1 5 - - 2 16 2 10 5 31 Worms - - 3 28 1 7 4 28 8 63 Adenitis - - 2 15 - - - - 2 15 Conjunctivitis - - 1 4 - - 2 12 3 16 Post Vaccination - - 1 3 - - - - 1 3 Thrush - - 2 4 3 18 10 56 15 78 Sore Buttocks - - - - 1 23 4 37 5 60 Post Parturition - - - - 1 7 - - 1 7 Hernia - - - - 1 5 1 3 2 8 Inflamed Eyes - - - - - - 2 8 2 8 Burns - - - - - - 3 23 3 23 Erysipelas - - - - - - 1 3 1 3 Enteritis - - - - - - 1 2 1 2 TOTALS 70 1,078 70 565 46 485 106 1,017 292 3,145 A fee of 1s. per visit was paid by the Borough Council to the Association for the above-mentioned cases. 28 CLINIC AND TREATMENT CENTRES. The following is the list of clincs in the borough. There are in addition school treatment centres controlled by Voluntary Committees at Bagley's Lane and Bishop Creighton House, Lillie Road. Clinics. Address. Hours. Provided by. ANTE-NATAL 90/2, Greyhound Road. Mondays—2 p.m. Fridays—10.30 a.m. Borough Council. 170, Wandsworth Bridge Road. Fridays—2 p.m. ditto. INFANT WELFARE 90/2, Greyhound Road. Wednesdays and Thursdays— 10.30 a.m. and 2 p.m. ditto. 170, Wandsworth Bridge Road. Mondays, Tuesdays and Wednesdays—2 p.m. ditto. DENTAL (expectant and nursing mothers and children under 5 years) Melmoth Hall, Eustace Road. Tuesdays and Thursdays—2 p.m. ditto. 90/2, Greyhound Road. Fridays—2 p.m. ditto. MASSAGE Bishop Creighton House, Lillie Road. Tuesdays and Fridays—10 a.m. Voluntary. TUBERCULOSIS DISPENSARY 114, New King's Road. Mondays—10 to 11.30 a.m. (Women and young children). Mondays—1.45 to 3 p.m. (School children). Tuesdays—10 to 11.30 a.m. (Men—old and new cases). Tuesdays—6 to 7.30 p.m. (Men and Women workers). Wednesdays—10 to 11.30 a.m. (Women—old and new cases). Thursdays—1.45 to 3 p.m. (Children—old and new cases). Borough Council. DIPHTHERIA IMMUNISATION 170, Wandsworth Bridge Road. Thursdays—2 p.m. ditto. 29 HOSPITALS. (a) GENERAL: There are no voluntary general hospitals in the borough, the needs of the district in this respect being fully met by Fulham Hospital, which is under the control of the London County Council Public Health Committee and has 555 beds (410 for medical, 04 for surgical, 12 for maternity, 10 for V.D., 19 for isolation, 14 for psychiatric, 22 for tuberculosis cases and 4 for sick members of the staff). Of these beds, 73 are reserved for children. (b) CHILDREN AND INFANTS: The Fulham Babies' Hospital is controlled by a voluntary committee, an annual grant being made by the Borough Council, who also provide the medical staff. It contains 21 beds and during the year admitted 124 patients, the average daily number of beds occupied being 13.3. This hospital works in the closest co-operation with the child welfare service and renders particularly valuable services in dealing with cases of difficult nutrition. (c) INFECTIOUS DISEASES: There is one hospital for infectious diseases in the borough, the Western Hospital, Seagrave Road, which is under the control of the London County Council and contains 479 beds. HEALTH PROPAGANDA. In November, 1935, a cinematograph projector, capable of showing 9 m.m. and 16 m.m. films was purchased for use in health propaganda work. A copy of Dr. Guy Bousfield's film "The Empty Bed" was also purchased and has since been shown on several occasions. Although no series of lectures was given by the Department during the year, mainly owing to the absence on sick leave of the Medical Officer of Health, Dr. Sullivan, the Fulham Branch of the British Social Hygiene Council continued their activities, and a list of the meetings arranged by them during the year is given below. During the year a Handbook giving full information respecting Public Health Services of the Borough was compiled and 10,000 copies were printed for free distribution. The Handbook is being distributed through the Infant Welfare Centres, the Dispensary, the Public Libraries and by the Sanitary Inspectors and Health Visitors. BRITISH SOCIAL HYGIENE COUNCIL. LIST OF LECTURES AND FILM SHOWINGS FOR THE PERIOD JANUARY 1ST TO DECEMBER 31ST, 1935. Date. Organisation or Place. Type of Audience. Film. Speaker. Attendance. Feb. 12th Baptist Church Women Gift of Life Miss Dugdale 80 Feb. 20th Central Library Mixed Public John Smith & Son Dr. I. Feldman 200 Sept. 9th Walham Grove Open-air - Mr. R. D. Sanders 250 Oct. 2nd Town Hall Responsible Citizens, Social Workers and Youth Leaders. Trial for Marriage Dr. Drummond Shiels. 70 30 MATERNITY AND CHILD WELFARE. Report by the Medical Officer in Charge of the Maternity and Child Welfare Department (Miss Ruby Thomson, M.B., Ch.B., D.P.H.) on the work of the Department. The work of the Maternity and Child Welfare Department has been carried on during 1935 on the general lines described in previous reports. My illness, during eight months of the year, necessitated certain changes in the medical staff. Dr. Barrett acted for me at the Town Hall. Dr. Wakeford had charge of the Babies' Hospital and the Maternity Home. For my clinics we were fortunate in obtaining the services of Dr. Louise Mathcson. Dr. Matheson is familiar with the borough and quickly settled into the work. HEALTH VISITORS. There were seven Health Visitors on the Staff during 1935, and each was responsible for the home visiting in one-seventh of the Borough. The foundations of Maternity and Child Welfare work are laid in the homes, and upon the tact and efficiency of the Health Visitor depends, in a large measure, the success or otherwise of the work of the Department. Except in the cases of mothers who are receiving free grants of milk, and who are therefore compelled to attend the Welfare Centres, it depends upon the personality and influence of the Health Visitor, to a great extent, as to how many of the mothers on her district come to the clinics. The Health Visitor has no "right of entry" into any house for ordinary visiting purposes, and it is fortunate that the Staff find few difficulties due to this drawback. It may be of interest to consider the wide extent of the knowledge and experience of the Health Visitors. All are fully trained nurses, holding the Certificate of the Central Midwives Board and the Health Visitor's Certificate, representing years of study and practical work. In addition to these essential qualifications, each one has specialised in one or other branch of nursing; for instance, three are trained Queen's Nurses; one is a fever-trained nurse; one has special training in venereal diseases and in tropical diseases; two have special experience in actino-therapy with, in one case, a special knowledge of massage; and all have had a wide experience of midwifery and the special diseases of women and children. There can, therefore, be few conditions occurring in the family where scientific nursing advice cannot be obtained from the Town Hall; and it should be remembered that this advice can be obtained for the asking and is given ungrudgingly. The whole Department is controlled by the provisions of the Maternity and Child Welfare Act, 1918, and a large proportion of the work of the Health Visitors is directly dependent on the Notification of Births Acts, 1907 and 1915, which make compulsory the notification of every birth to the Medical Officer of Health within 48 hours. The Health Visitor calls as soon as the period of attendance by the doctor or midwife has ended, i.e., eleven days after the birth of the child. This is done in all cases, whether the child has been born in an institution or at home. Advice is given on the general management of all children under five, and where there is an infant the importance of breast-feeding is stressed. Anything which may affect the wellbeing of the home is the concern of the Health Visitor, and mothers are encouraged to place their children under regular medical supervision, through the Welfare Centres or otherwise. In spite of all that is done to promote breast-feeding, artificial feeding is increasingly prevalent. It seems to be so much easier, when natural feeding becomes difficult, to buy a tin of some much advertised infant food than to persevere with the natural method. It is often very difficult to persuade a mother that the line of least resistance is frequently not the right one. 31 The Health Visitors visit all cases of ophthalmia neonatorum, puerperal fever and puerperal pyrexia, all cases of measles (which is notifiable in this Borough) in children under the age of five years (except during epidemics when special nurses are engaged), all ante-natal cases brought to our notice, and cases of pneumonia in children under 5 years, and epidemic diarrhoea and give such advice as may be desirable. The Health Visitors also visit pregnant women in the Borough who are booked to enter maternity wards in Hospitals. The Almoners send lists of such cases and by this means the Department gets into touch with many pregnant women who would otherwise remain unknown. The following table illustrates the wide scope of their work:— First visits to infants under one year 1,982 Total visits to infants under one year 11,519 First visits to infants between 1 and 5 years 87 Total visits do. do. 10,774 Visits to cases of Ophthalmia Neonatorum 8 do. Measles 12 do. Epidemic Diarrhœa 1 do. Pneumonia 22 do. Puerperal Fever 5 do. Puerperal Pyrexia 17 First ante-natal visits 1,329 Total ante-natal visits 1,944 Other visits 60 In addition to their work in the homes, the Health Visitors systematically attend at the various Centres during the medical sessions for the control and management of the clinics. Certain re-arrangements of the work of the Health Visitors and of their summer holiday locum tenens, requiring more of their time at the clinics than formerly, involved a corresponding loss to their home visits, and the number of visits made during the past year was somewhat less than in the previous year. INFANT LIFE PROTECTION VISITOR. In April, 1933, under an Order of the Minister of Health, the supervision of all fostermothers in Fulham was transferred from the London County Council to the Borough Council. Every foster-mother in the Borough is now required to be approved as such by the Council as the local authority. At the end of the year there were 99 foster-mothers with 126 children in their care. The Infant Life Protection Visitor paid 1,858 visits to foster-mothers and inspected 2,541 children at such visits. This work is an effort to prevent baby farming, formerly one of the scandals of the country. Suitable candidates for approval as foster-mothers are needed in the Borough, as we have more applications for their services than we can always meet. The duties of the Infant Life Protection Visitor are closely associated with those of the Health Visitors, and foster-mothers are urged to bring their charges to the Infant Welfare Centres, that they may be under regular medical supervision. Close co-operation is also maintained between the Infant Life Protection Visitor and the. School Authorities, as her duties relate to children between birth and nine years of age. The Visitor possesses the "right of entry" and may visit at night as well as by day, when necessary. / 32 The Maternity and Child Welfare Department maintains touch with the National Society for the Prevention of Cruelty to Children, whose co-operation is as ready as it is valuable. NOTIFICATIONS OF BIRTH. The Birth Rate for 1935 was slightly higher than in the previous year (13.8 compared with 13.7). Under the Notification of Births Acts, 1,960 births were notified to the Department during the year, of which 59 were stillborn. The number of births notified by midwives was 1,733, and by doctors and parents 227. The stillbirths equalled 3.01 per cent. of the notified births. MATERNITY AND CHILD WELFARE CENTRES. There are three Maternity and Child Welfare Centres in the Borough, viz., 90/92, Greyhound Road; 170, Wandsworth Bridge Road; and at Melmoth Hall, Eustace Road, all of which are attended by the Medical Officers in this Department. The times of the sessions are detailed on page 28. The total attendances at the clinics increased by 3,147, and the first attendances of children under one year of age represented 54.44% of the notified live births. The following table shows the attendances at the Infant Clinics during the year 1935:- Clinic. Number of Clinics held. First attendance of babies Total Attendances Age in years 0-1 1-5 0-1 1-5 92, Greyhound Road 200 492 79 6814 3617 170, Wandsworth Bridge Road 148 353 48 4667 2381 Melmoth Hall, Eustace Road 98 209 46 2890 2196 TOTALS 440 1054 173 14371 8194 Hitherto the issue of dried milk as ordered by the Medical Officers has been made at the Town Hall. An experiment, however, to save time for the mothers was commenced in March at the Greyhound Road Centre. Arrangements were made for the issue of dried milk to be made at this Centre while the medical sessions were actually in progress on Wednesdays and Thursdays, on each of which days a morning and afternoon medical session is held. The scheme is working well, and is proving a boon to the mothers. Arrangements are now being considered for such issue to be made at every medical session at all the Centres. In November, 1934, the scale of income under which free milk was supplied was made more generous, and in January, 1935, the granting of milk at half cost-price was reintroduced. As all milk is given strictly under medical supervision, these measures brought to the clinics an increased number of children who might otherwise not have been provided with the medical and nursing services given by the Borough Council. 33 In March a special Toddlers' Clinic was instituted at Greyhound Road, once weekly, and is slowly making headway. We have in the past had such sessions both at Wandsworth Bridge Road and Greyhound Road Centres, but neither proved successful; however, we are hoping that new ideas being put into practice may help to justify the present experiment. A large proportion of mothers still fail to realise the importance of the medical supervision of apparently healthy children. The average General Practitioner has neither the time nor the opportunity for this work. The clinics, on the other hand, are not concerned with the treatment of sick children. A more general recognition of these facts by everybody concerned would go far to producing a healthier community. The supervision of the pregnant and nursing mother is of primary importance; it is at the foundation of the whole edifice of Maternity and Child Welfare work. In Fulham since 1919 we have had special cards at the clinic for recording the history of nursing mothers, while pregnant women attend at separate sessions. Upon the mother depends, in large measure, the contentment and well-being of the family and at the Centres we lay great emphasis on this point. The presence in the Borough of open spaces such as Eelbrook Common, Parson's Green, the Recreation Ground, South and Bishop's Parks, is in itself an important factor towards this end. The organised games instituted in South Park, Bishop's Park and the Recreation Ground during the year must have had their place in assuring the mother of her child's safety and happiness while away from school and out of her sight. Increasing legislation throws added work on the clerical and Health Visiting staffs, which are not always concurrently increased, and I should like to place on record my deep appreciation of the wholehearted and loyal services of both the Health Visiting and clerical staffs. I am glad that we still retain the generous services of our regular Voluntary Workers. Mrs. Bell for several years attended regularly at five medical sessions a week, but has lately been unable to come quite so frequently. Her devoted work is gratefully acknowledged. The Fulham Free Church Women's Guild continue to provide tea and biscuits at a nominal cost for the mothers attending the Centres and their services are much appreciated. ANTE-NATAL CLINICS. Three ante-natal sessions are held each week, a morning and an afternoon one at Greyhound Road conducted by myself, and an afternoon session at Wandsworth Bridge Road conducted by Dr. Barrett. Public opinion is now being widely directed to the desirability of the regular medical supervision of pregnancy, and with the provision made by the Borough Council there is no reason why every expectant mother should not have adequate attention in this respect. The clinic sessions are on occasion uncomfortably crowded and the provision of extra ones may require early consideration. The value and importance of regular ante-natal supervision is not yet sufficiently widely recognised. There is no doubt that this measure properly applied can diminish the accidents and risks of child-birth, which have so far signally failed to respond to the public health measures which have in every other direction produced such striking results. The ante-natal clinics are intended primarily for supervision with a view to the occurrence of a safe confinement. It is the duty of Medical Officers of ante-natal clinics to satisfy themselves that any abnormalities are known and provided against, and that every woman attending has made suitable arrangements for the proper conduct of her confinement. A close co-operation is maintained between the clinics and the doctors or midwives concerned with all cases; and written reports are sent when necessary. 34 All patients who are booked for their confinements in the Council's Maternity Home are required to attend at the ante-natal clinics. An increasing number of expectant mothers are attending the ante-natal clinics at St. Stephen's and Fulham Hospitals, and the provision of a lying-in ward by the Princess Beatrice Hospital has also added to the facilities available. It is notable that there is an increased tendency to hospitalisation of normal confinements. Contributory factors towards this are the increasing public recognition of the importance of a properly supervised confinement and rest for the mother during her lying-in period, together with prevalent conditions of overcrowding. The following is a record of the work done at the ante-natal clinics during 1935:— Clinic No. of Sessions. No. of New Patients. Total No. of Attendances. 92, Greyhound Road. 99 250 436 1755 170, Wandsworth Bridge Road. 50 140 165 682 TOTALS 149 390 601 2437 It may be mentioned here that a stock of Maternity Outfits is maintained at the Town Hall and Centres. Each parcel contains all sterilised dressings, etc., likely to be required for use at a confinement in a private house, and may be obtained by any expectant mother or midwife at a cost of four shillings. OPHTHALMIA NEONATORUM. Ophthalmia Neonatorum—inflammation of the eyes of the new-born—is a disease which does a great deal of harm to the eyes of new-born infants, who may contract it at the time of birth unless careful precautions are taken. When a midwife is in charge of a case, any eye discharge occurring in the infant is required to be notified by her to her local supervising authority, which in London is the County Council; she must also call in a doctor who, if necessary, notifies the Medical Officer of Health. When a case of this kind is notified, the Health Visitor calls immediately, any necessary treatment being arranged. EYE AND SKIN DEFECTS. Cases of eye defects in mothers and children are dealt with by the London County Council oculist, and this is a convenience to the mothers. Children who attend the clinics regularly are referred to the London County Council local School Treatment Centres when they are found to be suffering from Impetigo Contagiosa, as no contagious or infectious disease is allowed in the clinics. MASSAGE CLINIC. Miss Christian Wickham continues her valuable services at the massage session at Bishop Creighton House. Except during her absence abroad, she has spent two whole mornings each week doing massage for our clinic patients. Her work is of very great value. 35 DENTAL CLINIC. One dental session is held weekly at Greyhound Road, and Mr. Dodd and Dr. Carswell, the anæsthetist, carry on a most valuable part of the medical services. Slowly but surely the clinic mothers are realising the importance of healthy mouths, and our attendance figures are mounting. During the year 259 new cases attended, making 738 total attendances. 186 extractions and 23 fillings were carried out, 27 dentures being also supplied. HOME NURSING. Home nursing is provided by the Borough Council for persons requiring such attention and unable to pay for it privately. There are three groups of cases included in the Council's scheme—certain illnesses in children under five years of age; certain illnesses in expectant and nursing mothers; and certain infectious diseases. A fee of 1s. per patient is paid for each attendance on a case, in the first two groups by the Maternity and Child Welfare Committee, and in the third group by the Public Health Committee. I have again to place on record the loyal co-operation and help we receive from Miss Watson, Superintendent of the District Nurses. MATERNITY HOME. The Fulham Borough Council Maternity Home is situated at 706, Fulham Road, S.W.G. It has ten beds for patients, with an isolation ward containing one bed. The Home is intended primarily to help mothers whose home circumstances render confinement at home for certain reasons unsuitable. It meets the needs of women who are unable to arrange for proper supervision during their first confinement, and it is equally an advantage that mothers who have large families should have rest during this trying period. It is unfortunate that more of such mothers do not avail themselves of the opportunities offered for institutional treatment. It seems to be still not quite understood that the Maternity Home is not capable of being used as a Hospital, and that there are no ante-natal beds. For some reason or other the services of Home Helps have not been used in Fulham to the extent that they might be. They can be arranged for through this Department. The Staff from the Maternity Home attend at the ante-natal clinic twice weekly and thus get practical experience in ante-natal work. Trained nurses are prepared for the certificate of the Central Midwives Board, as the Maternity Home is recognised as a training school by this Authority. The following is a record of the work done at the Maternity Home during 1935 :— Cases admitted 214 Average duration of stay (days) 14 Number of cases notified as Puerperal Sepsis - do. do. Ophthalmia Neonatorum - Number of cases of Infectious Disease - Number of infants not entirely breast-fed while in the institution - Number of maternal deaths - Number of foetal deaths (stillborn or within ten days of birth) 3 36 In January, 1935, the Council reduced from £3 to £2 the minimum fee for the fortnight at the Maternity Home, which is the normal duration of treatment. The highest fee charged during 1935/36 was £6 1s. 6d. for the two weeks, and the average fee was £3 6s. 11d. The cost per patient per week to the Council before deduction of patients' fees was £4 4s. 8d. for the financial year 1935-36. DAY NURSERY. The Fulham Day Nursery is situated at Eridge House, Fulham Park Road, S.W.6., and is under the control of a Voluntary Committee. The Council makes a grant of £626 per annum to the Day Nursery, in addition to providing the services of myself and the Assistant Medical Officer for Maternity and Child Welfare, as Medical Officers. The institution is visited by one or other of us four times weekly. The Day Nursery was established to meet the needs of mothers who are under the necessity of going out to work and who have no suitable person with whom to leave their children. Children can be left for whole or half-days, and it means much to these mothers to know that their children are being well looked after and fed, in many cases, in a manner which would be impossible in their own homes. Children are admitted between the ages of six weeks and five years, and a small daily payment is required. In every case the Matron receives a home report of the circumstances of the child, and these reports, made by the Health Visitors, are of great value to Matron and myself. Breast-feeding is not only encouraged but insisted upon where possible, if only partially. All the feeding of infants is done on the principle of the use of breast standard milk; and older children get a diet in the determination of which modern knowledge of nutrition has been taken into account. An open-air life is encouraged and, winter and summer, when the weather is suitable, the children live out of doors. An old army hut in the garden makes it possible for the children to be out even in wet weather. The following are the figures showing the attendances at the Day Nursery during 1935:— Individual children under 3 years 75 Individual children over 3 years 25 WHOLE DAYS:— Attendances under 3 years 5660 do. over 3 years 1484 - 7144 HALF DAYS:— Attendances under 3 years 1100 do. over 3 years 166 - 1266 8410 SUPPLY OF MILK. Under the provisions of the Maternity and Child Welfare Act, 1918, milk is supplied free to necessitious nursing and expectant mothers and to children under three years of age. The Local Authority is required by the regulations of the Ministry of Health to ascertain that need actually exists, and a special Visitor visits the homes of applicants and reports on the home circumstances, while the ordinary reports of the Health Visitors are also available for reference. A special Milk Sub-Committee of the Maternity and Child Welfare Committee meets every week to consider applications and make grants. 37 The approximate cost of the milk granted free or at less than cost price during 1935 was:— Dried milk £501 18 7 Wet milk £222 5 7 £724 4 2 Milk is also sold at cost price in cases recommended by the Medical Officers, Health Visitors, or any local practitioner or Hospital Medical Officer. During 1935 under this part of the scheme 5,071 lbs. of dried milk were supplied at a cost to the families of £401 10s. 10d., as compared with 4,447 lbs. at a cost of £389 10s. 10d. during the previous year. Under arrangements made with the Public Assistance Committee of the London County Council, dried milk is given in exchange for relief tickets in certain cases, and during the year 454 lbs. of milk were so issued at a cost to the Committee of £35 12s. 10d. My long experience in the Infant Welfare Centres of the needs of the infant population convinces me more than ever of the importance of the dried milk preparations on the market, and the influence these have on the reduction of infant mortality. As I have shown in previous reports, it is a waste of public money to supply wet milk to houses where it is impossible to keep it in a reasonable state of purity. Every house into which dried milk is received from the Borough Council is visited by a Health Visitor, who sees to it that full information is given as to the necessity for the addition of fresh fruit juice to the diet with this form of feeding. The Borough Council supplies a full-cream or humanised dried milk prepared by the spray method and similar preparations dried by the roller process. It is found that where one type of milk does not suit a child, almost invariably the other form will prove digestible. The digestibility of either form of dried milk is greater than that of wet milk. Recent research has proved conclusively that a large proportion of the population of Great Britain is suffering from anæmia of one degree or another. A dried milk with which iron in a digestible form has been incorporated is therefore also utilised, and is found very useful for mothers during pregnancy and lactation. CHARITABLE ORGANISATIONS. The Charity Organisation Society, the Invalid Children's Aid Association and the Invalid Kitchens of London have continued their helpful co-operation. The last-named conducts its local activities at Bishop Creighton House. Experience has shown that mothers living in the Wandsworth Bridge Road area of the Borough find it almost impossible to avail themselves of the dinners provided at Bishop Creighton House, owing to the distance, and the Council therefore decided to arrange for invalid dinners to be supplied at 170, Wandsworth Bridge Road. To carry out this scheme a resident housekeeper, who would also act as cook, was appointed at Wandsworth Bridge Road Centre. The arrangement with the Invalid Kitchens of London still continues. Each year the Women's Holiday Fund sends away for a fortnight mothers who would in ordinary circumstances be quite unable to get any relief from the wearisome round of domestic duty. The mental and physical refreshment thus gained is of great value. Mothers are encouraged in the early Spring to consider such holidays, and small payments are taken weekly, the total amount being assessed on the family income. MATERNAL MORTALITY. The Maternal and Child Welfare Department investigates all cases in which women have died during pregnancy, at childbirth or during the puerperium. Details of maternal deaths are given on page 35. 38 BABIES' HOSPITAL. The Fulham Babies' Hospital is under the control of a Voluntary Committee on which the Borough Council is represented. The type of case in which the hospital is mainly interested is that in which there are nutritional difficulties, but rickets, pneumonia, bronchitis, anaemia and certain post-operative conditions are also treated. The hospital is an invaluable adjunct to the child welfare services at whose request the majority of the children are admitted, and has been an important factor in reducing infant mortality. The medical staff is provided from the medical officers of the Borough Council. The appointment of a consultant pædriatrician was discussed towards the end of the year, but final arrangements were not completed. The medical statistics for 1935 were as follows:— Cases admitted, 124:— Clinic cases 105 General Practitioners (this number includes one from another district). 19 Average daily number in Hospital 13.3 Average duration of stay (in days) 34.3 In Hospital January 1st, 1935 13 In Hospital December 31st, 1935 - Hospital closed owing to outbreak of Chicken Pox. Reason for admission:— After Tonsillectomy 2 Debility and Marasmus 15 After Circumcision 10 Eczema 2 Anæmia 1 For observation 2 Bronchitis and Bronchial Catarrh 24 Indigestion 14 Pneumonia and Broncho- Pneumonia 2 Prematurity 2 Rickets 5 Convulsions 1 Loss of weight 21 Constipation 2 Test feeding 5 Diarrhœa, Enteritis and Vomiting 15 Tubercular Meningitis 1 Discharged:— Deaths:— In good health 84 Enteritis 4 Improved 37 Mucous Colitis 1 No improvement 9 Prematurity 1 Tubercular Meningitis 1 Discharged on account of infectious diseases:— Chicken Pox 8 German Measles 2 Pertussis 1 Nasal Diphtheria 1 Section III. SANITARY CIRCUMSTANCES OF THE AREA. 40 RIVERS AND STREAMS. No action to check pollution was necessary during the year. CLOSET ACCOMMODATION. All closets are of the water carriage type. There are no closets of the conservancy or waste-water type in the area. There is, however, a sad deficiency of the "sufficient" water closet accommodation of the Housing Acts. In an urban community this can only reasonably be interpreted as meaning one W.C. per family, a standard which is far from being realised locally. PUBLIC CLEANSING. REFUSE COLLECTION. Refuse collection is carried out by means of mechanical transport at an economic cost and with a general freedom from complaints. The Council endeavour to keep the type of vehicle engaged on the collection as up-to-date as circumstances will permit, and latterly have purchased three vehicles with enclosed bodies of the barrier type, which are giving every satisfaction not only to the Department, but to the residents generally; further vehicles of this type will, no doubt, be purchased in the near future when renewals become necessary. Generally the House Refuse is collected once weekly, but extra collections are made in the case of public buildings, large blocks of flats and other premises where special circumstances arise. There are still a few ash pits in the Borough, but these are gradually being abolished as opportunities occur. Special attention is given to the maintenance of the dustbins to see that these are kept in serviceable condition. DISPOSAL. Practically the whole of the House and Trade Refuse collected in the Borough continues to be disposed of at the Refuse Destructor in a satisfactory and economical manner. The volume of Refuse dealt with has increased out of proportion to the tonnage, and it is assumed this is due to the increasing substitution of gas and electric fires in place of solid fuel fires, and so curtailing facilities for burning Refuse on the premises. SCAVENGING AND WATERING. Practically all the streets in the Borough receive daily attention, and the more important thoroughfares are swept several times daily; mechanical watering vehicles are employed in the summer and gullies are mechanically cleansed by a modern machine. SANITARY INSPECTION OF THE AREA. During the year the sanitary staff numbered one senior inspector responsible for all new drainage work, seven district inspectors, three housing inspectors, one woman sanitary inspector and one food and drugs inspector. Three clerks assist in office routine. There is also a whole-time Rat Repression Officer in the Department. 41 The housing inspectors were in the main, engaged on routine house to house surveying of the whole district followed by the service of repair notices under Section 17 of the Housing Act, 1930. It was found in actual practice, however, that these inspectors became from time to time overwhelmed with the supervision of the works required by their notices, with the result that further'surveys had to be postponed. Arrangements were, therefore, made to abolish this system at the end of the year, and to divide the Borough into ten districts instead of seven, each inspector being responsible for all sanitary and housing work in his area. DWELLING HOUSES. The following table shows the number and nature of inspections carried out by the sanitary inspectors during the year. TABLE 9. DWELLING HOUSES. COMPLAINTS. Houses inspected for first time 2,860 Re-inspections 13,043 Intimations served 2,627 do. complied with 1,722 INFECTIOUS DISEASES. Houses inspected for first time 695 Re-inspections 1,308 Intimations served 181 do. complied with 87 HOUSE TO HOUSE INSPECTIONS. Houses inspected for first time 909 Re-inspections 7,555 Intimations served 807 do. complied with 627 STATUTORY NOTICES. Number served under:— Public Health and Metropolis Management Acts 683 Housing Acts 117 Number complied with:— Public Health and Metropolis Management Acts 400 Housing Acts 36 PENT RESTRICTION CERTIFICATES. Number of applications 9 Number of inspections made 9 Number of reports to M.O.H. 9 HOUSES LET IN LODGINGS BYELAWS. Annual Cleansing Inspections 1,108 Intimations served 267 do. complied with 174 Statutory served 31 do. complied with 31 42 DRAINAGE. Drains tested 4,251 Inspections of work carried out under Notice 6,010 Number of Notices received of voluntary work 345 Inspections of work carried out voluntarily 2,075 INFIRM AND DIRTY TENANTS. First inspections 42 Re-inspections 263 Notices served 5 LIGHTING OF TENEMENT STAIRCASES. Number of inspections 4 Number of Notices served 1 FACTORIES FACTORIES, INCLUDING FACTORY LAUNDRIES. Inspections 613 Intimation Notices served 30 do. complied with 17 Statutory Notices served 1 do. complied with 1 WORKSHOPS, INCLUDING WORKSHOP LAUNDRIES. WORKPLACES. Inspections 179 Intimation Notices served 5 do. complied with 1 Inspections 285 Intimation Notices served 21 do. complied with 20 Statutory Notices served 3 OUTWORKERS' PREMISES. SMOKE ABATEMENT ACT. Inspections 130 Intimation Notices served 3 Complaints received 6 Observations made 51 Intimation Notices served 3 FOOD PREMISES. Number of inspections to:— Food Factories 93 Milkshops and Dairies 538 Restaurants 35 Dining Rooms and Eating Houses 149 Bakers' Shops 37 Eel and Pie Shops 4 Slaughter Houses 91 Butchers' Shops 170 Fried Fish Shops 54 Fish Shops 24 Fish Curing Premises 20 Greengrocers' or Fruiterers' Premises 39 Ice Cream Premises 105 Stallholders' Storage Premises 53 Cooked Meat Shops 15 Licensed Premises 92 Other Food Premises 155 Number of Intimation Notices served 14 do. do. do. complied with 11 do. Statutory Notices served 1 43 SUMMARY. Cause of Inspection. First inspections. Reinspections. Total inspections. In consequence of Complaint 2,860 13,043 15,903 In consequence of Infectious Disease 695 1,308 2,003 House to House Inspections 909 7,555 8,464 Annual Cleansing Inspections — 1,108 1,108 Verminous or Aged Persons 42 263 305 Rent Restriction Act Applications 9 — 9 Totals 4,515 23,277 27,792 The following notices were served in respect of dwelling houses during the year:— Intimation Notices. Statutory Notices. Number served. Number complied with up to 31st December, 1935. Number served. Number complied with up to 31st December, 1935. 3,888 2,610 831 467 EVENINGS ON MARKET DUTY 144 OTHER INSPECTIONS. SHOPS ACT. Number of inspections 117 Number of Intimation Notices served 9 Number of Intimation Notices complied with 7 Number of Statutory Notices served 3 Number of Statutory Notices complied with 1 Inspections of Common Lodging Houses 85 Inspections of Public Conveniences 103 Visits to Smallpox Contacts 9 Inspections in connection with Housing applications 260 Visits to Verminous Schoolchildren 7 Inspections in connection with Underground Room Survey 41 Miscellaneous Visits 48 44 REPAIRS EFFECTED. The following works were carried out and repairs effected as a result of the action of the sanitary inspectors:— TABLE 10. DRAINAGE. Drains cleared 217 Drains repaired 584 Drains relaid 341 Soil and ventilation pipes repaired 85 Soil and ventilation pipes renewed 177 Rain water gutters and pipes repaired and renewed 506 Drains sealed off 6 Disused drains excavated 7 WATER CLOSETS. Traps cleansed, repaired, etc. 423 Pans renewed 655 Seats repaired or renewed 489 Flushing cisterns repaired 419 Flushing cisterns renewed 35 Additional W.C. accommodation provided 108 Lobbies provided to W.C. apartments 10 Fastenings provided to doors and doors repaired 145 W.C. apartments ventilated 24 SINKS BATHS AND LAVATORY BASINS. Sinks provided 273 Sinks renewed 451 Sinks repaired 80 Sink waste pipes trapped 317 New sink waste pipes 258 Sink and bath wastes repaired 166 New baths fitted 97 New lavatory basins 119 New bath and lavatory wastes 145 WATER SUPPLY Drinking water cisterns cleansed, etc. 122 Water supplied from mains 14 Occupied house provided with a sufficient supply 23 Water supply pipes and fittings repaired 65 Water supply provided to separate floors 27 CLEANSING AND INTERNAL WORK. Rooms cleansed 7,088 Verminous rooms cleansed 723 Decorations and internal house repairs 15,042 Fireplaces repaired (nuisances from smoke, etc.) 591 Kitchen ranges repaired or renewed (for cooking purposes) 1,081 Washing coppers repaired or renewed 366 Ventilation provided under floors 192 Dampness remedied 1,654 Staircases provided with adequate light and ventilation 131 Rooms provided with adequate light and ventilation 159 Ventilated food cupboards provided 189 45 EXTERNAL REPAIRS AND OTHER NUISANCES. Roofs repaired 1,271 Other external repairs 1,349 Accumulation of refuse removed 94 Dustbins provided 478 Yards and forecourts paved and drained 789 Abatement of nuisance from animals 14 Urinals in Public Houses cleansed and repaired 3 Urinals of factories cleansed and repaired 3 Rat runs traced 24 Overcrowding 48 Other nuisances abated 46 DRAINAGE OF BUILDINGS. The following drainage plans were submitted to and approved by the Public Health Committee during 1935. New Buildings:— Additions to existing buildings:— Factory 1 Hospital 2 Cinema 1 Recreation Ground 1 Block of flats 1 Railway Station 1 New Pavilion 1 Covered Yard 1 Power Station 1 Public Houses 3 Offices 1 Garage 1 Polo Stand 1 School 3 Laundry 1 Wharf 1 School 1 Factories 9 Vicarage 1 Paddling Pool 1 11 Conversion to Flats of existing buildings 29 „ „ Factory 2 „ „ Shop 1 ,, ,, Garage 2 ,, ,, Workshop 5 „ Club 1 Reconstruction of existing buildings 183 The supervision of the work, with the exception of reconstruction, is in the hands of the Council's drainage inspector. The following summarises his work in connection with drainage:— Visits to New Drainage 828 ,, ,, Extensions to existing drainage 263 ,, ,, Reconstruction work 301 - 1,392 Drains tested 1,516 46 COMBINED DRAINAGE. During the year the Council authorised the carrying out of work in connection with Combined Drainage in 19 cases. TABLE 11. LEGAL PROCEEDINGS. Proceedings were instituted in the following cases during the year:— Address. Offence. Result. 82, 84, 86 and 88, Cassidy Road. Nuisances and infringement of byelaws as to Houses Let in Lodgings. Work done in each case and summons withdrawn. Costs £1 2s. 0d. 22, Stanley Road Nuisance Fined £5 0s. 0d. and £2 2s. 0d. costs. Nuisance abated. 4, Anselm Road do. Fined £5 0s. 0d. and £2 2s. 0d. costs. Complaint withdrawn. Work done before hearing. 11, Anselm Road do. Fined £5 0s. 0d. Complaint withdrawn. Work done before hearing. 42, Mickletliwaite Road do. Fined £2 0s. 0d. and £2 2s. 0d. costs. Complaint withdrawn as nuisance abated before hearing. 331, North End Road do. Order to abate and fined £1 0s. 0d. 14, Pownall Road do. do. do. 101, Harwood Road do. Order to abate nuisance within 7 days and £11s. 0d. costs. 103, Harwood Road do. do. do. 543, Fulham Road do. Withdrawn, premises vacated. 201, Munster Road do. Withdrawn, work done before hearing. 31, Byam Street Failing to comply with drainage order. Fined £5 0s. 0d. 35, Byam Street Nuisance Order to abate within 14 days. 31, Byam Street do. do. do. 35, Byam Street Failing to comply with drainage order. Fined £2 0s. 0d. 35, Byam Street Failing to comply with cleansing notice. Fined £2 0s. 0d. 35, Byam Street Failing to supply dustbin Fined £1 0s. 0d. 10, Auriol Road Nuisance Summons not served. 54, Fulham Park Gardens do. do. 15c, Lillie Road do. Order for abatement within 14 days and £2 0s. 0d. costs. 15a, Lillie Road do. Fined 10s. 47 SMOKE ABATEMENT. During the year six complaints regarding smoke nuisance were received and 51 observations on chimneys were made by the sanitary inspectors; in three cases intimation notices were served on the owners to abate the nuisance. No legal proceedings were necessary during the year. RAG FLOCK ACTS, 1911—1928. These Acts prohibit the sale or use of unclean flock manufactured from rags in making any article of upholstery, cushions, bedding, etc. Regulations made by the Ministry of Health in 1912, provide that when not less than 40 grams of flock are thoroughly washed with distilled water at a temperature below 25° C., the chlorine must not exceed 30 parts per 100,000 of flock. This standard ensures a certain degree of cleanliness. No samples of Rag Flock were taken during 1935. PUBLIC BATHS AND WASH-HOUSES. The swimming baths at Walham Green consist of one first class male, one second class male and one ladies' swimming bath; 18 first class and 41 second class male slipper baths; 10 first class and 15 second class female slipper baths. The number of swimmers during the year was 197,446, and 112,314 persons used the slipper baths. The wash-houses contain 57 compartments, and during the year were used by 14,599 washers. MORTUARY. The Mortuary, which was reconstructed in 1934, provides cold chambers for the accommodation of eight bodies, two in each compartment. One compartment is entirely isolated from the general body of the chamber, so that two bodies of infectious cases can be accommodated separately. There is also a post-mortem room with modern equipment. During the year 137 bodies were removed to the Mortuary, and were admitted as follows:— By order of the Coroner 119 For convenience till funeral 18 137 75 post-mortem examinations were made and inquests were held in 62 cases. 48 PUBLIC CONVENIENCES. The following tables show the existing accommodation in Public Conveniences in the Borough. Under the control of the Public Health Department. Convenience. Date erected. Men. Women. Total W.C.s. Free W.C.s. Urinal Stalls. Wash Basins. Total W.C.s. Free W.C.s. Wash Basins. WALHAM GREEN (enlarged in 1030) 1895 7 2 14 4 8 2 2 GIBB'S GREEN 1900 4 1 9 2 4 1 2 LILLIE ROAD 1905 3 1 4 2 3 1 2 EELBROOK COMMON 1929 4 1 9 - 4 1 - PUTNEY BRIDGE 1934 5 1 11 2 7 1 2 WYFOLD ROAD 1936 2 2 4 1 3 3 1 EFFIE ROAD (for men only) 1903 4 1 8 2 — — — Total 29 9 59 13 29 9 9 Under the control of the Borough Surveyor's Department. SOUTH PARK : Lodge, Clancarty Rd. 1903 1 1 3 — 3 1 2 Lodge, Hugon Rd. 1903 2 2 3 — 3 2 — BISHOPS PARK : Pryor's Bank Paviln. 1898 3 1 3 3 1 1 Chalet by Bandstand (Women's enlarged 1931). 1905 2 1 4 5 2 2 Total 8 5 13 — 14 6 5 Total for the Borough 37 14 72 13 43 15 14 The Conveniences under the control of the Public Health Department are open from 8 a.m. to 12 midnight on weekdays, and on Sundays from 10 a.m. to 10 p.m. The hours of those in the Parks are regulated by the hours of opening and closing of the Parks. 49 INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920—1933. During 1935, nine applications for certificates under the above-named Acts as to the fitness of dwelling-houses for habitation were received and in six cases were issued; in the other three cases the applications were withdrawn. In addition three applications that work specified in certificates had been carried out were received from owners and in all cases " Clearance Certificates " were issued. REMOVAL OF AGED, INFIRM AND PHYSICALLY INCAPACITATED PERSONS. Section 28 of the London County Council (General Powers) Act, 1928, gives the Council power to apply to a Magistrate for an Order for the removal to a hospital, institution or other similar place, of aged, infirm or physically incapacitated persons, living under insanitary conditions. During the year no persons were removed, but 25 cases voluntarily agreed to enter institutions on the advice of the Woman Sanitary Inspector. In addition, 40 cases were kept under supervision, but it was not thought necessary to arrange for them to enter institutions. RAT REPRESSION AND DESTRUCTION. The Borough Council employs a Rat Officer who is a whole-time employee of the Public Health Department. He attends to complaints regarding rat and mice infestation in the Borough and takes steps necessary for their destruction. He also traces the manner in which the rats have gained entry to the premises and gives advice regarding the methods necessary to prevent a recurrence of the trouble. In all cases the Rat Officer works in close association with the Sanitary Inspectors. During the year 173 formal complaints regarding infestation by rats were received, and 2,414 visits were made to dwelling houses and business premises in the Borough. In addition, 1,051 visits to sewers in all parts of the Borough were made. Poison baits were laid as follows:— In dwelling houses 244 In business premises 56 In sewers 3,151 Out of the 173 complaints investigated, in 85 instances or 49.13 per cent., the rats gained admission to the premises owing to defective drains. The type of drainage defect was as follows:— Defective drains under premises 37 Defective connections under footway 41 Direct from sewers 7 85 50 Rats were caught as follows during the year:- In cage traps in sewers 230 In dustbin traps in sewers 213 In sewers under repair 67 By ferrets and break-back traps in premises 303 Under footways 62 875 The amount received by the Council from property owners for the services of the Eat Officer during the year ended 31st March, 1936, was £26 5s. 0d. and, in addition, £5 0s. 0d. was credited to the department for the services of the Rat Officer to other departments of the Council. RAT WEEK. During National Rat Week held from November 4th to 9th, an intensive campaign against rats was carried out by the Rat Officer with the assistance of two labourers. In the small sewers of the Borough no less than 14,000 poison baits were laid in the stunt ends of 12 inch pipe sewers which were known to harbour rats, in 92 streets in the Borough. Whilst it is difficult to estimate the mortality amongst the rat population, as the result of this action, it is satisfactory to note that most of the baits were found to have been taken. In addition to this direct action by the Rat Officer, posters were exhibited on the Council's vehicles, and a letter explaining the purpose of National Rat Week was sent to all factories in the Borough with a request that the letter should be exhibited on the Staff Notice Board. Letters were also sent to, and published, by the local press. NUISANCE FROM PIGEONS. Section 52 of the London County Council (General Powers) Act, 1927, gives the Borough Council powers to abate or mitigate any nuisance caused by pigeons having no owner, subject to the consent of the owner of the land or building upon which the birds congregate. No action was taken during the year under this Section. SHOPS ACT, 1934. During the year the Sanitary Inspectors made 117 inspections of shops under the abovenamed Act in connection with ventilation, temperature and sanitary conveniences. Nine Intimation and three Statutory Notices were served regarding these matters and 13 certificates under Section 10 of the Act exempting shops from the provision of sanitary conveniences were issued. All the certificates were issued on the ground of restricted accommodation making it impossible for the conveniences to be provided on the premises. In two cases additional Water Closet accommodation was provided as the result of action by the Sanitary Inspectors and in two cases means to maintain a reasonable temperature were provided. 51 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. TABLE 12. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including factory laundries) 613 31 — Workshops (including workshop laundries) 179 5 — Workplaces (other than outworkers' promises) 285 24 — Total 1,077 60 — DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. TABLE 13. Particulars. (1) Number of defects. Number of offences in respect of which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts :— Want of cleanliness 30 30 — — Want of ventilation 8 8 — — Overcrowding - — — — Want of drainage of floors — — — — Other nuisances — — — — Sanitary accomodation insufficient 11 11 — — unsuitable or defective 13 13 — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops (Transfer of Powers) Order, 1921.) 23 23 Total 87 87 — — 52 HOME WORK DONE BY OUTWORKERS. In certain industries specified in the Home Work Orders made by the Home Secretary, if work is given out by employers or contractors to be done in private houses, the workers are known as Outworkers and the premises in which they work are subject to inspection by the Sanitary Inspectors of the Borough Council. In Fulham this duty is carried out by the Woman Sanitary Inspector. The object of the inspections is to prevent such work being done in unwholesome premises or in houses in which infectious diseases are present. The following table gives the number of Outworkers' premises in the Borough, the nature of the work carried on and the classification of the Outworkers' premises into factories, workshops and workplaces:— Nature of Work. Nature of Premises. Total. Factories Workshops. Workplaces. Woaring Apparel 5 9 40 54 Bootmaking — — 34 34 Toy making - - 5 5 Totals 5 9 79 93 OUTWORK IN UNWHOLESOME PREMISES. Nature of Work. Instances. Notices served. Prosecutions. Boot Making 1 1 — China Repairing 1 1 — Toy making 2 4 — Wearing Apparel 1 1 — Total 5 7 — TOTAL INSPECTIONS. Premises. Male Inspectors. Woman Inspector. Total. Factories 511 102 613 Workshops 56 123 179 Workplaces 126 159 285 Outworkers' Premises 2 128 130 Total 695 512 1,207 Section IV. HOUSING. 54 GENERAL. The earliest records of the district date back to the year 691 when the manor was granted to Earconauld, Bishop of London. The Parish was then known as Pulenham from which the present name is evolved. This place name is from the Anglo-Saxon and means " foul hamlet," not with the modern significance of the phrase, but rather in the sense of " miry " or " muddy," as the Thames used to inundate the low lying lands along its course. Down to the year 1834 Fulham and Hammersmith constituted one Parish, but by Act of Parliament, Hammersmith was then made a separate Parish. They were governed in the ensuing years, first by a Board of Highways, and then by the Fulham District Board of Works, which was dissolved under the Metropolis Management Act, 1886, Fulham becoming a separate sanitary district under the jurisdiction of the Fulham Vestry. At the date of the Ordnance Survey about 1861, the district consisted of four villages, namely, Fulham, North End, Parsons Green and Walham Green, separated by lands used chiefly for agricultural purposes. About 1870, the large estates and market gardens were sold for building purposes. DEVELOPMENT. The Census figures for the last century are as follows:— Year. Population. Number of Houses. Year. Population. Number of Houses. 1801 4,428 — 1881 42,900 5,833 1811 5,903 — 1891 91,790 12,896 1821 6,492 — *1896 113,871 — 1831 7,317 — 1901 137,289 18,534 1841 9,319 — 1911 153,284 20,737 1851 11,886 — 1921 157,944 26,630 1861 15,539 2,481 1931 150,928 26,738 1871 23,350 3,469 - - — *Intercensal population taken under the Equalisation of Rates Act in the night of Sunday, 29th March, 1896 From these figures it will be seen that there was a very rapid increase in the population from the year 1871; during the period 1881-1891, the population more than doubled itself. Unfortunately for Fulham the character of the building during this period left much to be desired. Dr. Young, Assistant Medical Officer of Health to the London County Council, reported as follows in 1896 :— "A marked feature which attracted attention in this district is the inferior character of the building which has taken place in some parts. Houses, which I found had only been built within recent years, were already becoming defective owing, apparently, to the inferior quality of material used in their construction and to inferior workmanship." This period of expansion has left a considerable and troublesome legacy in the form of inferior and unsatisfactory houses, which will only be solved finally by demolition and re-building. OCCUPATIONS. Of Fulham residents in 1921, 13,621 males and 9,890 females were known to work in Fulham and 30,761 males and 13,000 females worked outside Fulham. Of the 43,761 with work outside the Borough 39,582 were known to be working in London. These figures clearly indicate the position of Fulham as an integral part of London, sharing London's peculiar housing and transport problems. 55 POPULATION. The following table gives an analysis of the population and houses in the Borough as ascertained from the Census returns during the century. TABLE 14. ACREAGE, POPULATION, NUMBER OF DWELLINGS AND FAMILIES PER DWELLING. Census. Area in Acres. Population. Average No. of Persons per Acre. Average No. of structurally separate Dwellings per Acre. No. of structurally separate Dwellings. Average No. of Families per structurally separate Dwelling. Average No. of Persons per Family. Rooms per Persons. Persons per Room. 1901 1,703.5 137,289 80 .59 11.48 19,667 1.63 4.27 Not available. — 1911 1,703 .5 153,284 90.0 12.17 20,737 1 .75 4.13 0.92 1.07 1921 1,706 157,938 92.6 15.60 26,630 1 .51 3.82 0.96 1.05 1931 1,706 150,928 88.5 11.48 19,667 1 .64 3 .38 0.97 1.02 The built up character of the Borough is well shown and is further illustrated by the following table, showing for the Census decennia the actual increase of the population, the natural increase, that is the excess of births over deaths, and the loss by migration. TABLE 15. LOSS BY MIGRATION SINCE 1901. Date of Census. 1. Population. 2. Increase (+) or Decrease (—) of Population. 3. Natural increase of Population (Excess of Births over Deaths). 4. Loss by Migration. (-) Number. (Col. 3—Col. 4.) 5. Percentage (of col. 5 to previous Census Population +Col. 4). 6. 1901 137,289 — — — — 1911 153,284 (+) 15,995 24,521 — 8,526 —5.3 1921 157,938 (+) 4,654 16,444 —11,790 -6.9 1931 150,928 -7,010 9,730 —16,740 -9.9 *1935 143,600 -7,328 1,216 - 8,544 -5.6 * Registrar General's Mid 1935 Estimate. 56 Fortunately for the remaining 143,600 a net total of 45,600 people have left Fulham since 1901. It is noteworthy that migration is not a tendency of the last few years, but has been operating for over thirty years. Its results are more evident only by reason of the decline in the birth rate. Its justification is illustrated by the following table, showing the population per acre in Fulham and the various divisions of London. TABLE 16. PERSONS PER ACRE IN FULHAM, LONDON, OUTER LONDON AND GREATER LONDON. BASED ON CENSUS RETURNS. Date of Census. Persons per Acre. Fulham (acreage 1706). London. England and Wales (Urban Areas). County (acreage 74,850). Outer (acreage 368,605). Greater (acreage 443,455). 1901 80.59 60.6 5.5 14.8 5.56 1911 90.0 60.4 7.4 16.4 6.23 1921 92.6 59.9 9.1 16.9 7.08 1931 88.5 58.7 10.3 18.5 7.1 These figures help towards an appreciation of the following table. An area of 1,706 acres contained at the 1931 Census a population of 150,928, of whom 146,071 were in 43,153 private families. For these families, 26,738 structurally separate dwellings were available giving an average of 1.64 families per structurally separate dwelling. If shared dwellings only are considered, the average family occupation per shared dwelling is 2.32. 57 58 TABLE 17. COMPARATIVE STATISTICS OF AREA, POPULATION, FAMILIES, DWELLINGS AND OVERCROWDING, 1911-1931. Date of Census. Area in Acres. Population. Families. Dwellings. Overcrowding. More than two persons per room. Shared Dwellings. Total Population. Increase (+) or Decrease ( —) over previous Census. Density. Population in Private Families. Number of Private Families. Increase or Decrease (—) over previous Census. Number of structurally separate Dwellings (including vacant). Increase or Decrease (—) over previous Census. Number of vacant structurally separate Dwellings. Population Overcrowded. Proportion of total Private Family Population. Increase or Decrease (—) over previous Census. Number of Dwellings Occupied by two or more Families. Proportion of total occupied Dwellings. Population. Proportion of total Family Population. 1901 1,703.5 137,289 + 45,499 80.59 132,726 32,137 — 19,667 6,771 634 — percent. — percent. — percent. 1911 1,703.5 153,284 + 15,995 90 .0 149,702 36,432 4,295 20,737 1,070 842 21,784 14 .6 — — — — 1921 1,706 157,938 + 4,654 92.6 154,514 40,436 4,004 26,630 5,893 651 20,265 13. 1 -1,519 -I .5 12,191 46 .72 1931 1,706 150,928 -7,010 88.5 146,071 43,153 2,717 26,738 108 493 15,398 10.5 -4,867 -2.-6 12,796 48 .8 59 The Borough is divided into eight wards, of which half have densities of more than .00 persons per acre, as shown in the following table. There are 106 out of a total of 307 vards in London with a population density of more than 100 persons per acre. TABLE 18. WARDS IN FULHAM WITH HIGH POPULATION DENSITIES—100 OR MORE PERSONS PER ACRE, CENSUS, 1931. Ward. No. in the London List. Area in Acres. Population. Average No. of Persons per Acre. Average No. of structurally separate Dwellings occupied per Acre. Average No. of Families per structurally separate Dwelling. Average No. of Persons per Family. No. of Private Familioe. Persons per Room. LILLIE 53 177 23,173 130.9 21.5 1.77 3.30 6,754 1.05 MARGRAVINE 77 147 16,843 114.6 18.0 1.64 3.61 4,336 1.10 WALHAM 98 140 14,375 102.7 15.7 1.78 3.58 3,935 1.15 MUNSTER 101 339 34,403 101.5 18.4 1.60 3.43 9,973 1.01 * i.e. list of wards in London arranged from highest to lowest according to density. In considering the figures set out in the foregoing tables it should be remembered that properly constructed flats are counted as separate dwellings. There are in the Borough therefore, a considerable number of working class houses which are congested on the site and which have facilities which on the standard of Section 62 of the Housing Act, 1930, arc inadequate; washing and drying accommodation, yard space, cooking facilities, food stores, water and closet accommodation, and various other necessities which might be made adequate for one family are not available and cannot be provided for two families. This is illustrated by a special inquiry into bathroom accommodation made for the purposes of a Ministry of Health inquiry on the Council's application for a loan sanction to modernise the swimming baths. There are in round figures, 26,000 structurally separate houses in the Borough. Of these 11,000 (42 per cent.) contain no bathrooms. Over 20,000 families (47 per cent.) out of some 43,000 in the Borough inhabit these houses. Many houses which have bathrooms are let to two or more families, one of which has no access to the bathroom. A very great proportion of the poorer working class houses in the Borough are let in multiple family occupation and have no bathroom. 60 OVERCROWDING. The Housing Act of 1935 provided for a survey of every sanitary district to determine the extent of overcrowding. A person under 10 years of age counts as half an "equivalent person," and a child under 1 is ignored. The following standards are specified by the Act:— TABLE I. Where a house consists of Permitted number of persons (a) one room 2 (b) two rooms 3 (c) three rooms 5 (d) four rooms 7½ (e) five or more rooms 10 with an additional two in respect of each room in excess of five. TABLE II. Where the floor area is Permitted number of persons (a) 110 sq. ft. or more 2 (b) 90 sq. ft. or more, but less than 110 sq. ft. 1½ (c) 70 sq. ft. or more, but less than 90 sq. ft. 1 (d) 50 sq. ft. or more, but less than 70 sq. ft. ½ (e) under 50 sq. ft. Nil The maximum permitted number of persons per house is that determined by applying these two tables. Thus, for example, a three roomed house in which each of the rooms were between 70 and 90 sq. ft. would accommodate three persons only; a similar house in which all the rooms exceeded 110 sq. ft. would accommodate 5 persons, not 6, subject to the modification determined by the age of the persons. The Survey in Fulham was commenced in October, 1935, and completed at the beginning of February, 1936. The total staff engaged on the work numbered 10 clerks, 18 enumerators and 12 survey assistants. 24,502 structurally separate dwellings containing 38,882 families were enumerated on Form A, and presumptive evidence of overcrowding discovered in 4,277 cases, i.e., 17.5 per cent. of the houses visited. All rooms in the houses were measured in these cases, with the result of a final classification of 1,795 houses overcrowded on the standard of the Act. 61 The Ward classification of these houses is as follows:— Ward. Number of Families. Number Overcrowded. Percentage Overcrowded. Barons Court 3,027 139 4.5 Lillie 5,814 310 5.3 Walham 4,056 276 6.8 Margravine 5,759 314 5.4 Munster 7,517 331 4.4 Hurlingham 2,392 34 1.4 Sands End 6,260 330 5.2 Town 4,057 61 1.5 Total 38,882 1,795 4.6 With regard to houses owned by the Council, there were 370 families living at Fulham Court, of whom 17 were overcrowded, and at Wyfold Road, 11 out of 36 families were overcrowded. 6.9 per cent, of the estimated total "equivalent population" in the Borough is overcrowded; put another way, 4.6 per cent. of the families enumerated are overcrowded. The summary for the Borough is given in Table 19. TABLE 19.—HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. Size of Family (" equivalent number" of persons) Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Total of Families. *0 * l 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over Overcrowded Not Overcrowded Total 1 10 18 1,499 277 901 174 4 918 25 37 1 295 4 3 6 93 - 3 33 - 16 1 - - 14 10 4,372 4,382 1½ — - - 4 7 26 10 4 26 - 1 1 5 - 1 — - _ 1 86 86 2 — 1 2 27 †227 1,762 666 8 4,785 108 564 6 1,892 24 24 42 561 2 9 326 5 2 100 __ - 90 |32 11,201 11,233 2½ — - 26 21 32 613 10 1,634 63 242 4 483 9 6 8 81 1 34 1 6 - - - 5 47 3,232 3,279 3 — 2 27 24 19 582 8 3,021 105 546 5 2,032 29 33 84 804 12 14 452 6 133 2 - 135 72 8,003 8,075 3½ 5 3 143 101 7 657 34 166 4 376 13 11 22 110 2 5 48 1 12 - - - 20 252 1,488 1,740 4 — —_ 3 2 142 102 9 34 95 1,000 5 1,235 34 47 81 636 8 8 516 10 3 164 3 1 - 123 258 4,003 4,261 4½ 39 36 4 27 230 4 247 5 7 18 94 3 4 86 3 1 28 - - - 15 96 772 868 5 45 29 4 28 45 386 6 597 20 19 48 332 8 15 373 9 2 84 2 4 - 130 152 2,035 2,187 5½ 2 16 7 1 113 10 50 3 168 5 12 11 69 2 2 75 1 1 12 1 - - 10 199 372 571 6 — 1 i 14 4 2 140 16 83 10 31 38 29 71 146 8 9 187 7 - 56 1 2 - 108 271 693 964 6½ — - - i 7 5 — 48 5 12 4 10 17 18 32 37 1 43 1 16 - - 17 92 182 274 7 1 - 3 1 - 37 6 15 5 18 15 12 38 68 3 4 99 2 1 41 _ 1 - 66 101 335 436 7½ - - - - - - 2 - 19 1 7 - 11 9 4 18 23 3 2 24 4 1 8 1 - - 8 53 92 145 8 2 15 10 1 32 2 4 12 2 2 3 37 2 - 19 - - - 21 78 86 164 8½ — - 5 3 14 1 3 4 — 2 1 12 2 1 4 - - - 3 30 25 55 9 — - - - 1 1 15 1 1 1 1 1 3 20 2 4 1 - _ 25 22 55 77 9½ — — 1 1 - _ 7 - 1 - 4 2 1 2 - 1 3 10 13 23 10 — . - - — — 1 - - - 4 - - I 1 - 1 - 1 1 - 1 1 _ 20 8 23 31 10½ — 1 3 - 1 - - _ — 1 - _ 1 5 2 ! 7 11 _ _ _ ■ - _ - 1 - 1 - - - — - 1 3 2 I 4 6 11½ - - - - _ _ _ 1 _ - - - - - - - 1 — 1 12 - - - j - 1 - - - - 1 - - - - - - 2 _ - - - - - - - 7 3 7 10 12½ - - - _ | - -i - 1 - _ | - , 1 - 1 1 - - - — - - - 1 — 1 Totals of Dwellings 13 & over - - - - - - - - - - - - - - - - - - - - - - - , - - 6 _ 6 6 Overcrowded - 4 90 t56 430 288 20 425 85 180 21 112 28 12 19 9 2 2 1 _ — - - _ †1,795 - — Not Overcrowded — _ 18 1,503 509 2,721 2,045 41 11,075 457 3,222 39 7,361 198 221 479 3,057 57 82 2,369 59 13 706 11 13 - 831 37,087 — Total - 11 22 1 1,593 565 1 3,151 2,333 61 11,500 | 542 | 3,402 | 60 j 1 7,473 226 233 498 3,066 59 84 2,370 59 13 706 11 13 —- 831 — - 38,882 * 0 = a dwelling of 1 room under 50 square feet: ½ = a dwelling of 1 room between 50 and 70 square feet. †Including 2 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 66 The following tables give further information about overcrowding. TABLE 20. OVERCROWDING—SHOWING NUMBER AND PROPORTION OP THE POPULATION LIVING 2, 3 AND 4, ETC., PERSONS PER ROOM. Population, 1931, living more than Living more than three per room. Increase ( + ) or decrease (—) Proportion of total population (in private families). 2 per room. 3 per room. 4 per room. 5 per room. 6 per room. 7 per room. 8 per room. 1911-1921 1921-1931 1921 1931 Decrease in percentage 1921-31 Population 15,398 3,397 1,073 355 103 40 _ -1,519 -4,867 — — — Percent. 10.54 2.33 0.73 0.24 0.07 0.03 — — — 13.12 10.54 -2.58 67 TABLE 21. POPULATION LIVING IN PRIVATE FAMILIES AT VARIOUS DENSITIES (PERSONS PER ROOM), 1911 TO 1931. Census. Population living in Private Families at various densities of Population. Percentage living at various densities. Population living in Private Families more than three Persons per Room. Percentage living in Private Families more than three Persons per Room. More than two Persons per Room. One-two Persons per Room. Less than one Person per Room. Total. More than two Persons per Room. One-two Persons per Room. Less than one Person per Room. 1911 21,707 89,971 38,024 149,702 14.5 60.1 25.4 3,530 2 .358 1921 20,265 66,834 67,415 154,514 13.1 43.2 43.7 3,643 2.357 1931 15,398 54,815 75,858 146,071 10.5 37.5 52.0 3,397 2.325 TABLE 22. MULTIPLE OCCUPATION OF DWELLINGS, 1911 TO 1931. Date of Census. Number of structurally separate Dwellings Occupied. Number of Families. Average No. of Families per Dwelling in Number of Families in Occupation. Proportion of Families in Multiple Occupation. Single Family Occupation. Multiple Family Occupation. All Dwellings. Shared Dwellings. Two Families per Dwelling. Three or more Families per Dwelling. Total two or more Families per Dwelling. 1911 19,895 36,432 1 -83 not available. not available. not available. not available. not available. not available. 1921 25,979 40,436 1 -56 2-25 14,434 18,460 7,542 26,002 64 -3 1931 26,245 43,153 1 -64 2-32 13,449 19,284 10,420 29,704 66-8 TABLE 23. FAMILIES LIVING MORE THAN TWO UNITS PER ROOM, OVERCROWDING SURVEY, 1935. FAMILIES Equivalent Number of Persons OCCUPYING Total Living more than 2 units per room (according to size of Family) Overcrowded as shown on the Survey 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6 Rooms 7 Rooms 8 or more Rooms 1 1,804 1,075 1,034 309 96 33 17 14 4,382 __ 10 1½ 11 36 31 6 1 1 86 2 257 2,428 5,465 1,988 572 333 100 90 11,233 32 2½ 47 645 1,949 510 82 35 6 5 3,279 47 47 3 53 601 3,680 2,183 830 458 135 135 8,075 53 72 3½ 8 244 864 426 117 49 12 20 1,740 8 252 4 5 244 1,138 1,402 652 529 167 124 4,261 5 258 4½ 75 278 281 101 90 28 15 868 75 96 5 74 464 690 355 384 90 130 2,187 74 152 5½ 2 23 174 199 73 77 13 10 571 25 199 6 2 18 241 179 163 194 59 108 964 20 271 6½ 1 12 65 81 38 44 16 17 | 274 78 92 7 1 4 58 88 75 102 42 66 436 63 101 7½ 2 27 42 28 29 9 8 145 29 53 8 2 25 51 7 39 19 21 164 27 78 8½ 8 22 3 15 4 3 55 30 30 9 1 19 5 22 5 25 77 20 22 9½ 2 8 7 3 3 23 10 10 10 1 5 1 2 2 20 31 6 8 10½ 1 4 - i 1 7 5 5 11 — 2 1 3 6 2 2 11½ — — — 1 — — 1 1 1 12 1 2 7 10 3 3 12½ 1 — 1 1 1 13 - - - - - - - 6 6 - Total 2,191 5,484 15,505 8,490 3,209 2,442 729 832 38,882 _ Families More than 2 units per room 119 211 187 55 10 - - - - 582 - Overcrowded as shown on Survey 161 718 710 192 13 1 — — — — 1,795 69 THE RE-HOUSING OF OVERCROWDED FAMILIES. The calculation of the number of houses required to abate the overcrowding in the 1,795 families is somewhat complicated. Making allowance for the maximum re-allocation of overcrowded families in houses now overcrowded but which can be utilised for smaller families, some 639 new houses will be required. On the London County Council basis of 1½ persons per room these will be of the following sizes:— Size of House in Rooms 3 4 5 6 7 8 9 Number of Houses 237 157 181 34 24 5 1 Total 639 This figure will in due course be modified by deducting a proportion for overcrowded families living in unfit houses which can be dealt with under the Housing Act, 1930, but the exact figure is still problematical. It will be clear from the preceding tables that there is no shortage of occupants for 639 additional houses. 70 RECENT PROVISION OF WORKING CLASS HOUSES. The following table shows the source and amount of the 1,343 working class flats built in the Borough in the last 30 years. TABLE 24. NEW HOUSES PROVIDED FOR THE WORKING CLASSES SINCE 1906. Estate. No. of flats. Approximate date of erection. Erected under. Private Enterprise :— Peabody Trust, Lillie Road 240 1911 — Lewis Trust, Vanston Place 378 1922 — Lewis Trust, Lisgar Terrace 199 1928 — Rosamund Bldgs., Parsons Green (Fulham Housing Association). 6 1929 — Total 823 — — Borough Council :— Wyfold Road 36 1925 Housing Act, 1924. Fulham Court 369 1933 Housing Act, 1924. Carnwath House ... 27 1936 Housing Act, 1930. Total 432 — — London County Council :— Bearcroft Buildings 40 1906 Non-assisted scheme. Broxholme House 44 1931 Housing Act, 1924. Total 84 — — Grand Total 1,339 — — LONDON COUNTY COUNCIL ESTATES. Since October, 1924, 15 out of every 1,000 houses erected on London County Council estates have been allocated to Fulham residents recommended by the Public Health Department. Besides those families recommended by the Department, families applying direct to the London County Council are also accommodated. 71 The following table shows the number of families accommodated on the various estates since, October, 1924:— TABLE 25. Estate. Accommodated on recommendation by the Fulham Borough Council. Accommodated on applying direct to the London County Council. Total Fulham families accommodated. EAST HILL, Wandsworth. 14 40 54 WATLING, Middlesex. 139 84 223 DOWNHAM, Kent. 54 20 74 BECONTREE, Essex. 108 436 544 ST. HELIER, Morden. 123 275 398 BROXHOLME HOUSE, Fulham. 1 45 46 ROEHAMPTON, CASTELNAU, CENTRAL LONDON, Etc. 142 513 662 TOTALS: 588 1413 2001 During the year 171 applications were made to the Public Health Department of the Borough for accommodation on the London County Council estates, and were dealt with as follows:— 102 families were recommended to the County Council for preferential consideration; 7 of them subsequently refused the accommodation which was offered. 32 families proved upon enquiry to be unsuitable for recommendation, but 7 applications were forwarded to the London County Council for inclusion in the " ordinary list " of applicants. 37 applicants decided that the estates available were not suitable for them on account of the distance from their places of employment. In addition 42 applicants made enquiries but did not return their application forms or notify the Department of their reasons for not doing so. During the year 30 families were successful in securing accommodation as a result of recommendations from the Public Health Department. The County Medical Officer asked the Public Health Department for reports on several applicants who stated that they desired accommodation on grounds of ill-health or the bad sanitary condition of their premises, and in 9 cases the County Medical Officer was informed that the conditions did not warrant the granting of preferential consideration in the allocation of housing accommodation; the alleged bad conditions were capable of being remedied and suitable notices were served by the sanitary inspectors. In all other cases the application was supported, 72 In 6 cases the London County Council refused to offer accommodation to families recommended by the Department, mainly because the rent plus travelling expenses would be too great a drain on the resources of the applicants. Where suitable, these applicants were advised to apply for accommodation nearer their places of employment. SAMUEL LEWIS TRUST DWELLINGS. The Secretary of the Trust has continued to co-operate with the Public Health Department in the prevention of re-overcrowding, and during the year he forwarded information concerning 23 families who were being accommodated in the dwellings belonging to his Trust. All these cases together with cases accommodated by the London County Council and the Borough Council are followed up to see that vacated premises are not re-let so as to be overcrowded and, where necessary, warning letters are sent to the landlords concerned. HOUSINC WORK DURINC 1935. A summary of the housing work carried out during the year is given in Section III, pages 43 and 44. HOUSE-TO-HOUSE INSPECTION. At the beginning of the year the Council decided to appoint an additional Inspector for house-to-house inspection work, and the new Inspector commenced duty in February, 1935. Until the beginning of 1935 the Housing Inspectors selected for house-to-house inspection streets containing houses suitable for registration under the London County Council Bye-laws with respect to houses divided into separate tenements, but since that time all streets containing houses suitable for occupation by members of the working classes have been inspected, irrespective of their suitability or otherwise for registration. Details of house-to-house inspections carried out during the year will be found in the following table which gives the housing statistics in the form desired by the Minister of Health. The figures include annual inspections of houses registered under the Bye-laws with respect to houses divided into separate tenements:— TABLE 26. 1. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,515 (b) Number of inspections made for the purpose 27,792 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 909 (b) Number of inspections made for the purpose 8,464 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation ... 3,888 2. Remedy of Defects during the year without Service of Formal Notices:— Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,610 73 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number ot dwelling-houses in respect of which notices were served requiring repairs 117 (2) Number of dwelling-houses which were rendered fit after service of formal notice:— (a) by owners' 36 (b) by Local Authority in default of owners 4 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 683 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 400 (b) by Local Authority in default of owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders *1 (d) Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 7 (2) Numoer of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or rooms having been rendered fit *In addition two dwelling-houses were demolished voluntarily. LONDON COUNTY COUNCIL BYE-LAWS WITH RESPECT TO HOUSES DIVIDED INTO SEPARATE TENEMENTS. 229 houses were added to and 6 removed from the Register of houses under these Byelaws, which at the end of the year contained the addresses of 746 houses. 1,108 "Annual Cleansing " inspections were carried out during the spring, two of the district Inspectors being temporarily taken off their districts to do these inspections. The routine work of the two districts was shared amongst the other district Inspectors. As a result of these inspections, 267 Intimation and 31 Statutory Notices were served on tenants and owners regarding failure to carry out the provisions of the Bye-laws regarding annual cleansing. UNDERGROUND ROOMS. During the year Closing Orders were made by the Council in respect of 7 underground rooms which did not comply with the Regulations. Two of the Orders were made at the beginning of the year under Section 20 of the Housing Act, 1930, prohibiting the use of the rooms for sleeping purposes and the remaining 5 were made under the same Section as amended and extended by Section 84 of the 1935 Act, which prohibits the use of the rooms for human habitation. 74 CLEARANCE AREAS. The Albert Mews, Lillie Yard and Burlington Road (1934) Clearance Orders were confirmed by the Minister of Health in February, 1935, but the properties in the areas were not. demolished during the year as the tenants were only re-housed in the early part of 1936. DEMOLITIONS UNDER PART 2, HOUSING ACT, 1930. One house was demolished in November in consequence of an Order made by the Council on the 22nd May, 1935, and two others were demolished voluntarily in pursuance of an undertaking given by the owners in lieu of the Council making Demolition Orders. COMMON LODGING HOUSE. At the beginning of 1935 there were two Common Lodging Houses in the Borough, one capable of accommodating 36 men and the other 8 women. In March, 1935, the owner of the Women's Lodging House applied for permission to take men instead of women, and the application was granted after certain structural alterations had been carried out. At the beginning of October she applied for permission to have her licence revoked and to take women again, but while the matter was under consideration she informed the Council that she had decided to discontinue using the premises as a Common Lodging House. Both Houses were kept under constant supervision during the year, 85 visits being made to them by the Inspectors concerned. DISINFESTATION. The Borough Council have entered into an Agreement with the Kensington Borough Council for the use of the latter authority's Hydrogen Cyanide Disinfestation Plant in connection with the removal of tenants from slum clearance areas to new dwellings. The furniture of the tenants is taken to the Kensington Depot for treatment and delivered direct to the new flats later in the day; meanwhile the bedding is taken to the Fulham Disinfection Station for treatment by steam before delivery to the new flat. No use was made of this arrangement during 1935. For the treatment of infested premises, the usual procedure is to have the room stripped of all woodwork and then fumigated by means of sulphur candles. In some cases where fumigation was inconvenient the rooms were sprayed with a formalin solution. Towards the end of the year experiments with various proprietary insecticides were commenced and the use of formalin has now been superseded by these. During the year 324 rooms were fumigated and 31 sprayed on account of vermin. THE VITAL STATISTICS OF WORKING CLASS FLATS. Unfit houses produce ill-health, particularly of a respiratory character. This cannot always be shown in figures, but it is of interest to examine the vital statistics of the fairly stable populations living in modern blocks of working class flats. The influence of good nutrition on these statistics has been strikingly shown by Dr. McGonigle, of Stockton-on-Tees, 75 in his comparison of the vital statistics of a re-housed slum population before and after re-housing with a similar population living under continued bad housing conditions. Dr. McGonigle showed conclusively that where the family income per head is low, good housing alone will not prevent ill-health. Fortunately, these considerations do not apply the statistics of the working class flats given in the following table:— TABLE 27. Fulham Borough. Fulham Court. Lewis Trust, S.W.6. Lewis Trust, W.14. Peabody Buildings. Population :— (a) Total 143,600 1,895 1,346 766 599 (b) Under 10 16,291 577 388 202 67 (c) Per cent, under 10 11.1 30.7 28.1 26.3 11.2 Births 1,989 24 18 7 7 Birth Rate 13.8 12.66 13.37 9.13 11.68 Deaths :— (a) Total. 1,662 9 8 9 8 (b) Under 10 162 5 1 4 (c) Under 1 100 3 1 1 Total Death Rate (crude) ... 11.6 4.84 6.68 11.74 13.35 Death Rate under 10 on population under 10 9.94 8.66 2.57 19.80 '- Infant Mortality Rate 51 125 55 143 — Diphtheria, No. of Cases :— (a) Total 375 17 20 12 2 (b) Under 10 261 13 17 8 2 Attack rate per 1,000 :— (a) Total 2.6 8.97 14.85 15.66 3.34 (6) Under 10 16.14 20.79 43.81 39.6 29.85 Scarlet Fever, No. of Cases :— (a) Total 317 7 6 5 — (b) Under 10 199 6 2 3 — Attack rate per 1,000 :— (a) Total 2.2 3.69 4.45 6.52 — (6) Under 10 12.21 10.39 5.15 14.85 — It will be noted that the infant mortality rate in Fulham Court and in Lewis Trust, W.14, is high. Of the three infant deaths in the former case one was from enteritis, one from orbital cellulitis (following an accident) and one from broncho-pneumonia. The Lewis Trust, W.14, figure is based on one death only from birth injury. Section V. INSPECTION AND SUPERVISION OF FOOD. 78 MILK. During the year under review 580 samples of milk (including 1 of machine-skimmed milk) were,-examined. Of these, 217 were purchased from milk vendors in the streets during the early hours of the morning (4.30 to 7.30 a.m.), 69 were taken at the early morning delivery to hospitals, etc., in the Borough which are under the control of the London County Council, and 98 were purchased on Sundays and public holidays. Only 2, or 0.3 per cent. of the 580 samples of milk examined were reported as adulterated. One sample, taken at the Fulham Hospital, was 7.3 per cent. deficient in fat and legal proceedings were taken against the contractors, who were convicted and fined £10 10s. 0d., and ordered to pay £5 5s. Od. costs. The other adulterated sample contained 3:4 per cent, of added water. Legal proceedings were instituted against the vendor and the summons was dismissed on payment of £3 3s. Od. costs. Particulars of the number and percentage of adulterated samples of milk for the years 1928 to 1935 inclusive are given in the following table:— TABLE 28. SAMPLES OF MILK ADULTERATED. Year. 1928 1929 1930 1931 1932 1933 1934 1935 No. examined 591 565 548 540 543 641 554 580 No. adulterated 15 28 4 3 4 18 6 2 Percentage of adulteration 2.5 4.7 0.7 0.55 0.74 2.8 1.1 0.3 As in previous years, samples of milk were taken in course of delivery to the Hospitals, Institution and Schools in the Borough which are under the control of the London County Council. The following were taken during 1935:— TABLE 29. Institution. Samples taken for Chemical Analysis. Bacteriological Examination. Fulham Hospital 27 14 Fulham Institution 4 4 Western Hospital 33 24 Elizabethan Open Air School 5 3 L.C.C. Schools 45 32 79 AUTOMATIC MILK MACHINES. There are in the Borough three automatic milk machines fixed to the doors of shops from which milk is obtainable after ordinary trading hours. These were regularly sampled (between 8 and 10 p.m.) during the year and no adulterations reported. COMPOSITION OF MILK SAMPLES. The following table gives the monthly average composition of all milk samples taken during 1935 (excluding machine-skimmed milk):— TABLE 30. Month. No. of Samples. Fat. Solids not Fat. Remarks. January . 55 3.35% 8.86% February 46 3.47% 8.86% Including one sample containing 3.4% added water. March 51 3.50% 8.86% April 50 3.43% 8.87% May 45 3.51% 8.92% June 42 3.56% 8.97% July 44 3.47% 8.88% August ... 42 3.53% 8.77% September 52 3.75% 8.81% October ... 51 3.91% 8.79% November 42 3.64% 9.00% Including one sample 7.3% deficient in fat. December 59 3.78% 8.89% 579 3.60% 8.88% Legal Standards 3.00% 8.50% Average composition of normal cow's milk 3.7% 8.9% It is satisfactory to note that the average figures for milk supplied in the Borough are well above the standard of the Ministry of Agriculture and Fisheries. Any sample, therefore, which shows figures as low as the legal standard should be, and is, looked upon with suspicion. MILK AND DAIRIES (AMENDMENT) ACT, 1922, AND MILK AND DAIRIES ORDER, 1926. Section 2 of the Act empowers the Council to refuse to enter any person's name on the Register of Dairymen and Dairies or to remove names from the register if they are satisfied that the public health is, or is likely to be, endangered by any act or default of the person in relation to the quality, storage or distribution of the milk. 80 During the year under review no applications for registration were refused nor were any names removed from the Register. Special attention has again been given to the enforcement of Article 31 (2) of the Milk and Dairies Order, 1926, which requires that the bottling of milk shall be carried out only on registered premises. No contraventions were reported during 1935. There were on the Register, at the end of 1935, 112 dairymen occupying 110 registered dairies situated within the Borough. In addition there were 28 dairymen retailing milk in Fulham from premises situated and registered in adjoining Boroughs. The following are details of changes which took place during 1935:— No. of dairymen on the Register:— No. on Register at 31st December, 1934 113 No. who transferred their business or discontinued selling milk during the year, 1935 17 96 No. of Registrations granted during 1935 16 No. on Register at 31st December, 1935 112 In addition to the above, registration was granted during the year to 27 persons, entitling them to sell fresh milk only "in the properly closed and unopened receptacles in which it is delivered to the premises." Such registration relates to the person only and not to the premises. At the end of 1935 there were 145 names of such persons on the Register. INSPECTION AND SUPERVISION OF DAIRIES AND MILKSHOPS. The Sampling Officer made 538 visits to dairies and milkshops during 1935 and served 55 written notices, and in addition gave many verbal intimations of defects noted during his inspections. The question of the methods employed by dairymen when cleansing utensils used for the purpose of their business was carefully considered and the Public Health Committee decided that Article 21 of the Milk and Dairies Order, 1926, should be more strictly enforced. This Article provides, inter alia, that all vessels and appliances used by dairymen in connection with their business should be thoroughly washed as soon as may be after use, and shall be cleansed and scalded with boiling water or steam before being used again. The use of boiling water for milk bottle washing is, of course, impracticable, and in order that the provisions of the Order should be properly carried out, the only alternative is sterilisation by steam. The dairymen in the Borough were circularised and given notice to provide the necessary steam-raising plant and sterilising chests, and it is satisfactory to note that the dairymen, always anxious to give the public the best possible service, have taken the necessary steps to comply with the Order. With the exception of the milk sold by one dairyman, who is a producer-retailer owning a farm in Surrey, all the milk sold in Fulham is pasteurised (excluding, of course, "Certified" and "Grade A (Tuberculin Tested)" milk, which may only be sold in a raw condition), and it was not necessary to take any action under Section 4 of the Milk and Dairies (Consolidation) Act, 1915, which empowers Local Authorities to stop the supply of milk from any dairy if such milk causes, or is likely to cause, tuberculosis. Similarly, there was no evidence that milk sold in the Borough was infected by persons suffering from infectious diseases, so that no action was taken under Article 18 of the Milk and Dairies Order, 1926. 81 MILK (SPECIAL DESIGNATIONS) ORDERS, 1923 and 1934. The licences granted by the Borough Council during 1935 were as follows:— Number of Licences to sell Certified Milk 5 Number of supplementary Licences to sell Certified Milk 2 Number of Licences to sell Grade A (Tuberculin Tested) Milk 33 Number of supplementary Licences to sell Grade A (Tuberculin Tested) Milk 2 Number of Licences to sell Pasteurised Milk 35 Number of supplementary Licences to sell Pasteurised Milk 4 Number of Supplementary Licences to sell Grade A (Pasteurised) Milk 1 Number of samples taken in accordance with the instructions of the Ministry of Health BACTERIOLOGICAL EXAMINATION OF MILK. Under the above-named Orders there are five designations applicable to Graded Milks, viz:— Designation. Maximum No. of Bacteria permitted per c.c. of the Milk. Standard for Bacillus Coli. Certified 30,000 Absent in l/10th c.c. Grade A (Tuberculin Tested) 200,000 „ „ l/100th „ Grade A 200,000 „ „ 1/100th „ Grade A (Pasteurised) 30,000 „ l/10th „ Pasteurised 100,000 No standard During the year under review, 109 samples of graded milk and 33 samples of ungraded milk were purchased for bacteriological examination. Sixty of these were taken from vendors in the streets during the early hours of the morning, and 45 at the early morning delivery to hospitals and institutions in the Borough which are under the control of the London County Council. . Of the total of 142 samples examined, 38 were specially tested by animal inoculation for the presence of tubercle bacilli under Section 5 of the Milk and Dairies (Amendment) Act, 1922. In one case, i.e., a sample of "Grade A (Tuberculin Tested)" Milk, the examination revealed the presence of tubercle bacilli, and the necessary action was taken to trace, if possible, the source of the infection. The Medical Officer of the County in which the milk was produced caused an examination to be made of the cows on the suspected farms, and further samples were taken in Fulham, upon which satisfactory reports were received. 82 The following table gives the number of samples of the various types of milk examined:- TABLE 31. Type of Milk. Examination Made. Bacteriological Count only. Bacteriological count and Animal inoculation for tubercle bacilli. Certified — — Grade A (T.T.) 11 5 Grade A (Pasteurised) 4 2 Pasteurised 94 14 Ordinary 23 10 Raw 7 5 Homogenised 1 — Carton 2 2 Totals 142 38 Grade A (Tuberculin Tested) Milk. Of the 11 samples examined, none was reported to contain bacteria in excess of the standard, the figures ranging from 1,850 to 94,500 bacteria per c.c. Grade A (Pasteurised) Milk. Four samples were examined during the year and the results were excellent, one sample containing as few as 85 bacteria per c.c., whilst the highest count recorded was 1,920 bacteria per c.c. Pasteurised Milk. In none of the 94 samples examined was the bacteriological limit exceeded, the highest count being 57,000 bacteria per c.c., whilst the lowest was 1,800. Ordinary Milk. There is, of course, no legal bacteriological standard for this milk, but the 23 samples which were taken during the year were satisfactory, the average bacteriological content per c.c. being 35,652. In addition to the above, seven samples of raw milk, two of carton milk and one of homgenised milk were examined and satisfactory reports received in each case. FOOD AND DRUGS—ADULTERATION, ETC. During the year one thousand and two articles of food and drugs were purchased or taken by Inspector Gammack in his capacity as Sampling Officer, and were submitted to the Public Analyst for analysis. The samples were taken under the Food and Drugs (Adulteration) Act, 1928 and other Acts, Regulations and Orders relating to foodstuffs. Of these, 40, or 3.99%, were reported to be adulterated or not up to standard. Full details of the adulterated samples, together with particulars of action taken, will be found on page 83, 84 and 85. 83 Every adulterated sample is reported to the Public Health Committee, and when the offence does not warrant legal proceedings the vendor is warned by letter, and further samples are purchased to ensure that the adulteration is not continued. Hie following table gives details of the number and percentage of adulterated samples of all articles during the years 1928 to 1935 inclusive:— TABLE 32. SAMPLES OF ALL FOOD (INCLUDING MILK) REPORTED AS ADULTERATED ON CHEMICAL ANALYSIS. Year. 1928 1929 1930 1931 1932 1933 1934 1935 No. examined 1,000 1,000 1,000 1,000 1,001 1,000 1,000 1,002 No. adulterated 31 44 40 22 29 35 43 40 Percentage of adulteration 3.1 4.4 4.0 2.2 2.89 3.5 4.3 3.99 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 & 1927 and PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 & 1927. Seven samples of condensed milk were purchased during 1935, and in all cases the milk, labelling of tins, etc., were in accordance with the Regulations. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS, 1925—1927. During the year samples were examined for the presence of preservatives, and two contraventions, relating to sausages, were reported. In one case the offence consisted of selling sausages containing preservative without disclosing its presence at the time of sale. The preservative used was sulphur dioxide, and the amount below the limit which would have been allowed if there had been a declaration. In the other instance the presence of preservative was declared on a label attached to the sausages, but the size of the lettering was less than that prescribed by the Regulations. For a detailed report on the results of the analysis of food and drugs, see the report of the Council's Public Analyst on page 88 and 89. 84 85 TABLE 33. DETAILS OF ACTION TAKEN IN CONNECTION WITH ALL SAMPLES REPORTED TO BE ADULTERATED OR NOT IN ACCORDANCE WITH PRESCRIBED STANDARD Sample No. Article. Result of Analysis. Action Taken. 95 Malt Vinegar Consisted of Artificial Vinegar Summons—Vendor fined 10/ -. 96 Malt Vinegar 5 % deficient in acetic acid Vendor cautioned. 97 Malt Vinegar Consisted of Artificial Vinegar Summons—Vendor fined 10/-. 104 Milk 3.4 % of added water Summons—Dismissed on payment of £3 3s. Od. costs. 155 Cream doughnuts The filling contained fat which had the composition of margarine fat Vendor cautioned 156 Cream horns The filling contained fat which had the composition of margarine fat Vendor cautioned. 157 Cream doughnuts The filling contained fat which had the composition of margarine fat Vendor cautioned 159 Cream doughnuts The filling contained fat which had the composition of margarine fat Vendor cautioned. 180 Malt Vinegar Consisted of Artificial Vinegar Summons—Vendor fined £1. 182 Malt Vinegar Consisted of Artificial Vinegar Summons—Vendor fined £1. 207 Ammoniated Quinine Tablets 28% deficient in Ammonia Informal sample—see 231. 209 Ammoniated Quinine Tablets Contained no Ammonia Informal sample—see 230. 223 Pork Sausages Contained 197 parts of SO2 per million but were not. labelled "Preserved." Vendor cautioned. 230 Ammoniated Quinine Tablets Contained no Ammonia Summons—Dismissed on payment of £2 2s. 0d. costs. 231 Ammoniated Quinine Tablets 28% deficient in Ammonia Vendor cautioned. 243 Milk Chocolate Egg (Whipped Cream) The milk chocolate contained over 15% of maize starch and the fat was a mixture of cocoa butter and palm kernel or coconut stearine Informal sample—see 294. 294 Milk Chocolate Egg (Whipped Cream) Prepared with skimmed milk. Shell added beyond that natural to the cocoa-nib. 50% of the fat content was coconut fat. 10 % foreign starch added. Matter taken up with manufacturers. 390 Malt Vinegar 8.8 % deficient in acetic acid Vendor cautioned. 458 Glauber Salts 17 % deficient in water Informal sample—see 484. 484 Glauber Salts 41 % deficient in water Manufacturers cautioned. 499 Malt Vinegar 53 % deficient in acetic acid Vendor cautioned. 509 Malt Vinegar Consisted of wood vinegar Vendor cautioned. 561 Iodine Paint 11.3% deficient in potassium iodine 15.2 % deficient in iodine Vendor cautioned. 589 Turpentine Liniment 57 % deficient in turpentine Vendor cautioned. 617 Carbolic Ointment 98 % deficient in phenol Informal sample—see 650. 650 Carbolic Ointment 77 % deficient in phenol Summons—fined £1 and £2 2s. 0d. costs. 698 Mercury Ointment Contained 4.4% of Mercury instead of 30% as required by the B.P. Vendor cautioned. 699 Mercury Ointment Contained 4.8% of Mercury instead of 30% as required by the B.P. Vendor cautioned. 781 Currants Contained maggots Remainder of stock surrendered and destroyed. 816 Raisins Contained maggots Remainder of stock surrendered and destroyed. 830 Malt Vinegar Not Malt Vinegar Summons—dismissed under P.O. Act. 832 Malt Vinegar Not Malt Vinegar Summons—fined £1 and £1 1s. 0d. costs 839 Carbolic Ointment 38% deficient in phenol Summons—dismissed, the magistrate holding that deficiency in phenol was not to prejudice of purchaser £2 28. 0d. costs allowed against Council. 840 Carbolic Ointment 21% deficient in phenol Summons—dismissed, the magistrate holding that deficiency in phenol was not to prejudice of purchaser. £2 2s. 0d costs allowed against Council. 841 Carbolic Ointment 25% deficient in phenol Summons—dismissed, the magistrate holding that deficiency in phenol was not to prejudice of purchaser. £2 2s. 0d costs allowed against Council. 842 Orange Quinine Wine Tonie (Triple strength) 96% deficient in Quinine Summons—fined £2 and £5 5s. 0d. costs 854 Butter 3.1% excess water Vendor cautioned. 882 Milk 7.3% deficient in fat Summons—Vendors fined £10 10s. 0d and £5 5s. 0d. costs. 885 Butter Beans Contained maggots Remainder of stock destroyed. 910 Whisky 0.27% deficient in alcohol Vendors cautioned 86 INSPECTION OF BAKEHOUSES AND BAKERS' SHOPS. There are 66 registered bakehouses in the Borough, 38 of which are underground. Of the 66 bakehouses, 54 are factories and 12 are workshops; in addition there are 13 retail bakers' shops in the Borough without bakehouses attached. During 1935, 416 visits were made and 81 notices served, principally for the limewashing and cleansing of the interior of bakehouses. In addition, a large amount of cleansing, etc., is carried out as the result of verbal intimation to the occupiers. INSPECTION OF MEAT AND OTHER FOODS AND OF FOOD PREMISES. This is extremely important for the health of the community. The inspections are made for many reasons, but principally: (1) To ensure that articles of food are sound, wholesome, free from disease and fit for the food of man. (2) That the premises are in good sanitary condition and clean. (3) That the persons engaged in food occupations are clean in their persons and free from disease, and that they carry out their duties in a hygienic and wholesome manner. The public can assist materially by encouraging clean food shops and discouraging any that are not obviously clean and hygienic. The following table shows the number of inspections of the various types of food premises:— Milk shops and dairies 538 Ice cream premises 105 Butchers' shops 170 Fish shops 24 Fried fish shops 54 Fish curing premises 20 Greengrocers' and Fruiterers' premises 39 Cooked meat shops 15 Eel and pie shops 4 Dining Booms and Eating Houses 149 Restaurants 35 Licensed premises 92 Street Traders' storage premises 53 Slaughter Houses 91 Factory bakehouses 331 Workshop bakehouses 38 Workplace bakehouses 10 Bakers' shops 37 Food factories other than those included above 93 Other food premises 155 2,053 The inspection of food shops and of food is carried out by the District Inspectors and the Woman Inspector as well as by the Sampling Officer. Two Inspectors are on duty two evenings a week inspecting the North End Road Market, the Fulham Market and other street markets in addition to shops. All the male Inspectors take their turn on this duty. 87 SLAUGHTER-HOUSES. There is now one licensed slaughter-house in the Borough. No slaughtering having taken place in the second slaughter-house since October, 1934, and the premises not complying in all respects with the Regulations, no licence was issued for 1935. Four slaughter-men were licensed for the year 1935 by the Council under the provisions of the Slaughter of Animals Act, 1933. The following is a summary of the work performed in connection with the slaughterhouse by Mr. Hutchinson, in whose district it is situated. Visits 91 Animals inspected 383 sheep. Meat condemned 22 pairs of lungs. 3 livers (G lbs.). The lungs were condemned on account of abscesses and strangulosis and the livers on account of abscesses. REGISTRATION OF PREMISES UNDER SECTION 5 OF THE LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1932. At the end of 1935, 219 premises were on the Register relating to the sale or manufacture of ice cream, as follows:— Premises registered for manufacture, storage and sale of ice cream 86 Premises registered for the storage and sale of ice cream 119 Premises registered for the manufacture and storage of ice cream 10 Premises registered only for the manufacture of ice cream 4 219 PRESERVED FOOD. At the end of the year there were 97 premises on the Register relating to the preparation for sale of preserved foods. UNSOUND FOOD. The under-mentioned articles of food, examined at the request of the owners, were condemned and destroyed during the year:— 1 Australian Lamb. 15½ lbs. of Bacon. 2 Stone of Cods' Roes. 773 Tins of Tinned Fruit, 4 Stone of Hake fillets. 9 Tins of Ham. 2 Stone of Skate. 1 Tin of Salmon. 25 Tins Corned Beef. ¾ Case of Pomegranates. 9 Stone Skate wings. 30 Boxes of Dutch beans. 4 Stone of Cod fillets. 327 Baskets of Pears. 2 Chickens. 1½ Tons of potatoes. In addition to the above voluntarily surrendered food, 1½ lbs. of mushrooms and 124 lbs. of butterbeans were seized and destroyed. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925 No notices were received from Port Sanitary Authorities under these Regulations during the year. 88 REPORT OF THE PUBLIC ANALYST. (Thomas McLachlan, A.C.G.F.C., F.I.C.) During the year under review, the percentage of adulteration, 3.99 per cent., was slightly lower than last year, but still higher than it has been for some years. Of a total of 579 samples of milk analysed, only two, or 0.3 per cent., were found to be adulterated. Of these, one contained added water, whilst the other sample was deficient in fat. Although the quality of the milk supplied in the Borough may not always be quite as good as it might be, yet it shows that dairymen, as a whole, are delivering a product which compares very favourably with that supplied to the rest of the country. Of a total of 330 samples of foods, other than milk, beers, or spirits, 21, or 6.4 per cent., were reported adulterated. One sample of butter contained 3.1 per cent, of excessive water. Two samples of milk chocolate cream Easter eggs, one informal and the other formal, were reported against on the grounds that milk chocolate should contain "Roasted, shelled cacao beans, sugar, and not less than 15 per cent, of the dry solids of full cream milk, with or without harmless flavouring matter." The substance in question contained 10 per cent, of added starch, 18 per cent, of a palm kernel fat, and 9.6 per cent, of the solids of skimmed milk. The actual amount of shelled, fat-free cocoa was about 4.1 per cent. These preparations are bought mostly by poor children, who believe that they are obtaining real milk chocolate at a cheap price, and it seems a pity, therefore, that the Departmental Committee on the Composition and Description of Food, in its Report issued in 1934, recommended that no standards, or declarations of composition, or definitions, are needed at present for sweetmeats. Such a decision naturally militates against the interests of reputable manufacturers, and encourages others to use well-recognised terms for substances of an entirely inferior type. Considerable activity has been shown by Local Authorities during the year in the examination of so-called "Cream" pastries. Four samples were examined and returned as adulterated, on the grounds that the fat employed consisted of margarine and not milk fat. In this connection it is of interest to note that your Analyst himself obtained samples from 16 representative shops in Westminster and found genuine milk fat was present in 12 of the samples, three were labelled with fancy descriptions other than cream, and the last sample, which he considered as adulterated, was unlabelled, but was sold as "Cream." Two samples of dried fruits and one of butter beans were condemned on account of the presence of maggots. A sample of lemonade was sent to the Medical Officer of Health with the complaint that it had made a person sick. When examined bacteriologically, it was found to contain yeasts, and also bacteria capable of growing in the presence or absence of air. The bottle had evidently not been properly sterilised before use. No other complaints were received about the same batch manufactured by the same firm. One sample of sausages, which were not labelled to that effect, was found to contain preservative, contrary to the Preservatives, etc., in Food Regulations. Ten samples of vinegar were condemned. Some of these were sold as "Malt Vinegar," when they contained no malt vinegar, whilst others were deficient in acetic acid, the active ingredient, which supplies its keeping and most of its flavouring properties. Of 30 samples of beers and spirits, one sample of whisky contained added water. 89 63 drugs were examined, and 16, or 25 per cent., were reported as adulterated. Of these, two samples of Ammoniated Quinine Tablets contained no ammonia, and two others were 28 per cent, deficient in that drug. Two samples of Glauber's Salts were 41 and 47 per cent, respectively deficient in water. When this salt loses water, its volume alters considerably, so that people are unaware of the dose of purgative which they are taking. Two samples of mercury ointment contained less than 5 per cent, of mercury, instead of 30 per cent, as required by the British Pharmacopoeia. Of twelve samples of mercury ointment asked for during the last two years, four have been genuine, five have contained one third of the required amount of mercury, two have contained less than one fifth, and the last sample contained a tenth of the stipulated quantity. Sometimes the samples have been labelled indicating their inferior strength, but not usually. In any case, a discreet enquiry by the pharmacist would soon ascertain the probable type of "Mercury ointment" required, though it must be remembered that there is only one official ointment. So far, no action has been taken against the vendors of any of these preparations, but the danger attaching to the use of preparations of such variability will be appreciated by most, particularly by doctors. Five samples of carbolic ointment have been condemned on account of a deficiency of carbolic acid. Prosecutions have been instituted in four instances, and in the first case a conviction was secured. Three other cases were heard at the same time, and the defendants joined forces for their defence. In order to upset the certificates of your Analyst, three expert witnesses were secured, namely the Secretary of the Pharmacopoeia Committee of the General Medical Council, a member of the Pharmacopoeia Commission, and a third, who besides being a member of the Pharmaceutical Chemistry Sub-Committee of the Pharmacopoeia Commission, is also Editor of the British Pharmaceutical Codex and of the " Extra-Pharmacopoeia." One can only remark that the experience of these experts is not in accordance with that of your Analyst, and express the hope, that now that the Pharmacopoeia Commission has had its attention drawn to the unsatisfactory position, it will state its requirements more definitely in the forthcoming supplement to the Pharmacopoeia. A sample of Orange and Quinine Wine Tonic (Triple Strength) was found to contain only 0.03 per cent, of quinine, whereas ordinary Quinine Wine contains 0.23 per cent, of quinine, and a summons was therefore taken out against the vendor. The magistrate expressed the opinion in the cases both of the carbolic ointment and the orange and quinine wine that the Borough Council had only performed a public duty in bringing the actions. 90 TABLE 34 -SAMPLES ANALYSED, 1935. Article. Number of Samples. Total Samples Analysed. Total Samples Adulterated. Percentage of Adulteration. Taken Formally. Adulterated. Taken Informally. | Adulterated. Milk 568 2 11 — 579 2 0.3 Skimmed Milk 1 — — 1 — Condensed Machineskimmed Milk — — 7 — 7 — — Cream 4 — 3 — 7 - Butter 69 — 16 1 85 1 1.2 Margarine 8 — 8 — 16 — — Cheese — — 3 — 3 — — Lard 8 — 2 — 10 - — Shortening 1 — — — 1 — — Dripping 3 — — — 3 — Suet 5 — — — 5 — — Tea 3 — 3 — 6 — — Cocoa — — 2 — 2 — — Cocoa Essence — — 1 — 1 — — Pepper — — 9 — . 9 — — Cayenne Pepper — — 4 — 4 — Mustard — — 1 — 1 — — Ground Almonds 4 — — — 4 — — Demerara Sugar 2 — 4 — 6 — — Icing Sugar — — 1 — 1 — — Chocolate Eggs 1 1 3 1 4 2 50.0 Lemonade Powder — — 3 — 3 — Honey — — 3 — 3 — — Marmalade 2 — — — 2 — — Mincemeat 4 — — — 4 — — Candied Peel 1 — 2 — 3 — — Dried Fruits 20 2 4 — 24 2 8.3 Butter Beans 3 1 — — 3 1 33.3 Self-raising Flour 1 — 5 — 6 — — Bread 2 — — — 2 — — Sponge Cake — — 4 — 4 — — Cream Pastries 4 4 — — 4 4 100.0 Arrowroot — — 3 — 3 — — Custard Powder — — 4 — 4 — — Oatmeal 2 — — — 2 — — Rice 2 — 4 6 — — Ground Rice 1 — 2 — 3 — — Sago 2 — - — 2 — — Tapioca 3 — 5 — 8 — — Meat Paste 2 — — — 2 — — Fish Paste 1 — — — 1 — — Sausages 7 1 1 — 8 1 12.5 Preserved Sausages 6 — - 6 — — Meat Pies 14 — — — 14 — — Tinned Fish —. — 5 — 5 — — Mineral Water 2 — 2 — 4 — — Fruit Cordials (Non-alcoholic) 1 — 3 — 4 — — Malt Vinegar 23 10 1 — 24 10 41.7 Ale 7 — — — 7 — — Stout 8 — — —. 8 — — Brandy 3 — — — 3 — — Gin 3 — 1 —. 4 — — Rum 4 — — — 4 — — continued. 91 Article. Number of Samples. Total Samples Analysed. Total Samples Adulterated. Percentage of Adulteration. Taken Formally. Adulterated. Taken * Informally. Adulterated. Whisky 4 1 — — 4 1 25.0 Ammoniated Quinine Tablets 2 2 3 2 5 4 80.0 Black Draught — — 4 — 4 — — Boric Ointment 2 — — — 2 — Camphorated Oil — — 4 — 4 — — Carbolic Ointment 4 4 4 1 8 5 62.5 Compound Tincture of Cardamom — — 3 — 3 — — Epsom Salts — —. 3 — 3 — — Glauber's Salts 1 1 3 1 4 2 50.0 Iodine Ointment — — 1 — 1 — — Tincture of Iodine — — 3 — 3 — Iodine Paint 1 — 1 1 2 1 60.0 Mercury Ointment — — 6 2 6 2 33.3 Weak White Precipitate Ointment — — 1 — 1 — — Orange Quinine Wine Tonic — — 1 1 1 1 100.0 Sal Volatile — — 3 — 3 — — Sulphur Ointment 2 — 4 — 6 — — Turpontine Liniment 1 — 4 1 5 1 20.0 Zinc Ointment 2 — — — 2 — — Totals 824 29 178 11 1002 40 3.99 Section VI. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 94 TABLE 35. TABLE SHOWING THE AGE AND WARD DISTRIBUTION OF THE CASES OF INFECTIOUS DISEASES NOTIFIED DURING 1935. Notifiable Diseases. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. At all Ages. At Ages—Years. Baron's Court Ward. Lillie Ward. Walham Ward. Margravine Ward. Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. Total cases removed to Hospital. Deaths. 0—1. 1—2. 2—3. 3—4. 4—5. 5—10. 10—15. 15—20. 20—35. 35—45. 45—65. 65 and upwards. Smallpox — — — — — — — — — — — — — — — — — — — — — — — Cholera, Plague — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 375 8 9 18 39 30 157 56 14 35 3 6 — 40 55 93 19 46 27 75 20 375 12 Erysipelas 56 1 2 — — — 2 — — 8 7 24 12 4 6 4 9 16 5 8 4 39 — Scarlet Fever 317 — 17 20 22 36 104 54 17 38 8 1 — 28 38 43 41 71 22 52 22 307 — Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 10 — — — — 1 — 2 1 4 — 2 — 3 2 — 1 1 1 1 1 7 — Relapsing Fever, Continued Fever — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 6 — — — — — — — 1 5 - - — 1 1 1 - 2 - — 1 6 3 Puerperal Pyrexia 28 — — — — — — — 2 24 2 — — 3 4 1 6 8 1 2 3 27 — Cerebro-Spinal Meningitis 1 — 1 — — — — — — — — — — — — — — — — — — 1 1 Polio-myelitis 3 — — — — — — — — — — — — — — — — — — — — 3 — Ophthalmia Neonatorum 11 11 — — — — — — — — — — — 3 1 2 — 2 1 2 — 7 — Tuberculosis of Respiratory System 185 — 1 — 1 - 4 6 11 88 29 43 2 26 27 15 19 45 7 26 20 111 Non-Pulmonary Tuberculosis 55 3 1 4 3 2 10 5 5 14 4 2 2 5 4 8 5 14 3 5 10 — 17 Measles 41 11 6 1 2 2 10 4 2 3 — — — 6 7 6 6 8 2 4 2 8 — Encephalitis Lethargica 2 — — - — — 1 — — — — 1 — 1 — 1 — — — — — 2 1 Pneumonia 139 6 8 5 5 6 12 7 7 19 20 32 12 7 22 10 29 42 7 17 5 54 84 Diarrhoea 4 4 — — — — — — — — — — — — 1 1 2 — — — — 3 22 Malaria — — — — — — — — — — — — — — — — — — — — — — — Dysentery 4 — — — — — — — — 3 1 — — — 1 — — 1 1 1 — 4 — Trench Fever — — — — — — — — — — — — — — — — — — — — — — — Total 1237 44 45 49 72 77 301 134 61 241 74 111 28 127 169 189 137 256 78 193 88 843 251 95 The cases were distributed as follows over the twelve months of the year: TABLE 36. Notifiable Disease. January February March April May June July August September October November December Totals. Pneumonia 13 15 16 13 13 7 10 3 7 8 11 23 139 Scarlet Fever 34 24 30 32 32 24 28 11 32 27 30 13 317 Diphtheria 46 39 41 21 23 21 19 33 37 41 37 17 375 Puerperal Fever — 1 — 1 1 1 — — 1 — - 1 6 Puerperal Pyrexia — 2 3 1 4 2 5 1 4 1 5 — 28 Erysipelas 6 9 7 2 4 6 1 3 2 5 4 7 56 Ophthalmia Neonatorum — 2 1 — — 1 3 - 1 3 — - 11 Cerebro-Spinal Meningitis — — 1 — — — — — — — — — 1 Enteric Fever — 2 - - - 1 1 3 2 1 - - 10 Polio-myelitis — 1 — — — — 1 — 1 — - - 3 Encephalitis Lethargica — — — 1 — — — — — — — 1 2 Measles 8 — 3 2 4 2 5 5 4 2 1 5 41 Epidemic Diarrhoea 1 — — — — — — — — 1 1 1 4 Dysentery — — — — — — — 1 — — 2 1 4 Totals 108 95 102 73 81 65 73 60 91 89 91 69 997 The age distribution of the cases is given in the table on p. 94 TABLE 37. COMPARATIVE STATEMENT OF NOTIFIABLE INFECTIOUS DISEASES, 1929—1935. 1929 1930 1931 1932 1933 1934 1935 Scarlet Fever 489 595 331 543 720 691 317 Pneumonia 345 207 275 241 203 180 139 Diphtheria 370 402 225 177 185 473 375 Erysipelas 78 74 86 106 104 117 56 Puerperal Fever 23 17 11 11 11 4 6 Puerperal Pyrexia 51 33 47 37 27 37 28 Enteric Fever 2 13 3 11 5 4 10 Ophthalmia Neonatorum 32 19 17 28 15 15 11 Cerebro-Spinal Meningitis 5 2 9 8 5 6 1 Encephalitis Lethargica 5 2 1 3 - 1 2 Polio-myelitis 5 3 4 1 2 2 3 Measles 948 2526 110 2682 163 2967 41 Epidemic Diarrhoea 36 31 33 22 13 14 4 Dysentery 2 — - 2 - 1 4 Smallpox — 7 — — — — — Totals 2391 3931 1152 3872 1453 4512 997 96 97 98 table 38. number of cases of infectious disease notified from 1900-1935 inclusive. 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1928 1927 1928 1929 1930 1931 1932 1933 1934 1935 Small-Pox 9 16 94 11 — — — — — — — — — — — 7 — — — — — — 2 — — — — — 1 — 7 — 2 — — — Scarlet Fever 552 600 552 404 294 779 674 668 596 511 354 384 484 766 1,042 621 286 234 228 371 930 961 626 466 360 398 311 360 416 489 595 331 543 720 691 317 Diphtheria 641 644 429 293 302 286 403 604 400 322 257 311 231 270 272 271 312 237 203 336 623 579 438 277 259 276 345 390 359 370 402 225 177 185 473 375 Typhoid Fever 92 133 74 80 39 56 45 58 39 41 18 38 26 34 40 14 5 11 15 6 25 7 16 3 7 10 8 11 41 2 13 3 11 5 4 10 Erysipelas 154 132 121 115 131 143 141 128 127 115 115 115 115 121 152 89 73 50 45 75 102 92 94 76 92 74 77 58 81 78 74 86 100 104 117 56 Cholera — 1 — — — — — — — — — — — — — — —. — — — — — — — — — —. — — — — — — — — — Cerebro-Spinal Meningitis — — — — — — — 3 4 3 7 3 2 5 1 20 12 20 8 9 5 4 1 2 2 3 4 7 4 5 2 9 8 5 6 1 Poliomyelitis — — — — — — — — — — — 1 5 2 — — 3 5 2 2 2 5 2 5 7 3 7 3 3 5 3 4 1 2 2 3 Ophthalmia Neonatorum — — — — — — — — — — — 15 13 23 55 47 49 57 44 47 40 30 33 22 27 32 29 33 38 32 19 17 28 15 15 11 Measles — Notifiable from 1st January, 1916 — — — — — — — — — — 751 2,021 1,592 615 942 396 2,438 1,951 1,692 589 3,700 463 2,099 948 2,526 110 2,682 16 i 2,967 41 Encephalitis Lethargica — Notifiable from 1st January, 1919 — — — — — — — — — — — — — 6 2 7 3 2 21 10 12 5 2 5 2 1 3 — 1 2 Pneumonia — Notifiable from 1st March, 1919 — — — — — — — — — — — — — 199 198 215 300 218 326 320 288 310 297 345 207 275 241 203 18 139 Epidemic Diarrhoea — Notifiable from 2nd July, 1919 — — — — — — — — — — — — — 83 51 140 17 79 40 70 50 18 60 36 31 33 22 13 140 4 Puerperal Fever 9 7 7 19 8 24 17 15 17 34 20 23 30 19 33 24 22 15 12 35 32 27 31 32 26 21 15 16 16 23 17 11 11 11 4 6 Puerperal Pyrexia — Notifiable from 1st October, 1926 — — — — — — — — — — — — — — — — — — — — 12 28 51 51 33 47 37 27 37 28 Trench Fever — Notifiable from 1st March, 1919 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery — Notifiable from 1st March, 1919 — — — — — —— — — — — — — — 9 — 2 1 — — — — 6 1 2 — — 2 — 1 4 Malaria — Notifiable from 1st March, 1919 — — — — — — — — — — — — — 104 20 9 1 1 3 — — 1 4 — 2 — 2 1 — — Totals 1,457 1,533 1,277 922 774 1,288 1,280 1,476 1,183 1,026 771 890 906 1,240 1,595 1,093 1,513 2,650 2,152 1,898 2,972 2,474 4,003 3,134 2,862 1,806 4,858 1,709 3,473 2,391 3,933 1,152 3,876 1,454 4,512 997 TABLE 39. NUMBER OP DEATHS FROM THE SEVEN PRINCIPAL ZYMOTIC DISEASES DURING 1900-1935 INCLUSIVE. 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Small-Pox — 3 13 — — — — — — — — — — — — 3 — — — — — — 1 — — — — — — — — — — — — — Measles 80 37 168 62 64 85 53 69 71 74 65 64 65 49 31 121 18 75 46 14 24 2 41 23 29 2 47 — 15 10 27 1 26 2 31 — Scarlet Fever 23 20 19 8 4 23 18 14 17 10 7 6 6 4 21 17 5 4 4 5 9 15 12 5 5 3 4 1 2 3 2 2 2 6 1 — Diphtheria 65 48 51 24 24 24 33 38 32 39 14 27 15 15 23 27 20 16 12 32 44 43 33 20 11 11 14 11 13 10 19 9 10 8 30 12 Whooping Cough 54 76 65 48 58 82 31 75 34 48 60 28 45 27 43 51 32 22 58 4 17 30 26 14 14 35 6 8 12 25 5 7 12 14 7 5 19 22 9 16 6 10 13 8 10 4 2 8 8 8 9 4 1 2 5 2 4 1 4 — 1 — — 2 1 — 1 2 1 — 1 — Diarrhoea (and Enteritis under 2 years) 181 199 140 165 235 202 275 115 130 105 74 211 34 100 127 81 64 71 60 44 36 71 27 25 22 36 30 19 53 35 34 15 22 20 18 19 Totals 422 405 2.93 465 323 391 426 423 319 294 280 222 344 173 203 254 304 140 190 185 101 134 162 144 87 82 87 101 41 96 83 88 36 73 50 88 36 Zymotic Death Rate 3.17 3.25 2.19 2.57 2.73 2.66 2.00 1.94 1.83 1.45 2.25 1.12 1.28 1.62 2.00 0.90 1.31 1.29 0.66 0.88 1.30 0.93 0.53 0.50 0.53 0.60 0.20 0.60 0.50 0.57 0.25 0.49 0.33 0.61 0.25 100 DIPHTHERIA. 375 cases were notified compared with 473 the previous year, the attack rate being 2.6 per 1,000 compared with 3.3. This incidence is still high, but the epidemic which commenced in the fourth quarter of 1934 shows definite signs of waning and the greatest number of cases this year occurred during the first quarter. All cases were removed to hospital for treatment; 12 deaths occurred, the fatality rate being 3.2% as compared with 6.4% last year. The age distribution of the cases is shown in Table 35 (p. 94). DIPHTHERIA ANTITOXIN. This is available to practitioners upon request at the Health Department. During the year 72 issues, each of 8,000 units, were made. DIPHTHERIA IMMUNISATION. In this country some 60,000 cases of Diphtheria are reported annually, chiefly among the population of pre-school age, and, unhappily, about 3,000 cases terminate fatally—a heavy toll. Diphtheria is thus a serious disease, which, despite the most intensive treatment, still kills about one in twenty of those it attacks. It is most prevalent in the winter and shows increased epidemicity every five or six years. There also tends to be a still bigger epidemic about every twenty years. The last five years or so have shown a marked increase in the virulence of the disease, particularly in northern towns, where a considerable number of cases of the gravis type have been reported, with a high mortality rate. Fortunately the situation is not as bad everywhere, but the fact remains that a definite variation in the clinical type of diphtheria towards the dreaded virulent type has been noted. The case for a simple and harmless measure designed to check the incidence of the disease is abundantly clear. Immunisation is still by no means a universal practice. Only about half the total number of metropolitan and county boroughs and certain smaller sanitary districts in twenty-three counties in this country offer facilities for this treatment. That it has not been more widely adopted as a public health measure is largely due to the prejudice which exists against the practice among people who do not understand its value. Health Visitors and welfare workers who are in close contact with parents, and who have their confidence, can help to dispel this prejudice. A clinic for immunisation was inaugurated in the Borough in April, 1934, and has been held every Thursday afternoon at 170, Wandsworth Bridge Road. The Medical Officer in charge is Dr. Guy W. J. Bousfield. Since the inception of this clinic, 1,350 persons have received treatment, and the following tables show the work which has been done during the year under review. All the applicants were Schick tested and, if positive, received three inoculations of Toxoid-Antitoxin Floccules or Toxoid-Antitoxin Mixture. A final Schick test was made three months after the last injection, and, if this proved negative, a certificate was issued. The clinic has been supported by propaganda on the subject in the schools and in the Council's Infant Welfare Clinics, and by the distribution of leaflets throughout the Borough and also by the display of poster announcements. One aspect of Diphtheria Immunisation is of epidemiological importance. Artificial immunisation does not appear to diminish the incidence of infection in a community until about forty per cent, of the population is protected. At the commencement of a campaign, therefore, the benefits are to the individual and not the community. The economics of Diphtheria Immunisation should be stressed. The average case of Diphtheria requires six weeks or more in hospital and costs about £20. Allowing for doctors' and nurses' salaries, for the cost of apparatus and materials, and for administrative expenses, a Schick test, complete immunisation, and a Re-Schick test costs about four shillings. A hundred cases can, therefore, be immunised at the same cost as one case can be treated. The cases which occur annually in this country must cost well over a million pounds. 101 102 TABLE 40. AGES OF PERSONS SCHICK TESTED WITH RESULT. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—0 years. 0—10 years. 10—11 years. 11 — 12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Grand Totals Positive 15 49 37 59 49 60 42 34 22 20 13 13 6 5 2 11 437 Negative — — 1 — 3 7 7 11 10 8 3 6 7 5 3 15 86 Not read — 1 1 1 2 1 — — 1 1 — — — — — 1 0 Total 15 50 39 60 54 68 49 45 33 29 16 10 13 10 5 27 532 No. of Clinics held 45 Total attendances 2974 Average attendance 6G Certificates of Immunity issued 497 Discontinued treatment (included in above table). 54 Refused treatment do 1 Removed from Borough and transferred to other areas (included in above table) 3 103 104 TABLE 41. IMMUNISATION TREATMENT. (Prophylactics:—Toxoid-Antitoxin Mixture and Toxoid-Antitoxin Floccules.) No. of Injections. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—9 years. 9—10 years. 10—11 years. 11—12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Total Injections. 1st 17 48 38 57 47 57 43 33 24 18 13 15 7 5 2 8 432 2nd 16 46 38 55 48 57 43 32 23 17 12 14 7 5 2 7 422 3rd 16 43 37 55 47 54 43 33 25 17 14 13 7 7 2 6 429 4th — — — 1 3 5 — 1 — — 1 2 — 2 1 1 17 5th — — — 1 2 4 — 1 — — 1 2 — 2 — — 13 6th — — — — — — — — — — 1 — — 1 — — 2 7th — — — — — — — — — — 1 — — — — — 1 Grand Total 1,316 TABLE 42. Ages of Persons Re-Schick tested after Injections and found to be NEGATIVE. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—9 years. 9—10 years. 10—11 years. 11—12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Total. 13 50 47 72 58 62 60 43 40 27 18 18 10 13 3 8 542 TABLE 43. Ages of Persons Re-Schick tested after Injections and found to be POSITIVE. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—9 years. 9—10 years. 10—11 years. 11—12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Totals. 1 1 1 2 3 5 2 1 1 — 1 1 - 1 -- 1 21 TABLE 44. Ages of Persons found to be NEGATIVE after Primary Schick test and Positive after Re-Schick test. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—9 years. 9—10 years. 10—11 years. 11—12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Total. - 1 - - - 3 - 1 1 - - 1 1 — — — 8 TABLE 45. Ages of Persons found to be NEGATIVE after both Primary and Final Schick test. 6—12 months. 1—2 years. 2—3 years. 3—4 years. 4—5 years. 5—6 years. 6—7 years. 7—8 years. 8—9 years. 9—10 years. 10—11 years. 11—12 years. 12—13 years. 13—14 years. 14—15 years. 15 years and upwards. Total. - - 1 1 7 4 12 10 19 7 4 13 11 6 6 10 111 106 SCARLET FEVER. 316 cases occurred compared with 691 in 1934. The attack rate was 2.2 (4.7 in 1934), The age distribution and seasonal incidence of the disease are shown in the tables at the beginning of this section (Tables 35 and 36). 307 cases were hospitalised and it is pleasing to report that no deaths occurred from the disease. MEASLES. This disease, which is notifiable in Fulham, breaks out every two years in London with clock-work regularity. It is particularly a disease of the young, being most fatal to those under the age of five years, and, whilst it may occur any season, is most prevalent in the spring. 1935 was an inter-epidemic year and only 41 cases were notified, compared with 2,967 in the epidemic year of 1934. Notification depends upon the calling-in of the doctor, a proceeding which is not yet as routine as it should be in this common but dangerous disease. It is certain, therefore, that there were cases which escaped notification. No deaths occurred. ENTERIC FEVER. Ten cases were notified during the year compared with four last year; no deaths occurred from this disease. CEREBRO-SPINAL MENINGITIS. One case occurred during the year—a child of 1½ years. It proved fatal. PUERPERAL FEVER. Six cases were notified and there were three deaths from puerperal sepsis. The incidence in 1935 was equivalent to 3.4 per thousand of the registered births (live and stillbirths) . Three of the cases occurred at home, two in hospital and one in a nursing home. All the cases occurring at home were removed to hospital for treatment. PUERPERAL PYREXIA. Puerperal Pyrexia is defined in the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations of 1926, as "any febrile condition, other than a condition which is required to be notified under the Infectious Diseases (Notification) Acts, occurring in a woman within twenty-one days after childbirth or miscarriage in which a temperature of 100.4° Fahrenheit (38° Centigrade) or more has been sustained during a period of 24 hours or has recurred during that period." Twenty-six cases were notified during 1935 as compared with 37 during 1934. The incidence per thousand births (live and stillbirths) was equivalent to 12.66. 107 CONSULTANT. The services of Mr. Alexander Galletly are available for the purposes of consultation with private practitioners in cases of Puerperal Fever and Puerperal Pyrexia and also for difficult obstetric cases. During 1935 he was called in to two cases under the latter heading. No requests for his services in connection with Puerperal Fever or Puerperal Pyrexia cases were received during the year. OPHTHALMIA NEONATORUM. During the year 11 cases of Ophthalmia Neonatorum were notified, compared with 15 during the previous year, giving an attack rate of 7.5 per thousand of the registered live births. Through an arrangement between the Borough Council and the District Nursing Association the services of the District Nurses are available for cases which are under medical treatment in their own homes. During 1935, 36 visits were paid to two such cases. The following table shows the place of treatment and the result of the 11 cases. Cases notified 11 Treated at Home 4 Treated in Hospital 7 Vision Impaired - Vision Unimpaired 6 Total Blindness - Deaths 1 Left the Borough 1 Still receiving treatment at the end of the year 3 NON-NOTIFIABLE INFECTIOUS DISEASES. During 1935 the Woman Sanitary Inspector paid visits to cases of non-notifiable infectious diseases as follows: Chicken Pox 262 Whooping Cough 119 Mumps 332 Suspicious cases (sore throats, spots, etc.) 149 862 These visits are paid to ascertain that the children are not suffering from any notifiable infectious disease and that they are receiving adequate medical and nursing attention. Information as to the cases is received daily from the Head Teachers of the schools in the Borough on Form 84. The table on page 27 shows inter alia the number of non-notifiable infectious disease cases which were visited by the Fulham District Nursing Association on behalf of the Borough Council. 108 CANCER. The 218 deaths classified as Cancer occurred from the following causes: TABLE 46. Organ Affected. Total. Males. Females. Digestive Organs and Peritoneum 93 47 46 Respiratory Organs 28 13 15 Buccal cavity and Pharynx 17 17 — Breast 25 1 24 Uterus 19 - 19 Genito-Urinary Organs (males) 12 12 — Other Organs 24 13 11 Totals 218 103 115 Classification. Total. Males. Females. Carcinoma 207 97 110 Sarcoma 5 2 3 Epithelioma 1 1 — Not defined 5 3 2 Totals 218 103 115 The ages at death of persons dying from Cancer were: TABLE 47. Age periods. Total. Males. Females. 0-25 years 1 — • 1 25-35 years 3 1 2 35 -45 years 17 6 11 45-55 years 31 12 19 55-65 years 71 35 36 65-75 years 69 34 35 75 years upwards 26 15 11 Totals 218 103 115 From the table showing the principal causes of death it will be seen that one out of every seven deaths in the Borough during 1935 was due to Cancer. The death rate from the disease was 1.52 per 1,000 compared with 1.59 for England and Wales. 109 The yearly death-rates from Cancer since 1920 are as follows: 1920 1.19 1928 1.38 1921 1.32 1929 1.53 1922 1.27 1930 1.57 1923 1.31 1931 1.51 1924 1.35 1932 1.57 1925 1.20 1933 1.62 1926 1.59 1934 1.86 1927 1.36 1935 1.52 PREVENTION OF BLINDNESS. No action was taken under Section 66 of the Public Health Act, 1925. TUBERCULOSIS. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925 (relating to persons suffering from pulmonary tuberculosis employed in the milk trade), or under Section 62 of the Public Health Act, 1925 (relating to the compulsory removal to a hospital of persons suffering from tuberculosis). TUBERCULOSIS REGISTER. During the year under review the Tuberculosis Register has been corrected by the removal of all cases under the headings: recovered, arrested, diagnosis not confirmed, lost sight of, left the district or died, and the addition of all new cases notified, in accordance with the Public Health (Tuberculosis) Regulations. The details of these removals and additions are as follows: Pulmonary : Non-Pulmonary : Males. Females. Males. Females. TOTALS Number of cases on Register at commencement of 1935 579 577 293 293 1,742 Number of cases removed during the year 115 81 19 18 233 464 496 274 275 1,509 Number of cases notified for the first time during 1935 117 89 32 31 269 Number of cases remaining on the Register at the end of 1935 581 585 306 306 1,778 The number of cases notified for the first time during 1935 includes 240 cases analysed in Table 50, page 113 and 29 in Table 51, page 114; these 29 cases are, of course, also included in the 233 cases removed from the Register during the year. 110 In Table 35, page 94, the notifications received during the year are classified according to the ages of the persons affected, and the number of cases notified in each ward of the Borough is also given. MORTALITY FROM TUBERCULOSIS. Respiratory system: 112 Deaths 67 males, 45 females. Death rate 0.78 per 1,000, being 0.01 higher than in 1934. 93 notified (80.34 per cent.). 19 not notified (16.96 per cent.). Of these 19 cases, 12 died in institutions. Other Tuberculous Diseases: 17 Deaths 6 males, 11 females. Death rate 0.12 per 1,000, being 0.02 lower than in 1934. 9 notified (52.94 per cent.). 8 not notified (47.06 per cent.). Of these 8 cases, 5 died in institutions and three were notified after death. PERIOD BETWEEN PRIMARY NOTIFICATION AND DEATH. Respiratory system: Under 1 month 10 (10.75 per cent.) 1-3 months 11 (11.83 per cent.) 3-6 months 12 (12.90 per cent.) 6-12 months 16 (17.20 per cent.) 1-2 years 20 (21.51 per cent.) Over two years 24 (25.81 per cent.) Other Tuberculous Diseases: Under 1 month 6 (66.67 per cent.) 1-3 months — 3-6 months — 6-12 months — 1-2 years 2 (22.22 per cent.) Over two years 1 (11.11 per cent.) Ill DISPENSARY STATISTICS, 1913—1935. TABLE 48. New Patients. Attendances at Dispensary. Year. Suffering from Pulmonary Tuberculosis. Suffering from other forms of Tuberculosis. Doubtful Cases. NonTuberculous Cases. Insured. Uninsured. Doctors' Home Visits. Nurses' Home Visits. 1913 324 86 323 429 2361 11967 2175 1517 1914 203 45 261 361 2276 8084 2385 2547 1915 174 28 260 323 1171 5568 1910 2918 1916 225 13 311 200 852 5954 1079 2828 1917 286 13 349 329 1052 6528 1141 2789 1918 235 14 201 478 1223 8465 1435 2317 1919 221 50 251 281 1444 8116 1724 4043 1920 142 37 239 342 1850 6713 2004 4989 1921 116 23 163 344 2074 5387 2217 5640 1922 155 35 13 388 2507 3703 1264 5447 1923 132 70 24 401 2288 3261 552 4603 1924 142 65 32 443 2133 3619 549 4775 1925 162 44 46 414 1956 3405 605 5421 1926 183 53 37 318 1741 2876 481 5355 1927 143 56 14 431 1612 2666 592 5422 1928 160 42 26 490 1548 2448 571 4989 1929 158 48 23 436 1411 1834 521 5272 1930 154 25 7 407 1558 1545 427 4532 1931 159 20 7 422 1444 1625 292 4156 1932 143 35 7 380 1329 1521 291 4125 1933 161 14 - 331 1312 1916 409 3936 1934 172 25 6 338 1265 2262 435 3895 1935 144 21 12 328 1232 1871 448 3857 112 TABLE 49. Notifications. Deaths. Death-Rate. Year. 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 1921 287 76 153 31 0.96 0.19 1922 272 113 163 33 1.02 0.20 1923 319 155 149 32 0.92 0.19 1924 270 126 129 33 0.80 0.20 1925 279 114 151 22 0.92 0.13 1926 312 122 161 17 0.98 0.10 1927 251 95 126 21 0.77 0.13 1928 258 75 114 33 0.73 0.21 1929 279 85 149 24 0.96 0.15 1930 244 52 118 16 0.76 0.10 1931 275 78 146 23 0.97 0.15 1932 236 90 137 23 0.91 0.15 1933 219 38 126 14 0.85 0.09 1934 258 33 112 20 0.77 0.14 1935 185 55 112 17 0.78 0.12 113 TABLE 50. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. SUMMARY OF NOTIFICATIONS DURING THE PERIOD FROM 1st JANUARY, 1935 TO 31st DECEMBER, 1935. Age Periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications. 0—1. 1—5. 5—10. 10—15. 15—20. 20—25. 25—35. 35—45. 45—55. 55—65. 65 & upwards Total (all ages). Pulmonary: Males — 2 2 2 7 18 23 15 19 15 2 105 202 Females — — 2 4 4 17 30 14 7 2 — 80 132 Non-Pulmonary: Males 2 5 6 3 5 4 — 2 1 — 1 29 40 Females 1 5 4 2 — 4 6 2 1 — 1 26 33 Totals 3 12 14 11 16 43 59 33 28 17 4 240 407 114 TABLE 51. NEW CASES OF TUBERCULOSIS COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER OF HEALTH DURING THE PERIOD, OTHERWISE THAN BY FORMAL NOTIFICATION. Age Periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 upwards Total Cases Pulmonary :— Males — — — — — — 1 4 3 4 12 Females — 1 — — — — 5 1 — — 2 9 Non-Pulmonary:— Males — 2 — — — — - - — 1 3 Females — 3 — — — — — — 1 — 1 5 Totals —< 6 — — — — 5 2 5 3 8 29 115 TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR By P.L.T. BENNETT, M.C., M.R.C.S., L.R.G.P.. D.P.H., T.D.D. Tuberculosis Officer and Medical Officer, Borough Bacteriological Laboratory. Staff Changes. Owing to the absence of the Tuberculosis Officer, who was Acting Medical Officer of Health at the Town Hall for nine months during the year, two Locum Tenens officers were appointed to carry on the Dispensary work. Dr. Harley Stevens acted in this capacity from January to July, after which time, owing to his appointment to a permanent post in another borough, the work was taken over by Dr. Gregory Kayne until October. The part-time clerk, Miss M.. Wright, resigned in May, and Miss D. Grimstone was appointed in her place. Routine and Statistics. There was no change in the Dispensary time-table during the year; and, notwithstanding the change of officers, always a matter of difficulty as regards continuity of service, the work of the department has been well maintained. As in the preceding year six routine fixed sessions for men, women and children were carried out during the week; in addition, one session was devoted to consultation work in Fulham Hospital and a weekly visit was made to the Elizabethan School. Special appointments were as usual given to patients not able for various reasons to attend the ordinary sessions; and a morning and afternoon were usually set apart for visiting and outside consultations with practitioners. A good deal of clerical work in connection with reports on patients is always necessary in a department dealing with many different authorities, and this has, as usual, been carried out when time could be arranged conveniently. Regulations formulated by the Ministry of Health to a large extent govern or direct procedure in tuberculosis dispensaries, and are designed to create a system which is uniform throughout the country and to ensure that the categorisation of disease and statistical returns of the same are both comprehensive and comparative. The summary of our tuberculosis statistics, given at the conclusion of this report, show under most headings a slight decrease as compared with those of 1934. This decline is partly due to various "local" factors which vary annually (chiefly as regards movements of the tuberculous population, staff changes, etc.), and partly to an epidemiological decline in incidence and mortality which has been recognised during the past fifty or sixty years. More complete knowledge of the disease and its infectivity together with improved hygienic conditions, better housing, higher wages and consequently improved nourishment, are all factors which have also had a responsible share in this decline. There is still a "long way to go," however, and a disease which has a mortality figure of nearly 30,000 per annum for England and Wales, can still only be described as very fatal. The examination of all family Contacts is urged by the Dispensary Staff with varying success. A fair proportion do eventually come up to the clinics, but many are no doubt scared of being found tuberculous, and prefer to "carry on and trust to luck," and it is often rather difficult to persuade people who feel quite fit and have no symptoms of illness at all to submit themselves for examination. That so many do come must be attributed in a large measure to the perseverance and tactful persuasion of the Nursing Staff on their home visiting. X-ray Examinations. Under arrangements made between the Borough Council and the Brompton Hospital for Consumption, cases for X-ray examination are sent by appointment to that Institution. During 1935, there were 350 patients so referred, though it should be understood that a large number of additional cases are frequently "X-ray-screened" whilst having refill treatment for artificial pneumothorax. The use of X-rays is becoming increasingly valuable in connection with the work of the Tuberculosis Dispensary, and we are fortunate in being able to refer our cases to the X-ray department at Brompton. 116 All cases are reported on by the Hospital radiologist, Dr. Rawlinson and his staff, and the films and reports are sent to the Dispensary, where the patient's case sheets are appropriately annotated and the films filed for reference after being examined by the Tuberculosis Officer. Specialised Treatments. Under this heading can be placed all those cases where surgical measures are adopted for causing a diseased lung to have as much "rest" as possible-i.e., by "artificial pneumothorax," "phrenic evulsion," etc.—and where special injections of Sanocrysin, Tuberculin and other preparations are thought advisable (possibly in addition to surgical treatment). All such treatments are usually commenced whilst patients are away in hospital or sanatorium, and are continued on their return home, and may go on for months or even years, the patients meanwhile being able in many cases to carry on normal working life. For cases of lupus, arrangements are made with the London Hospital for Finsen Light Treatment, and those patients with bone and joint tuberculosis are referred for periodical examinations by the Surgeons of the Orthopaedic Departments at General or Special Hospitals, and usually, after their period of Sanatorium, are seen at intervals by the London County Council surgical specialists at County Hall. During the year under review, 457 artificial pneumothorax refills and 22 Sanocrysin injections have been given at Brompton Hospital to Dispensary cases, and 89 Finsen Light Treatments at the London Hospital—the total cost being £266, approximately. All patients having special treatments at Brompton Hospital or elsewhere are kept under periodical supervision at the Dispensary; and it is the regulation that payment for such treatments are all authorised in the first- instance by the Tuberculosis Officer. Institutional Treatment. The London County Council is the Authority responsible for the provision of Sanatorium treatment, and cases recommended for such are referred by the Tuberculosis Officer. There has in the past year been very little difficulty or delay experienced in getting patients away for Sanatorium or other institutional treatment, 157 being provided for by the London County Council, including six children boarded-out under the Contact Scheme, whilst 49 were dealt with through the valued assistance of various voluntary agencies, namely, the Invalid Children's Aid Association, the Children's Country Holiday Fund, the Charity Organisation Society and the United Services Fund, together with the Public Assistance Committee. Sanatorium treatment still remains the best one for tuberculosis from which any permanent benefit can be expected—provided that it is taken at as early a stage as possible and for a prolonged period—and specialised treatments such as artificial pneumothorax, Gold Salt injections, etc., are in many cases valuable adjuncts. Unfortunately many patients break down sooner or later owing to the necessity of working in competition with healthy workers in the same field, but being less fitted to do so by reasons of an impaired constitution. The post-sanatorium period is in reality the most difficult time in a tuberculous patient's life, and the recommendation so often seen, "capable of doing light work" is unfortunately one which it is almost impossible to carry out in these days of economic stress. The "light job" is almost a myth: occasionally some particularly benevolent employer or firm will undertake to place a patient on a special job—or on a parttime basis—but this is comparatively rare. Co-operation with Medical Practitioners. As in former years, this has been well maintained. Of the 505 new patients in the year, 176 were directly referred for diagnosis and treatment by doctors practising in the Borough. The Tuberculosis Officer is also in close touch with the School Medical Authorities, to whom details concerning Contacts of school age are frequently sent, enabling those who fail to come to the Dispensary to be kept under periodical observation by the School Medical Officers. Tuberculosis in Children. Most children in towns become infected sooner or later with the causative organism of tuberculosis, but fortunately comparatively few develop tuberculous 117 disease of the adult type, owing to the phenomenon known as "immunity," which may be natural or acquired. The Mantoux Tuberculin test carried out at the Dispensary is useful in determining if this infection or tuberculisation has taken place. A positive Mantoux test, however, should not be taken invariably to indicate that the child is suffering from a notifiable tuberculosis, though a strongly positive reaction in certain suspicious cases might help to clinch a diagnosis. Particular significance, however, attaches to a definite positive reaction occurring in a Contact infant under the age of two years, as the state of natural resistance or immunity has hardly sufficient time to develop, and an X-ray taken at this period may demonstrate a primary focus with some adjacent glandular inflammation at the lung root. The reaction may not prove positive if the test should happen to be taken within about six weeks of infection, as the body has to develop a certain tuberculin "sensitiveness," so repeated Mantoux tests are always advised for negative reactors. As yet, owing to considerations of time and practicability, only yearly tests are done. Special observation of doubtful cases and treatment for notified children is very readily provided by the L.C.C. on those cases recommended by the Tuberculosis Officer, or by hospital out-patient departments. The period away is invariably of great benefit for the children, and on their return to town a certain proportion are admitted to the Elizabethan Open-air (Special) School in Broomhouse Lane. At this institution the children go daily for school under "open-air" conditions, where hours of work, rest and exercises are regulated and under supervision of the Head Mistress, and where a good and varied mid-day meal is served, together with the usual supply of milk in the morning. The Tuberculosis Officer is also Medical Officer to the School and pays a weekly visit, at which an average of about twelve children are examined; the school accommodates 60, thus it will be seen that each child is examined about once in every five weeks, or more often if medical reasons so indicate. Extra medicaments are also prescribed in many cases (malt and oil, cod liver oil emulsion, Haliverol, Virol, Irradex and Radio-Malt) according to the special needs of the child. Under this regime, the children do remarkably well, both at school and in their after "working" life. Cases requiring Ultra Violet Light treatment are (as before) referred to the physicians in charge of these special departments at general or children's hospitals. Dental Scheme. A routine examination of the teeth and throat is made in all cases attending the Dispensary, and, as might be expected, a large number of defects are found. A good many patients are referred to their own doctors for the necessary attention; but notified cases can be dealt with—if they are willing—under the dental scheme in connection with the Dispensary. Thirteen patients were recommended for treatment under this scheme in 1935. Of these, eleven were supplied with dentures, one had extractions and scaling, and the other eventually did not take the treatment. The Tuberculosis Care Committee. This Committee has met at the Dispensary every other week. An agenda, comprising a number of items concerning tuberculous patients and their families, questions of help and extra nourishment and other matters relevant to the Tuberculosis Scheme in general, is gone through. Extra nourishment is recommended through the Borough Council for cases coming under certain headings—especially those going to and returning from Sanatorium—where a weekly provision of milk, butter and eggs is a sufficient supplement to the patient's normal nourishment: but those cases already on out-relief, are referred to the Public Assistance Committee, as extra nourishment on the lines laid down by regulation would not be adequate. During 1935, the total number recommended for extra nourishment was ninety-four, and seventy-one invalid dinners were also provided. Gloving Class. During the year thirty-eight lessons were given and attendances totalled 203. The size of the class remains small and varies between twelve and six, but the quality 118 of the work done has improved and a really high grade glove is turned out. A Sale was held at the Dispensary in October, when just over £15 was taken in cash and sufficient orders were taken to keep the class employed almost till Christmas. It is worth recording that through the kindness of a friend an outing was arranged for the class, who thoroughly enjoyed going to Kew Gardens, the return home being accomplished by steamer. Care Committee. I would like to thank the Chairman, Secretary and members of the Care Committee for their valuable assistance during the year. To illustrate the wide scope of assistance rendered by the Care Committee, the Secretary, Miss Sargent, has kindly selected specimen cases which are here appended: A. Is a married man with a wife and baby. The family lived in one furnished room, the National Health Insurance benefit being supplemented by Public Assistance. One baby had already died and the existing child was far from robust, but it was most difficult to persuade the parents to allow her to be placed under the care of Fulham Hospital until, at any rate, the family had obtained two rooms. It was done, however, and after some searching two unfurnished rooms were found and taken. The Public Assistance Committee increased their grant to allow for extra rent, and provided beds and bedding. The Charity Organisation Society were appealed to and, in co-operation with the Public Assistance Committee, provided additional furniture, so that the young couple, for the first time since they married, had a home of their own. The child remained away for five months and has been under the care of the Infant Welfare Centre since returning home. A. is doing well, but so far has been unable to find suitable work, his own trade (that of a shoe repairer) not being considered good for him, and he is further handicapped through having one leg amputated owing to an accident in boyhood. B. Developed a tuberculous hip following a kick at football and was sent to sanatorium, being discharged in 1934, aged 19. He was unfit for work but his one desire was to study the violin. There were financial difficulties in the way: his mother was a widow and application had to be made to the Public Assistance Committee for maintenance for B. By April, 1935, he was considered strong enough to undertake serious study, and the Care Committee arranged for him to have violin lessons at the Trinity College for Music where he is getting on very well indeed, though he had a temporary set-back and had to be re-admitted to hospital during the summer for a few weeks. It is hoped that he may eventually gain a scholarship, as his teacher states he has a real talent for music. C. Was an advanced case of pulmonary tuberculosis when we first heard of her. Her husband was in an asylum and she had been working to keep the home together. The eldest child had started work by the time his mother fell ill, but there were two girls of school age, both of whom were delicate and one of whom attended an M.D. special school. Relatives came forward to care for the children temporarily, but when C. died in Hospital it was felt that some permanent arrangement must be made and the children placed in residential schools. The Chairman of the Care Committee undertook to visit and obtain the grandfather's consent to application being made to the Public Assistance Committee, and the children are now in schools under their care. Bacteriological Department. Sputum, etc., examinations. Miss Robinson has carried out in the laboratory 1,300 examinations for Tubercle Bacilli in sputa; whilst seven specimens of freces and four of suspected urines have been specially cultured in addition. The amount of other bacteriological work done has grown very much during the past few years, making this department an increasingly important one. 119 543 Mantoux tests have been carried out, of which the following are the results. TABLE 52. (1) Total number of injections given:— 1—10,000 Dilution 227 Total 543 1—1,000 Dilution 166 1—100 Dilution 150 (2) Number of Positive Reactions:— 1—10,000 Dilution 51 or 22.47% 1—1,000 Dilution 8 or 4.82% 1—100 Dilution 6 or 4.00% Total number of Positives 65 or 11.97% (3) Number of those who received tests:—227 For the first time 170 (59+ 111—) For the second time 41 ( 5+ 36—) For the third time 16 ( 1+ 15—) As is stated elsewhere all negative reactors are requested to attend the following year for re-test, but it is often difficult to persuade parents and guardians that this is necessary, as they appear to think that because tests in one year are negative they will always be so in the future. Clerical Department. The work in this department, which includes keeping of registers for the Ministry of Health's returns, is carried on by Miss Sargent, clerk to the Dispensary and secretary to the Care Committee, assisted by Miss Grimstone on a part-time basis. During 1935 there were:— Letters written 5,478 Reports to Doctors 708 Reports to Public Bodies 640 In addition to this work Miss Sargent has, in the course of her work, numerous interviews with patients or their relatives concerning ways and means, and is in close touch with County Hall regarding the provision of institutional treatment. It can be readily understood that this takes a great deal of time, and in many cases considerable tact and sympathy is necessary. Conclusion. I wish to express my appreciation of the able manner in which Dr. Harley Stevens and Dr. Gregory Kayne acted as locum tenens officers during so many months of 1935. To those members of the Dispensary Staff, Miss Sargent and her helper in the clerical department, Miss Robinson, who has again rendered signal service in Mantoux testing and bacteriological work, and to the Tuberculosis Health Visitors and the Janitor, I wish to accord my best thanks for their unfailing assistance at all times during a somewhat difficult year. SUMMARY OF STATISTICS, 1935. No. of New Patients:— Insured 213 Uninsured 292 Total 505 No. of Attendances:— Insured 1232 Uninsured 1871 Attendances of Contacts 651 Other Attendances 816 Total 4570 120 No. of patients who have attended, both old and new ... ... 1184 No. of Notifications:— Pulmonary ... ... ... ... ... 145 Non-pulmonary ... ... ... ... 23 Total ... ... 168 No. of Sputa examined . . .. . ... 1300 No. of Physical examinations .. . . ... 2519 No. of Contacts examined ... ... ... ... 255 No. of Home Visits paid by Doctor ... .. ... 448 Bedside consultations included in above ... 263 Consultations otherwise ... ... ... 639 No. of Home Visits paid by Nurses ... ... ... 3857 No. of Reports sent to Public Bodies ... ... 640 No. of Reports sent to Doctors ... ... ... 708 No. of Letters written ... ... ... ... 5478 No. of Patients referred to Brompton Hospital ... 23 For X-ray ... ... ... ... ... 350 No. of Notified cases on Dispensary Books on 31.12.35 ... 749 No. of Patients sent away into institutions or to the country in 1935 ... ... ... ... 206 TABLE 53. 206 Patients were sent to residential institutions on the recommendation of the Dispensary Medical Officers. (a) 151 by the London County Council Public Health Department:— 38 to Sanatoria. 3 to Colonies 4 to Convalescent Homes. 106 to Hospitals. Men 16 3 1 51 Women 22 — — 32 Children — — 3 23 (b) 19 by the Public Assistance Committee:— 10 to Hospitals. 9 to Sanatoria or Convalescent Homes. Men 4 Women 2 Children 4 9 17 Children were sent to Convalescent Homes by the Invalid Children's Aid Association. 6 Children were boarded out under the Contact Scheme. 3 Women were sent to Convalescent Homes by the Charity Organisation Society. 4 Men were sent to Convalescent Homes by the United Services Fund. 6 Children were given holidays through the Children's Country Holiday Fund. 121 TABLE 54. Showing sources of New Cases. 176 were recommended by private doctors. 27 ,, ,, ,, the Medical Officer of Health. 3 ,, ,, ,, the School Medical Authorities. 1 was ,, ,, the School Authorities. 134 were „ ,, Hospitals and Sanatoria. 19 ,, ,, „ other Dispensaries. 6 ,, ,, ,, the London County Council. 77 ,, ,, ,, the Dispensary Staff. 10 „ „ „ friends. 44 ,, ,, ,, the doorplate. 6 ,, ,, ,, the Invalid Children's Aid Association. 2 ,, ,, ,, Public Assistance Authorities. 505 TABLE 55. New Cases. Pulmonary Tuberculosis. Other Forms. Suspects. NonTuber cular. Percentage Tubercular. 255 Males 92 10 9 144 40.00 250 Females 52 11 3 184 25.20 505 both sexes 144 21 12 328 32.67 TABLE 56. Sex and Age of the New Patients for 1935. Under 5 yrs. 5 to 10 yrs. 10 to 15 yrs. 15 to 25 yrs. 25 to 35 yrs. 35 to 45 yrs. 45yrs. and over. All ages. Males 16 34 23 37 46 35 64 255 Females 28 27 29 54 54 33 25 250 Both Sexes 44 61 52 91 100 68 89 505 122 TABLE 57. Diagnosis at Various Age Periods. New Patients. Pulmonary Tuberculosis. Other Forms. Suspects. NonTuber cular. Percentage Tubercular. Under 5 years 2 4 2 36 13.63 Under 10 years 8 3 1 54 9.83 Under 15 years 5 4 1 42 17.31 Under 25 years 28 4 1 58 35.16 Under 35 years 37 4 2 57 41.00 Under 45 years 28 2 2 36 44.12 45 and over 41 — 3 45 46.07 All ages 144 21 12 328 32.67 TABLE 58. Housing Conditions. Of 154 of the 165 tuberculous patients found in 1935:— 7 lived in the basement. 28 lived on the ground floor. 43 lived on the first floor. 18 lived on the second floor. 7 lived on the third floor. 7 lived on the top floor. 18 lived on more than one floor. 26 lived in the whole house. TABLE 59. Housing Accommodation. Number of Families occupying One room. Two rooms. Three rooms. Four rooms. Five rooms. Six rooms or more. Patient living alone 12 1 — — - - Patient living with 1 other - 6 15 4 - - 2 others - 12 16 7 4 2 3 „ - - 15 8 6 3 4 „ - 2 4 4 4 1 5 „ - 1 2 3 5 - 6 „ - 2 2 3 4 - 7 „ - - - 1 1 - 8 ,, - - - 2 - - 9 „ - - - - - 1 11 „ - — — — 1 - 12 24 54 32 25 7 123 TABLE 60. Sleeping Accommodation of 154 Tuberculous Patients. The patient slept:— In a separate room in 61 cases. Alone in bed with one other in room in 14 cases. Alone in bed with two others in room in 5 cases. Alone in bed with three others in room in 2 cases. Alone in bed with six others in room in 1 case. In bed with one person and no others in room in 50 cases. In bed with one person and one other in room in 14 cases. In bed with one person and two others in room in 6 cases. In bed with two persons and no others in room in 1 case. TABLE 61. Occupations of 93 Men (New Cases) in 1935. 1 Bank Messenger. 5 Motor Drivers. 1 Barber. 1 Newsagent. 2 Barmen. 1 Newspaper Vendor. 1 Bill Poster. 1 Night Watchman. 2 Boot Repairers. 1 Odd Job Man. 1 Bricklayer. 1 Ordnance Surveyor. 1 Cabinet Maker. 2 Packers. 1 Cab Washer. 1 Painter. 2 Carpet Fitters. 1 Paperhanger. 1 Chemist. 1 Plasterer. 10 Clerks. 1 Postman. 2 Coal Porters. 1 Press Reader. 1 Cook. 1 Printer. 1 Depot Inspector. 1 Professional Footballer. 2 Draughtsmen. 1 Schoolmaster. 2 Electricians. 8 Shop Assistants. 2 Engineers. ] Shopkeeper. 1 Factory Hand. 1 Student. 1 Fishmonger. 1 Theatrical Manager. 2 Gas Fitters. 1 Tool Maker. 1 Gate Keeper. 1 Traveller. 1 G.P.O. Installer. 2 Van Porters. 1 Groom. 1 Veterinary Assistant. 1 Hotel Porter. 1 Waiter. 2 Insurance Agents. 1 Watchmaker. 6 Labourers. 1 Yardman. 5 No occupation. Occupations of 51 Women (New Cases) in 1935. 1 Barmaid. 22 Housewives. 1 Cashier. 3 Laundry workers. 4 Clerks. 1 Nurse companion. 1 Dentist's Assistant. 1 Presser. 5 Domestics. 3 Shop Assistants. 2 Dressmakers. 6 Waitresses. 1 Factory Hand. Under 15 years of age. 9 Boys. 12 Girls. 124 VACCINATION. Mr. H. Davies, the Vaccination Officer, has supplied me with the following figures relating to his work :— Number of births registered during 1934 1,591 Successfully vaccinated 927 Insusceptible of vaccination 2 Unvaccinated on account of conscientious objections made by the parents 391 Died unvaccinated 62 Postponed by medical certificate and unvaccinated on 31st January, 1936 44 Removed to other districts and unvaccinated on 31st January, 1936 40 Removed to places unknown 112 Outstanding on 31st January, 1936 13 Number of successful primary vaccination certificates received during 1935 1,269 Number of Conscientious Objection Certificates received during 1935 445 The figures show that 58 per cent. of the infants born in 1934 had been successfully vaccinated by the end of January, 1936. DISINFECTION. The following rooms were disinfected and cleansed after infectious diseases, etc.:— TABLE 62. Diphtheria 356 Scarlet Fever 304 Phthisis 202 Erysipelas 45 Scabies 57 Cerebro-Spinal Meningitis 1 Cancer 22 Pneumonia 11 Measles 4 Puerperal Fever 4 Puerperal Pyrexia 1 Chicken Pox 4 Paratyphoid 1 Rooms fumigated by request 20 Ward of Maternity Home fumigated 7 Day Nursery 20 Encephalitis Lethargica 2 Enteric Fever 4 Mumps 2 Poliomyelitis 3 1070 125 The following articles were disinfected at the Council's Disinfecting Station:— TABLE 63. Articles. From private houses. From institutions. Total.  Beds 486 - 486 Mattresses 1141 116 1257 Palliasses 12 — 12 Spring beds 5 — 5 Pillows 2232 216 •2448 Cushions 412 — 412 Bolsters 707 — 707 Blankets 2737 446 3183 Sheets 1746 247 1993 Covers 527 108 635 Counterpanes 715 14 729 Carpets 60 — 60 Hearth rugs 659 — 659 Clothing 5071 1682 6153 Eiderdowns 414 82 496 Sundries 1549 311 I860 18423 3332 21755 126 CONTENTS. Page. Ambulance Facilities 26 Aged and Infirm Persons 49 Babies' Hospital 38 Bacteriological Examinations 26 Bakehouses and Bakers' Shops, Inspection of 86 Cancer 108 Certification of Causes of Death 13 Clearance Areas 74 Clinic and Treatment Centres 28 Closet Accommodation 40 Combined Drainage 46 Committees, Public Health and Maternity and Child Welfare 4 Common Lodging Houses 74 Deaths, Causes of 15. 21. 22 Deaths of Fulham Residents outside the Borough 14 Deaths in Public Institutions 13 Demolitions under Part 2, Housing Act, 1930 74 Diphtheria—Antitoxin 100 Diphtheria Immunisation 100. 105 Disinfection 124 Disinfestation 74 Drainage of Buildings 45 Dwelling Houses 41 Extracts from Vital Statistics 10 Factories, Workshops and Workplaces 42. 51 Food and Drugs, Adulteration of 82 Food and Food Premises, Inspection of 42. 86 Food, Unsound 87 General Statistics 10 Health Propaganda 29 Home Nursing 27 Hospitals 29 House-to-House Inspection 72 Housing 54 General 54 Development 54 Occupations 54 Population 55 Loss by Migration since 1901 55 Persons per acre in Fulham, London and Greater London 56 Comparative Statistics of Area 57. 58 Wards with High Population Densities 59 127 Page. Overcrowding 60. 66 Multiple occupation of Dwellings—Persons per room, 1911-1931 67 Families living more than two units per room 68 Re-housing of Overcrowded Families 69 Provision of Working-Class Houses 70 London County Council Estates 70 Houses divided into Separate Tenements 73 Underground Rooms 73 Housing Estates 70 Ice Cream, Registration of Premises 87 Infantile Mortality 16. 23. 24 Infectious Diseases 94. 95. 106. 107 Infectious Diseases, Non-notifiable 107 Introduction 3 Laboratory Facilities 26 Legal Proceedings (Adulteration of Food) 84. 85 „ „ (Sanitary and Housing) 46 London County Council (General Powers) Act, 1932, Sec. 5. Registration of Premises 87 Maternity and Child Welfare (Report by Dr. Ruby Thomson) 30 Ante-natal Clinics 33 Charitable Organisations 37 Day Nursery 36 Dental Clinic 35 Eye and Skin Defects 34 Home Nursing 35 Home Visitations 30 Infant Life Protection 31 Maternity and Child Welfare Centres 32 Massage Clinic 34 Maternity Home 35 Maternal Mortality 17. 37 Notifications of Birth 32 Provision of Milk 36 Milk, Automatic Milk Machines 79 Milk, Bacteriological Examinations of 81 Milk, Examination of 78 Milk, Inspection and Supervision of Dairies and Milkshops 80 Milk Purveyors 80 Milk Samples, Composition of 79 Milk and Dairies (Amendment) Act, 1922, and Milk and Dairies Order, 1926 79 Milk (Special Designations) Orders, 1923 and 1934 81 Mortuary 47 128 Page. Nuisance from Pigeons 50 Outworkers 52 Overcrowding 60 Prevention of Blindness 109 Preserved Food, Registration of Premises 87 Public Analyst, Report of 88 Public Baths and Washhouses 47 Public Cleansing 40 Public Conveniences 48 Public Health (Condensed Milk) Regulations, 1923 and 1927 83 Public Health (Dried Milk) Regulations, 1923 and 1927 83 Public Health (Imported Food) Regulations, 1925 87 Public Health (Preservatives, etc., in food) Regulations, 1925 and 1927 83 Rag Flock Acts, 1911-1928 47 Rat Repression 49 Recent provision of Working-Class Houses 70 Re-housing of Overcrowded Families 69 Rent Restrictions Acts, 1920-1933 49 Repairs effected 44 Rivers and Streams 40 Samples purchased for Analysis 90 Sanitary Inspection of the District 40. 41 Seasonal Mortality 14 Shops Act, 1934 43. 50 Slaughter Houses 87 Smoke Abatement 47 Social Conditions 11 Staff—Public Health and Maternity and Child Welfare Departments 5. 6. 7 Statistics, 1901-1935 19 Summary of Sanitary Inspections 43 Tuberculosis 109 Tuberculosis Dispensary, Report by Dr. P. L. T. Bennett 115 Bacteriological Department 118 Care Committee 117. 118 Contacts 120 Dental Treatment 117 Dispensary Statistics 111 Extra Nourishment 117 Handicraft Class 117 Home Visits 120 Mantoux Test 117. 119 Mortality from Tuberculosis 110 Sanatorium Treatment 116 129 Page. Special Treatment 116 Summary of Statistics 119 Tuberculosis in Children 116 X-Ray Examinations 115 Notifications, 1913-1935 112. 113 New Cases, 1935 114 Underground Rooms 73 Vaccination 124 Vital Statistics for the Borough 18 „ „ of London Boroughs, 1935 20 „ „ of Working-Class Flats 74 „ „ comments on 12 „ „1901-1935 19 Zymotic Deaths 14 ■