METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1948 REPORT of the MEDICAL OFFICER OF HEALTH for the year 1948 P.L.T.BENNETT M.C., M.R.C.S.L.R.C.P., T.D.D.,D.F.H., Medical Officer Of Health. Ful 39 METROPOLITAN BOROUGH OF FULHAM Public Health Department, Town Hall, Fulham,S.W.6. August, 1949. The Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Mr.Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the health of the Borough for the year 1948. As in previous years this report is again presented in an abridged form on the instructions of the Ministry of Health. According to the Registrar General ' s estimate, the mid-year population of the Borough was 123,300, which shews an increase of 1,020 over the estimated mid-year figure for 1947. The birth-rate of 18.3 per 1,000 of the population is somewhat decreased (21.58 in 1947); the infantile mortality rate 26.5 per 1,000 live births shews a considerable decrease on the figure for the previous year which was 32.9 per 1,000 population, and is again the lowest rate on record for the Borough. The year's statistical records indicate that the health of the Borough was maintained at a satisfactory standard and there was nothing of particular interest from the infectious disease standpoint and no outbreaks of any special nature. Great and far reaching changes were brought about in 1948 by the commencement in operation of the three great Acts, the National Health Service Act, the National Insurance Act, and the National Assistance Act; and as social welfare services were so vitally affected, as might be expected the year proved a very heavy one for the Public Health Departments all over the country. The Fulham Matornity and Child Welfare and Tuberculosis Dispensary services were transferred chiefly to the London County Council and partly to the Regional Hospital Board on 5th July, 1948. It was undoubtedly a matter of great regret and concern that the very fine Maternity Home and Welfare Clinics at Parsons Green had to leave our jurisdiction alone with all the other personal health services, such as Home Help Service, the Ultra-Violet Light and Chirepodists' departments (the latter having had such success in the preceding two years, that it was found necessary to obtain the services of an additional full time chiropodist in February 1948, and open another centre on a part time basis, as well as increasing the scope of the main clinic in Fulham Road). It might be quite reasonably expected that such tremendous changes would have caused a big disruption in the Welfare Services, and inevitably there has been a certain amount of difficulty; but it is quite correct to say that generally the services have been efficiently maintained throughout with but little impairment of their functions, and that very cordial co-operation on both sides has been a feature which may well have had a bearing on this. Many criticisms have been (and continue to be) directed at the new system, but in my opinion it is too early to dogmatize one way or another, and experience will shew how things are shaping when the initial periods of administrative and operative difficulty have had time to settle down. The changes involved the departure from the Council's service of all the medical staff with the exception of the Medical Officer of Health. These were:- Dr. Price, Deputy M.0.H., and Tuberculosis Officer; Dr. Wolff, (Acting) Senior M.O. for the M & C.W., Dr. Barrett, Asst, M.O., M & C.W., Dr. Elyan, Asst. M.0., M & C.W., Dr. Hay, Senior R.M.O., Maternity Home & M & C.W., D r.Egan, R.M.0., and M & C. W., and the two public vaccinators - Dr.Dunwoody & Dr. Duff- Miller. To offset the transfer of the Deputy Medical Officer of Health, arrangements were made whereby the essential Public Health Services in Fulham and Hammersmith Boroughs could be carried out by the two Medical Officers respectively, with the assistance as necessary of the Deputy Medical Officer of Health of the latter Borough, as an interim measure; and that medical examinations of Council's staff, hitherto carried out by the Medical Officer of Health and his staff, should be carried out by a local general practitioner under suitable arrangements. Together with the transfer of the Departmental Medical Officers, the Chief Clerk, Mr. Trendell was transferred to the L.C . C. on the 2nd May; and the second clerk (who took over his duties) on the 5th July, (the senior clerk of the Public Health Department after this being Mr.Sharp, who carried on until the end of the year). A number of clerks in the M & C.W Services were transferred to the L.C.C. as well on the 5th July. The changes necessitated an entire re-casting of the remaining members of the Public Health Department and this was being worked out at the close of the year. Under mutual arrangements between the Fulham Borough Council and the L.C.C., the Medical Officer of Health of the Borough continued to act in a "day-to-day" supervisory capacity for the L.C.C. in respect of the transferred services, from 5th July, 1948; and this arrangement still holds good at the time of writing this report, and as far as my Department is concerned it is a pleasure to record the smooth working of the transferred services under the Divisional Medical Officer, Division I, Dr. Harry Smith, L.C.C., with whom my relations have always been most friendly. Continued difficulty has been experienced in maintaining reasonable standards of fitness in existing housing accommodation, largely owing to the shortages in material of various kinds and labour during the year 1948, but it has also been necessary to institute legal proceedings in 126 cases for non-compliance with Statutory Notices served by the Council's Sanitary Inspectors, It is of interest that Court Orders were obtained in 13 instances. As in the previous year very close co-operation has been maintained with the Housing Department under Mr. Lovell, Director of Housing & Public Buildings, and my thanks are due to him for sympathetic and efficient help given on all occasions. Deposited rubbish on bombed sites has continued to be a source of extreme annoyance and many indignant protests to the Council from the local residents have been directed against this nuisance, Many have suffered from such acts of irresponsible and selfish members of the community; and as far as my Department is concerned this has proved one of the most difficult matters to cope with under existing legislation. A very interesting investigation and report into the "grit" nuisance, a subject of increasing agitation amonght the public in Sands End Area and one for which there was much justification, was carried out by the Sanitary Inspectors in my Department in collaboration whilst the Borough Engineer & Surveyor during April, 1948. Whilst there was every evidence of an exceptional nuisance from soot and grit in this particular area, opinions were no means unanimous as to the actual source of the nuisances; though the Power station was largely blamed. A more detailed summary of this survey is given in the report. The investigation and its disclosures was of assistance to the Town Clerk in treparing a case for presentation to the Chancellor of the Exchequer, with the effect that eventually the necessary permission was obtained Government for the installation of apparatus and plants; which, when completed it is expected will mitigate the nuisance from "furnaee"grits. In conclusion, I should like to thank the mayor,Chairman and Members of the Public Health Committee and other councillors for their consideration and support during the year, and to express my appreciation of the help and co-operation of my colleagues and staff at all times. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, P.L.T.BENNETT. Medical Officer of Health. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1948 POPULATION, estimated, 1948 123,300 LIVE BIRTHS: Rate per 1,000 Population Total Males Females 1948 1947 Legitimate 2080 1054 1026 16.9 20.11 Illegitimate 177 96 81 1.4 1.47 2257 1150 1107 18.3 21.58 STILLBIRTHS: Legitimate 30 12 18 0.24 0.38 6 3 3 0.05 0.03 Illegitimate 36 15 21 0.29 0.41 DEATHS: 1417 696 721 11.5 12.2 1948 1947 56 59 Percentage of Deaths in Public Institutions Death rate of Infants under One year of Age: 1948 1947 All Infants per 1,000 live births 26.5 32.9 Legitimate Infants per 1,000 legitimate births 26.4 32.5 Illegitimate Infants per 1,000 illegitimate births 22.6 38.9 Deaths from: 1948 1947 Cancer (all ages) 276 252 Measles (all ages) - - Whooping Cough (all ages) 3 4 Diarrhoea (under two years of age) 7 12 CLASSIFICATION OF CAUSES OF DEATH: 1417 deaths as follows:- 1948 1947 Typhoid 1 Cerebro Spinal Fever - 1 - Whooping Cough 3 4 Tuberculosis of Respirdtory System 68 60 Other forms of Tuberculosis 5 11 Diphtheria 3 - Syphilitic disease 8 18 Influenza 2 13 Poliomyelitis 4 - Acute Infectious Encephalitis 1 - 4 Cancer of (a) buccal cavity (b) uterus 18 11 12 (c) stomach & duodenum 51 41 (d) breast 27 29 (e) other sites 176 159 Diabetes 4 9 Cerebral Haemorrhage 127 137 Heart Diseasa 391 393 Other diseases of the circulatory system 66 57 Bronchitis 110 114 Pneumonia 65 112 Other respiratory diseases 15 18 Ulcer of stomach or duodenum 15 27 12 Diarrhoea (under two years) 7 Appendicitis 3 4 Oother digestive diseases 33 28 Nepheitis 34 31 Matarnal causes 2 - Premature birth 22 17 Congenital malformations etc., 23 32 Puerperal and post abortive sepsis 1 - Suicide 8 19 Road traffic accidents 15 12 Other violent causes 26 32 All other causes 74 83 Infantile Deaths: There were 59 deaths of infants under the age of one year, the causes being as follows:- 1948 1947 Whooping cough 3 2 Syphilitic disease 1 - Acute Infective Encephalitis - 1 Influenza - 1 Cerebro Spinal Fever 1 - Bronchitis 1 1 Pneumonia 5 17 Diarrhoea 7 12 Prematurity 22 17 Other respiratory diseases 1 1 Asphyxia 1 4 Congenital malformations etc. 16 26 Otitis Media - 1 Meningitis 1 1 Infective Hepatitis 1 - Mongolism 1 - Marasmus 1 - 59 87 The Infant Mortality rate was 26.5 per 1,000 live births (32.9 in 1947) MATERNITY AND CHILD WELFARE SERVICES The National Health Service Act, 1946, resulted in the transfer from the Fulham Borough Council to the London County Council and the Metropolitan Regional Hospital Boards on 5th July, 1948, of the responsibility for certain services. The following details, therefore, relate only to the work carried out between 1st January and 4th July, 1948. Nursing in the Hom. The Fulham District Nursing Association continued to carry out this work on behalf of the Council during the period from 1st January to 4th July, 1948, when visits were paid to Maternity and Child Welfare cases and 503 visits to cases of Infectious Disease. Ultra Violet light Clinic.During the period 1st January to 4th July, 1948, attendances totalled 6, 843. In addition, 305 massage, 194 infra-red, 989 radiant heat and 55 K.R.O.M. treatments were given. Maternity & Child Welfare Centres. Four centres were open at Parsons Green, Greyhound Road, Wandsworth Bridge Road, and Burne Jones House. There were 14 ante-natal, 2 post-natal, and 15 infant sessions per week. During the period 1st January to 4th July, 1948, the following attendances were made:- Infants under one year 11,624 Infants between one and five years 5,203 Ante-Natal 7,959 24,786 Home Visiting.. The total number of visits made by the Health Visitors during the period 1st January to 4th July, 1948, was 14,683. Infant Life Protection. On the 4th July, 1948, there were 65 children in the care of 45 foster-mothers. Premature Infants. The following figures relate to the period from 1st January to 4th July, 1948:- No.of notifications received 28 No. born at home 5 No.born in hospital 23 No.of deaths 5 Dental Clinic. The work at this Clinic during the period 1st January to 4th July, 1948 is detailed in the following tables:- No.of sessions 52 No.of patients 484 No.of new cases 350 Total attendances 1,041 Maternity Home. The following figures relate to the work at this Institution during the period 1st January to 4th July, 1948:- Admissions. Births 377 Ante-natals 19 . 396 Stillbirths. Macerated 5 Abnormality 1 Post-Maturity 1 7 Neo-Natal Deaths. Prematurity There were no Maternal deaths. Additional Maternity Accommodation. Under the London County Council scheme , eight beds were allotted to Fulham in Queen Charlotte's Hospital. During the period from 1st January to 4th July, 1948, admissions totalled 48. Day Nurseries. Five Day Nurseries, including the Babies' Hospital were maintained during the period from 1st January to 4th July, 1948, and there was a constant waiting list Tor vacancies. The accommodation provided was as follows:- Nursery No.of Children Eabies ' Hospital 18 Grove House 45 Eridge House 50 St. James 45 St. Andrews 45 203 Supply of sheets for expectant mothers. The arrangements for the issue of priority dockets to expectant mothers, continued in operation and during the period 1st January to 4th July, 1948, 406 dockets were issued. Home/Domestic Help Service. The Home & Domestic Help Service established in April 1947, was in great demand during the period from Ist January to 4th July, 1948, when 19,000 hours were worked in the patients' homes. Foot Clinics. 3 ,000 attendances were made at the Clinics at Fulham Road and Greyhound Read during cue period from Ist January to 4th July, 1948, The Clinic at Greyhound Road was opened in February 1948 as a result of the increasing demand since the inception of this service. Diphtheria Immunisation. Diphtheria immunisation was carried out at Greyhound Road and Wandsworth Bridge Road Clinics during the period from Ist January to 4th July, 1948, at which date the number of children immunised since the beginning of the campaign in 1934 had reached 15,772. No. of sessions held 52 No. of new cases 936 Total attendances 3,643 SANITARY CIRCUMSTANCES OF THE AREA Sani t ar y, Inspec tion. The following table gives a summary of the inspections made by the Sanitary Inspectors during the year:- Inspections after complaint 5,427 Re-inspections 16,711 Inspections after Infectious Disease 938 Drains tested 297 Drains inspected 2,671 Inspections of Outworkers Premises 92 Inspections of Food Premises 1,378 1,300 Other Visits Intimations served 4,205 Statutory Notices served 1,950 Intimations complied with 4,292 Statutory Notices complied with 1,755 SUMMARY OF WORKS CARRIED OUT UNDER SUPERVISION OF SANITARY INSPECTORS. Fresh Sir Inlet 35 Soil and Vent Pipes repaired 17 Drains cleared 227 Drains repaired 126 Drais relaid 140 Rainwater gutters and pipes repaired or renewed 840 Drains sealed off 4 Disused drains excavated 3 Cesspools closed - Soil and Vent pipes renewed 96 Traps cleansed, repaired, etc 84 Pans renewed 457 Seats repaired or renewed 169 Flushing cisterns repaired 300 Flushing cisterns renewed 61 Additional W.C. accommodation provided 20 Lobbies provided to W.C. apartments 10 Fastenings provided to doors, and doors repaired 258 W.C. apartments ventilated 16 Sinks provided 120 Sinks renewed 101 Sinks repaired 31 Sink waste pipes trapped 110 New sink waste pipes 63 Sink and bath wastes repaired 168 New baths fitted 51 New path and lavatory wastes 5 New lavatory basins 57 Baths cleansed 39 Drinking water cisterns cleansed, etc., 71 Water supplied from mains Occupied house provided with a sufficient supply 7 33 Water supply pipes and fittings repaired 259 Water supply provided to separate floors 35 Rooms cleansed 3,245 Decorations and internal house repairs 8,819 Fireplaces repaired (nuisances from smoke etc.) 631 Kitchen ranges repaired or renewed (for cooking purposes) 330 Washing coppers repaired cr renewed 21 Dampness remedied 2,354 Rooms provided with adequate light & ventilation 15 Staircases provided with light & ventilation 5 Ventilated food cupboards provided 7 Ventilation provided under floor 53 Roofs repaired Other external repairs 1,778 906 Accumulations of refuse removed 108 Dustbins 276 Yards, forecourts paved and drained 184 Animals in state of nuisance 7 Urinals in Public Houses cleansed and repaired 1 Urinals of Factories cleansed and repaired - Rat runs traced 21 Other nuisances 12 22,786 Factories and Workshops,. Sanitary Acconmodation Want of cleanliness 3 Insufficient 4 Want of ventilation 1 Unsuitable or defective 3 Vermin 47 Not separate for sexes 1 Shops Act, W.C.Accommodation 1 9 Legal Proceedings wore instituted for non-compliance with Statutory Notices in 126 cases. Court Orders were obtained in 13 of these cases. Two successful applications were made for the recovery of drainage expenses. Drainage of Buildi ngs. During the year 91 drainage plans were approved by the Public Health Committee, Rent Restrictions Acts. In response to applications by tenants, 14 certificates were issued during the year, FACTORIES ACT. 1,937 The following details relate to the matters under Parts I & VIII of the Factories Act, 1937, which are administered by the Fulham Borough Councils:- Part I of the Act. Premises No. of Inspections No. of written Notices 20 Factories without mechanical power 5 Factories with mechanical power 296 29 Other premises under the Act (building operations & works of engineering construction) - - TOTAL 316 34 Particulars No. of cases in which defects were found Found Remedied Referred To H.M. inspector By H.M. Inspector Want of cleanliness 3 2 1 1 5 1 Inadequate ventilation 4 1 4 - Ineffective drainage of floors 3 2 3 Sanitary Conveniences (a) Insufficient 12 11 - (b) Unsuitable or defective 3 8 - 8 1 (c) Not separate for sexes 5 - 6 Other offences against the Act, (Not including those relating to Outwork) 10 - 8 - 48 41 4 9 TOTAL No prosecutions were instituted under the Factories Act, 1937 during 1948. 10 Part VIII of the Act. (Outwork) Nature of Work. No, of Outworkers on List. Wearing Apparel (Making etc) 64 Household Linen 7 Lace, Lace Curtains & Nets 2 Furniture & Upholstery 8 Locks, Latches & Keys 1 Paper Bags 3 The making of Boxes or other receptacles or parts thereof, made wholly or partially of paper 2 Carding etc. of buttons 1 Stuffed Toys 5 Cosaques, Christmas Crackers, and Stockings etc., 1 1 Lampshades TOTAL 95 NATIONAL ASSISTANCE ACT, 1948 The above Act, which came into force in July, had particular reference under two of its Sections to the duties of the Public Health Authorities, These two Sections are as follows:- Section 47. Removal to suitable premises of persons in need of care and attention . Only one case occurred in which it was necessary to take action under this Section. The details are as follows:- Mrs. Elizabeth Isabella Dobritzhoper of 15, Mitford Buildings, was removed to Fulham Hospital, to be detained and maintained therein for the space of 3 months, on the 22nd November, 1948, by order of the West London Police Court. This person was aged 81 and had no near relatives or anyone to look after her. The room occupied was in an insanitary condition, so much so that the Hone Helps, after locking after her for a considerable period, refused to attend her any longer as the smell and conditions of the room were so bad, Mrs. Dobritzhoper was eventually removed from Fulham Hospital to Tooting Bee Hospital. 11 Section 50. Burial or Cremation of the Dead. Twenty-five funerals wore under the provisions of this Section The funerals were Mr.J. Goulborn,of 62. Greyhound Road, who had been given the contract to carry out the funerals for the Fulhan Borough Council, Mr. Goulborn previously held a similar contract with the London County Council. Details of the cost of the Burials are as follow:- * 25 Funerals as per contract £ 179. 14s. 0d. Less amount recovered from estate of deceased, or by gifts, or responsble relatives traced £105. 3s. od. Cost to Council £74. 11s. Od. * The cost of the funerals varies, the average cost of an adult being approximately £9 as against £2 for a child. RODENT CONTROL The Council's Rodent Control Service has carried out a continuous campaign against rate and mice throughout the Borough. Routine inspections were made of food Premises and Business Premises and, in addition, 597 complaints were dealt with from Premises have co-operated very well, and in no case has the Council had recourse to legal proceedings. Charges were made and collected without difficulty in 69 cases, the total sum amounting to £50. 15s 9d. No charges is, of course made for infestation of private dwellings, but in numerous cases the disused drains; the cost of these works was born by the owners of the premises. Three sewer treatments were carried out during the year with good results in estimated kills, The bombed sites in the Borough ware, and continue to be, inspected periodically, and in only one case was there slight evidence of infestation, This has received attention and, with th completion of the rebuilding work thereon, will be satisfactorily dealt with. The Borough Council properties and flats were also inspected. The Wharfside promises are inspected by the Ministry's own Wharf Rodent Office, but a routine inspection by the Council's Rodent Operators was also carried out and infestation dealt with in collaboration with the Wharf Rodent Officer. Since the Nationalisation of the Railway Undertakings, complete co-oparation has been extended by the Railway Executives and very satisfactory results obtained. Destruction of Pigeons. Section 121 of the Public Health (London) Act, 19369 gives the Sanitary Authority power to seize and destroy, or sell or otherwise dispose of any house doves or pigeons appearing to have no owner, in order to prevent or minimise any nuisance, annoyance or damage which they might cause. On 24th November, 1948, the Public Health Committee decided, after consideration of a report from the Medical Officer of Health, that this work should be undertaken by the Rodent Operatives. Two prototype traps were constructed and used in two cases where complaint had been received. No pigeons were actually caught, but in each case the pigeons gave no further cause for complaint and trapping was abandoned. The service however, is still in being and will be used when occasion demands. GRIT NUI SANGS - SANDS END WARD The Medical Officer of Health arranged for the entire staff of Sanitary Inspectors to carry out a survey of Sands End Ward in order to obtain direct evidence of the nuisance from grit etc., together with the personal experience of residents throughout the area. As it was impossible in the time to arrange for a complete house to house visitation, ten per cent of the houses in evary street in the Ward were inspected and the residents , views obtained in the form of a questionnaire- the latter dealing with all aspects of the nuisance from the householder's point of view, and giving details of alleged injury to health attributable directly or indirectly to it. Survey Figures - April 1st. 2nd and 3rd 1948. Number of Roads visited 66 „ „ Houses visited 405 „ „ Persons interviewed 483 „ „ „ noticing nuisance before 1946 207 „ „ „ „ „ since 1946 58 „ „ „ „ „ 'worse since 1939' 353 Number attributing nuisance to Power Station 270 „ „ „ „ other industrial sources 92 „ „ „ „ unknown sources 127 127 Comlaints due to soot and grit in householder's opinion. (1) Contamination: Food, clothes etc. 310 (2) Windows stated shut at all times 315 (3) Eye injuries (foreign bodies in eye etc.) 303 (4) Pulmonary troubles ( br onch itis , as thma , T.B. etc.) (Worse 60%?) 176 (5) Psychological, and other health factors, debility etc. 307 (1A) No Contaimination: Food, clothes etc. 123 (2A) Unnecessary to shut windows 178 (3A) No eye injuries 180 (4A) No pulmonary trouble 307 (5A) No psychological or other health factors 176 These figures are, of course, open to correction, as many of those interviewed were themselves doubtful as to the definite answer, and were often somewhat vague in their statements- particularly does this refer to psychological and general health answers as many complained of "tiredness", "being fed up with cleaning" etc., rather than any recognisable factor. Many of the interviewed could not say definitely when they were first aware of the grit nuisance, but there was certainly a general impression that it was worse now than it had been in previous times. 13 In addition, the Medical Officer of Health and the Chief Sanitary Inspector paid a visit to the Coal and Fuel Research Station at Greenwich to consult the Director and his technicians. I would like here to express my appreciation of the able manner in which, at short notice, this survey was carried out by the Chief Sanitary Inspector and the staff. DISINFECTION, DISINFESTATION, & LAUNDRY SERVICES. The following details relate to The services provided by the Disinfecting Superintendent and his staff during 1948:- No. of rooms disinfected after Infectious Disease 173 No. of articles stoved 6, 347 No. of rooms disinfested 859 No. of inspections made of prospective Council tenants 109 No. of cases in which disinfestation was necessary 31 No. of articles laundered for M & C.w services 49,750 No. „ „ „ „ Public Conveniences 2,469 In addition, transport was provided as necessary for the M & C.W. Services throughout the year. Identification was made in 47 cases where insects were brought in by the public, and the necessary treatment was carried out where these insects wore found to be harmful. INSPECTION & SUPERVISION OF FOOD There are no slaughterhouses in the Borough, and no animals are killed for human consumption, All food premises are kept under observation and frequently inspected, and the following figures relate to this work during 1948 :- Food Factories 135 Milk Shops & Dairies 630 Factory Bakehouses 513 Bakers Shops 59 Restaurants 104 Dining Rooms, etc., 57 Butchers Shops 126 Fried Fish Shops 67 Fish Shops 89 Greengrocers 103 Grocery & Provisions 239 Ice Cream Premises 282 Stallholders Stores 60 Cooked Meat Shops 12 Licenced Premises 60 Other Food Premises 125 Food and Drugs - Adulterations etc. During the year under review, one thousand articles of food and drugs, were purchased by the Sampling Officer and submitted to the Public Analyst for analysis. Of these, 37 or 3.7 per cent., were adversely reported upon and in ten instances legal proceedings were instituted. Only one- a sample of Non-brewed Vinegar - which was 11.5 per cent, deficient in acetic acid, calls for special mention. In this instance, the Magistrate at the West London Police Court dismissed the summons on the grounds that the certificate of the Public Analyst was vague as it did not specify the accepted standard for acetic acid. Against this the Council appealed to the High Court, where the Magistrate's decision was upheld. 14 Milk. During 1948, 493 samples of milk were purchased by the Sampling Officer for chemical analysis by the Public Analyst. Of those 348 were purchased fron milk vendors in the streets of the Borough during the early delivery. 77 were purchased on Sundays and public holidays, and 41 were taken at the early morning delivery to hospitals etc., in the Borough which are under the control of the London County Council. Three, or 0.6 per cent, of the 493 samples of milk examined were reported to be below the legal standards, but in no case was the deficiency sufficient to justify legal proceedings and the vendors concerned were warned by letter on the recommendation of the Public Health Committee. As in previous years, the arrangement for samples of milk to be taken in course of delivery to the hospitals, institutions and schools in the Borough which are under the control of the London County Council was continued, and the following were taken for chemical analysis during 1948, No adulterations were reported. Institution: No of samples taken: For chemical analysis For bacteri ological examination Fulham Hospital 20 24 Western Hospital 21 24 L.C.C. Schools 31 29 Day Nurseries, Meals Kitchens, etc., 6 - 78 76 TOTALS Bacteriological Examination of Milk. During 1948, 213 samples of milk were purchased by the Sampling Officer for bacteriological examination, 155 being purchased during the early morning delivery from milk vendors in the streets, 47 in course of delivery bo hospitals, and 29 at schools. The following are details of the samples taken, all of which satisfied the prescribed legal tests:- Tuberculin Tested Milk (Certified) 2 Tuberculin Tested Milk 3 Tuberculin Tested Milk (Pasteurised) 18 Pasteurised Milk 180 Sterilised Milk 10 Food & Drugs Act. 1938. Section 22, and the Milk & Dairies Order, 1926. The registration of dairymen and dairy premises is regulated by the above and the following are details of the changes which took place during the year 1948:- Number of dairymen on the Register at 31.12.47 73 Number who transferred their business or discontinued selling milk during 1948 8 65 Number of registrations granted during 1948 8 Number on Register at 31st December, 1948 73 In addition, there are 42 shops in the Borough, the occupiers of which are registered to sell Milk which is supplied only in the properly closed and unopened receptacles in which it is delivered to the premises. 15 Ba ct erological Examination of Ice Cream. One hundred samples of Ice Cream were purchased by the Sampling Officer during 1948, 97 of which were subjected to the Methylene Blue Test and graded as follows :- Provisional Grade. Number of Samples. 1 65 2 14 3 16 4 2 The remaining three samples, which contained colouring matter and were subjected to a plate count, gave satisfactory results. Pharmacy and Poisons Act 1933 etc. This Act and the Poison Rules regulate the sale of Part II poisons, and the local authority is required to keep a register of all persons licensed to sell such poisons. At 1st January, 1943, there were 114 persons so licensed, and during the year 1948, 34 names were added, making a total of 148 names on the register at 31st December, 1948 Nineteen samples of Part II poisons were purchased by the Sampling Officer during 1948 and submitted to the Public Analyst, but none calls for special comment. Rag Flock. The sale and use of Rag Flock is regulated by Section 136 of the Public Health (London) Act, 1936, and by Regulations of the Ministry of Health. During 1948, five samples of Rag Flock were procured by the Sampling Officer, all of which complied with the Regulations. Water Supply. The Metropolitan Water Board are the responsible authority for supplies of water in fulham; no well waters are used for drinking or culinary purposes. No complaints were received during the year. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES Smallpox. Contacts of Smallpox numbering 47 were kept under observation during the year. No cases occurred in the Borough. Scabies, Treatment for Scabies was arranged for 47 men, 58 women, and 37 children. All cases were followed up, to ensure that contacts received appropriate treatments. Other conditions. Treatment was given for 5 men, 22 women, and 10 children who were infested with pediculi capitis. Close contact with the hairdressers in the Borough is maintained, and some of the girls and women had been referred by them. Cancer. The percentage of deaths from this cause was 19.5, an increase over last year's figure of 16.9. Notifiable Diseases. The following table shows the number of cases notified during 1948 (corrected figures), with the comparative figures for 1947:- 16 Disease No. of Notifications 1948 1947 Diphtheria 10 17 Scarlet Fever 100 93 Measles 889 814 236 Whooping Cough 368 Acute Poliomyelitis 2 2 7 Acute Polioencephalitis - 8 75 Acute Pneumonia 28 Dysentery 13 1 Enteric or Typhoid Fever 1 - Paratyphoid Fevers 2 - Cerebro-spinal Fever 1 6 Erysipelas 25 23 Puerperal Pyrexia 14 10 Ophthalmia Neonatorum 2 8 Epidemic Diarrhoea (under 5 years) 40 41 67 160 Scabies Food Poisoning 7 7 226 Pulmonary Tuberculosis 203 33 Non-Pulmonary Tuberculosis 23 TOTAL 1,795 1,785 TUBERCULOSIS DISPENSARY This institution was transferred on July 5th, 1948, to the London County Council and Regional Hospital Board, so that the following statistics relate mainly to the work performed during the period from January 1st to July 4th, 1948. The death rate from Tuberculosis during the year 1948 was 0.59 (pulmonary 0.55, non- pulmonary 0,04). During the year 203 pulmonary and 23 non-pulmonary notifications were received. During the period from 1st January to 4th July, 1948, 1,875 attendances were made, inducing 365 cases who attended for the first time; 58 were referred for institutional treatment. 1,892 patients were interviewed by the Almoner, and in 540 cases extra nourishment was provided. The Chest Physician (Dr. H.C. Price) who was Tuberculosis Officer and Deputy Medical Officer of Health before his transfer to the Regional Hospital Board on the 5th July, 1948, has kindly given me permission to quote from his Annual Report to the Fulham & Kensington Hospital Management Committee for 1948/49 as follows:- The Chest Clinic under the new Health Services: "The year has been noteworthy for the occasion on 5th July of the inauguration of the National Health Service. The immediate effects of the nationalisation of the Health Service and the consequent transfer of the service from the local Health Authority to the Regional Hospital Board was very slight, no major changes of policy have been made during the year under review. However, certain tendencies and trends inherent in the Act itself made their appearance during the year and are worthy of note. For the first time the Tuberculosis Service, as many of us have known it in the past, came under dual control; this dichotomy is likely to haunt us for many years. The diagnosis 17 and treatment of tuberculosis remains the responsibility of the major Hospital Authorities, but the After Care, both Nursing and Rehabilitation has remained in the hands of the local Health Authority (L.C.C,). No really serious arguments have ever been put forward for this arrangement and many of us feel that the reasons were other than scientific or clinical, since as far as the patients are concerned no competent authority has yet ruled where the clinical division between treatment and After Care is likely to be found on examination. The long wait for Sanatorium admission: One of the greatest, if not the greatest, problem facing the Regional Hospital Boards on July 5th, was the extensive waiting lists of patients awaiting institutional treatment of one kind or another, inherited from the old hospital authority. This problem has not lessened and in fact in some areas it has become worse, and everywhere remains as a running sore in the efficiency of the New Service. The lack of beds has been instrumental in changing the policy of Chest Clinics in regard to new patients. It is fair to say that in most instances only those cases who are young and in when the prognosis is likely to be very good ever find their way on to the waiting list for Sanatoria, so that in fact the official waiting list bears little or no relationship to the present day local needs for Sanatorium admission. In this Clinic only about one third of the new cases, or old ones requiring re-admission, have been submitted to the Regional Board for this purpose. The other luckless patients have been treated as well as was possible in overcrowded and unsuitable rooms surrounded by their overworked relatives and susceptible off-spring. Such a situation creates a vicious circle, in that it will tend to increase the incidence of new cases in a few years time, and thereby aggravate the existing burden on our available hospital beds for many years to come, unless we can hope for a financial outlay on hospital rebuilding far in excess of anything yet proposed, together with greatly improved rates of pay and conditions of service for those who work in the difficult surroundings of Sanatoria. Home Conditions: It would be invidious to show up the difficulties we experience with shortage of Sanatorium beds without at the same time spotlighting the equally dangerous situation created by the shortage of houses. Here we are dealing with the fundamental problem of prevention as far as pulmonary tuberculosis is concerned. In 1939 D'Arcy Hart and Payling Wright in their excellent survey of "Pulmonary Tuberculosis and Social Conditions in England and Wales" showed clearly and conclusively the direct correlation between bad over-crowded housing conditions and the incidence rates of pulmonary tuberculosis. In this Borough of approximate population 130,000 there are nearly 5,000 on the waiting list for rehousing, including 68 tuberculous families awaiting priority for rehousing. This priority is only granted when patients with positive sputa are forced to live and often sleep in the same room where there are children. As stated we are only able to arrange hospital or Sanatorium treatment for early treatable cases. For these more fortunate patients awaiting a future bed in four to eight months time, together with the less fortunate with no hope of a bed. there is the overcrowded flat, in which the whole family, mother, father and babies live their lives in one or two rooms. Where the patient happens to be the wife, it is occasionally possible to provide a Home Help, although the number of women who are willing to volunteer to look after this type of case, is understandably small. The number of those available would 18 certainly be increased by the payment of danger money and the possibility of a disability pension in the event of their contracting the disease. This proposal is frowned upon in official circles as liable to frighten away many possible volunteers. However true this the Leaflet warning them in official language of the dangers of infection from tuberculosis is likely to be a very much greater source of terror than any additional pay." Bac toriological & other examinations carried out at Dispensery. For Tubercle Bacilli: Sputa 506 Sputa with positive result 107 Sputa with negative result 399 Other examinations: Diphtheria 109 Urine 23 Miscellaneous 3 The following bacteriological ana other examinations were also carried out during the year 1948 at West London Hospital for the Council:- Diphtheria 427 Haemolytic Streptococci 294 Vincent's Angina 44 Sputa 197 Urines 43 Friedmans 26 Faeces 21 Miscellaneous 35