AC 4346 LIBRARY FUL 40 METROPOLITAN BOROUGH OF FULHAM R E P 0 R T of the MEDICAL OFFICER, OF HEALTH for the year 1949 P.L.T. BENNTT, M.C., M .R.C.S., I.R.C.P., T.D.D., D.P.H. Medical. Officer of Health, 659 76 CONTENTS Public Health Committee. Staff. Page No. Introduction 1-3 Vital Statistics 4-8 Infectious Diseases 9-14 Bacteriological Examinations 15-16 Public Mortuary 16 Free Washing Facilities 17-18 Sanitary Administration 18-21 Factories Act, 1937. Parts I & VIII (Outworkers) 22-23 National Assistance Act, 1948 - Sections 47 & 50 24 Rodent Control 25 Disinfection, Disinfestation & Laundry Services 26-27 Housing Applications - L.C.C. 27 Food Administration 28-32 Milk, Regulations for sale of 33 Basement Bakehouses 34-35 Milk & Dairies Regulations, 1949 35-36 Milk, Bacteriological Examination of 36-37 Ice Cream (Heat Treatment) Regulations, 1947 37 Pharmacy & Poisons Act, 1933 37-38 Tuberculosis 38-40 MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at December 1949) Ex-officio: Councillor A.J. Jiggins, M.M., J.P. (Mayor) Chairman: Councillor C. Lancaster, J.P. Vice-Chairman: Councillor J.W. Perotti. J.P. Alderman Mrs. H.M. Fournier Councillors Albert James Frost Vivian Arthur Baron Mrs. Marjorie Annie Gale Miss Gladys Emily Cowell Thomas Holloway Miss Alma Grace Fox David Shopland Herbert Henry Poulter Thomas Alfred Winstanley STAFF OF THE PUBLIC HEALTH DEPARTMENT (December 1949) Medical Officer of Health - P.L.T. Bennett, M.C., M.R.C.S., L.R.C.P., T.D.D. (Wales), D.P.H. Deputy Medical Officer - Mary Adams, B.Sc., M.B., B.Ch., of Health D.P.H. (Services shared with Hammersmith M.B.C.) Public Analyst - T. McLachlan, A.C.G.F.G.,F.I.C. (Paid by fees) Administrative and Clerical Section. Chief Clerk - J.E. Burton, D.F.M. Second Clerk - J.W. Chance Administrative Clerk - B.C. Bolton Clerk - S.T. Ansell Clerk - R.G. Larcher Clerk - S. Wright Clerk - L.C. Crane (H.M. Forces) Secretary to M.O.H. - Mrs. H.A. Stapp Shorthand-Typist - Miss E.L. Barringer Clerk-Typist - Mrs. E. Lidiard Clerk-Typist - Miss R. Reed Miscellaneous. Disinfecting Superintendent - J.H. Hughes Mortuary Keeper - G. Churchill Sanitary Inspectors' Section. Chief Sanitary Inspector - T.H. Robey Deputy to Chief Sanitary - F.E. Walsh Inspector Factories & Smoke Abatement - F.C. Payne Inspector Lady Sanitary Inspector - Miss E.H. Sexton District Sanitary Inspector - H. Hutchinson do. - C.J. Price do. - I. Jones do. - R.D. Richards do. - C.W. Owens do. - D.G. Martin do. - G. Bailey do. - B.J. Parsons Food & Drugs Section. Senior Sanitary Inspector - A.W. Gammack Sanitary Inspector - W.G. Thurgood do. A.H. Newport do. - A.G. Patterson METROPOLITAN BOROUGH OF FULHAM Public Health Department, Town Hall, FULHAM,S.W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Fulham. Mr. Mayor, Ladies & Gentlemen, I have the honour to present the Annual Report on the health of the Borough for the year 1949. On the instructions of the Ministry of health this report is again presented in an abridged form. The Registrar General's estimate gives the mid-year population of the Borough as 124,040, an increase of 740 on the figure for the preceding year. The Birth Rate of 16.48 per 1,000 is somewhat lower than the figure for 1948 (18.3 per 1,000), and the Infantile Mortality Rate of 26.4 per l,OOO live-births also shows a very slight decrease (26.5 in 1948), and is again the lowest recorded rate for the Borough. Statistical records for the year indicate that the health of the public was maintained at a very satisfactory standard, although Fulham did not escape the epidemic of Poliomyelitis which was universal throughout the country during the summer months. There was also a minor outbreak of Typhoid Fever during the months of June and July, 10 cases being notified, one proving fatal. Further details of these two outbreaks are given in the appropriate section of the Report. Special attention has been given to food hygiene and the importance of clean food, with increasing supervision of all premises where food is stored, prepared or sold (including those where meals are taken such as restaurants, cafes and eating houses of all types). A special section of Sanitary Inspectors, headed by the Inspector of Food & Drugs was formed early in the year for the specific purpose of carrying out a complete survey of all such establishments in the Borough, and giving advice on all matters connected with food hygiene. - 2 - The Senior Food & Drugs Inspector includes in the Report a summary of the investigations carried out. Co-operation on the part of the Council regarding the formation of a Clean Food Guild for the Borough was considered also; but it was postponed pending an investigation by the Food Inspectors into conditions prevailing in the Borough, and chiefly because the Public Health Committee felt that there should be a uniform method of procedure in operation in all Boroughs, rather than individual cases of practice, and the possibility of divergencies in different areas. (I might add that at the time of writing there is further consideration being given on this special subject, in conjunction with the Fulham Chamber of Commerce). As in the previous year continued difficulty has been experienced in maintaining reasonable standards of fitness in existing housing accommodation. Not only have there been shortages of labour and material, but the primary fact remains that much of the housing in the Borough is old-some of it worn out even before the last war period, and the effects of aerial warfare, together with the almost entire cessation of repair work during the war years, have led to rapid deterioration which is very difficult to cope with. Many properties are really not worth the continual patching up necessary to preserve any kind of minimal habitability; and the increasing use of Housing Act, Sections 9 and 11 - the only course possible In many cases - is creating a situation which is becoming more and more formidable to the Council's Housing and Public Health Departments from both financial and re-housing aspects. Owing to the economic situation created by restriction of rents, many property owners appear to be unable to maintain their properties (owing to the heavy costs of repair work nowadays) to the standard to which they would otherwise have been maintained; and this has shown a reaction in the number of complaints received. This question of housing is in my opinion far and away the most important and difficult problem facing the Borough Council, and the sooner long-delayed operations can be commenced in regard to "systematic" clearance of insanitary and overcrowded areas, and re-housing of the public, the better for all concerned. - 3 - Relations and co-operation between the Council's Public Health Department and that of the Divisional Medical Officer, Division 1, London County Council, has been maintained on cordial and satisfactory terms throughout the year 1949 the first year of complete operation under the new schemes brought into being by the National Health Act, 1946, which commenced in July 1948. It is with much regret that I have to record the death of Dr. Harry Smith, the first Divisional Medical Officer for Division 1; but it is a great pleasure to feel that the same happy relations and co-operation have continued through the year with his successor, Dr. Violet Russell, who was confirmed in the appointment in December, 1949. Dr. Mary Adams was appointed Deputy Medical Officer of Health in January, 1949, sharing these duties with those as Deputy Medical Officer of Health for Hammersmith. Dr. Day, Medical Officer of Health for Hammersmith, and Dr. Adams have both given most valuable service to this Borough on several occasions during my absence, either through illness or on leave, and I have pleasure in recording my great appreciation for their help given so efficiently. In this, my last Annual Report to the Fulham Borough Council before my retirement on health grounds, I would like to record my appreciation and thanks to the Mayor, Aldermen and Councillors, and in particular to the Chairman and Members of the Special Committees with whom I have had the pleasure of serving for so many years, for the kindness, help and courtesy which has invariably been extended to me and for the sympathetic consideration on many difficult problems. To the Town Clerk and all the other Chief Officers, who have been such helpful and friendly colleagues, I express my very sincere thanks. Finally, my good wishes and thanks are very gratefully extended to the Chief Sanitary Inspector, Mr. Robey, and the Chief Clerk, Mr. Burton, of my Department, and to all the other members of my staff in the Town Hall, who have been loyal and efficient colleagues, giving that practical help and skilled service - so essential in carrying out their specialised duties for the health and good of the public. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, P.L.T. BENNETT, Medical Officer of Health. - 4 - EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1949 POPULATION, estimated, 1949 124, 040 LIVE BIRTHS: Rate per 1,000 Population Total Males Females 1949 1948 Legitimate 1916 1028 888 15.5 16.9 Illegitimate 122 69 53 0.98 1.4 2038 1097 941 16.48 18.3 STILLBIRTHS: Legitimate 43 23 20 0.34 0.24 Illegitimate 6 3 3 0.05 0.05 49 26 23 0.39 0.29 DEATHS: 1499 741 758 12.09 11.5 1949 1948 Percentage of Deaths in Public Institutions 54 56 Death Rate of Infants under One Year of Age: 1949 1948 All Infants per l,000 live births 26.4 26.5 Legitimate Infants per 1,000 legitimate births 25.0 26.4 Illegitimate Infants per l,000 illegitimate births 26.2 22.6 Deaths from: 1949 1948 Cancer (all ages) 260 276 Measles (all ages) 2 - Whooping Cough (all ages) 2 3 Diarrhoea (under two years of age) 5 7 -5- -6- CLASSIFICATION OF CAUSES OF DEATH 1499 deaths as follows:- 1949 1948 Typhoid 1 1 Cerebro Spinal Fever - - Whooping Cough 2 3 Measles 2 — Tuberculosis of Respiratory System 52 68 Other forms of Tuberculosis 8 5 Diphtheria — 3 Syphilitic disease 11 8 Influenza 7 2 Poliomyelitis - - Acute Infectious Encephalitis - - Cancer of (a) Buccal cavity 8 4 (b)Uterus 13 18 (c) Stomach & Duodenum 42 51 (d) Breast 24 27 (e) Other sites 173 176 Diabetes 8 4 Cerebral Haemorrhage 131 127 Heart Disease 420 391 Other diseases of the circulatory system 88 66 Bronchitis 108 110 Pneumonia 99 65 Other respiratory diseases 21 15 Ulcer of stomach or duodenum 20 15 Diarrhoea (under two years) 5 7 Appendicitis 3 3 Other digestive diseases 33 33 Nephritis 24 34 Maternal causes 1 2 Premature birth 11 22 Congenital malformations etc. 28 23 Puerperal and post abortive sepsis 1 - Suicide 22 19 Road traffic accidents 7 15 Other violent causes 34 26 All other causes 92 74 Totals 1499 1417 - 7 - - 8 - Infantile Deaths:- There were 53 deaths of infants under the age of one year, the causes being as follows:- 1949 1948 Whooping cough 2 3 Syphilitic disease - 1 Bronchitis 2 1 Pneumonia 6 5 Diarrhoea 4 7 Prematurity 11 22 Other respiratory diseases - 1 Asphyxia 2 1 Congenital malformations etc. 19 16 Otitis Media 1 - Meningitis 1 1 Mongolism - 1 Tuberculosis of respiratory system 1 - Other digestive diseases 1 - Want of attention at birth 1 - All other causes 2 - 53 59 The Infant Mortality rate was 26.4 per 1,000 live births (26.5 in 1948). - 9 - TABLE OF NOTIFIABLE DISEASES Disease Authority for Notification Acute Encephalitis Public Health Act, 1936 (Section 143). Regulation (No. 2259) made by the Minister of Health 1949 (l.1.50). Acute Influenzal Pneumonia Public Health Act, 1936 (Section 143). Regulation (No. 1207) made by the Minister of Health. 1927 (1.1.28). Acute Primary Pneumonia do. Acute Poliomyelitis Public Health Act, 1936 (Section 143). Regulation (No. 2259) made by the Minister of Health, 1949 (1.1.50). Anthrax L.C.C. Order-Public Health (London) Act, 1936 (Section 305). Cholera Public Health (London) Act, 1936 (Section 304). Continued Fever do. Diphtheria do. Dysentery Public Health Act, 1936 (Section 143). Regulation (No. 1207) made by the Minister of Health,1927 (1.1.28). Enteric Fever (includes Typhoid and Paratyphoid) Public Health (London) Act, 1936 (Section 304). Regulation (No. 1207) made by the Minister of Health, 1927 (1.1.28). - 10 - Disease Authority for Notification Erysipelas Public Health (London) Act, 1936 (Section 304). Food Poisoning Food and Drugs Act, 1938 (Section 17). Glanders L.C.C. Order-Public Health (London) Act, 1936 (Section 305). Hydrophobia in Man do. Malaria Public Health Act, 1936 (Section 143) Regulation (No. 1207) made by the Minister of Health, 1927 (1.1.28). Measles Public Health Act, 1936 (Section 143). Regulations made by the Minister of Health, 1938 and 1940. Membranous Croup Public Health (London) Act, 1936 (Section 304). Meningococcal Infection Public Health Act, 1936 (Section 143). Regulation (No. 2259) made by the Minister of Health, 1949 (l.l.50). Ophthalmia Neonatorum L.C.C Order-Public Health (London) Act, 1936 (Section 305). Plague Public Health Act, 1936 (Section 143). Regulations of Local Government Board, 1900. Puerperal Pyrexia Public Health (London) Act, 1936, as amended by the L.C.C. (General Powers) Act, 1948. - 11 - Disease Authority for Notification Relapsing Fever Public Health (London) Act, 1936 (Section 304). * Scabies County of London (Scabies) Regulations, 1943 Scarlatina or Scarlet Fever Public Health (London) Act, 1936 (Section 304). Small-pox do. Tuberculosis Public Health (Tuberculosis) Regulations, 1930. Typhus Fever Public Health (London) Act, 1936 (Section 304). Whooping Cough Public Health Act, 1936 (Section 143). Regulations made by the Minister of Health, 1938 and 1940. Zymotic Enteritis or Summer diarrhoea (under 5 years of age only) Public Health (London) Act, 1936 (Section 305). * A notification is not required where to the knowledge of the Medical Practitioner, a case of scabies has occurred in the house and has been notified within the four weeks immediately preceding the date on which he first became aware of the disease in the case he is attending. - 12 - PREVALENCE OF AND CONTROL OYER INFECTIOUS AND OTHER DISEASES Smallpox: Contacts of Smallpox numbering 12 were kept under observation during the year. No cases occurred in the Borough. Scabies : Treatment was arranged for 16 men, 21 women and 32 children. All cases were followed up, to ensure that contacts received appropriate treatment. Other Treatment was given for 4 men, 19 women and 7 Conditions: children who were infested with pediculi. Cancer: The percentage of deaths from this cause was 17.3, a decrease on last year's figure of 19.5. Notifiable The following table shows the number of cases Diseases: notified during 1949 (corrected figures), with the comparative figures for 1948:- Disease No. of Notifications 1949 1948 Diphteria 6 10 Scarlet Fever 327 100 MeaSleS 1099 889 Whooping Cough 192 368 Acute Poliomyelitis 32 2 Acute Polioencephalitis 4 - Acute Pneumonia 32 28 Dysentery 10 13 Enteric or Typhoid Fever 10 1 Paratyphoid Fevers - 2 Cereb.ro-spinal Fever 4 1 Erysipelas 20 25 Puerperal Pyrexia 14 14 Ophthalmia Neonatorum 6 2 Epidemic Diarrhoea (under 5 years) 45 40 Scabies 28 67 Food Poisoning 11 7 Pulmonary Tuberculosis 245 203 Non-Pulmonary Tuberculosis 23 23 2108 1795 - 13 - TYPHOID 1949 There was a small outbreak of Typhoid Fever in the Borough in the middle of the year. Of the 26 cases admitted to hospital as suspect cases of Typhoid Fever, 10 were subsequently confirmed as suffering from the disease, one case being fatal. These patients were notified in the period 7th June to 6th July, and in all cases the date of onset was within a period of 23 days in June. All the cases were of the Vi phage type D1 with the exception of one case which was Vi phage type E1 about which there was some doubt. The great difficulty experienced in the endeavour to trace the actual source of infection in this outbreak was due to the fact that the first case notified had actually been in hospital for an abdominal operation, and previously had been under medical care outside for some days before being sent in to the hospital for the operation. There was also a case notified who had been in hospital for a month and had been admitted to hospital in the first case with a suspected kidney disease. Thorough investigations were made, including the taking of specimens from all contacts and food handlers at food premises coming under suspicion, and the positioning of special absorbent pads in various drains. All methods failed to indicate the source of the infection however, and it can only be assumed that it was either:- (i) Due to a carrier who was temporarily in the district and then left. (ii) That some particular consignment of food, infected with Salmonella Typhi, had been consumed in its entirety, and the source of infection therefore ceased. If the latter is the case, the opinion was that the infection must have occurred at some time during the first three weeks in May. - 14 - POLIOMYELITIS & POLIO-ENCEPHALITIS During the period 26th July to 20th December 70 suspect cases of Poliomyelitis were admitted to hospital. Of these 32 cases were confirmed as suffering from Poliomyelitis, and 4 cases confirmed as suffering from Polio-encephalitis. Thorough disinfection was carried out after the removal of each case to hospital, including spraying of D.D.T. when there was a prevalence of flies; and all close contacts were kept under observation. Of the total number of cases 20 occurred in children under 5 years, 7 occurred in children of school age, and the remaining 9 cases occurred in persons over school age. - 15 - BACTERIOLOGICAL EXAMINATIONS The following bacteriological and other examinations were carried out during the year 1949 at West London Hospital for the Council:- Diphtheria 285 Haemolytic Streptococci 182 Vincent's Angina 49 Sputa - Urines 28 Friedmans - Faeces 57 Miscellaneous 6 SAMPLES OF SWIMMING BATH WATER TAKEN FOR CHEMICAL & BACTERIOLOGICAL EXAMINATION Date Taken from Result of Examination 28.4.49 Ladies Bath (inlet) Fulham Baths Morning Sample No organism in 1 c.c. of water. Faecal types of B.Coli not isolated. do. do. (outlet) do. do. do. do. (inlet) Afternoon Sample do. do. do. (outlet) do. do. 30.6.49 Mixed Bath (inlet) Morning Sample Coliform bacilli not present. Pathogenic organism not isolated. do. do. (outlet) do. do. do. Ladies Bath (inlet) do. do. 16 Date Taken from Result of Examination 30.6.49 Ladies Bath (outlet) Morning Sample Coliform bacilli not present. Pathogenic organism not isolated do. Gents Bath (inlet) do. do. do. do. (outlet) do. do. 18.8.49 Bathing Pool (inlet) Hurlingham Club do. 2.5 parts per million of free chlorine. do. do. (centre) do. 2.0 parts per million of free chlorine. do. do. (outlet) do. do. 25.10.49 Ladies Bath do. No organism in 1 c.c. of water. Coliform bacilli not isolated. PUBLIC MORTUARY The following number of bodies were admitted to the Mortuary during the year:- By order of Coroner 295 Convenience Cases (i.e. admitted at the request of Undertakers) 114 Total 409 No. of Post Mortem Examinations conducted 295 17 FREE WASHING FACILITIES For some considerable time the question of providing "Free Washing Facilities" for members of the public using the Council's Public Conveniences, had been receiving the attention of the Public Health Committee. In 1947, when the subject was first discussed, it was agreed by the Committee that the provision of "free washing facilities" would be a great step towards promoting health and hygiene In the Borough, and would go a long way towards setting a standard both for the general public and more particularly the "food handlers" of the Borough. It was decided that the Committee would recommend to the Council, at the first opportune moment, the implementation of a scheme for "free washing" to be provided,. After giving this matter further consideration it was decided, at the September meeting of the Public Health Committee, to instal "free washing" at all the Conveniences. These facilities to be provided by means of absorbent paper towels and a liquid cleanser. In deciding to use paper towels instead of electric hand dryers, which was the original suggestion, the Committee were influenced by the experience of the St. Marylebone Borough Council, who were exceedingly helpful in providing details of working costs, and of their experience in installing "free washing" (a visit was made to one of their busiest Conveniences to see their system in operation). The Committee decided that "paid washing" (In addition to "free washing") should be kept at the three busiest Conveniences (Walham Green, Putney Bridge and Effie Road). It was felt that not only did the demand justify its retention at these Conveniences, but it was not intended that the "free washing" should replace the "paid wash and brush up" service, but should be additional to it, and primarily intended for persons who, after using the W.C., required to rinse their hands. The work of installing the necessary fittings was carried out by the Director of Housing and Public Buildings' Staff, and the facilities were made available to the public at the beginning of December, with two exceptions, namely Walham Green (Men's) and Gibbs Green Conveniences, where the work required to make the necessary conversions was more extensive. 18 Posters and labels were displayed, advising and encouraging the public to make full use of the facilities. The Convenience Attendants were told of the necessity for adequate supervision to prevent abuse, and were asked to give their full co-operation to "educate" the public in the use of the "free washing". The provision of these facilities has much increased the work of Mr. Hughes, Disinfecting Superintendent, and his staff, in delivering the bulky packets of towels and liquid cleanser (the latter is broken down to half strength at the Disinfecting Station before being delivered to the Conveniences), and especially so at the commencement of the scheme when the demand could only be guessed at, and frequent additional deliveries were often necessary. As this report is concerned only with 1949, and the service was only inaugurated in the December of that year, it is not possible to draw any conclusions; but when the public become in the habit of automatically washing their hands after using the toilet, I am confident that the increase in personal hygiene will result in an improvement in the health of the populace of the Borough. SANITARY CIRCUMSTANCES OF THE AREA Inspections after complaint 6,175 Re-inspections 19,894 Inspections after Infectious Disease 1,048 Drains Tested 461 Drains Inspected 2,492 Inspections of Outworkers' Premises 74 Inspections of Food Premises 5,105 0ther Visits 3,785 Intimations served 4,780 Statutory Notices served 2,566 Intimations complied with 4,711 Statutory Notices complied with 2,022 19 SUMMARY OF WORKS CARRIED OUT UNDER SUPERVISION OF SANITARY INSPECTORS Fresh Air Inlet 57 Soil and Vent Pipes repaired or renewed 91 Drains cleared 364 Drains repaired 117 Drains relaid 141 Rainwater gutters and pipes repaired or renewed 554 Drains sealed off 2 Disused drains excavated 22 Traps cleansed, repaired, etc. 74 Pans renewed 288 Seats repaired or renewed 112 Flushing cisterns repaired or renewed 264 Additional W.C. accommodation provided 12 Fastenings provided to doors, and doors repaired 283 W.C. apartments ventilated 10 Sinks provided, repaired or renewed 188 Sink and bath wastes repaired or renewed 236 New baths fitted 6 New lavatory basins 35 Baths cleansed 46 Drinking water cisterns cleansed etc. 59 Water supply pipes and fittings repaired 150 Water supply provided to separate floors 69 Rooms cleansed 3371 Decorations and internal house repairs 9770 Fireplaces repaired (nuisances from smoke etc.) 687 Kitchen ranges repaired or renewed (for cooking purposes) 286 Washing coppers repaired or renewed 37 Dampness remedied 2106 Rooms provided with adequate light & ventilation 10 Staircases provided with light & ventilation 122 Ventilated food cupboards provided 5 Ventilation provided under floors & repairs 520 Roofs repaired 1465 Other external repairs 638 Accumulations of refuse removed 79 Dustbin 166 Yards, forecourts paved and drained 110 Animals in state of nuisance 4 Rat runs traced 19 Bombed sites 20 Other nuisances 69 21,664 20 LEGAL PROCEEDINGS PUBLIC HEALTH (LONDON) ACT, 1936 Date Nature of Offence Remarks 7th Feb. Nuisance 176, Lillie Road. Order for work to be done in 21 days. Work completed. 7th Feb. Nuisance 43, Claybrooke Rd. Order for work to be done in 21 days. Work completed. 7th Feb. Nuisance 1, Playfair Street. Order for work to be done in 21 days. 7th Feb. Nuisance 49, Delorme Street. Adjourned 7.3.49. Order for work to be done in five weeks. 7th Feb. Nuisance 67, Chesilton Road. Order for work to be done in seven days - work completed. 9th May. Nuisance 15, Rylston Road. Adjourned to 13th June. Order for outstanding work to be done in 7 days. 9th May. Nuisance 9, Lundy Street. Adjourned to 13th June. Order for work to be done in 14 days. 9th May. Nuisance - 175, Estcourt Road. Adjourned to 13th June. Order for work to be done in 21 days. 13th June. Nuisance - 68, Harwood Road. Order for work outstanding to be done in 14 days. 20th June. Nuisance - 66, Chesilton Rd. Order for work to be done in 28 days. 20th June. Nuisance - 62, Colehill Lane. Order for work to be done in 7 days. 25th July. Nuisance - 10, Cedarne Road. Adjourned to 29th August work in hand. No appearance. Order in 14 days. 29th Aug. Nuisance - 50, Greyhound Rd. Order for abatement (except skylight) in 14 days. 21 Date Nature of Offence Remarks 12th Sept. Nuisance 17, Cambria Street. Order to abate nuisance in 7 days. 12th Sept. Nuisance 35, Ongar Road. Order to abate nuisance in 14 days. 17th Oct. Nuisance 71, Petley Road. Adjourned sine die. Order for work to be done in 14 days. £l.ls.0d. costs 24.10.49. 7th Nov. Nuisance 109, Bulow Road. Order for work to be done in 21 days. £2.2s.0d. costs. Work completed. 7th Nov. Nuisance 43, Bulow Road. Order for work to main roof and in front room to be done in 10 days. £2.2s.0d. costs. 7th Nov. Nuisance 111, Bulow Road. Order for work to be done in 14 days. £2.2s.0d. costs. 19th Dec. Nuisance 11, Gironde Road. Order for work to be done in 10 days. In 198 other cases the Summons was withdrawn, the work having been completed. DRAINAGE OF BUILDINGS During the year 87 drainage plans were approved by the Public Health Committee. RENT RESTRICTIONS ACTS. In response to applications by tenants, 35 certificates were issued during the year. FACTORIES ACT, 1937 The following details relate to the matters under Parts I & VIII of the Factories Act, 1937, which are administered by the Fulham Borough Council:- Part I of the Act. Premises No. of Inspections No. of written Notices Factories without mechanical power 74 10 Factories with mechanical power 216 12 Other premises under the Act (building operations & works) of engineering construction - - Total 290 22 Particulars No, of cases In which defects were found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 80 80 5 4 Inadequate ventilation 15 15 - - Ineffective drainage of floors 20 18 2 - Sanitary Conveniences (a) Insufficient 15 12 - - (b) Unsuitable or defective 120 110 - - (c) Not separate for sexes 10 10 - - Other offences against the Act. (Not including those relating to Outwork) 60 50 - - Total 320 295 5 4 No prosecutions were instituted under the Factories Act,1937 during 1949. 23 Part VIII of the Act. (Outwork) Nature of Work No. of Outworkers on List Boot Making 9 Wearing Apparel (Making etc.) 88 Lace, Lace Curtains & Nets 2 Furniture & Upholstery 6 Paper Bags 3 The making of Boxes or other receptacles or parts thereof 9 Carding etc. of buttons 2 Stuffed Toys 85 Lampshades 6 Fancy Goods 21 Miscellaneous 11 Total 236 SMOKE ABATEMENT. Total No. of Observations and Inspections made 175 Complaints Received 12 Observations (external) 143 Inspections (internal) 32 24 NATIONAL ASSISTANCE ACT. 1948 Section 50: Burial or Cremation of the Dead. Fifteen funerals were arranged under the provisions of this Section. The funerals were carried out by Mr. J. Goulborn, of 62, Greyhound Road, who has been given the contract to carry out the funerals for the Fulham Borough Council. Mr. Goulborn previously held a similar contract with the London County Council. Details of the cost of the Burials are as follows £ S. d. £ s. d. * 15 Funerals as per contract 110. 7. 6. 2 Removals of drowned bodies from foreshore of River Thames 2. 15. 0. 113. 2. 6. Less amount recovered from estate of deceased, or by gifts, or responsible relatives traced 42. 5. 6. Balance being cost to Council 70. 17. 0. * The cost of the funerals varies, the average cost of an adult being approximately £9 as against £2 for a child. Section 47. Removal to suitable premises of persons in need of care and attention. There were no removals made under the provisions of this Section. Application was made to the West London Magistrate's Court for a hearing of one case, but the person died two days prior to the date of hearing. 25 RODENT CONTROL The Council's Rodent Control Service continued its campaign against rats and mice throughout the Borough. 822 Complaints from occupiers of dwelling houses were dealt with - this is an increase on the number during the previous year, and is undoubtedly due to the general public becoming more aware of the Council's services. A large percentage of these complaints were of mice infestations, and there is no indication that rat infestation has increased. The occupiers of business premises have continued to co-operate freely, and in no case has the Council had recorse to legal proceedings for the recovery of charges. Charges were made and collected in 175 cases, the total sum involved amounting to £50.l5s.l0d. No charge is, of course, made for treatment of private dwellings, but as in most cases the rat infestation was traceable to either defective or disused drains (the cost of these works was borne by the owners of the premises). 2 Sewer treatments were carried out during the year, and from the resultant records it would appear that the rat population of the sewers has decreased, due in no small measure to the regular sewer treatments, combined with the sealing off of disused sewer connections, and repair of defective drains, thus reducing the potential breeding places of the rats. The bombed sites in the borough were periodically inspected and test baits laid. 26 DISINFECTION, DISINFESTATION & LAUNDRY SERVICES The following details relate to the services provided by the Disinfecting Superintendent and his Staff during 1949:- No. of rooms disinfected after Infectious Disease 535 No. of articles stoved 5,278 No. of rooms disinfested 1,050 No. of Inspections made of prospective Council tenants 174 No. of articles laundered for M. & C.W. services and Public Conveniences 19,741 Transport was provided as necessary for the M. & C.W. Services of the London County Council. The Disinfecting Superintendent has also dealt with many kinds of infestation such as cockroaches, beetles, ants, silver fish, moths etc. S.S. MOOLTAN A request was received from Dr. M.T. Morgan, Medical Officer of Health, Port of London Authority, in December, 1949 for assistance in fumigating the bedding and linen from the crew's quarters of the S.S. Mooltan following an outbreak of Typhoid Fever. The necessary arrangements were made, and the following articles were dealt with at the Disinfecting Station. The cost of the work, amounting to £ll.17s. 0d., was borne by the P. & 0. Steamship Company, and the articles were collected and delivered on their behalf by Associated Fumigators Ltd. Mattresses 163 Blankets 350 Pillows 251 Sheets & Pillow Cases 1065 1829 27 LIST OF VERMINOUS & STAINED ARTICLES DESTROYED DURING 1949 Pots and Pans 3 Mattresses 85 Eiderdowns 1 Beds 16 Chairs 6 Bed Springs 6 Tables 1 Sideboards 1 Washstands 1 Dressing Tables 1 Chests of Drawers 1 Divans 3 Pictures 1 Carpets 3 Armchairs 2 Cushions 5 Bedding 34 Clothing, Articles of 325 Pillows 47 Total 542 REHOUSING OF FULHAM RESIDENTS ON L.C.C. HOUSING ESTATES During the year 694 families were visited by the Sanitary Inspectors at the request of the London County Council in connection with applications for alternative accommodation. Of this number 524 cases applied on the grounds of overcrowding, and the remaining 170 on medical grounds and the insanitary condition of their living accommodation. 315 Families were found to be living in overcrowded conditions, and reports were sent to the Director of Housing and Valuer, London County Council, recommending them for alternative accommodation on the L.C.C. Housing Estates. 84 Families were known to have been rehoused during the year. 28 INSPECTION & SUPERVISION OF FOOD There are no slaughterhouses in the Borough, and no animals are killed for human consumption. SURVEY OF FOOD ESTABLISHMENTS On 2nd May, 1949, a complete survey of all food establishments in the Borough was undertaken by the Special Food & Drugs Section of the Sanitary Inspectors under Mr. A.W. Gammack, the Council's Senior Food & Drugs Inspector, and complete records obtained as to structural condition of the premises, the suitability of equipment, water supply, sinks, etc. The principal legislation relating to cleanliness in food premises is contained in Section 13 of the Food & Drugs Act, 1938, and the provision of suitable and sufficient sanitary conveniences in food shops is made obligatory by Section 10 of the Shops Act, 1934. Bye-Laws: Section 15 of the Food & Drugs Act, 1938, empowers a local authority to make bye-laws for sanitary and cleanly conditions in connection with the handling, wrapping and delivery of food whether in a shop or exposed for sale in the open air, and in London the London County Council is the authority to make such bye-laws. Model bye-laws were published in October, 1949, and are still under consideration. The following gives details of the various types of food premises in the Borough, together with the number of inspections made during 1949 and the Notices served on the persons responsible calling for the remedy of defects. A great deal, however, is achieved by personal contact between the Inspectors and the Shop-Keepers, and in many cases much more satisfactory results are obtained by personal discussion and advice rather than by written notice. 29 Food Shops Categories No. on Register No. of Inspections Notices Written Verbal Complied With Bakehouses (Non-Basement) 29 246 16 5 10 Bakehouses (Basement) 21 142 8 4 3 Bread & Cake Shops 14 72 3 1 3 Butchers' Shops 68 480 36 10 28 Cooked Meat Shops 7 18 3 2 4 Dairies (Incl. Purveyors of Bottled Milk) 101 414 - - - Eel & Pie Shops 5 12 - - - Food Factories 3 91 - - - Fishmongers' Shops 20 183 9 9 8 Fried Fish Shops 38 207 20 9 18 General Food Shops 165 748 65 16 54 Greengrocers & Fruiterers 81 254 27 23 22 Horseflesh Butchers 2 25 1 - - Ice Cream (Manufacturers & Dealers) 172 828 35 19 25 Licensed Premises 85 172 29 2 4 Restaurants & Working Class Dining Rooms 124 543 76 31 51 Stallholders' Storage Premises 34 377 11 5 6 Other Food Premises 24 293 2 - 1 Totals 993 5,105 341 136 237 30 Although Section 13 of the Food & Drugs Act, 1938 empowers local authorities to take legal proceedings when contraventions are found, it is the usual practice to intimate in writing to the person responsible any defects, and recourse to the Police Courts is rarely necessary. As a result of this informal action, much work of improvement has been carried out on food premises, and the following table sets out details of the more important defects remedied:- Water heaters installed 113 New sinks provided 44 New W.C's provided 4 W.C's. repaired or cleansed 22 Kitchens, preparation rooms etc. redecorated 243 Floors renewed or repaired 18 Shop fronts repaired or redecorated 15 Shop fronts re-built 6 New dustbins provided 53 Counter cases for protection of food provided 10 PREMISES USED FOR THE PREPARATION OF FOOD Under the provisions of Section 14 of the Food & Drugs Act, 1938, premises used for the preparation of certain specified articles of food must he registered with the local authority. At the end of 1949 there were fifty-four premises on the Register relating to the preparation of preserved foods and one-hundred and thirty-six premises on the Register relating to the manufacture or sale of Ice Cream, the latter being analysed as follows:- Premises registered for manufacture, storage and sale of Ice Cream 15 Premises registered for storage and sale of Ice Cream 16 Premises registered only for sale of Ice Cream 105 Total 136 31 UNSOUND FOOD This is dealt with in Section 9 of the Food & Drugs Act, 1938, which makes it an offence to sell, offer or expose for sale or possess for the purpose of sale any food intended for, but unfit for, human consumption. It is the practice of shopkeepers who have in their possession any unsound food to notify the District Food Inspector, and If he is of the opinion that the article is unsound, surrender it to him to be dealt with under this Section. During 1949, one-thousand three-hundred and twentyeight Certificates of Condemnation were issued by the Food Inspectors relating to the undermentioned unsound articles of food:- Meat 13,567 lbs Fish 406 stone Tinned Goods 12,804 tins Potatoes 17 cwt Poultry & Game 3,884 lbs Other Food 10,121 lbs COMPLAINTS During 1949, twenty-seven complaints were received from members of the public regarding foreign matter in articles of food. These included cigarette ends in cakes, string in bread, nail in chocolate cake, and dirty milk bottles. Every complaint is Investigated and reported to the Public Health Committee. In twenty-four cases, the complaint was brought to the notice of the persons responsible by letter, whilst in three instances legal proceedings were instituted with the following results:- No. Offence Fine Costs 1. Cigarette end in Loaf £15 £5. 5s. 0d. 2. String in Loaf £10 £8. 8s. 0d. 3. Cigarette end in Doughnut £1 £1. 1s. 0d. 32 FOOD & DRUGS ACT. 1918 Samples of Food & Drugs for Chemical Analysis During the year 1949, one thousand articles of food and drugs were purchased by the Sampling Officer and submitted to the Public Analyst for chemical analysis. Of these fifty-one or 5.1 per cent were adversely reported upon, and in six cases legal proceedings were instituted as follows:- Sample No. Article Fine Costs 11 Beef Sausage Meat £3 £2. 2s. 0d. 12 " " " £3 £2. 2s. 0d. (Proprietor of business) 12 " " " £5 £2. 2s. 0d. (Manager of Shop) 102 Malt Vinegar £1 - (for selling to prejudice of purchaser) 102 " " £15 £5. 5s. 0d. (for misleading label) l6l Beef Sausage Meat £27 £3. 3s. 0d. 352 Beef Sausages £5 £3. 3s. 0d. 626 Cough Lozenges Summons withdrawn The remaining forty-five unsatisfactory samples were dealt with as follows:- Warning letters 12 No action 11 Referred to appropriate Authority 15 Remainder of stock destroyed 5 Private samples 2 45 33 MILK Sale of Milk Regulations. 1939 During the year under review, four-hundred and sixty samples of milk were purchased by the Sampling Officer for chemical analysis by the Public Analyst. Of these three-hundred and thirty-six were purchased from milk vendors in the streets of the Borough during the early delivery, seventy-three were purchased on Sundays and fortyseven were taken at the early morning delivery to hospitals in the Borough. Six (or 1.3 per cent) of the four-hundred and sixty samples of milk examined were adversely reported upon, four of which were below the legal standards, and two containing small amounts of soda. The details are as follows:- Sample No. Result of Analysis n Taken 114 15% deficient in fat Purveyor warned 542 3% deficient in solids not fat " " 561 3.5% deficient in solids not fat " " 610 Contained .172% of soda Matter investigated, but cause not traced. 611 Contained .242% of soda 990 1% added water Purveyor warned As in previous years, the arrangement for samples of milk to be taken in course of delivery to the hospitals. institutions, schools etc., in the Borough which are under the control of the London County Council was continued and the following were taken for chemical analysis during 1949. No adulterations were reported- Institution No. of Samples taken For Chemical Analysis For bacteriological examination Fulham Hospital 28 29 Western Hospital 19 18 L.C.C. Schools 61 45 Meals Kitchens etc. 20 - Fulham Maternity Home 2 - 130 92 34 FACTORIES ACT, 1917 - BASEMENT BAKEHOUSES Certain duties are imposed on Local Authorities under Section 54 of the above Act with regard to closure or Certificates of fitness for use of basement bakehouses, and the Act provided that all basement bakehouses should be examined between 1st July, 1938 and 30th June, 1939, and in every fifth succeeding year. During the twelve months ended 30th June, 1939, a complete survey of the forty-seven basement bakehouses in the Borough was carried out, and of these twelve were granted Certificates of Suitability for five years; and thirty-five were given notice that the Certificate of Suitability issued under the Factories & Workshops Act, 1901, (repealed by the Factories Act, 1937) should cease to have effect after the expiration of six months from the date of notice, i.e. on 12th December, 1939. Seventeen of the thirty-five basement bakehouses had already fallen into disuse before the passing of the 1937 Act, the use of five was discontinued following receipt of the notice, and one was closed upon erection of the non-basement bakehouse. The owners of the twelve remaining basement bakehouses upon whom notice had been served that the Certificate of Suitability should cease to have effect, and whose bakehouses were still in use, lodged appeals as provided for in the Act, the first appeal to be heard being dismissed by the Magistrate at the Westminster Police Court who upheld the Cornell's action in withdrawing the Certificate of Suitability. Two further appeals were allowed by the Magistrate at the West London Police Court who directed that the Certificate of Suitability issued under the 1901 Act should continue to operate in respect of two basement bakehouses. Against this decision the Council appealed to the King's Bench division by whom the findings of the lower Court were upheld and the Council's appeals dismissed. The result of these proceedings and the fact that war had been declared made it inopportune to proceed with the outstanding appeals which were, therefore, adjourned sine die, and no action regarding the closure of basement bakehouses was desirable at the second quinquennial survey in 1944. 35 As a result of the Survey carried out in 1949, the Certificates of Suitability in respect of eleven of the twelve basement bakehouses granted in 1939 were renewed for a further five years, one bakehouse having been destroyed by enemy action. Of the ten which were given notice to close in 1939, and which were still in operation, one had been so improved since the original inspection in 1939, that its condition was such that the issue of a Certificate of Suitability for five years was justified, the remaining nine being given notice, dated 28th November, 1949, that the Certificate of Suitability should cease to have effect at the expiration of twelve months, i.e. on 28th November, 1950. In four instances, the owners exercised their rights of appeal, one of which was lodged after the expiry of the statutory period of twenty-one days, and could not be proceeded with, and that part of the bakehouse covered by the Notice has already been closed. The other two are still under consideration. Of the remaining five, one owner has completed the erection of a non-basement bakehouse over the existing basement bakehouse, one has transferred his business to level premises in another part of the Borough, while three will be required to discontinue use on 28th November, 1950. FOOD & DRUGS ACTS., 1938-1944 MILK & DAIRIES REGULATIONS, 1949 The registration of purveyors of liquid milk is regulated by the above, and the Register which was revised during 1949, now contains details of forty-nine dairy premises in the Borough. In addition, there are fifty-two shops, the occupiers of which are registered to sell milk which is not supplied otherwise than in the properly closed and unopened receptacles in which it is delivered to their premises. During the year 1949, four-hundred and eightyseven visits of inspection were made to these dairies and milkshops. 36 MILK & DAIRIES REGULATIONS, 1949. Section 29 (2) of these Regulations makes it an offence to remove or tamper with the disc or other device used for closing bottles at any time after it has left the dairy and before delivery to the consumer. During the year, one contravention of this Section was reported, and the milk-roundsman, by whom the offence was committed, was warned on the recommendation of the Public Health Committee. MILK (SPECIAL DESIGNATION) (PASTEURISED & STERILISED MILK) REGULATIONS, 1949. MILK (SPECIAL DESIGNATION) (RAW MILK) REGULATIONS, 1949. The tests prescribed by the Milk (Special Designation)(Pasteurised and Sterilised Milk) Regulations, 1949, for Pasteurised Milk are:- (a) The Phosphatase Test for efficient pasteurisation which is satisfied by milk which gives a reading of 2.3 Lovibond Blue Units or less and (b) Methylene Blue Test for keeping quality which is satisfied by milk which fails to decolourise methylene blue in thirty minutes. Sterilised Milks: The Turbidity Test is prescribed for sterilised milk, the presence of any signs of turbidity, indicating that the milk has not been treated to sterilisation temperature. Bacteriological Examination of Milks: During the year under review, 201 samples of milk were purchased by the Sampling Officer for bacteriological examination, 146 being purchased (from Milk Roundsmen In the streets) during the early morning delivery, 47 in the course of delivery to hospitals, and 45 at London County Council schools, etc. in the Borough. The following are details of the samples taken:- Tuberculin Tested Milk (Farm Bottled) 4 Tuberculin Tested Milk (Pasteurised) 21 Pasteurised Milk 167 Sterilised Milk 9 Total 201 37 Satisfactory reports were received with the exception of one sample of Pasteurised Milk which failed to satisfy the Phosphatase Test for efficient heattreatment. Four samples of Tuberculin Tested (Farm Bottled) Milk, one of Tuberculin Tested Milk (Pasteurised) and one of Pasteurised Milk were specially examined for the presence of tubercle bacilli with negative results. During 1949, the following licences to sell designated milks were granted by the Borough Council:- No. of licences to sell Tuberculin Tested Milk 34 No. of supplementary licences to sell Tuberculin Tested Milk 5 No. of licences to sell Pasteurised Milk 30 No. of supplementary licences to sell Pasteurised Milk 7 No. of licences to sell sterilised milk 88 No. of supplementary licences to sell Sterilised Milk 4 ICE CREAM (HEAT TREATMENT) REGULATIONS, 1947 One-hundred and eighty-four samples of Ice Cream were purchased during 1949, one-hundred and thirty-six of which were subjected to the Methylene Blue test and Graded as follows:- Provisional Grade No. of Samples  1 72 2 25 3 13 4 26 Total 136 The remaining forty-eight samples and thirteen of those tabulated above were specially examined for organisms of the typhoid group and all proved negative. THE PHARMACY & POISONS ACT. 1933 The Poisons Rules 1933 etc. The sale of poisonous substances is controlled by the above, and every trader who is not a registered pharmacist and who sells or desires to sell by retail to the general public, or to persons in certain occupations, any of the poisons or poisonous substances included in Part II of the 38 Poisons List is required to have his name entered in the List of Persons entitled to sell such poisons, kept by the Local Authority of the district in which his premises are situate. The Act and Rules lay down certain requirements regarding types of containers, labelling, storage, transport and sale of poisons. At the end of 1949 there were 161 names on the Council's Register, and Senior Sanitary Inspector for the Food & Drug Section, A.W. Gammack paid 211 visits of inspection. Fifteen samples of Part II poisons were purchased for analysis during the year and none calls for special comment. TUBERCULOSIS. I have received a most interesting Annual Report for the year 1949 from the Chest Physician at the Fulham Chest Clinic, Dr, Price, who has kindly given me permission to quote from his report. He states:- "GENERAL REVIEW The year under review is noteworthy for three main events. Firstly, the administrative machinery of the National Health Service shows signs of beginning to run a little more smoothly with the continued integration, at least on paper, of the various specialist branches of medicine including the chest service. Secondly; the public demand for the new service has shown little signs of decreasing following the tremendous initial demand, illustrating clearly that this was not just a temporary effort on the part of the ordinary people to get something for nothing. In fact the introduction of the new service seems to have lifted a corner of the curtain hiding a deplorable state in the general health of the people. The service has certainly not overspent, the need has been grossly underestimated in official circles. The medical services were at last mobilised to tackle the enormous task of satisfying an overwhelming popular need. Thirdly, we heard the first distant rumblings heralding the rapid approach of what is known as financial stringency. Considerable bitterness has been aroused since it became apparent that the brilliant, expanding, vista for positive activity opened up by the Health Act of 1948 was being obscured by official directives on "The need for care in spending" - a term not unknown in the past history of the Health Service. 39 In Falham a fourth event can be added to this list. Domicilliary therapy was commenced on a mass scale for the first time early in 1950. The allocation of eight general hospital beds in the Western Hospital, for short stay for acute cases encourages the hope that the scope of this type of therapy may expand "Because of the lack of staff etc., it has only recently become possible to introduce this form of therapy in Fulham. The development of this type of therapy opens up the possibility of dealing more rapidly and effectively with the threat to public health of the tuberculosis problem in Fulham. Official encouragement and drive from the Ministry of Health, Regional Hospital Boards and Hospital Management Committees, is the oil which will lubricate the wheels of this programme. But at the moment it appears that no money will be available. SANATORIUM TREATMENT The Ministry of Health announced during the year that there were 10,000 patients awaiting Sanatorium treatment in England and Wales. During the year an increased number of patients from Fulham have been sent to hospital and sanatorium and the waiting period, especially for women, is still about twelve months. There has been some slight improvement for the men, particularly those waiting to go to King George V. Sanatorium, Godalming. The long wait, often from twelve to eighteen months, for major surgery can only be described as disastrous." Quoting from the figures supplied by Dr. Price, it will be noticed that in 1938 the number of new cases notified during the year in Fulham was 200, whereas in 1949, 239 were notified. I think this reflects the increase in tuberculosis notifications which is a general feature and which was the same after the first World War, when figures went up slightly. There is no doubt that the housing problem with its evils of overcrowding, etc., together with the stresses and strains of the war years is responsible for the increase, but I expect that with energetic action this will tend to drop as before. In the Chest Clinic many innovations have been introduced and there is no doubt that the scientific aids to diagnosis of early cases (for instance, the great increase in the number of X ray and screening examinations now made available is a tremendous advantage) and 40 Dr. Price quite rightly states that certain ancilliary services are absolutely essential, such as the provision of home nursing, and adequate Home Help Service and invalid meal service and regular visits by the clinic staff. A very interesting feature at the Chest Clinic is the introduction of the service for carrying out artificial Pneumothorax. In pre-war days by arrangement with Brompton Hospital and other hospitals, A.P. treatment, (as it was called), was carried out on many selected cases, but this invariably meant patients had to go to the hospitals and wait, - perhaps for a long time - before their turn came for treatment. Now this is, to a large extent remedied by the provision of the necessary rooms and apparatus at the Chest Clinic and carried out by Dr. Price and his assistant. I was also very glad to hear that Dr. Price had success in getting contacts up for examinations for example in 1938, 272 contacts were examined, whereas in 1949, the figure was 493. Contact examinations were, sometimes very difficult to arrange and it was not an easy matter to persuade contacts to come up, especially if they were feeling quite well themselves and had no symptons which were apparent. I think there is undoubtedly a greater intelligence on the part of the public, and this may account for a more ready response to the persuasion of the Chest Clinic staff. As Dr. Price says, "The new attitude to the Epidemiology of Tuberculosis and particularly the growing realisation that social factors play such a large part in the spreading of disease, together with the new diagnosis aids and introduction of simpler, easier and more efficient methods of treatment and rehabilitation are rapidly changing the attitude of the Chest Clinic staff and more slowly of the general population."