AC 4346 Ful 41 METROPOLITAN BOROUGH OF FULHAM REPORT of the MEDICAL OFFICER OF HEALTH for the year 1950 M. I. ADAMS B.Sc., M.B., B.Ch., D.P.H. Medical Officer of Health CONTENTS Page No. Public Health Committee 1 Public Health Staff 2 Introduction 4 Vital Statistics 8 Classification of Causes of Death 9 Infantile & Maternal Deaths 10 Infectious Disease 11 Hospitals in the Borough 16 Bacteriological Examinations 17 Metropolitan Boroughs' Golden Jubilee 18 Clean Food Campaign 20 Public Conveniences 21 Public Mortuary 22 National Assistance Act, 1948 23 Rehousing of Families 25 Sanitary Circumstances of the Area 27 Legal Proceedings 28 Disinfection, Disinfestation & Laundry Services 29 Drainage 30 Rodent Control 31 Factories 32 Food Inspection 35 Food Establishments 43 Rag Flock 46 Pharmacy & Poisons 46 L.C.C. Health Services 47 Tuberculosis (Extract from the Annual Report of Dr. H.C. Price - Chest Physician) 50 (1) MEMBERS OF THE PUBLIC HEALTH COMMITTEE (as at December, 1950) Ex-officio: Councillor H.J. Rickards, J.P. (Mayor) Chairman: Councillor C. Lancaster, J.P. Vice-Chairman: Councillor J.W. Perotti, J.P. Alderman Mrs. H.M. Fournier. Alderman Mr. W. Rankin. Councillors. Vivian Arthur Baron Arthur Andrew Clark Thomas Michael Cox, J.P. Miss Alma Grace Fox Mrs. Marjorie Annie Gale Alan John Jiggins, M.M. Herbert Henry Poulter Thomas Alfred Winstanley. (2) STAFF OF THE PUBLIC HEALTH DEPARTMENT. (December 1950) Medical Officer of Health - Mary Adams, B.Sc., M.B., B.Ch., D.P.H. Deputy Medical Officer of Health - (Vacant) Public Analyst (Paid by fees) - T. McLachlan, A.C.G.F.G., F.I.C. Administrative and Clerical Section. Chief Clerk - J.E. Burton, D.F.M. Second Clerk - J.W. Chance, A.I.Hsg., M.R.I.P.H.H. Administrative Clerk - B.C. Bolton. Clerk - S.T. Ansell. Clerk - R.G. Larcher, A.B.I. Clerk - S. Wright. Clerk - L.C. Crane. 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.K. Hughes. Mortuary Keeper - G. Churchill. (3) Sanitary Inspectors' Section Chief Sanitary Inspector - T.H. Robey (l) (2) Deputy to Chief Sanitary - F.E. Walsh (l) (2) Inspector Factories & Smoke Abatement - F.C. Payne (l) (2) (3) Officer Lady Sanitary Inspector — Miss E.H. Sexton (l) District Sanitary Inspector - H. Hutchinson (l) (2) do. - C.J. Price (1) (2) do. - I. Jones (l) do. - R.D. Richards (l) do. - C.W. Owens (l) do. - D.G. Martin (l) do. - G. Bailey (l) do. - B.J. Parsons (l) Food & Drugs Section Senior Sanitary Inspector - A.W. Ganmack (l) (2) Sanitary Inspector - W.G. Thurgood (l) (3) do. - A.H. Newport (1) (2) do. - A.G. Patterson (l) (2) (1) Cert. S.I.B. (2) Meat & Other Foods Certificate. (3) Member of the Royal Institute of Publics Health & Hygiene. (4) 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. Your Worship, Ladies and Gentlemen, I have the honour to present the Annual Report on the health of the Borough for the year 1950. On lst November, 1950 I took over the duties of Medical Officer of Health owing to the retirement through ill-health of my predecessor Dr. Percy L.T. Bennett, M.C., whose retirement is deeply regretted by all who knew and worked with him, and who will long be remembered in the Borough for his wise and ready help and his unfailing kindness. Dr. Bennett's detailed knowledge of housing, building construction and practical experience in engineering, as well as his special knowledge of all forms of tuberculosis and infectious diseases, will continue to be reflected in improved standards of health and lowering of death rates in the Borough for a considerable time to come. I wish to record my personal tribute of thanks to Dr. Bennett for the sound help and willing assistance I always received from him whilst I was his Deputy and until his retirement. 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 123,400, a decrease of 640 on the figure for the preceeding year. The Birth Rate of 14.35 per 1,000 is somewhat lower than the figure for 1949 (16.48 per 1,000), and the Infantile Mortality Rate of 25 per 1,000 continues to decrease on the figure for 1949 (26.4), and is again the lowest ever recorded in the Borough being lower than that of London (26.3) and England & Wales (29.8). The Maternal Mortality Rate is 1.7 per 1,000 births (live and still). (5) Statistical records for the year indicate that the health of the public was maintained at a very satisfactory standard throughout the year, and that Fulham is in a favourable condition compared with London England & Wales. The incidence of Infectious Diseases and their allied conditions has continued to decrease with the single exception of Measles, In Fulham, as in many other areas,, a small number of cases (ll) of Poliomyelitis occurred during the year, one proving fatal. It is gratifying to record that not a single case of Diphtheria occurred during the year. This reflects on the high percentage of the child population which has always been immunised against Diphtheria in Fulham which was 70% at the end of the year. The incidence of notified cases and deaths from Tuberculosis again shows a decrease. Many cases now receive home treatment. This home treatment with, the combination of home treatment on discharge from hospital has resulted in a substantial reduction in the sanatorium waiting list, though this list is still too large, and of the notified cases too great a proportion still have to share a room with one or more other persons. The combination of circumstances in housing bringing about the difficulties experienced in maintaining reasonable standards of fitness in existing housing accommodation, which was referred to by Dr. Bennett in his post-war Annual Reports, continues. Whilst the number of cases calling for statutory action brought to the notice of the Department decreased slightly compared with 1949, it was found necessary to deal with an increased number of sanitary defects, the rise being particularly noticeable in regard to those of a more serious nature, e.g. leaking roofs and damp walls. By comparison with pre-war years, officers of the Department, continued to find It necessary to pay many more visits and deal with a vastly increased correspondence in order to bring most cases to a satisfactory conclusion. Despite these active steps, recourse to Court action continued to be necessary in an unduly large number of cases. This meant that deterioration of the premises concerned took place, often bringing about further defects during the time lag between the date of service of the original Sanitary Notices and the hearing of the cases at Court. There are still a number of premises in the Borough not worth maintaining which, nevertheless, have to be patched up to provide some sort of accommodation during the housing shortage. I regard it as a great step forward that at. the time of writing it appears a measure of slum clearance may soon take place. (6) During the year an increasing number of aged persons have been brought to the notice of the Public Health Department. There are several Associations in the Borough specially undertaking welfare work and visitation of old people; also providing meals, entertainments etc., and whose co-operation we appreciate and welcome in bringing those we can help to the Department's notice. These are enfeebled and incapacitated old folk who are (a) suffering from a grave chronic disease (b) aged, infirm or physically incapacitated (c) unable to devote proper care and attention to themselves, and are not receiving it from others. In addition to (a) (b) and (c), the above-mentioned must also be living in insanitary conditions. Where possible persuasive powers are used to encourage any who need care and attention to voluntarily enter an eventide home. The year 1950 was the Golden Jubilee of the Borough and was celebrated by holding a Civic Exhibition including an excellent section in Food Hygiene. The Food Inspectors have continued to pay regular visits to the various food preparing premises in the Borough, and it is noteworthy that the recent emphasis which has been placed on the importance of clean food has done much to bring about improvements in the hygienic condition of these establishments. Food shopkeepers and their staffs are becoming more aware of their responsibility to the general public and are always very co-operative and anxious to provide the best possible service for their customers. Several efforts to interest young people in the Borough in Health Education have been made by the holding of Film Shows, with the kind co-operation of Sir Allen Daley of the London County Council. Whilst the audiences were fair, it is felt they should be better, and with the experience gained it is hoped to try and increase their interest by providing programmes of a different type in future. It gives me pleasure to record that the relations between the Public Health Department of the Borough and the officers and staff of the London County Council Health Services of Division I continue as they have always been, happy and. helpful. (7) I would like to thank all the members of the Fulham Borough Council for their help and co-operation, and particularly the Chairman and Vice-Chairman and members of the Public Health and Staff Committees of the Council for their encouragement and sympathetic consideration of health and medical problems of the Council staff. May I take this opportunity of thanking the Chief Officers, with the members of their Departments, for their help and co-operation, and of expressing hearty appreciation and thanks to every member of my staff for their loyalty and the efficiency with which each one has carried out his or her duties. I have the honour to be Your Worship, Ladies & Gentlemen, Your obedient Servant (8) EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1950. POPULATION (estimated) 123,400 SEPARATE DWELLINGS (estimated) 31,909 LIVE BIRTHS: Rate per 1,000 Population. Legitimate Total Males Females 1950 1949 1652 857 795 13.3 15.5 Illegitimate 130 64 66 1.05 0.98 1782 921 861 14.35 16.48 STILLBIRTHS: Legitimate 28 19 9 0.23 0.34 Illegitimate 5 3 2 0.04 0.05 33 22 11 0.27 0.39 DEATHS: 1416 695 721 11.5 12.09 Death rate of Infants under one year of aees 1250 1949 All infants per 1,000 live births 25.0 26.4 Legitimate Infants per 1,000 legitimate births 23.8 25.0 Illegitimate Infants per 1,000 Illegitimate births 46.0 26.2 Deaths from: 1950 1242 Cancer (all ages) 280 260 Measles (all ages) Nil 2 Whooping Cough (all ages) 1 2 Diarrhoea (under two years of age) 4 5 (9) CLASSIFICATION OF CAUSES OF DEATH 1/16 deaths as follows:- Total 34 8 7 — 1 1 — — 1 280 7 114 141 65 249 56 9 77 121 17 22 6 12 10 3 19 103 5 34 13 1 1416 over 45 16 3 6 — — 1 — — 1 254 5 114 139 65 235 54 9 70 118 16 21 2 11 10 1 7 69 4 23 11 1 1266 Age Groups 5-45 18 3 1 — — — — — — 24 2 — 2 — 14 2 — 1 3 1 1 — 1 — 2 2 11 1 8 2 — 99 1-5 — 1 — — — — — — — 2 — — — — — — — 1 — — — — — — — — 1 — 1 — — 6 under 1 — 1 — — 1 — — — — — — — — — — — — 5 — — — 4 — — — 10 22 — 2 — — 45 Tuberculosis Respiratory Tuberculosis other Syphilitic Disease Diphtheria Whooping Cough. Meningococcal Infections Acute Poliomyelitis Measles Other infective & paralytic diseases Cancer Diabates Vascular lesions of nervous system Coronary disease Hypertension With heart disease Other heart disease Other circulatory diseases Influenza Pneumonia Bronchitis Other diseases of respiratory system Ulcer of stomach & duodemm Gastritis enteritis, diarrhoea Nephritis & nephrosis Hyperplasia of prostrate Pregnancy, childbirth, abortion Congenital malformations Other ill-defined and defined diseases Motor vehicle accidents All. other accidents Suicide Homicide and operations of war (10) Infantile Deaths:- There were 45 deaths of infants under the age of one year. A large number of deaths in the first month being, as is usual, due to prematurity, immaturity and congenital malformation. Cause of death 1950 1949 Whooping Cough 1 2 Pneumonia 5 6 Gastritis, enteritis & diarrhoea 4 4 Prematurity 12 11 Asphyxia 1 2 Atelectasis 5 — Congenital Malformations 10 19 Meningitis 1 1 Pulmonary Tuberculosis — 1 Non-pulmonary Tuberculosis 1 — Want of attention at birth 1 1 All other causes 4 6 45 53 The Infant Mortality rate was 25 per 1,000 live births (26.4 in 1949). There were 3 maternal deaths in 1950 giving a rate of 1.7 per 1,000 births (live and still). (11) NOTIFIABLE INFECTIOUS DISEASES The following table shows the number of cases of infectious disease notified during 1950 (corrected figures) with the comparative figures for the last five years. 1950 - 126 527 428 Para. 6 Non- _ Para. - - 32 10 - - 3 12 10 4 12 20 - 6 209 19 1429 1949 6 327 1099 192 32 4 - 32 10 10 — 4 20 14 6 45 28 - 11 245 23 2108 1948 10 100 889 368 2 - _ - 28 13 1 2 1 25 _14 2 40 67 - 7 203 23 1795 1947 17 93 631 236 27 8 75 1 - - 6 23 11 8 41 160 - 7 226 33 1603 1946 39 157 814 227 3 - _ 1 53 13 — 1 11 31 22 4 33 312 2 5 241 22 1991 Infectious Disease Diphtheria Scarlet Fever Measles Whooping Cough Acute Poliomyelitis Acute Polioencephalitis Encephalitis Lethargica Acute Pneumonia 1 Dysentery Enteric or Typhoid Fever Paratyphpid. Fever Meningococcal Infection (Cerebro-spinal Fever) Erysipelas Puerperal Pyrexia (including Puerperal Fever) Ophthalmia Neonatorum Epidemic Diarrhoea Scabies Malaria Food Poisoning Pulmonary Tuberculosis Non-pulmornary tuberculosis Totals (12) DIPHTHERIA (13) The following are some of the infectious disease rates for Fulham as compared with London and England & Wales Rates per 1.000 population Fulham London Eneland & Wales Notifications Scarlet fever 1.02 1.23 1.50 Diphtheria 0.00 0.03 0.02 Meningcoccal infection 0.02 0.03 0.03 Whooping Cough 3.46 3.21 3.60 Measles 4.27 6.57 8.39 Pneumonia 0.26 0.50 0.70 Acute Poliomyelitis: Paralytic 0.04. 0.08 0.13 Non-paralytic 0.04 0.05 0.05 Food Poisoning 0.04 0.25 0J.7 Erysipelas 0.09 0.17 0.17 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Smallpox: During the year 4 contacts of cases of smallpox and U persons arriving ints this country from "Areas of Risk" were kept under daily observation until the expiration of a period of 16 days after first exposure to infection. No cases occurred in the Borough. Typhoid & Paratyphoid: No cases were reported0 Scabies & Allied Treatment was arranged for 27 adults and 23 children Conditions: at the Kensington Medicinal Baths. Food There were no outbreakss but 6 cases were notified. Poisonings One death occurred, Salmonella typhi murium being isolated. (14) Tuberculosis Deaths Tuberculosis Notifications An extract from the Chest Physician's Annual Report appears on page 5l. (15) POLIOMYELITIS The Minister of Health introduced new regulations on Poliomyelitis which came into force on the 1st January, 1950. These regulations split acute Poliomyelitis into two sections, paralytic and non-paralytic, and brought acute Polioencephalitis under the heading of acute Poliomyelitis. During the year, 29 suspect cases of Poliomyelitis were admitted to hospital, Of these, 6 cases were confirmed as suffering from paralytic Poliomyelitis, and 5 cases confirmed as suffering from non-paralytic Poliomyelitis. One case, a woman of 45 years, suffering from paralytic Poliomyelitis, died a few days after admission to a Fever Hospital, Of the total number of cases, 4 occurred in children under 5 years, 4 occurred in children of school age, and the remaining 3 cases were persons over school age. An enquiry was made in each case as to whether the patient had been immunised against Diphtheria and/or Whooping Cough within the previous 30 days of the date of onset of the disease, but none of the cases had been immunised within that period. Graph comparing 1949/1950 outbreaks (16) EXCLUSION FROM WORK OF CONTACTS OF INFECTIOUS DISEASE Under the National Insurance Act of 1946, a certificate can be issued in any case where the Medical Officer of Health considers it advisable that a person should be excluded from work. This is usually done where a person is suspected of being a carrier of a disease, or has been in contact with a disease, and where the person, because of the nature of his/her occupation, is liable to transmit the disease (e.g. a food handler). The granting of such a certificate enables the person affected to claim sickness benefit. Three such certificates were issued during the year. HOSPITALS IN THE BOROUGH OF FULHAM 1. Fulham Hospital: St. Dunstan's Road, W.6. An acute general hospital for medical and surgical cases; mental observation unit; chronic sick wards; out-patient department. Number of staffed beds - 384. 2. Fulham Maternity Hospital: 5-7, Parsons Green, S.W.6. Number of staffed beds - 30. 3o Western Hospitals: Seagrave Road, S.W.6. A hospital for the treatment of infectious diseases of all kinds; poliomyelitis unit; pulmonary tuberculosis wards. Number of staffed beds - 192. 4. Fulham Chest Clinic: 114, New King's Road, S.W.6. Clinic for the out-patient treatment of tuberculosis. (17) BACTERIOLOGICAL EXAMINATIONS. The following bacteriological and other examinations were carried out during the year 1950 at the West London Hospital for the Council:- Nose & throat swabs 315 Urines 6 Faeces 50 Miscellaneous 6 SAMPLES OF SWIMMING BATH WATER TAKEN FOR CHEMICiLL & BACTERIOLOGICAL EXAMINATION. Result of Examination. Bacteria per c.c. Coliform Bacilli Free Chlorine Darts per million 27. 4. 50. Ladies' Bath A.M. 4,960 - 0.2 do. P.M. 1,380 - 0.3 8. 6. 50 Gents' Bath A.M. - - 0.64 do. P.M. - - 0.74 20 . 7 . 50 Mixed Bath A.M. 5,000 0.3 do. P.M. - - 0.4 (18) METROPOLITAN BOROUGHS GOLDEN JUBILEE. As it is 50 years since the formation of the Metropolitan Boroughs, it is interesting to make some comparisons between some of the statistics in this Annual Report and those reported by Dr. J.C. Jackson, who was Medical Officer of Health in 1901. 1901 1950 Population 137,289 (est.) 123,400 (est.) Birth Rate 33.3 per 1,000 14.4 per 1,000 Death Rate 15.78 per 1,000 11.5 per 1,000 Infantile Mortality (legitimate) 152 per 1,000 25 per 1,000 (illegitimate) 302 per 1,000 46 per 1,000 Diphtheria 636 cases (48 fatal) Nil. Scarlet Fever 552 cases (20 fatal) 126 (none fatal) The following graphs illustrate the rise and fall in the population of the Borough during the last 50 years and, the fairly even decline in the death rate with a similar fall in the birth rate. It is interesting to note that the two increases in the birth rate following the two wars, offsets the rise in the death rate during the two wars. POPULATION 1901-1950. (Five Yearly Intervals). (19) GRAPH SHOWING COMPARISON BETWEEN BIRTH AND DEATH RATES FOR FIVE YEARLY PERIODS FROM 1901 to 1950 (20) CLEAN FOOD CAMPAIGN Early in the year it was decided to hold a Clean Food Exhibition in collaboration with the Ministry of Agriculture & Fisheries and the Central Council for Health Education. However, as it was decided to hold a Civic Exhibition in the large hall at the Public Baths from October 28th to November 4th, as part of the Council's celebrations in connection with the Metropolitan Boroughs' Golden Jubilee, the Clean Food Exhibition became part of this larger exhibition. The Public Health Department had 10 stands, 8 of which had Clean Food as their subject, the others being devoted to the general work of the Department and Smoke Pollution. The exhibition was well attended by some 13,000 people, the Public Health Section being one of the outstanding features. Film Shows were given, and a competition was run in connection with the film "Another Case of Food Poisoning", the public being invited to spot the food handling faults. Six prizes of £1. were awarded to the six persons listing most faults. The winners were presented with their prizes at a meeting of the Public Health Committee. (21) PUBLIC CONVENIENCES FREE WASHING FACILITIES: The Free Washing Facilities provided in the Public Conveniences have now been in operation since November, 1949, and it is possible to draw some conclusions. It was found that in spite of the free washing there was still a demand from the public for the paid "wash and brush up" with a linen towel. This had been anticipated, and the paid wash had been retained in the three busiest Conveniences (Walham Green, Effie Road, Putney Bridge) but, in February the decision was made to reinstate the paid wash at all the Conveniences, and at the same time increase the charge from 2d. to 3d. to cover the increased cost of laundering the linen towels. The public have shown their appreciation of the free wash service, both by favourable comment, and the reasonably careful use they have made of the facilities. In only one Convenience has any damage been done to the fittings. The demand has been fairly constant over the year, although some Conveniences, situated in or near parks or football grounds, have shown the seasonal variations expected. One particular aspect which has been very pleasing is the way the street traders of the North End Road Market, have taken advantage of the facilities at Walham Green Convenience, The cost of the scheme, in towels and soap, for the year was £72 which, on the basis of 2.3 paper towels per person per wash, provided 33,650 washes. The original estimated annual cost of the scheme was £70. I am vary pleased with the success and general working of the scheme which, I consider, is a big step forward in giving both encouragement and the opportunity to the public to promote their personal hygiene. I would like to record my appreciation to the Convenience Attendants, who have supervised the use of the facilities, and to Mr. Hughes and his staff who have bad additional work in handling the required stores. Without the co-operation of all concerned the scheme would not have been the success it has. (22) PUBLIC MORTUARY. The following number of bodies were admitted to the Mortuary during the year:- By order of the Coroner 252 Convenience Cases (i.e. admitted at the request of Undertakers) 196 Total 448 Number of Post-Mortem Examinations conducted 252 PROVISION OF CHAPEL & VIEWING ROOM AT MORTUARY. A scheme for converting the room at the Mortuary, originally used and designed as a Coroner's Court, into a Chapel and Viewing Room had been agreed in the previous year. A sum to cover the necessary work, which included some items of war damage, was therefore included in the Estimates. The work which consisted mainly of redecorations, plus some small structural alterations was carried out by the Director of Housing & Public Buildings' Department. Curtained partitions were arranged to form two separate resting places and waiting accommodation. An altar, on a raised platform, was constructed, and the room suitably furnished as a Chapel. Flowers are supplied by arrangement with the Borough Surveyor's Department. (23) NATIONAL ASSISTANCE ACT. 1948. Section 50: Burial or Cremation of the Dead. Seven funerals were arranged under the provisions of this Section. The funerals were carried out by Mr. J. Goulborn of 62, Greyhound Road, the Council's official Contractor. Details of the cost of the Burials are as follows:- * 7 funerals as per contract £70. 2s. 0d. Less amount recovered from estate of deceased, or by gifts, or responsible relatives traced £29. 13s. 9d. Balance being cost to Council £40. 8s. 3d. * The cost of the funerals varies slightly, the average cost of an adult being approximately £10. Section 47: Removal to suitable premises of persons in need of care and attention. Section. There were five removals made under the provisions of this Brief details of each case are given belows:- Case. Reasons for removal. Action taken. Miss H.P. (Aged 82) Occupied 3 rooms which were in an insanitary condition. Miss P. suffered from double incontinence. Removed to Fulham Hospital for 3 months. Magistrate's Order dated 24.2.50. Died 8.3.50. - bronchitis. Mrs .B.L. (Aged 85) Occupied 1 room in a filthy condition. Chronic alcholie. Removed to Kings Mead Institution for 3 months, Magistrate's Order 27.3.50. Died 11.5.50 - senility. Mrs. E.L. (Aged 88) Occupied 3 rooms in a verminous and insanitary condition. Mrs. L. suffered from stress incontinence. Removed to Fulham Hospital for 3 months. Magistrate's Order 4.4.50. At the expiration of the 3 months Mrs.L's. health had improved greatly and she agreed to her being removed to Newington Lodge Institution. (24) Mr. C.C. (Aged 88) Occupied 3 rooms (upper flat). Rooms in an insanitary condition. Mr. C. incontinent. Removed to Newington Lodge Institution for 3 months. Magistrate's Order 24.8.50. Extension of the Order for a further 3 months made by Magistrate 23.11.50. No further extension necessary, Mr. C. agreeing to remain voluntarily in the Institution. Miss E.S. (Aged 76) Occupied 1 room in a verminous and filthy condition. Miss S. was undernourished and mentally ill. Removed to Brocklebank Institution for 3 months. Magistrate's Order 24.8.50. Extension of the Order for a further 3 months made by Magistrate 23.11.50. No further extension necessary, Miss S. agreeing to remain voluntarily in the Institution. Visits to Aged & Infirm Persons; 379 visits were made by the Lady Sanitary Inspector and myself to aged and infirm persons during the year, and 61 cases were voluntarily removed to Institutions and Hospitals. (25) REHOUSING OF OVERCROWDED FAMILIES. Persons desiring housing accommodation may register with the London County Council and/or the Fulham Borough Council. The Fulham Borough Council give a priority for Tubercular persons only, while the London County Council give priority to Tubercular persons and persons living in overcrowded conditions. It was decided in June of this year that the Housing Department should go through their Housing List and where a family appeared to be overcrowded the details should be forwarded to the Public Health Department, which acts as the local agent for the London County Council in making housing enquiries. The Public Health Department check from their records whether the family are already registered with the London County Council, and if the prescribed form certifying overcrowding has been submitted to the London County Council. The Housing Department are then informed of the families of which the Public Health Department have no record, and their officers visit and invite them to fill in the necessary application forms for London County Council accommodation. The Sanitary Inspectors visit all cases where overcrowding appears to exist, check the details of occupation, and where families are overcrowded the London County Council are informed. During the year 115 cases of this nature were submitted to the Public Health Department for action to be takes., with the following results 40 families were found not to be were.rowded. 4 families had already found alternative accommodation. 11 families were not registered with the London County Council. These were invited to complete an application form; 8 availed themselves of the offer, and on subsequent investigation they were all found to be overcrowded. (26) 60 families were found to be living in overcrowded conditions, and the requisite orange forms were forwarded to the London County Council. There is close co-operation between the Housing Department and Public Health Department on all matters relating to housing;, and this system of linking the applicants on the Fulham Borough Council Housing List with the London County Council priority for overcrowding, has proved of benefit to all concerned. REHOUSING OF FULHAM RESIDENTS ON L.C.C. HOUSING ESTATES. During the year 793 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 520 cases applied on the grounds of overcrowding, and the remaining 273 on medical grounds and the insanitary condition of their living accommodation, 361 families were found to be living in overcrowded conditions, and reports were sent to the Director of Housing aad Valuer, London County Council, recommending them for alternative accommodation en the L.C.C. Housing Estates. • 146 families were known, to have been rehoused during the year. (27) SANITARY CIRCUMSTANCES OF THE AREA Inspections alter complaint 4,943 Re-inspections 17,988 Inspections after Infectious Disease 712 Drains tested 599 Drains inspected 3,117 Inspections of Outworkers' Premises 225 Inspections of Food Premises 6,225 Other visits 5,204. Intimations served 4,058 Statutory Notices served 1,874 Intimations complied with 3,611 Statutory Notices complied with 1,799 SUMMARY OF WORKS CARRIED OUT TOPER SUPERVISION OF SANITARY INSPECTORS. Fresh Air Inlets 59 Soil and Vent pipes repaired or renewed 93 Drains cleared 334 Drains repaired 105 Drains relaid 170 Rainwater gutters and pipes repaired or renewed 658 Drains sealed off 1 Disused drains excavated 11 Traps cleansed, repaired, etc. 65 Pans renewed 228 Seats repaired or renewed 158 Flushing cisterns repaired or renewed 277 Additional W„C0 accommodation provided 5 Fastenings provided to doors, and doors repaired 271 W.C. apartments ventilated 6 Sinks provided, repaired or renewed 170 Sink and bath wastes repaired or renewed 213 New baths fitted 10 New lavatory basins 42 Carried Forward 2,876 (28) Brought Forward 2,876 Baths cleansed 17 Drinking water cisterns cleansed etc. 56 Water supply pipes and fittings repaired 177 Water supply provided to separate floors 25 Rooms cleansed 3,943 Decorations and internal house repairs 9,435 Fireplaces repaired (nuisances from smoke etc.) 724. Kitchen ranges repaired or renewed (for cocking purposes) 309 Washing coppers repaired or renewed 37 Dampness remedied 2,882 Rooms provided with adequate light & ventilation 35 Staircases provided with light & ventilation and repaired 134 Ventilated food cupboards provided 5 Ventilation provided under floors am repairs 685 Roofs repaired 2,036 Other external repairs 468 Accumulations of refuse removed 92 Dustbins 166 Yards, forecourts paved and drained 128 Animals in stgte of nuisance 8 Rat runs traced 22 Bombed sites 16 Other nuisances 173 Total 24,449 LEGAL PROCESSINGS PUBLIC HEALTH NUISANCE SUMMONSES. During the year ended 1950^ 306 Summarises were down for hearing at the West London Magistrates Gourt with regard to cases where Owners had failed to comply with Statutory Notices served reader the PrsMie Health (London) Act, 1936. The cases were dealt with as follovrss- No. of No. of No. of cases Summonses Orders withdrawn or served. made. adjourned sine die. 306 37 269 (29) RENT RESTRICTIONS ACTS During the year, 20 applications for a Certificate of Disrepair were received. In 17 cases the premises were found not to be in a reasonable state of repair, and certificates were issued, but the remaining 3 cases the property was outside the scope of the Acts. 13 Revocation Certificates were issued to owners during the same period on satisfactory completion of the necessary repairs. HABTTATT0N CERTIFICATES UNDER SECTION 95 (2) OF THE PUBLIC HEALTH (LONDON) ACT. 1936 During the year 96 certificates were issued in respect of newly erected and rebuilt premises in the Borough. PUBLIC HEALTH (LONDON) ACT. 1936 - SECTION 122 3 Certificates under the above-named Act and Section were issued requiring the cleansing or destruction of filthy and/or verminous articles. DISINFECTION. DISINFESTATION & LAUNDRY SERVICES The following details relate to the services provided by the Disinfecting Superintendent and his staff during 1950s- Number of rooms disinfected after Infectious Disease 372 Number of articles stoved 5515 Number of rooms disinfested 985 Number of inspections made of prospective Council tenants 225 Laundry carried out for the Dust Destructor Staff from 22,2.50 to 31.12.50:- Roller towels 338 Dust Coats 28 Bath towels 1815 Boiler Suits 29 Hand towels 76 The Disinfecting Superintendent has also dealt with many kinds of infestation such as cockroaches, beetles, ants, silver fish, moths etc. (30) LIST OF VERMINOUS & STAINED ARTICLES DESTROYED DURING 1950 Mattresses 64 Overlays 22 Beds 11 Divans 4 Pillows 43 Blankets 13 Bolsters 10 Quilts 4 Clothing, Articles of 876 Couches 3 Chairs 22 Tables 6 Armchairs 12 Pictures 12 Total 1102 DRAINAGE OF NEW BUILDINGS & RECONSTRUCTION OF DRAINAGE During the year 100 applications for approval of drainage works were received and approved. Of this number 18 cases were for the re-building of premises following demolition by enemy action. In 34- cases applications were in respect of the reconstruction of the whole or part of the drainage system; and in the remaining 58 cases the applications were in respect of the erection of new buildings or additions to existing buildings. Plans submitted for the carrying out of new drainage work included the provision of new housing accommodation as follows Sulivan Court. Hurlinghams 10 Blocks - 249 flats by the Borough Council. Edith Villa3„ North End Roads 2 Blocks - 60 flats by the London County Council. Work began on both these projects during the year, and in October the first two blocks at Sulivan Court, comprising 24 flats, were officially opened by the Rt. Hon. Herbert Morrison, M.P. A special feature of these blocks is that a system of sanitary plumbing, known as the "single pipe system" was adopted. The details of the installation was worked out by the Sanitary Inspector in charge (31) in close co-operation with officers of the Housing Department, both in the planning stages and actual installation. Before each block of flats was certified as fit for occupation, the plumbing system was submitted to very careful tests and was found to be satisfactory in every respect. As a result the future development of this site, comprising as it will 400 flats in 18 separate blocks, will utilise the same system of sanitary plumbing. It is noteworthy that this housing project is the largest of its kind in which this system has been used, and is therefore being watched with very great interest, as the system results in a considerable saving in plumbing costs, whilst at the same time it is both simple and efficient. Another matter worthy of note was the extensive fire which occurred on 7th September, 1950 at the riverside premises of Messrs. Convoys Ltd., Townmead Road. The fire involved a large quantity of wax which, when melted, flowed into the sewer in Townmead Road resulting in a partial chokage of the sewer, and complete stoppage of numerous outlet drains of houses in Townmead Road and several communicating streets. The clearance and removal of this wax was undertaken by the Borough Engineer. Every assistance was given by the Sanitary Inspectors to the owners of the houses, whose outlet drains were affected, and to the Borough Engineer's Department. RODENT CONTROL The Rodent Officer and staff of Rodent Operatives continued the campaign against rats and mice during the year. A total of 754 complaints, or notifications of the existence of rats or mice, were received by the Department which represents a slight decrease over those received last year. The investigation of these complaints including routine inspections of riverside premises necessitated 6,500 visits by the staff to dwelling houses, and 1,502 visits to business premises. The number of infestations by mice were nearly double those by rats. In the case of dwelling houses a total, of 382 premises were treated, 577 for mice and 305 for rats. In the case of business premises a charge is made for treatment which at present is at the rate of 6/~ per man-hour for actual treatment, no charge being made for the initial investigation. In 92 such cases charges were made. In accordance with the requirements of the Ministry of Agriculture & Fisheries 2 treatments of the public sewers were carried out in January and June. (32) The year under review saw the coming into operation (on 31st March, 1950) of the Prevention of Damage by Pests Act, 1949. This Act repealed the Rats & Mice Destruction Act, 1919, and the Infestation Order 194-3, and more clearly defines the duties of owners of property and local authorities. The Act lays down that it is a duty of any occupier to notify the local authority of the presence of rats or mice on premises or land. Notification of the presence of pest infestation of food premises is to be made direct to the Ministry. . * * 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 Inspections No. of written Notices Factories without mechanical power 47 Int. 13 Factories with mechanical power 172 Stat. 4 Other premises under the Act (building operations & Works)of engineering construction. 6 - No. of re-inspections of all factories 563 - Total 788 17 (33) No. of cases in which defects were found Particulars Found Remedied Referred To H. Inspector By H.M. Inspector Want of cleanliness 98 98 - 2 Inadequate ventilation 19 19 - 4 Ineffective drainage of floors 13 10 - - Sanitary Conveniences (a) Insufficient 18 16 - 3 (b) Unsuitable or defective 94 90 - 2 (c) Not separate for sexes 2 2 — — Other offences against the Act (not including those relating to Outwork) 24 20 - - Total 268 255 - 21 No prosecutions were instituted under the Factories Acts 1937 during 1950 DRAINAGE No. of drains inspected 490 No. of drains tested 86 No. of drains water tested 20 No. of drains cleared 25 No. of sinks renewed 30 SMOKE ABATEMENT Total No. of Obaerrations and Inspections made 419 Complaints received 23 Observations (external) 67 Inspections (intersal 352 (34) WUPBORNE DEPOSITS OF GRIT. ASH & SOOT No. of complaints received 18 No. of re-inspections 58 NOISE No. of complaints received 16 No. remedied 12 No. of re-inspections made 51 Part VIII of the Factories Act: OUTWORK No. of Outworkers Nature of Work on list Boot Making 8 Wearing apparel 70 Paper Bags 2 The making of boxes 3 Upholstery 2 Toy making 109 Lampshades 2 Printing 1 Fancy Goods 23 Miscellaneous 4 Total 224 225 Visits were made to Outworkers during the year. (35) INSPECTION & SUPERVISION OF FOOD One application to slaughter animals was received and granted; these licences are issued to any approved individual who is a Slaughterer by trade. There are no slaughter houses in the Borough, and no animals are killed for human consumption. 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 the 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 1950, one-thousand one-hundred and sixty-four Certificates of Candemnation were issued by the Food Inspectors relating to the undermentioned unsound articles of foods- Meat 9,839 lbs. Fish 207 3tone Tinned Goods 14,059 tins Bottled Foods 160 bottles Tomatoes 6,456 lbs. Other Foods 11,954 lbs. COMPLAINTS During 1950, twenty-eight complaints were received from members of the public regarding foreign matter in articles of food. These included bread, milk, dirty milk bcttles, flour, beer, buttered rolls, sausage rolls, cake and Swiss rolls. Every complaint is investigated and reported to the Public Health Committee. In twenty cases the complaint was brought to the attention of the person responsible by letter, one case called for no action, and in one instance the explanation of the firm was accepted., whilst in six cases legal proceedings were instituted with the following results (36) No. Offence Fine Costs 1. Paint in Beer £5 £8. 8s. Od. 2. String in Loaf £5 £8. Os. Od. 3. Mouldy Loaf Dismissed £3. 3s. 0d. (Against Council) 4. Dirty Milk Bottle £2 . £3. 3s. Od. 5. Mouldy Wrapped Loaf Dismissed - 6. Nail in Loaf Absolute £5. 5s. Od. discharge FOOD & DRUGS ACT. 1938-1950 Examination of Samples of Food & Drugs During the year 1950, one thousand articles of food and drugs were purchased by the Council's Sampling Officer and submitted to the Public Analyst for chemical analysis under the above. Of these 44 or 4.4 per cent, (including 4 samples of milk referred to on page 41) were adversely reported upon, and in one case legal proceedings were instituted as followss- Sample No, Article Fine Costs 298 Malt Vinegar (deficient in acetic acid) £1 £4-. 4s. Od. The remaining forty-two unsatisfactory samples, other than milk samples, were dealt with as follows?™ Warning letters 2 No Action 4 Referred to appropriate Authority 9 Result of analysis communicated to Manufacturers 20 Remainder of stock destroyed 6 Private samples 1 Total 42 (37) Details or Samples of Food & Drugs examined by the Council's Public Analyst Articles Formal Adulterated Informal Adulter ated Total Percentage Adulterated Samples Adulterated Milk 460 2 63 2 523 4 76% Ale 33 - 2 - 35 - - Almonds (Grd.) 3 - - - 3 - - Acetic Acid 1 — - - 1 - - Baking Fdr. - - 1 - 1 - - Black Pudding 1 - - - 1 - - Blancmange Pdr. - - 1 - 1 - - Batter Mixture 3 - - - 3 - - Butter 37 - - - 37 - - Cake - - 1 - 1 - - Decorations (Cake) 2 - - - 2 - - Cake flour 1 - - - 1 - - Caramels of Menthol 1 1 - - 1 1 100% Cheese 5 - - - 5 - - Chop Sauce - — 1 - 1 - - Choc. Drink Tabs. 1 1 - - 1 1 100% Coconut (Dess.) 6 - - - 6 - - Coffee Essence 4 - - - 4 - - Confectionery 14 - 5 2 19 2 10.5% Crystallised Fruit 5 3 - 2 5 5 100% Dripping 2 - - - 2 - - Fat (Cooking) 8 2 1 1 9 3 33.3% "(Kosher) 5 - - - 5 - - "(Frying) - - 1 - 1 - — Gelatine 6 1 5 2 11 3 27.2% Ginger (Grd.) — - 1 - 1 - - "(Pdr.) - - 1 - 1 - - Gravy Pdr. 1 — - - 1 - - Carried Forward 599 10 83 9 682 19 (33) Articles Formal Adulterated Informed Adulterated Total Percentage Adulterated Samples Adulterated Brought forward 599 10 83 9 682 19 Herbs - - 1 - 1 - - Ice Cream 6 3 9 1 15 4 26.6% Jelly 2 - 1 1 3 1 33.3% Lemca Curd 1 - — — 1 — - " (Pdr.) 2 - 1 - 3 - — Lime Tablets 2 — — - 2 — — Liquorice Sticks 1 - — — 1 — — Margarine 5 - - - 5 - - Marmalade 4 — — — 4 — — Meat (Canned) - — 1 1 1 1 100% Mincemeat 11 2 — — 11 2 18.2% Malted Milk — - 1 — 1 — - Molasses 1 — — — 1 — — Mustard - - 1 — 1 — — Malt Extract 1 — - — 1 — - Oatmeal 3 — — — 3 — — Olive Oil - — 1 — 1 — — Paste (Fish) — — 1 1 1 1 100% Pastry Mixture 1 - — — 1 — — Peel 9 6 33 - 42 6 14% Pepper 1 — 1 — 2 — — Pie (Meat) 1 — — - 1 — — Saccharine Tablets 7 - — — 7 — - Sago 1 — — — 1 — - Sauce (Mint) — — 1 — 1 — — Sausages 71 — - - 71 — — Sausage Rolls 1 — — - 1 — — Saveloy 1 - — — 1 — - Spaghetti (Canned) 1 — — 1 1 1 100% Semolina 2 - - - 2 — - Suet (Shredded) 8 — — - 8 — — Salad Cream - - 3 1 3 1 50% Carried Forward 742 21 138 15 880 36 (39) Articles Formal Adulterated Informal Adulterated Total Percentage Adulterated Samples Adulter*ated Brought Forward 742 21 133 15 880 36 Tabs. Cocoa 1 1 - — 1 1 100% Tapioca 1 - - - 1 - - Tea Dust 1 - - - 1 — - Tomato Ketchup 1 2 3 - 4 2 50% Veg. (Canned) - - 1 - 1 — - Veg. (Broth) 1 1 — - 1 1 100% Vinegar (Malt) 12 - - — 12 - - (N.B.) 10 - 1 - 11 - - C ondiment (N.B.) 3 — — - 3 - - Fruit (Canned) — — 2 1 2 1 50% Fruit (Dried 3 1 — - 3 1 33.3% Fruit (Pineapple) 1 1 - - 1 1 100% Brandy 5 - - - - - - Gin 8 - - - 8 - - Rum 10 — — — 10 - — Sherry 2 1 — — 2 1 50% Whisky 10 — - - 10 - — Cherry Wine 1 - - - 1 - - Cider 2 — — — 2 — — Cocktail 1 — - — 1 — - Ginger Wine 7 1 - - 7 1 14.3% Grapefruit 4 - - - 4 - - Lemon Squash 4 - - - 4 - — Lime Juice 4 — — — 4 - - Pineapple Crush 1 - — - 1 - — Port Flavouring 1 - - - 1 - - Orange Squash 7 - - - 7 - - Raisin Wine 2 — — — 2 — — Unsweetened Wine 1 — — — 1 — — Aspirin 4 - — - 4 - - Digestive Mints - — 2 — 2 - — Boric Acid Tabs - — 1 — 1 — - TOTALS 850 29 148 16 998 45 Plus 2 Private Samples bringing the total No. of Samples to 1000 (40) ICE CREAM (HEAT-TREATMENT) REGULATIONS. 1947 The above Regulations were introduced in 1947 to control the preparation and subsequent treatment of Ice Cream. These require that after initial preparation by adequate heattreatment and rapid freezing, ice cream must be protected from contamination and kept at a temperature not exceeding 28°F. Bacteriological standards hare not been adopted as, at present, they are not considered sufficiently reliable, but a modified Methylene Blue Test is, however, recommended as a provisional test of bacterial cleanliness, and four grades have been defined as a tentative measure. During the year under review the following samples were examined:- Grade Wrapped Taken from Bulk Ice Lollies Total 1 33 44 7 89 2 11 8 - 19 3 7 14 - 21 A 6 23 - 29 Totals 62 89 7 158 MILE & DAIRIES REGULATIONS., 1949 Section 29 (2) of these Regulations make 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 no contraventions of this Section were reported. MILK (SPECIAL DESIGNATION) (PASTEURISED & STERILISED MILK) REGULATIONS„ 1949 ' MILK (SPECIAL DESIGNATION! (RAW MILK) REGULATIONS. 1949 The tests prescribed by the Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations, 1949, for Pasteurised milk ares- (41) (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# SALE OF MILK REGULATIONS. 1939 During the year under review, four-hundred and fifty-eight samples of milk were purchased by the Sampling Officer for chemical analysis by the Public Analyst. Of these three-hundred and six were purchased from milk vendors in the streets of the Borough during the early delivery, seventy-one were purchased on Sundays and seventy-two were taken at the early morning delivery to hospitals in the Borough. Four (or 1.02 per cent) of the four-hundred and fifty-eight samples of milk examined were adversely reported upon,, the details being as follows Sample No. Result of Analysis Action taken 5 6% added water (Informal) )(All taken from same vendor. Legal proceedings re Nos. 18 & 16 8.5% " "32. Fined £3 on each of two )summonses and £3.3s.0d. costs. 18 5.956 » « (Formal) ) ) 32 4% As in previous years, the arrangement for samples of milk to be taken in course of delivery to the hospitals, institutions, schools eto., in the Borough was continued, and the following were taken during 1950;- No. cf Samples Taker: Bacterid ogical Institution Chemical Analysis Examination Fulham Hospital 42 36 Western Hospital 30 24 L.C.C. Schools 59 42 Meals Kitchens etc. 21 - Fulham Maternity Home 1 - Totals 153 102 (42) Four of the 153 samples of milk taken for chemical analysis were reported to contain added water (see page 41) whilst two samples of pasteurised milk taken in course of delivery to a local hospital and two taken at L.C.C. schools failed to satisfy the Phosphatase test for efficient heat-treating. Sterilised Milk: 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, two-hundred and eight samples of milk were purchased by the Sampling Officer for bacteriological examination, one-hundred and forty-five being purchased from milk roundsmen in the streets during the early morning delivery, seventy-two in the course of delivery to hospitals, and forty-two at London County Council schools etc. in the Borough. The following are details of the samples taken; Tuberculin tested milk (Farm Bottled) 6 Tuberculin tested, milk (Pasteurised) 20 Pasteurised milk 168 Sterilised milk 14 Total 208 Satisfactory reports were received with the exception of seven samples of pasteurised milk which failed to satisfy the Phosphatase test for efficient heat-treatment. 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 1950 the following licences to sell designated milks were granted by the Borough Councilj- No„ of licences to sell Tuberculin Tested Milk 35 No. of Supplementary licences to sell Tuberculin Tested Milk 9 (43) No. of licences to sell Pasteurised Milk 61 No. of Supplementary licences to sell Pasteurised Milk 9 No. of licences to sell Sterilised Milk 66 No. of Supplementary licences to sell Sterilised Milk 9 FOOD ESTABLISHMENTS A complete survey of all food establishments was completed and a detailed list of these premises will be found in the following table. Regular inspections were carried out during the year resulting in the service of 81 written Notices, and 195 verbal intimations to the persons responsible requiring the execution of essential work. In no case was it necessary to institute legal proceedings for non-compliance. The majority of the eating-houses in the Borough are of the smaller type owned and conducted by a single individual.. The business in some has outgrown the facilities available, and the kitchens and food-preparing rooms are inadequate resulting in a great deal of congestion. Constant hot water has been provided in all food shops, and every effort is and has been made to get a sink or handbasin installed for the exclusive personal use of those engaged in food handling, when this is at all practicable. In many instances, however, lack of space makes this very difficult. Details of the more important improvements which have been effected in food premises during the year are given belcw:- Water heaters installed 100 New sinks provided 47 New W.C's. provided 20 W.C's. repaired or cleansed 17 Kitchens, preparation rooms etc. redecorated 224 (44) Floors renewed or repaired 22 Shop fronts repaired or redecorated 24 Shop fronts re-built 9 New dustbins provided 35 Counter cases for protection of food provided 17 No. of Food Shops No. on Inspect- Notices Complied Categories Register ions Written Verbal with Bakehouses (Non-Basement) 26 103 4- 7 10 Bakehouses (Basement) 10 94- - - 1 Bread & Cake Shops 11 31 2 2 3 Butchers' Shops 72 522 6 26 31 Cooked Meat Shops 7 36 -43 Dairies 47) Purveyors of Bottled Milk 53) Eel & Pie Shops 5 14- - 2 2 Food Factories 3 97 11- Fishmongers Shops 21 198 9 14- 20 Fried Fish Shops 33 264 7 18 22 General Food Shops 289 938 13 41 41 Greengrocers & Fruiterers 94 4-00 12 13 20 Horseflesh Butchers 2 25 111 Ice Cream (Manufacturers & Dealers) 178 524 2 18 18 Licensed Premises 85 372 4 4-2 Restaurants & Working Class Dining Rooms 135 1277 19 43 75 Stallholders' Storage Premises 34- 683 1 1 2 Other Food Premises 24 217 - - - TOTALS 1129 6225 81 195 251 (45) PREMISES USED FOR THE PREPARATION OF FOOD Under the provisions of Section 14- of the Food & Drugs Act, 1933, premises used for the preparation of certain specified articles of food must be registered with the local authority. At the end of 1950 there were fifty-eight premises on the Register relating to the preparation of preserved foods and one-hundred and seventy-eight 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 18 Premises registered for storage and sale of Ice Cream 16 Premises registered only for sale of Ice Cream 114 Total = 178 MILK & DAIRIES REGULATIONS. 1949 The registration of purveyors of liquid milk is regulated by the above, and the Register contains details of forty-seven dairy premises in the Borough. In addition there are fifty-three shops, the occupiers of which are registered to sell milk which is not supplied otherwise than in properly closed and unopened receptacles in which it is delivered to their premises 0 During the year 1950, four hundred and thirty visits of inspection were made to these dairies and milkshops. BAKEHOUSES There are in the Borough 36 bakehouses, ten of which are "basement" bakehouses0 Special reference was made to basement bakehouses in the Annual Report for 1949, during which year the quinquennial survey was carried out. On 28th November, 1949? the owners of nine basement bakehouses were given notice that the certificate of suitability should cease to have effect at the expiration of twelve months, i.e. on 28th November, 1950. (46) The use of six of the basements discontinued either on or before the expiration of the Notice? two, with the approval, of the Public Health Committee were given permission to continue in use until 31st December, 1950, and in one instance the owner carried out extensive alterations arri improvements which justified the issue of a certificate of suitability for a further period of five years. RAG FLOCK The sale and use of rag flock is regulated by Section 136 of the Public Health (London) Act, 1936, and the Regulations made by the Ministry of Health. The Regulations prohibit the sale or use of unclean flock manufactured from rags in making any article of upholstery, cushions, bedding etc., and provide that when not less than 1$) grams of flock are thoroughly washed with distilled water at a temperature below 25°C, the chlorine must not exceed 30 parts per 100,000 of flock. This standard ensures a certain degree of cleanliness. During 1950, five samples of rag flock were taken by the Sampling Officer, all of which complied with the Regulations. THE PHARMACY & POISONS ACT, 1933 „ THE POISONS RULES, 1936 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 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 the premises are situate. The Act and Rules lay down, certain requirements regarding types of containers, labelling, storage, transport and sale cf poisons. At the end of 1950 there were 154- names on the Council's Register, and 187 visits of inspection were made during the year under review. Twenty samples of Part II poisons were purchased for analysis during the year, and none called for special comment. (47) LONDON COUNTY COUNCIL - HEALTH SERVICES The Maternity arid Child Welfare Services since July 1948 are the responsibility of the London County Council. Division I of the London County Council consists of the Metropolitan Boroughs of Chelsea, Fulham, Hammersmith and Kensington. The Divisional Medical Officer is assisted in each of the four Boroughs in the day to day administration of the Maternity and Child Welfare Services by the respective Borough Medical Officers. Dr. Violet I. Russell, the Divisional Medical Officer, has kindly supplied the following information regarding these services for the year 1950. Ante-Natal and Post-Natal Clinics,. Number of women who attended during the year Ante-Natal clinics 1657 Post-Natal clinics 553 Maternal Deaths. There were 3 maternal deaths during the year. Infant Welfare Centres. Total number of children who attended centres during the year 3828 Dental Clinic. No. of expectant & nursing mothers treated 215 No. of cases in which general anaesthetic was administered 77 No. of teeth extracted 322 No. of children under 5 years treated 350 No. of cases in which general anaesthetic was administered 31 No. of teeth extracted 193 (43) Health Visitors. No. of infants under 1 year of age visited for first time 1713 Total visits to infants under 1 year 7347 Total visits to children 1-5 years 12358 No. of expectant mothers visited for first time 830 Total visits to expectant mothers 1567 Infant Life Protection. No. of Foster mothers at 31st Dec. 1950 43 No. of Foster children " " " " 59 Child Minders (Daily Guardians). No. of daily guardians (voluntary) 72 No. of children minded 54 Care of Premature Infants. No. of premature births during the year 91 No. of deaths under 1 month 6 Immunisation and Vaccination. 960 children were immunised in L.C.C. clinics during the year, a further 636 being immunised at schools and by private doctors. 1057 received boosting injections. The percentage of the child population immunised against diphtheria at the end of the year was 70/6. 896 children were vaccinated in L.C.C. clinics during the year. (49) SERVICES Ante-Natal Mornings Afternoons 5/7, Parsons Green Monday, Tuesday Tuesday, Thursday 170, Wands. Bridge Road. Wednesday 90/92, Greyhound Road. Monday, Friday Thursday 62/63, Burne Jones House. Friday Wednesday Family Planning Greyhound Road - Tuesday Parsons Green Thursday Infant Consultation 5/7, Parsons Green. Wednesday, Friday Monday, Wednesday 170, Wands. Bridge Road. Wednesday Wednesday 90/92, Greyhound Road. - Monday, Wednesday & Friday 62/63, Burne Jones Hse. Thursday Monday, Thursday Toddlers' Clinic 62/63, Burne Jones Hse. - Tuesday 90/92, Greyhound Road. Thursday - Day Nurseries. Eridge House, Fulham Park Road. Grove House, Bagley's Lane. St. James, Maxwell Road. Mulgrave, Mulgrave Road. 23, Broomhouse Road. Vaccination. Mornings Afternoons 90/92, Greyhound Road Wednesday 170, Wandsworth Br.Rd. Thursday - Immunisation. 90/92, Greyhound Road. Tuesday - 170, Wandsworth Br.Rd. - Thursday Home Help Service. (Office where application may be made - 129* Fulham Palace Road) No. of cases attended during the year Maternity 103 Tuberculosis 32 Other 857 (50) TUBERCULOSIS I have received the Annual Report for the year 1950 from the Chest Physician at the Fulham Chest Clinic (Dr. H.C„ Price). It is packed with interesting information, including the wide sweep and development in the work at the Chest Clinic during the year. Dr. Price has kindly allowed me to quote from his Report. "GENERAL REVIEW The year has seen considerable changes in the routine and work of the clinic. Priority has been given to the treatment of acute cases of pulmonary tuberculosis, and because of the shortage of staff the follow up of contacts and investigation of the primary cause of infection in each notified case has tended to take second place. The most important change has been the rapid expansion of domiciliary treatment of all types of pulmonary tuberculosis and the integration of this type of treatment with In Patient treatment in the "short stay" treatment beds in the tuberculosis wards in the Western Hospital, Seagrave Road. The careful assessment of all cases requiring treatment, the early introduction of bed rest at home and chemotherapy, the correct allocation of priorities to the waiting list for hospital beds, together with the continuation of home treatment following discharge from hospital ha? resulted in the reduction of the sanatorium waiting list by about However, the number of new notifications coming in, (average U.3 per week), together with the relapse due to the bad conditions of living and work existing in the Borough, of patients who have previously responded satisfactorily to treatment, has resulted in the development of a waiting list of between 12 and 15 for the existing tuberculosis beds and has meant the discharge of patients from hospital much sooner than is desirable. Finally, it is still not possible to maintain one or two beds for each sex to admit emergency csases either directly from their often overero jded homes or from the wards of the ether general hospitals (especially Fulham Hospital) in the area where they are often a danger to other patients, particularly children. Whilst recognising that some improvement has been attained in the treatment of pulmonary tuberculosis in Fulham, there is still a long way to go before it villi be possible to provide the optimum treatment for all patients in hospital as the necessity arises. When this is achieved the problem of tuberculosis .in Fulham, as far as the treatment side is concerned, will be nearing solution." In his 194-9 Annual Report Dr. Bennett stated that there were some 10,000 patients awaiting sanatorium treatment in England & Wales. It is gratifying that in domiciliary therapy a satisfactory way has been found of greatly decreasing the sanatoria waiting list. (51) "SANATORIUM TREATMENT. Official sources stats that the waiting lists in general have been reduced. This is in the main due to many more patients receiving domiciliary treatment - resulting in many cases in their being able to return to work without the necessity of Sanatorium treatment sudsing. But the waiting list for major surgery is still in the region of from one year to eighteen months. It is high time that the whole question of the relationship between domiciliary treatment, treatment in the local general hospital and sanatorium regime was reviewed both from the clinical and administrative points of view. The chronic case and the aged still constitutes a grave problem. The extension of facilities for the treatment of the early case will go far to prevent the development of the chronic type of lesion. This would help to cut the present vicious circle of early cases deteriorating whilst awaiting sanatorium treatment and finally ending up by permanently blocking a bed in the chronic sick wards of the local general hospital. Not only would it be possible for many eases who are now put on sanatorium waiting lists to be treated entirely in the local general hospital, but a to and fro exchange could be arranged so that patients receiving treatment in sanatorium and/or general hospital or at home could be switched from one to the other as the lung lesion changes. In this way it would be possible to arrive at a state of affairs where the sanatorium and hospital waiting lists could be reduced to zero and patients would not be in the unfortunate position they are today of having completed one step of their treatment and are unable to receive any further treatment because the institution to which they are waiting to go is unable to receive them. However, it would be a serious mistake to imagine that this state of affairs will be achieved merely by the re-assessment of the clinical condition cf the patient, it would require the opening up of many more beds in the local general and fever hospitals and the augmentation of staff and equipment at the chest clinic. HOME CONDITIONS.. It is true to say that most clinics in the London area have been forced to undertake domiciliary therapy on quite an extensive scale because of the long sanatorium waiting list, and because of the introduction of chemo-therapy which has radically altered the treatment of tuberculosis of the lungs. Nevertheless, for three main reasons this type of therapy cannot always be successfully undertaken. Firstly, the patient may require immediate hospitalisation because of domestic difficulties. Secondly, the type of lesion and the stage to which it has advanced may render the patient unsuitable for this type of therapy. Thirdly, the home conditions themselves may be so bad as to render any type of domiciliary treatment impossible. For example, this year, (52) of 201 notifications in the Borough, 90 i.3. had to share a room with somebody else in spite of efforts to re-arrange the household. THE FUTURE DEVELOPMENT OF TEE SERVICE. The chief aim towards which the service in Fulham is directed, is the provision of sufficient hospital beds in the Borough to provide accommodation for every acute case requiring treatment within seven days of the necessity arising." In Dr. Price's opinion the priorities are:™ " Firstly,, the opening up of further tuberculosis beds at the Western Hospital, to provide at least 50 or 60 beds for the treatment of Fulham patients alone. Secondly, the completion and staffing of an X-ray unit at the Western Hospital, capable of carrying out up to 9,000 to 10,000 X-ray investigations a year, and enabling patients to be X-rayed and screened within 21+ hours of the need arising and not within three weeks to a month as at present. Thirdly,, the development at the Western Hospital of a minor chest surgery unit The full use of this will of course inevitably bring to light further cases of tuberculosis and increase the need for the development of the other two sections of the service mentioned above and fourthlyo it is essential that a Mass Radiographic Unit be permanently installed in the Borough.